... and It May Surprise You.
The Talk
By now most of us have heard of the brand names Ozempic and Wegovy. They are in the news. There has even been a South Park episode lampooning the public debate regarding their use. Those are two established brand names for a drug with the generic name semaglutide.
Like all public debates, there is plenty of misinformation. This can be a complicated subject, but I think we can do a very practical dive into how semaglutide can actually help with permanent weight loss, and more.
The widespread use of semaglutide has changed everything in how we think about and treat excess weight. But if you think weight loss is the ultimate benefit, THINK AGAIN. The real miracle is how using it as part of a holistic health program can, within months, set you on your own trajectory toward wellness.
My Own Journey with Semaglutide
As an experienced functional medicine physician, I know that an effective wellness program needs to address many arenas. Creating a personalized holistic approach teaches each patient to focus on healing with the goal of a long and vibrant "healthspan."
Even though I don’t specialize in weight loss by itself, my integrative medicine approach appreciates the profound role diet plays in health.
So in 2020, I created a weight loss program for my existing patients that uses the incredibly effective semaglutide as an ‘opening act.’ At first I thought it was the main event, but it turned out only to set the stage for a successful program. Semaglutide wasn’t the ‘it’ drug long term. Its strongest effects eventually wear off.
I was Patient Number 1 for my program, having gained my ‘COVID 19 (pounds).’ Because I am not diabetic and do not have any of the 'comorbidities' that would have allowed approval of the prescription brands, I used compounded semaglutide (from a reputable and long-established pharmacy) along with a weight loss app. There are lots of apps to choose from. I happened to choose Noom. My program allows you to use the tool of your preference to keep you on track as we manage your progress.
At first I considered it rather simplistic, but as I dove deeper into the program, I learned not only to track my weight on a graph, but to log my foods so I could compare my progress with what I had eaten. No surprises there! But the neat thing was that there were no forbidden foods. Even having a couple of bites of dessert was OK as long as I controlled how much I ate. That took a huge amount of negative self-judgment out of the equation.
Further along the app tackled more advanced topics, such as overeating due to social cues, visual cues, and starting to deal with the underlying cause of my own overeating - emotions. There were even mental exercises to simulate the negative emotions I had been experiencing for years. Those were not my favorite exercises because I had tried, after all, to avoid experiencing those by using food both to comfort and numb myself. But they were useful.
The amazing thing is that I discovered other ways to manage. We’re talking decades of overeating here. But I needed time to incorporate these changes.
Lessons Learned and Shared
I bring my personal experience with my own program to guide my patients along their journeys to attain their best health and wellness goals.
Here are some key details.
Appetite suppression, one of the mechanisms of how this medication works, by slowing down the digestive tract, is only effective for some months, anywhere from 6-12. After that there is much less suppression because your body has gotten used to the medication. The unpleasant GI symptoms some people experience also lessen and resolve.
What this medication does, however, is lower the urgency of “I need to eat now” or “I’m going to finish this extra slice of pizza.” This gives you a pause, some breathing space, to start to make a different decision relative to food. Sometimes taking that extra bite translates into nausea - itself a great learning tool. I call it rehabilitating the “I am full” button. I know my own had long since vanished from the rear view mirror. My overweight patients on my program confirm the same.
Enter the star of the show - reshaping the relationship with food, also known as behavior modification. The most successful people who have used the medication and kept the weight off used some form of this. While there are some excellent apps, what many people don’t know is that some health insurance companies offer programs free to their members. That includes Medicare coverage for weight counseling and Blue Cross, among other insurers, with its own program. Inquire if your insurance provider offers a free benefit like this. You might be surprised!
According to this article at Healthline.com (https://www.healthline.com/health/how-long-does-it-take-to-form-a-habit#takeaway), it can take up to 8 months to form a new habit, though the average is 66 days Semaglutide gave me that opening between the thought, cue, or impulse of over-eating and actually biting into something. I had gained the ‘breathing space’ to start to apply the principles taught in the app (or insurance-provided program or counseling) before putting food in my mouth. That 6-12 month window is sufficient to do the hard work of changing a habit as primal as overeating.
While this may not help everyone, my bottom line: behavior modification is key. Semaglutide made it much easier!
As an integrative physician, I did not want to become reliant, nor want my patients to become reliant, on a prescription if I could instead change something in lifestyle that had a permanent effect.
Please understand that every medication has risks. The longer you use a drug, the higher the dose, the greater the likelihood of unwanted or dangerous side effects. So I instruct my patients to start with a low dose, and gradually increase until they experience appetite suppression. They stay at that dose until or if it is no longer doing the job. Then, working with each patient, I increase the dose to the next level of effectiveness.
If you are using semaglutide solely for weight loss (as opposed to diabetes) please consider this: to maintain weight loss, many people remain on the medication, at full dose or at a lower ‘maintenance’ dose, long term. That is a lifetime crutch, something you lean on, become dependent upon, as opposed to a short-term tool applied as part of a holistic health program. You have a choice: use this medication as a simple weight loss approach, or use it to elevate yourself and your health to a higher level without chronic dependence on medication.
While ‘lifelong meds’ may be necessary for serious disease, there are other options for my patients who struggle with extra weight. I recommend using the time that semaglutide affords you at its peak effect (6-12 months) to lift yourself into wellness with new healthier behavior.
This means using it as a tool to improve overall health and lay the groundwork for a vibrant healthspan. Establish new patterns for a lifetime of freedom from a dysfunctional relationship with food as well as from weight issues, prescription medicine, injections, risk, and expense. Using semaglutide as part of a thoughtful holistic health plan, you can emerge from this part of your life's journey in charge and drug-free.
To your good health - Gesundheit!
Dr. Bettina
#GLP-1
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