A Comprehensive Guide to Semaglutide: The Current Skinny on the World's Favorite Weight Loss Drug

It’s stuck in your head (oh, oh, oh, Ozempic), it’s all over social media, and it’s all around you. Semaglutide treatments (a.k.a. Ozempic, Wegovy, Rebylsus) have taken the country by storm. Oprah Winfrey, Amy Schumer, and Tracy Morgan are just a few celebrities out of many who have jumped on the weight-loss drug bandwagon, but it’s not just for the rich and famous. Semaglutides are affording patients genuine results says Dr. William Kennedy, MD,, Board Certified Head and Neck Surgeon and Facial Plastic Surgeon. It is hard to overstate the positive effects semaglutides will have on the cosmetic as well as medical community with drastic improvemetns in both ones cosmetic appearance as well as cardiopulmonary health. It seems like just about everyone in NYC is on some form of semaglutide, says David Shafer, MD, a double board-certified plastic and reconstructive surgeon and founder of Shafer Clinic in New York City. But, what exactly are semaglutide treatments, and what’s available on the market today? For everything you could ever want to know about the crazed weight-loss drug, read on.

What is Semaglutide?

While frequently used for weight loss, semaglutide is actually an antidiabetic medication commonly used to treat type 2 diabetes. The medication functions as a glucagon-like peptide-1 (GLP-1) receptor agonist. GLP-1 is a naturally occurring hormone that is responsible for several digestive functions, like triggering the release of insulin and sending satiety signals to the brain. When a GLP-1 agonist medication (either a semaglutide or tirzepatide) is taken, it mimics the hormone and triggers the same effects. So, a semaglutide will act the same way as a naturally-occurring GLP-1 hormone, signaling satiety and releasing insulin to signal the body to convert glucose (sugar) into energy. Because of that, semaglutide treatments work effectively to reduce appetite and, subsequently, food intake.

“We are seeing a number of patients who simply can't shed that extra 10 to 15 pounds despite exercise and proper diet choices. In many cases, this program allows them to jump-start their weight loss and fine-tune the results they already have achieved,” says Gregory Buford, MD, a board-certified plastic and reconstructive surgeon in Lone Tree, CO.

Risk Factors of Semaglutide

When it comes to deciding whether or not semaglutide for weight loss is right for you, you’ll want to first look at your medical history. In addition to those with a history of heart disease, William Bruno, MD, a board-certified plastic surgeon in Beverly Hill, says semaglutide treatments are not for patients with a history of pancreatitis or thyroid cancer, those who are pregnant, those who have suffered from or are currently managing an eating disorder, or those with a BMI under 27.

That being said, Jamie Gabel, PA-C, a certified physician assistant at New York’s Advitamin at the Shafer Clinic, says that because there are so many variables, the best way to determine if you would or wouldn't be a good candidate for GLP-1’s is through a consultation.

“At Advitam, we always perform a comprehensive consultation and dig into our patient's health history and daily routine first. Our assessment also involves blood work, body composition analysis, and physical exam and then from there, we can better determine which medications/peptides would be most advantageous. It's not a cookie-cutter approach at Advitam, it's a customized well thought-out program,” says Jamie Gabel.

The Big Three: Ozempic, Wegovy, and Rybelsus

When it comes to semaglutide treatments, there are three main players on the market. The most well-known are Ozempic and Wegovy. The drug for both is the same (semaglutide), but they are prescribed with different doses and indications. While these two brands are injectables, there is also a semaglutide treatment in tablet form under the name Rybelsus.

In addition to these three brands, a lot of practitioners will also compound semaglutide to personalize the treatment. “Compounding,” as Dr. Buford explains, effectively means that a specific drug is "compounded" or created by a specialized compounding pharmacy to match the exact formulation of the original drug. In this case, Ozempic and other GLP-1s can be compounded. When they are compounded, then they are referred to not by their trade name (e.g. Ozempic, Wegovy, or Rybelsus) but instead by their generic name (e.g. Semaglutide). From there, Dr. Buford says other additives, like vitamins and salts, can be added to create additional desired effects.

At Dr. Buford’s practice, he offers a compounded semaglutide called Slim Shot because he finds it to be a more comprehensive approach to weight loss. “We know that our patients are going to lose weight and we also know that there will be changes to not only their overall body appearance but also more specifically to their skin, hair, nails, etc. So we discuss these anticipated changes early on and design a plan to specifically and proactively address these potentially unwanted ancillary changes so that as the weight comes off, our patients still look great. This is a big difference in our program as compared to many others that just focus on weight loss and not the patient's overall appearance,” Dr. Buford says.

Considerations of Semaglutide for Weight Loss

When it comes to weighing the options (see what we did there?), there are a few things to consider. First, is budget and insurance coverage. Technically, Ozempic and Rybelsus haven’t received FDA clearance for weight management; the two have only been approved for people with type 2 diabetes. Wegovy, on the other hand, has been FDA-approved specifically for weight management. The FDA states that Wegovy is indicated for those with a BMI of 30 or greater or a BMI of 27 or greater if there are associated health problems, like high blood pressure, type 2 diabetes, or high cholesterol.

Unless you meet the requirements set by the FDA, your insurance will most likely not cover your semaglutide prescription. When using semaglutide specifically for weight loss, a lot of programs do not go through insurance. Instead, patients will have to pay out of pocket. Dr. Buford says that since many of his patients are not trying to lose a massive amount of weight and are not diabetic, their treatment wouldn’t be covered by insurance.

Another consideration is your lifestyle and preferences for medication. Ozempic and Wegovy are at-home self-injectables that you administer once a week. Rybelsus is available as a tablet to be taken orally, but it needs to be taken daily. Each brand has a different dosage, so some might work better for others.

As with any drug, there can be side effects when taking semaglutide medication. The most common side effects are nausea, diarrhea, vomiting, constipation, abdominal pain, headache, tiredness, upset stomach, dizziness, feeling bloated, belching, gas, stomach flu, and heartburn.

How Long Can Semaglutide be Taken?

Lastly, it’s important to discuss a long-term plan for your semaglutide treatment. Currently, there are no set guidelines for how long someone should be on a semaglutide, so it really depends on the individual. Dr. Shafer, for instance, shared that he has been on it for about a year and a half and has lost about 30 pounds. And, Wegovy’s safety and efficacy trial was over a 68-week period.

“From a patient perspective, I have learned new eating habits with smaller meals and avoidance of doughy foods which tend to cause some discomfort. So, no more bread, pasta, french fries, etc. Even if I miss a dose, I have learned to avoid those foods which has helped sustain my weight loss,” Dr. Shafer tells us.

When stopping semaglutide, research has shown that many patients gain the weight back since they often revert to their former lifestyles. So, if starting a semaglutide treatment, be aware that you’ll most likely need to have ongoing treatment for maximized results.

Experts Predict Semaglutide Treatments for Weight Loss are Here to Stay

Dr. Shafer: Semaglutides and related treatments are definitely a game changer in the weight loss and plastic surgery world. As more understanding and protocols are developed we will see expanded uses and safety profiles. We have seen tremendous growth in our metabolic center, Advitam, at Shafer Clinic. Patients are becoming more sophisticated and understand that beauty and health start at the metabolic level so treating from the inside out is just as important as the external treatments we are performing for them.

Dr. Buford: The GLP-1s are here to stay and we have only seen the tip of the iceberg in terms of their benefits. My prediction is that this sector is going to be the next BOTOX. What started as a drug for diabetics and more massive weight loss is now being used by many centers like mine for not only isolated weight loss but also before and after body contouring surgeries to effectively get at fat that surgery just can't reach. In doing so, we are seeing even better results with this combinative approach and I foresee that the entire category of GLP-1's are going to grow in popularity over time and become a more common part of our approach to total body rejuvenation.

Dr. Bruno: I do believe that this class of injections for weight loss, as well as other peptides, is here to stay and more options will be available to patients over the course of the next few years. There will also be more clinical data available to support their use.

Dr. Kennedy: The remarkable weight loss resulting from Semaglutides use has resulted in drastic improvements in people's appearance as well as in their overall health. Exciting adoption of the drugs happens seemingly daily with most recently the Centers for Medicare approving coverage of the drug for patients with elevated cardiac risk factors. Semaglutides are the real deal and are certainly here to stay.

The Bottom Line

GLP-1’s, specifically semaglutide, have completely transformed the weight loss industry. With a daily tablet or a weekly injectable, patients have experienced life-changing results. Just keep in mind that even though these treatments are miracle workers, you’ll still have to maintain a similar lifestyle to keep the weight off!