By Jean Brannum and Maja Clasen
Christopher Maestas knew he had to lose weight. The Denver resident was up to 250 pounds and had been diagnosed with prediabetes. His doctor told him that the only way to reverse it was through weight loss.
It wasn’t easy. Christopher started losing weight at the beginning of 2020, but pandemic stress caused him to gain it back by the end of the year. By the time he started using semaglutide, the medication sold as the weight loss and type 2 diabetes blockbuster Ozempic, he was back up to his heaviest weight.
Immediately, the 53-year-old noticed a difference in his appetite. For the first few weeks, he could stomach only a single boiled egg for breakfast. Now, he has overnight oats and maybe a banana. Even on days when he chooses heavier, fattier breakfasts, he eats only a portion of what he used to.
How Semaglutide Works
Semaglutide is a GLP-1 receptor agonist. According to the Mayo Clinic, drugs in this family stimulate insulin production when the body’s blood sugar is high. Though originally developed to help manage type 2 diabetes, these drugs also help create unprecedented weight loss in ways that experts are still trying to decipher.
Amanda Velazquez, MD, the director of obesity medicine at the Cedars-Sinai Center for Weight Management and Metabolic Health, said that semaglutide mimics the gut hormone that makes the body feel full. This suppresses appetite, leading to easy weight loss.
Three U.S. Food and Drug Administration (FDA)–approved drugs contain semaglutide:
Ozempic, an injection that is approved to treat type 2 diabetes
Wegovy, an injection that is approved to treat obesity
Rybelsus, a less-powerful oral form of semaglutide approved to treat type 2 diabetes
Cutting Out Food Noise
Appetite suppression is only one effect of semaglutide’s effects; it also has a remarkable ability to quiet the intrusive, obsessive thoughts about food that many people contend with every day. Constant thinking about food is often called “food noise,” and like many others, Christopher noticed that his food noise disappeared when he started taking semaglutide. He says that he never realized how much he thought about food until the medication quieted the thoughts.
How powerful is the change? Christopher said that he will completely forget to eat sometimes. One day, Christopher put his lunch on a warming plate at 10:30 a.m. and continued working. Before he knew it, it was 1:30 p.m. and he had not even thought about his lunch.
“The nice thing about it is, I have been able to spend a lot of time in my brain and in my life not thinking about what are we gonna have for dinner. ‘What do we have for tomorrow?’ ‘Do we have enough?’ ‘Do we need to go to the store?’ ‘We need this.’ ‘We should get some snacks,’ I mean, there’s a lot of that chatter that went on in my head I don’t think I really realized.”
It’s also become easier to make healthy diet choices. At his favorite Mexican place, he orders a ceviche tostada instead of a large combo meal. When he dines out with his husband, there is an understanding that he will not want appetizers. Sometimes, he eats a combination of side dishes.
“What it has done for me is kind of changed my relationship with food, but it also taught me that I don’t have to have the giant breakfast every morning to get through the day. I don’t need 20 grams of protein at breakfast. I always thought I did.”
Christopher never consulted his primary care physician. He knew that he might have trouble getting insurance coverage for Ozempic or Wegovy — and that the drug would cost him dearly.
So, he decided to turn to an online clinic for a prescription. Experts have warned patients to be cautious about online clinics, some of which appear to provide very meager medical oversight. After completing a questionnaire and virtual meeting, Christopher received a prescription for cheaper compounded semaglutide. It costs him about $200 per month.
Compounded drugs live in a regulatory gray area with the FDA. The FDA does not regulate compounded medications the same way it does the regular versions available at normal pharmacies, and many experts fear that they can be unsafe or ineffective. Christopher’s semaglutide is mixed with vitamin B12 and is not identical to Ozempic or Wegovy.
Dr. Velazquez says that we can’t be confident that compounded forms are effective: “You could be spending $1,000 on water or something, maybe something comparable to Wegovy or Ozempic, but we have no clue.”
For the compounded form, Christopher draws up his own dose from a vial with an insulin syringe. He used to give B12 shots to his dog, so drawing injectables and using needles was not a scary concept for him. “There’s about a two-second hesitation when you’re about to stick it in because it’s just a little weird.”
At first, the side effects were a burden, but they were not unbearable and he was happy with the initial results.
“The side effects and the appetite suppression definitely get more intense as you titrate up in doses,” Christopher said. “But I started to lose weight right away.”
The most common side effects for semaglutide include nausea, vomiting, and indigestion. Christopher said that eating less helped a lot with minimizing their severity.
The medicine has been very effective. Christopher has lost about 43 pounds since starting his weekly semaglutide shot, and his blood sugar numbers have improved too.
Looking to the Future
Once he reaches his goal weight, he would like to discuss getting off the medication with his primary care physician. Many who stop taking semaglutide regain weight, according to Velazquez. After stopping Ozempic, the appetite usually returns and people will eventually gain weight back.
During the initial questionnaire from his telehealth provider, he never discussed whether semaglutide is a long-term medication. However, Christopher said he would like to try getting off the drug if his doctor thinks it is best.
“I would like to try because I feel like if I’ve done enough behavior modification, and if I get the results that I really want to get, I think that’s gonna be a big driving force for me.”