Weight loss is something that more and more people are struggling with, and that most people will encounter at some point in their lives. It is important to manage your weight, because excessive weight can increase susceptibility to some comorbid conditions, and even increase the risk of some cancers.
However, when talking about weight loss, people can feel isolated and shamed. This is because weight loss is often talked about as a “lifestyle” disease, and one that is easy to rectify. This is not always true, and when people struggle with maintaining a healthy weight through traditional practices they may be offered a pharmacological alternative, such as semaglutide.
Where to access semaglutide for weight loss
Semaglutide is a prescription only medication, which means in order to be given this medication you do have to go and have a chat with your doctor. For some people, this might be quite difficult and anxiety-inducing.
Talking with your doctor can be difficult when discussing topics such as weight loss. This is especially true if you have often struggled with weight loss, or have been trying to lose weight for a significant period of time.
In these cases, making sure that you are comfortable talking to your doctor is of the utmost importance. There is absolutely no point in going to see a doctor, getting told to diet and exercise exactly as you have been in the past, and then going home to see no changes.
Sometimes, the advice given to us doesn’t work for our specific situation, and that’s okay! However, it is important to make sure that you are comfortable talking to your doctor and communicating to them that the advice given hasn’t worked.
This means that your doctor will be able to work with you in order to come up with a solution that fits you, and helps you to regulate your weight and increase your quality of life. If you aren’t able to do this with your current doctor, it might be time to consider changing practitioners.
Telehealth options
There are a range of new and exciting ways to access a doctor, which has been largely brought about due to the COVID-19 pandemic. When access to a physical doctor’s office was fraught, we adapted to instead look into telehealth options.
The field of telehealth is now well-established, and there are companies that employ exclusively online doctors, who are able to meet virtually with anyone across the country. There are some significant advantages to using a telehealth company over a traditional doctors office.
For one, some people really enjoy the distance created by the virtual appointment. This means that they feel more comfortable opening up to their doctor, and are more likely to volunteer information, such as if the options you’ve been given before aren’t working.
In addition, telehealthcare means that you don’t have to physically go to the doctor's office. This means that you don’t have to waste your day sitting in the doctor's office waiting for them to get around to seeing you. You can simply get on with your day and login to a virtual consultation at a time that suits you.
Telehealth also has the advantage of giving you access to a variety of different specialists and professionals strewn across the country. This is great for people who live somewhere more rural, where the only healthcare option is the local doctor’s office.
Third Avenue Semaglutide – Most effective & editor’s choice
Third Avenue is a telehealth company that can prescribe and provide semaglutide, so it is a great option if you are interested in this medication specifically. It also has a few other advantages over other telehealth companies.
Third Avenue specializes in weight loss, and can connect you with a board certified specialist to make sure that you have only the best giving you advice on your weight loss journey.
They are also able to offer a personalized weight loss service. In addition to semaglutide, there are a variety of other products that are available to help with weight loss. If semaglutide is not the best fit for you, they can help you navigate to the product that is right for you and your situation.
These personalized weight loss plans don’t consist solely of custom medications, but also consider your age, sex, personal preferences, and medical history. Again, if you leave your doctor’s office knowing that there is no way you are going to be able to follow their advice, it’s been a bit of a wasted visit.
Third Avenue is able to work with you to ensure that the personalized plan that you leave with suits you and your expectations. This helps to ensure that you’ll be able to adhere to the plan they give you, which will increase the effectiveness of your treatment.
Finally, the Third Avenue team also provides ongoing support and guidance. Weight loss is a really difficult goal to commit to, with challenges cropping up unexpectedly all the time. If you happen to fall into a situation that you didn’t expect, in which you are unable to follow your given treatment for a time, they can help steer you in the right direction and keep you on track with follow-up care and ongoing appointments.
This helps to avoid the situation where you go on holiday and fall out of practice with your diet and exercise routines, or where you sprain your ankle and no longer want to do certain exercises prescribed by your doctor. With a traditional doctor, you would likely end up giving up on your journey rather than going through all the trouble of booking in to see them, waiting several weeks to get in, and then getting told that you just have to keep going with the current plan.
What is semaglutide?
Semaglutide is a medication that is offered to people who struggle to maintain a healthy weight. Although there are a variety of reasons that people may struggle with weight management, it typically culminates in that person becoming overweight, and potentially progressing to obesity.
Being overweight is clinically considered when you have a body mass index (BMI) of over 25 kgs per m2, while obesity is from 30 kgs per m2. It is growing more common for obesity to occur at a young age, and it can have lifelong consequences.
Once you have become obese, it is often very difficult to get back to a healthy weight through traditional interventions like diet and exercise. There are several good reasons for this, which we will explain later.
However, if these interventions have failed, then you may be offered a weight loss medication like semaglutide. Semaglutide can help you manage hunger and lose weight, and it is available as either a weekly injection or a daily tablet.
Semaglutide chemically mimics a hormone that is naturally expressed in humans. This hormone is called glucagon like peptide-1 or in the natural form as native GLP-1. The hormone is partially responsible for a variety of processes that help to determine how often and what you eat.
How does semaglutide work?
Native GLP-1 works on insulin secretion and inhibits the rate of glucagon release. It can also suppress gluconeogenesis in the liver. If you are unfamiliar with what this means, don’t worry! We will explain in more detail.
GLP-1 has long since been known to be involved in insulin secretion after nutrient intake. Once we eat food, insulin is usually released from the pancreas, and works to help keep blood sugar levels steady.
This is an important process, because it tells our brain whether or not we need to eat more food. Without insulin, the metabolism of food can become unregulated, and lead to a host of other problems within the body.
When insulin is released, it circulates around the body and tells the muscle, fat, and liver cells to take up glucose and use or store it. Once insulin levels come down a while after food has been ingested, this indicates to your body that there is no more glucose in the blood, and you need to ingest more food.
In some cases, this isn’t true, and the glucose level is still high, but the body can no longer respond to insulin. In this case, the blood sugar levels build up and it creates a condition known as hyperglycemia. Insulin insensitivity is what occurs in diabetes.
Insulin is related to GLP-1 because GLP-1 is responsible for up to 70% of insulin secretion in response to food intake. This means that it is mostly responsible for allowing glucose from your food to travel into your cells where it can be used.
Although we have known that GLP-1 is responsible for a large part of insulin regulation, we haven’t been able to do much with that knowledge for a really long time. This is because GLP-1 is naturally quite short lived in the body, with a half-life of only a few minutes.
This has led to the development of chemical mimics of GLP-1, like semaglutide. There are a variety of these medications, but semaglutide is the only one that has a formulation for both injection and oral tablets.
GLP-1 can also inhibit the release of glucagon. Glucagon is also responsible for maintaining blood plasma levels of glucose, like insulin is. However, glucagon is responsible for the circulating levels during fasting states, and creates a release of sugar from breaking down stored sugar in the liver. This breakdown of sugar in the liver to a soluble, circulating form is known as gluconeogenesis, and GLP-1 functions to suppress and stop this process.
The pharmacological mimics of GLP-1 can also have these effects in the body. However, unlike native GLP-1 which lasts only a few minutes, semaglutide lasts in the body up to a week.
Who needs semaglutide?
As we have covered above, semaglutide can help to control the amount of sugar present in the blood through its action on glucagon and insulin. This makes it an ideal medication for people who struggle with regulating blood sugar levels.
The most obvious group that struggles with blood glucose levels is type 2 diabetics. People with type 2 diabetes are unable to control their blood glucose levels because of a disruption to how insulin is managed in their body.
For type 2 diabetics, over time insulin can’t be secreted at the necessary levels. They also struggle with tissue insensitivity, when the receptors on the cells that use insulin as a signal can no longer detect it even when it is present.
These two factors combine so when insulin is both low in concentration, and can’t be detected as easily, the effect of insulin is negligible. Unlike type 1 diabetics (who don’t make insulin naturally), type 2 diabetics can’t simply add in more insulin.
This is because of the insulin sensitivity issues. Their cells would be unable to detect the insulin even if it was present at normal concentrations, so these patients need another way of regulating blood sugar levels.
Currently, this is done through diet control, and blood sugar monitoring. These methods help to keep the blood sugar at a safe level, as well as helping to lower weight in cases where obesity has led to diabetes as a comorbidity.
However, these interventions are often difficult to maintain, and can be particularly disruptive to your quality of life. This is especially true in cases of obesity, where you are essentially expected to maintain and control your diet in the same environment that you were initially unable to maintain and control your diet.
As a result, some people also need pharmacological agents like semaglutide to help as a second-line medication. This means a medication that is given if, after careful monitoring, it is found that the blood sugar level is still uncontrollable.
In these cases weekly injections of semaglutide can help to regulate blood sugar levels through the mechanisms of action explained above. However, semaglutide also has another mechanism that can be helpful for weight loss.
Semaglutide is also available for patients who are simply trying to lose weight and have not developed type 2 diabetes along with obesity. In these cases, although controlling blood sugar levels helps to manage hunger signals, the true potential of the drug is in its ability to interact in the brain.
Semaglutide has been found to interact with several regions of the brain in mice. These include the hindbrain and the hypothalamus, where it was able to activate these regions either directly through GLP-1 action, or indirectly. The activation of these regions is thought to explain how semaglutide can change the food preferences of those who take it, causing them to eat less and eventually lose weight.
In simple terms, the drug can change the foods you crave when dieting, and can stop you from failing at sticking to a lower calorie diet because of reward pathways in your brain.
Thus, it’s easy to see why semaglutide is becoming an increasingly utilized medication for not just type 2 diabetic patients. Patients who have struggled long term with obesity are also able to find relief from their chronic condition, as well as reduce the risk of developing further comorbidities.
Is semaglutide safe?
If you have been on the internet for a while, you might be used to the trending weight loss medications that pop up, promising to make your doctor hate you, and then do absolutely nothing for you.
As a result of this phenomenon, people are (rightly) wary of any new weight loss medication that they find on the internet. But semaglutide has been through a lot of clinical trials to extensively show that it is both safe and effective.
Semaglutide was given FDA approval in 2021, which means that it absolutely has to be safe for humans to use. This is quite difficult to achieve, and requires extensive trials showing in both cellular models and animal models that there are no significant or dangerous side effects.
The FDA also requires that the benefits of using the drug outweigh any known risks, as well as showing that the company who makes it can keep manufacturing the drug safely. This is all done before you even know the new medication exists.
Then the medication must go through extensive clinical trials in humans. This starts at very low doses, which are taken from animal trial data to show that there are no unusual dangerous side effects in humans that weren’t found in the animal models.
Then the drug goes through even more clinical trials to show that it is effective at a range of doses in healthy volunteers, and to determine the limits of safe dosage levels in humans. It is then tested in small subsections of sick patients to make sure it is effective, and then is introduced to larger testing groups to make sure there are no extremely unlikely but still possible negative effects.
The drug is then released to the market, where the consumer can finally access it. It is then monitored throughout the early to mid stages of it being available on the market, in case there any other effects crop up that didn’t come up in all the other testing.
So, as you can see, medications that have been approved for use by the FDA have to go through extensive safety testing, to make certain that any negative side effects are known, can be monitored, and are worth the risk for the benefits they give.
Is semaglutide effective?
Secondary to being safe, the most important thing that a medication can be is effective. We are going to go through some of the clinical data available from the extensive testing required for safety and FDA approval to show that using semaglutide for weight loss is effective.
SUSTAIN Trials
One of the first series of clinical trials for semaglutide was the SUSTAIN trials. There were many of these trials, plus several in specific populations that we will go through very briefly. There is much more information on these trials available if you have any interest in following up with them.
SUSTAIN 1: This initial study followed a population of around 450 patients who were either given a high dose of semaglutide (1 mg), a low dose of semaglutide (0.5 mg), or no semaglutide (placebo).
Results of this trial found that there was a reduction in body weight, as well as a reduction in several markers that show the severity of type 2 diabetes. There were some gastrointestinal adverse effects reported, but it was overall very safe.
SUSTAIN 2: The next trial consisted of only type 2 diabetics, and a population of 1225 patients received either a low or high dose of semaglutide as well as a placebo pill, or they received a once daily dose of sitagliptin (an already proven medication) and a placebo injection.
This was done to ensure that the patients couldn’t know which of the medications they were on. Both low and high doses of semaglutide were more effective than the current medication.
SUSTAIN 3: This trial was done with 813 people, and compared high dosage of semaglutide to another proven drug, exenatide. This again showed that semaglutide was more effective for weight loss and for managing other biomarkers associated with diabetes.
SUSTAIN 4: Semaglutide was compared directly to insulin glargine, with both high and low doses of semaglutide. Again, semaglutide was shown to cause a significant reduction of the diabetes biomarker HbA1c, as well as reducing the body weight of patients.
SUSTAIN 5: Another type 2 diabetic-only study, this trial compared patients who had only semaglutide at either a high or low dose compared to a placebo. The result of this trial was a significant reduction in both HbA1c and body weight.
SUSTAIN 6: This trial was conducted in patients who had cardiovascular or renal impairments. Negative cardiovascular and renal health are also comorbidities of obesity. In this trial, patients received either high or low semaglutide compared to placebo.
There was significant reduction in both HbA1c and body weight in patients. They also experienced a reduction in the common side effects of cardiovascular and renal impairment, including a slowing of the progression of atherosclerosis and lessening of retinopathy, nephropathy, or pancreatitis.
SUSTAIN 7: This was another trial to compare semaglutide with another clinically proven drug called dulaglutide. This trial involved 1201 patients who were given either high or low doses of either semaglutide or dulaglutide.
Although both were able to provide a reduction of HbA1c and body weight, semaglutide was shown to be significantly more effective than dulaglutide.
SUSTAIN 8: This trial determined whether semaglutide was more effective than canagliflozin, which is another proven medication. The study found that semaglutide decreased body weight and HbA1c significantly more than canagliflozin.
SUSTAIN 9: This trial used weekly dose escalations for semaglutide when taken at the same time as either another medication or with placebo. It was found that semaglutide in conjunction with the other medication was significantly better at reducing HbA1c and body weight. There was also a reduction in known gastrointestinal adverse events with the dose-scaling approach.
SUSTAIN 10: Semaglutide was compared to its closest relative liraglutide. It was found that semaglutide was more effective than liraglutide. Notably, semaglutide also only has to be injected once weekly, whereas liraglutide requires daily injections.
Further clinical trials were also done for SUSTAIN, but in the interest of keeping this brief, we won’t go into them. However, the in-depth dive into some of the SUSTAIN clinical trials shows the extensive testing necessary to establish both safety and efficacy for semaglutide.
These trials unequivocally show that semaglutide could be more effective and as safe as its already available competitor products. Semaglutide has also been tested extensively in the type 2 diabetic population, in order to make sure that it is safe.
The lessons learned from these clinical trials is that semaglutide can reduce both body weight and biomarkers for diabetes such as HbA1c. This means it is suitable for use in fighting both obesity and diabetes.
Semaglutide was also found to be most tolerable with dose-escalation, so it is likely that your doctor will prescribe a series of injections for you to get you up to the most effective dose with the least side effects.
The bottom line
Semaglutide is a medication that can help a lot of people who are struggling with maintaining their weight or with type 2 diabetes. It can modulate appetite, reduce body weight, and reduce biomarkers of diabetes like HbA1c.
You can easily gain access to semaglutide for weight loss through Third Avenue, which is a telehealth company that specializes in weight loss. You’ll be connected with a medical expert that will consult with you to ensure your journey with semaglutide is safe and effective.
