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I prescribe the popular weight-loss drug semaglutide to my patients. I hesitate to call it a magic bullet.

Hannah Moseley   

I prescribe the popular weight-loss drug semaglutide to my patients. I hesitate to call it a magic bullet.
  • Dr. Paul Kolodzik has been prescribing semaglutide to his diabetic patients since 2017.
  • Semaglutide's popularity as a weight-loss drug has created supply issues; similar drugs may become available in 2023.

This as-told-to essay is based on a conversation with Dr. Paul Kolodzik, a 64-year-old metabolic-health specialist and physician from Vandalia, Ohio, about the weight-loss drug semaglutide. It's been edited for length and clarity.

Six years ago, I decided to switch from a reactive to a proactive style of care and open my metabolic-health practice. Before that, I was an emergency physician for about 25 years, caring for patients with strokes, heart attacks, and diabetic emergencies.

I saw how metabolic-health problems, whether it be obesity, diabetes, or hypertension, resulted in people presenting to the emergency room. My initial focus in my practice was to help patients keep a low-carbohydrate lifestyle. It helps patients lose weight, reverse pre-diabetes, and improve blood pressure and cholesterol.

I started prescribing semaglutide under the label Ozempic to my diabetic patients in 2017

Novo Nordisk, a global pharmaceutical company, developed Ozempic as a medication for diabetics to control their blood sugar. In the trials, researchers noticed that diabetics using the drug were also losing weight. So Novo Nordisk went back and did studies on non-diabetics related to weight loss.

They found that patients who used this medicine in conjunction with a diet and exercise plan lost 12 to 15% of their body weight. Novo Nordisk then marketed it as Wegovy, and I've integrated it into my practice over the last 18 months.

One of my patients came to me because his wife said she was scared she'd lose him. At 53 years old, he was 267 pounds with chronic back pain and a family history of diabetes and heart disease. He even had difficulty taking his dog for a walk.

After seven months, that patient went down to 222 pounds, and we've since reset his goal from 230 to 200 pounds. His program included semaglutide injections, a low-carb diet guided by a continuous glucose monitor, intermittent fasting, and strength training. He's decreased his blood-pressure medication and can now enjoy long walks with his wife and dog.

It's very effective with my patients, but some regret not being able to enjoy food as much

Semaglutide has three mechanisms of action. One, it lowers blood sugar. Two, it decreases gastric emptying, so food stays in the stomach longer. Three, it acts on the hypothalamus in the brain to decrease hunger.

It's taken as a weekly injection, and the dosage ramps up slowly over time. Otherwise, the medicine can cause significant nausea, constipation, and other gastrointestinal side effects. My patients have some transient nausea for a day or two, and we treat that with nausea medicines. By the second or third injection at that dose, they aren't having any problems.

The only regret I hear from patients is that they can't enjoy food quite as much. There's also an apprehension that when they stop the medicine, they'll regain weight. Some patients, after being thrilled with the initial results, enter that stage of apprehension.

There are criteria for using Ozempic and Wegovy

People who aren't overweight or diabetic are pressuring clinicians to prescribe them the drugs, but it's not appropriate for those individuals.

To qualify for treatment, a patient needs to have a body-mass index of 27 or higher with a metabolic-health problem like high cholesterol or hypertension, or a BMI of 30 with no associated metabolic-health problems.

I've had people come to me with a BMI of 24 who want to have a BMI of 18. There's pressure out there from people who aren't overweight, and I don't know if other clinicians are prescribing it, but that's an issue.

Wegovy isn't covered by many insurance plans, including Medicare and Medicaid, because of the $1,200 out-of-pocket monthly cost. On the other hand, Ozempic is just as pricey as Wegovy, but it's much more likely that insurance will cover it.

Semaglutide's popularity has created major supply shortages, and some diabetics are suffering the loss

Wegovy came out and was immediately in short supply. So, physicians started prescribing some patients who weren't diabetic Ozempic off-label since Ozempic is not approved for weight loss — even though it's the same generic medicine. That caused supply issues to the point where some diabetics had difficulty getting the medicine at all.

In early 2022, a non-diabetic could get Ozempic, and it might've been covered by their insurance, but that's increasingly rare. In the last few months, insurance companies have cracked down on Ozempic being prescribed to non-diabetics so it can be more available for diabetics.

Supply-chain issues have caused shortages, but really the drugs have become overly popularized — especially with celebrities like Elon Musk promoting them. Despite shortages, I think semaglutide and drugs like it will be more available in 2023.

Novo Nordisk is gearing up their supply chains for medicines that are already available and the development of new medicines. I believe that access, starting with access for diabetics, is going to be much better as early as springtime.

I'm hopeful that over time, there'll be several of these medicines, called GLP-1 agonists, available and the competition will allow prices to come down. In fact, Eli Lilly is already doing studies to fast-track Mounjaro — its version of Ozempic — through the FDA for weight loss.

These medications are going to be very helpful to a lot of people, and not only to those trying to lose weight or manage diabetes

I think these medicines may be the most widely prescribed medicine in the history of the world sometime in the next five to 10 years. There are a few studies that suggest a person who takes this medicine in their mid-20s for weight loss might decrease their likelihood of becoming a diabetic or the likelihood of acquiring cardiovascular disease.

Again, people should use these medicines with an appropriate diet and exercise plan, so I hesitate to suggest it's a magic bullet, but I think in the long term, these medicines are going to be very accepted — not only for weight loss, but for improved health.

Have you used or prescribed semaglutide and would like to share your story? Email