Semaglutide Alternatives for Weight Loss

February 21, 2023

Now that we are deep into February, patients are becoming more likely to break their New Year’s resolutions for weight loss. In fact, only a small percentage of people will maintain their weight loss resolutions for more than one or two months.¹ To reach their ideal weight, patients may ask their prescribers for medications such as the popular semaglutide-containing drug Wegovy®, which has made headlines due to its promise of ~15 percent weight loss in obese and overweight patients.

Due to the popularity of Wegovy®, both it and Ozempic® (NovoNordisk’s semaglutide-based diabetes drug) experienced extended shortages that lasted through December 28, 2022. Although indicated for diabetes, Ozempic® has been a common off-label prescription for weight loss, which has also raised ethical questions about which group of patients should be prioritized for treatment: diabetic patients or those seeking to lose weight. Because of the shortage, some prescribers desperately tried to obtain semaglutide for their patients, which led to potentially dangerous compounding practices.

Semaglutide Side Effects

Semaglutide is a relatively new API with a number of possible side effects, ranging from mild (nausea) to severe (thyroid tumors). One of the most shocking side effects is “Ozempic® face,” a term coined by NYC dermatologist Paul Jarrod Frank, MD. Due to rapid weight loss, patients look much older as a result of the loss of facial volume. Furthermore, unless a patient is performing weight training while taking semaglutide, much of the weight loss will likely be due to muscle loss, not fat loss. In the STEP 1 clinical trial for semaglutide, DEXA scans showed that as much as 39 percent of the weight loss was due to lean mass. Finally, Wegovy® is only indicated for weight loss in overweight/obese individuals. Prescribing it to non-overweight individuals without excess body fat may jeopardize their health, as any weight loss will likely be due to muscle mass loss. Lean muscle loss will decrease their metabolism, making them even more likely to gain weight, especially if they ever stop taking semaglutide. This may explain why patients who stop taking semaglutide gain back as much as two-thirds of their lost weight within a year of stopping injections.

As health professionals are aware, there is no magic pill (or injection, in this case) or silver bullet. Due to the wide array of possible side effects and how new semaglutide is, prescribers should be cautious when recommending it as a weight-loss medication for their patients. They should also consider tracking their patient’s body composition to assess the loss of lean muscle. A successful weight loss and weight management plan will likely be a multifaceted approach that includes a combination of medication and long-term lifestyle changes. In this blog post, we’ll outline some popular weight loss and weight management alternatives to semaglutide and how prescribers can help provide the best combination of treatments to help their patients meet their weight loss goals.

Non-Medical Interventions for Weight Loss

Food Timing and Circadian Rhythm Fasting

Non-medical interventions for weight loss are popular because they do not require patients to take a medication or undergo a surgery and because they are often low-cost or even free. However, as with any intervention, patient adherence is a challenge.

Food timing, in which a patient eats only between certain times during the day, is often reported to reduce weight. According to Amy Shah, MD, even just three days of circadian fasting will lead to more energy, a stronger, leaner body, and improved overall health and sleep. Because of this, patients “may lose weight and feel better overall.”

While some studies have shown small benefits to timed eating, the peer-reviewed literature contains mixed results overall. Two recent large clinical trials showed a small but statistically insignificant difference between control and experimental groups, forcing the researchers to conclude that time-restricted eating did not provide a clear benefit to obese patients seeking to lose weight.^2,3 However, another recent study provided an opposing viewpoint, showing that time-restricted eating early in the day provided greater weight loss (but not fat loss) than eating over a longer window.⁴

In contrast to food timing, there is clear evidence that circadian rhythms are regulated by meal timing.⁵ Long-term circadian rhythm disruption increases the risk of obesity, as well as metabolic disorders. There is a link between circadian rhythms and lipid metabolism, and deregulating this relationship may place patients at greater risk for obesity and diabetes.⁶ Because food timing can help restore circadian rhythms, it may provide a medication-free option for helping patients lose weight.

Lifestyle Changes

No weight loss or weight management plan is likely to succeed without long-term lifestyle changes. These changes often include eating a caloric deficit to initially lose weight and then eating a different diet to maintain their desired weight. Often, patients will fail to make meaningful lifestyle changes and then gain back all of their lost weight—and often even more weight than they lost! The peer-reviewed literature has consistently shown that diet and exercise are effective weight loss methods, regardless of what medications patients are prescribed.⁷

Surgical Intervention and Intravenous Therapy

Although semaglutide is a powerful medication, there are a variety of other medical interventions available to help patients lose weight. Bariatric surgery is a popular option for morbidly obese patients due to its high effectiveness. It’s important to note, though, that any surgery poses risks, and there is a non-negligible risk of weight regain post-surgery.⁸ In addition, there is a chance that the surgery will lead to difficulty absorbing various vitamins, including vitamin B12, which is critical for lipid metabolism. As we discussed in last month’s blog post, vitamin B12 injections can be a powerful tool in your arsenal to help your patients reach their ideal weight. Other forms of IV therapy may help your patients lose weight, including providing energy with MIC or targeted fat loss using lipotropic injections.

Why Choose VLS Pharmacy and New Drug Loft?

As with any intervention, the treatment should be tailored to each patient. Due to the large variety of factors that affect weight loss and weight regain, a combination of different approaches may be necessary to help your patients lose weight and keep it off. As a 503A pharmacy specializing in sterile and non-sterile compounding, we will support you and your patients’ weight loss by creating safe, individualized, and effective pharmaceutical therapies. All formulations are compounded with high-quality pharmaceutical-grade APIs sourced directly from PCCA, the leader of superior-quality APIs.

For men and women at any age, feeling healthy, conﬁdent, and comfortable is of the utmost importance. Your patients’ needs will change with each life stage. As such, they require an adaptive and personalized treatment plan. By working with a trusted compounding pharmacy like VLS Pharmacy and New Drug Loft, you are expanding the possibilities for successful and sustainable care.

Reach out to our team to learn about best practices and to partner with our experts on custom compounded medications for your patients. All medications from VLS Pharmacy and New Drug Loft are prepared in a lab that follows safety and quality standards per our status as a 503A pharmacy.

References

Norcross JC, Vangarelli DJ. The resolution solution: longitudinal examination of New Year’s change attempts. J Subst Abuse. 1988;1(2):127-134. doi:10.1016/s0899-3289(88)80016-6
Liu D, Huang Y, Huang C, et al. Calorie Restriction with or without Time-Restricted Eating in Weight Loss. N Engl J Med. 2022;386(16):1495-1504. doi:10.1056/NEJMoa2114833
Lowe DA, Wu N, Rohdin-Bibby L, et al. Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men With Overweight and Obesity: The TREAT Randomized Clinical Trial. JAMA Intern Med. 2020;180(11):1491-1499. doi:10.1001/jamainternmed.2020.4153
Jamshed H, Steger FL, Bryan DR, et al. Effectiveness of Early Time-Restricted Eating for Weight Loss, Fat Loss, and Cardiometabolic Health in Adults With Obesity: A Randomized Clinical Trial. JAMA Intern Med. 2022;182(9):953-962. doi:10.1001/jamainternmed.2022.3050
Wehrens SMT, Christou S, Isherwood C, et al. Meal Timing Regulates the Human Circadian System. Curr Biol. 2017;27(12):1768-1775.e3. doi:10.1016/j.cub.2017.04.059
Li Y, Ma J, Yao K, et al. Circadian rhythms and obesity: Timekeeping governs lipid metabolism. J Pineal Res. 2020;69(3):e12682. doi:10.1111/jpi.12682
Swift DL, McGee JE, Earnest CP, Carlisle E, Nygard M, Johannsen NM. The Effects of Exercise and Physical Activity on Weight Loss and Maintenance. Prog Cardiovasc Dis. 2018;61(2):206-213. doi:10.1016/j.pcad.2018.07.014
8. Athanasiadis DI, Martin A, Kapsampelis P, Monfared S, Stefanidis D. Factors associated with weight regain post-bariatric surgery: a systematic review. Surg Endosc. 2021;35(8):4069-4084. doi:10.1007/s00464-021-08329-w