I’m a Doctor: Here’s Why I’ve Prescribed Ozempic to the ‘Healthy Overweight’
In light of controversy over the recent semaglutide drug shortages for the diabetes patients they're indicated for, one doctor illuminates another side of the case.
By Sharon Giese, MD, as told to Charlotte Hilton Andersen
From the Kardashians to that person you know at the gym: It seems suddenly many people are dropping pounds in record amounts of time, stepping out with transformed bodies in a matter of weeks. What’s happening? In many cases, it’s due to the diabetes medications whose usages many non-diabetic patients have adapted for weight-loss purposes. These meds go by the brand names Ozempic, Wegovy and Mounjaro.
General practitioners, cosmetic surgeons, and many other medical specialists now commonly find themselves answering questions from patients across all walks of life who wonder whether these drugs can serve as general weight-loss medications to help melt even just 10 pounds and achieve a”happy weight.” My opinion is that there are scenarios when it’s not worth waiting until diabetes, or the health complications that come with other obesity-associated conditions, are a threat.
Helping a lot of people lose a little weight
I started out as a board-certified plastic surgeon and have been practicing for 25 years. My early research focused on fat metabolization and the health benefits of weight loss.
When I first heard about semaglutide (the active ingredient of Ozempic and Wegovy), the reports got my attention. After doing extensive research about the drugs and consulting with a master nutritionist, I decided to start prescribing them and recording results in May 2022.
I call it the Elective Weight Loss program—a term I have trademarked. While I do treat some patients who are 50 or more pounds overweight, the majority of my patients are just five to 15 pounds over their “normal weight.” I will prescribe for people who are otherwise healthy and have not been able to attain their weight loss goal by other means, and for otherwise healthy obese patients with obesity being their only medical condition.
Finding your healthy weight
The question, of course, is then: What is the “right” healthy weight? I don’t believe someone’s weight should be dictated to them by a doctor or body mass index (BMI), which is an increasingly outdated barometer that doesn’t take into account factors like muscle mass. Many people don’t understand that the traditional BMI chart was not intended to be used clinically.
Many of us have been taught, or conditioned to believe, that it’s normal to gain weight as we age—especially women, after menopause—but the research shows that weight gain with age isn’t inevitable. Plus, the less weight you gain as you age, the healthier you’ll likely be. Keeping a healthy weight as an adult decreases cardiometabolic risk factors and may extend lifespan.
How the new weight loss drugs work
Semaglutide is a powerful tool for appetite suppression. The active ingredient is very similar to a peptide in our bodies that delays stomach emptying. This means you get full faster and stay full longer. With traditional diets, people get discouraged with the feeling of deprivation. Some patients find that these medications take the discomfort out of dieting.
Semaglutide drugs like Ozempic and Wegovy are administered via a weekly injection. Because the majority of my patients are not obese and seeking to lose eight to 25 pounds, their dosage is one-third to one-half of the dose a patient being treated for obesity typically takes. Pricing is based on the dose, and it isn’t cheap. Most of my patients pay $150 to $175 per week.
The downsides of Ozempic and other weight loss drugs
Like any medication, semaglutide has side effects—mainly nausea, vomiting and or constipation. I see this in about 5% of my patients and for most this is temporary, lasting up to three weeks as the body gets used to the medication. Very few people have stopped the medication because of these temporary symptoms.
But perhaps the biggest point to consider is that you do have to change your lifestyle to keep the weight off for good. Semaglutide can help you lose it, but a 2022 randomized, controlled study that involved researchers at 14 universities and hospitals systems in Asia, Europe, and the United States found that most individuals who lose weight with these drugs gain it back a year after stopping the medication. This isn’t weight loss without dieting. This drug simply helps you manage your appetite while losing the weight so you can make those healthy changes. It’s up to the patient to follow them for the long-term.
They aren’t for everyone, however—particularly folks who have serious pre-existing illnesses or conditions. People who are taking another medication to lower blood sugar, have a past history of pancreatitis or medullary thyroid cancer should never take these medications. Patients who have experienced eating disorders should also not take these medications.
How to find Ozempic for weight loss
Wegovy is FDA-approved for weight loss, but only in people who have a BMI of 27 and another medical condition. For this reason, most medical doctors are unlikely to write a prescription for a person who isn’t obese according to BMI or only wants to lose 10 pounds. To be clear: The FDA does not recommend using semaglutide in those cases.
That said, there are many doctors, like myself, who are writing prescriptions for the medication off-label. I do not recommend trying to source it off the Internet or buy it off the black market because there is no way to know what you’re really getting. But regardless of how you want to lose weight, find a doctor who will listen to your concerns and discuss all your weight loss options with you. And, find encouragement that more doctors are evolving their practices beyond the over-simplified, tired advice to eat less and exercise more. If anyone knows, it’s a doctor of obesity patients: You’ve probably tried that time and again.
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