Being overweight has a negative impact on every system in the body. From heart disease to diabetes, extra pounds bring extra risk. For decades, the best advice revolved around telling patients to eat less and work out more. Modern research has demonstrated that these approaches are rarely successful. In fact, most of what was considered as fact is being turned on its head.
As a board-certified Plastic Surgeon, I frequently counsel my patients about the dangers associated with being overweight – specifically as it applies to elective, aesthetic surgery. Often, I would tell a patient to just come back when their weight was better controlled. Since the advent of a new class of medications, that has changed. Now there are proven ways to help patients lose weight safely and effectively.
Research has shown time and again that medication alone – in the absence of behavior change – isn’t a long-term solution. Therefore, I recommend the following two-part approach to weight loss including medication and habit changes (more on that at the end).
Semaglutide – Injectable Medication for Weight Loss
In 2021 the FDA approved semaglutide for use in weight management. To that end, we offer a program of compounded semaglutide given weekly by injection to help patients achieve their goal / pre-surgical weight.
We work closely with a compounding pharmacy and will either have you come to the office for your weekly injections and weigh-ins or based on your comfort level – provide you with the materials for self-injection at home.
The BPS weight loss program is a 3 month program utilizing compounded semaglutide or tirzepatide administered weekly. The process begins with a consultation with Dr Baumholtz to review your health history and set expectations for the program. We will then order lab work to help guide the treatment. Once the lab work has been reviewed, your injections will begin. We ask you to track your weight weekly.
Each month we will increase your dose based on your response and how you are tolerating the medication. Lab work will be repeated before the start of the 3rd month. Patients who will continue beyond three months will be considered for a Maintenance program of weight loss. For patients who are comfortable giving themselves injections, we will teach you how and then provide you with the materials.
What is Semaglutide
Semaglutide belongs to a class of medications known as glucagon-like peptide-1 receptor antagonists, or GLP-1 RAs. It mimics the GLP-1 hormone, released in the gut in response to eating.
One mechanism of GLP-1 is to prompt the body to produce more insulin, which reduces blood sugar (glucose). For that reason, health care providers have used semaglutide for years to treat Type 2 diabetes.
Over the years, researchers learned that when GLP-1 is given in higher doses it also interacts with the parts of the brain that suppress your appetite and signal you to feel full. When used in conjunction with diet and exercise, these medications can cause significant weight loss in people who are obese or overweight. This is turns has been shown to lower the risk of diseases associated with being overweight.
In 2021, the FDA approved the use of semaglutide for weight loss when combined with diet and lifestyle changes. Treatment involves a weekly injection given subcutaneously (just below the skin). Injections will be performed here in the office or given to you for use at home (depending on your level of comfort / proficiency).
Who is Semaglutide For?
Patients with BMI (Body Mass Index) >30 who want to lose weight or BMI >27 with at least one weight related health issue (high blood pressure, diabetes, high cholesterol)
While using Semaglutide it is highly recommended that you:
- Eat a fibrous diet.
- Focus on fruits and vegetables that are high in fiber
- Eat small high protein meals as digestion is slowed down while on this medication
- Avoid foods high in fat as they take longer to digest
- Limit alcohol intake as this medication can lower blood pressure
- Drink at least 32oz of water a day to avoid constipation
What Does the Medication Do and How Does Semaglutide Work?
Benefits May include:
- Simply put – the medicine does 3 things all of which contribute to weight loss:
- You feel full
- Decreases appetite
- Lowers your blood sugars
In more detail (for those who want it)
- 94% similar to natural human GLP-1
- Acts as a physiological regulator of appetite
- Reducing food intake by reducing feelings of hunger
- Increasing feelings of fullness/satiety.
- GLP-1 stimulates the release of insulin from the pancreas,
- Which helps to lower blood sugar levels.
- It also reduces the amount of glucose produced by the liver and slows down the rate at which food is emptied from the stomach.
- This can help to regulate blood sugar levels and promote feelings of fullness.
- Weight loss can lead to secondary benefits by improving weight loss related health problems such as:
- Cardiovascular risk factors
- Blood glucose levels
- Waist circumference
- physical health related quality of life issues
- Cardiovascular risk factors
How Effective is Semaglutide for Weight Loss?
An early study of 2,000 obese adults compared people using semaglutide plus a diet and exercise program with people who made the same lifestyle changes without semaglutide. After 68 weeks, half of the participants using semaglutide lost 15% of their body weight, and nearly a third lost 20%. Participants who incorporated only lifestyle changes lost about 2.4% of their weight. You can see – these medications give patients an ENORMOUS benefit.
Subsequent studies have shown similar results but there is a common theme for patients once they stop taking the medication – for those who did not change their habits – the weight will come back.
Who is Semaglutide Not For?
You should not use semaglutide if you are allergic to it, or if you have:
- Multiple endocrine neoplasia type 2 (tumors in your glands)
- Personal or family history of medullary thyroid carcinoma (a type of thyroid cancer)
- Diabetic ketoacidosis
- Uncontrolled insulin dependent diabetes
- History of pancreatitis
Tell Your Practitioner if You’ve Ever Had:
- Stomach or intestinal disorder
- Kidney disease
- Eye problems caused by diabetes (retinopathy).
Semaglutide Side Effects
The side effects of semaglutide are typically mild — especially when compared to the complications associated with overweight and obesity. For some patients, a different GLP-1 medication may offer similar benefits with less side effects but it varies person to person.
People taking semaglutide for weight loss may experience:
- Gastrointestinal issues, such as diarrhea, constipation and gassiness
- Stomach issues, including nausea, vomiting, pain or distention (bloat)
Gastrointestinal issues are the most common complaint among people just starting semaglutide. To help minimize these side effects, we recommend beginning on a lower dose and then slowly increasing the amount you take.
What is the Process?
The process begins with a consultation here in our office (or online). From there, we will arrange lab work for you. After reviewing your medical history and lab work – we will start you on a regimen of once weekly injections. For those comfortable giving themselves injections – we will provide you with all the materials you need for a month of treatment.
For those who want a little extra help – we would be happy to inject you here in our office. Treatment cycles are 3 months with lab work at the beginning and before the 3rd month. During the ramp up period – the dosage will increase every 4 weeks. Once your at an effective dose for weight loss – we will continue you at that dose until we reach our goal.
Changing habits is hard. Where to begin?
Intermittent Fasting – Specifically the program outlined in the book, The Obesity Code by Dr Jason Fung. Dr Fung’s approach to weight management is outstanding.
Stopping the medication causes the weight to come back?
No. Bad eating habits cause the weight to come back. The medication can only help someone suppress bad habits to an extent. It is up to each patient to carefully and critically change their diet to truly maximize the benefits of these medications.
Is semaglutide safe for children?
Yes. The FDA approved semaglutide for teenagers with similar findings to their adult counterparts. Click here to read more about semaglutide and teenagers.
How can I calculate my BMI?
Click here for a BMI calculator and BMI tables.
What do I need to know about these medications and surgery?
There is some concern during any form of weight loss for depleting protein reserves which will impact your ability to heal. Typically, I have you stop the medication 4 weeks before surgery to allow your body to re-equilibrate in terms of nutrition.
What are the costs?
We charge $1200 for three months of treatment and oversight. After the initial 3 months, we charge $300 / month for the maintenance program.
Ready to take charge of your weight? Call us today to schedule your consultation.