Semaglutide is an anti-obesity drug which is prescribed to individuals embarking on a weight loss journey. With weight management being an area of growing significance, physicians all across the globe are turning to weight loss medications of different compositions such as semaglutide, liraglutide etc. There are different versions of semaglutide available. Wegovy is one of the most commonly prescribed drugs in the UK. 

All about Wegovy?

Wegovy is an FDA (Food and Drug Administration) approved injectable medication, manufactured by the Danish company Novo Nordisk. It is currently available in the United Kingdom post the success of the drug Ozempic. It is available in varying dosages which can be decided by a healthcare provider and may be increased depending on tolerance over a period of 16 weeks. It can also be obtained through a weight management specialist via the NHS (National Health Service), England. 

Prefilled pens are given to the patient which may be self-injected into the belly, upper arm, thigh areas of the body. 

Semaglutide, the active ingredient found in Wegovy, imitates Glucagon like peptide 1 – receptor agonist (GLP 1 RA) by stimulating the appetite regulating centres of the brain in a more sustainable manner.

It works by:

• Regulating appetite 
  
  
• Decreasing hunger
  
  
• Minimising cravings
  
  
• Delayed gastric emptying
  
  
• Decreased glucagon secretion and increased insulin secretion.
  
  
• Suppressing intentions to reach out for junk foods.
  
  

An individual may be suitable to be prescribed Wegovy, if the below category is fulfilled:

• BMI – > 30 kg/m2 
  
  
• BMI – 27 – 30 kg/m2 + 1 weight related medical condition (comorbidities – diabetes, hypertension, hyperlipidaemia, obstructive sleep apnoea (OS), heart attack, stroke, and blood vessel disorders).
  
  
• Adolescents who are above 12 years of age with a BMI > 95th percentile or weighing above 60kg.
  
  

Note – The criteria for BMI (Body Mass Index)  thresholds is reduced by 2.5 kg/m2 usually for individuals from (South Asian, Chinese, other Asian, Middle Eastern, Black African or African Caribbean family backgrounds). 

Individuals who may have contraindications to Wegovy are:

• Those with a history of thyroid cancer/gallbladder disease/pancreatitis/ multiple endocrine neoplasia syndrome type 2 (MEN2).
  
  
• Individuals who are pregnant or lactating.
  
  
• People above 75 years of age.
  
  
• Paediatric population (below 12 years of age).
  
  

Benefits of Wegovy

One can expect varied results depending on individual practises. However, the expected benefits of the prescription drug Wegovy include:

• 15% reduction in weight coupled with diet and exercise.
  
  
• Lowers blood pressure
  
  
• Improves cholesterol levels
  
  
• Reduces inflammation
  
  
• Reduces risk of stroke by 20%
  
  
• Reduces appetite
  
  
• May help in de-addiction of nicotine, opioids, alcohol etc.
  
  

Some people report reduced food noise and also develop an aversion to alcohol consumption.

A study conducted among adults with diabetes who are overweight/obese had significant weight loss with a weekly 2.4mg dosage of Wegovy along with lifestyle changes. 

Does one need to adapt to a healthy lifestyle alongside Wegovy?

Clinical guidelines for Wegovy, encourages the need for individuals to adapt to healthy lifestyle interventions for effective weight loss among individuals prescribed Wegovy. Lifestyle habits are multidimensional as listed below – 

Eating habits 

Owing to the manner in which the drug works, certain healthy eating habits may be adopted to minimise gastrointestinal symptoms like nausea, vomiting, abdominal pain, bloating, constipation, and diarrhoea etc. 

• Have a balanced diet with personalised calorie intake based on your height and weight.
  
  
• Include plenty of non-starchy vegetables, green leafy vegetables (kale, lettuce etc.), bean varieties and cruciferous vegetables in the diet. These provide fibre and essential vitamins and minerals.
  
  
• Consume a wide variety of colourful fruits like berries, melons, apples, citrus fruits etc.
  
  
• Eating smaller portions can help prevent nausea and vomiting.
  
  
• Consume whole grains like brown rice, whole wheat (if not gluten sensitive), pasta, sourdough bread etc. Refined grains can raise blood sugar rapidly.
  
  
• Give priority to protein rich food such as lean meat, poultry (without skin), fish, shellfish, lentils and pulses, cottage cheese etc., which will help improve satiety and prevent muscle breakdown.
  
  
• Restrict intake of saturated fats like processed meats, red meat, coconut oil, palm oil, full fat dairy, fried  and spicy food.
  
  
• Opt for healthy fats like nuts, seeds, fatty fish etc. to boost skin health.
  
  
• Choose healthier eating options when dining out such as soups and salads along with grilled or poached meat.
  
  
• Avoid sugary beverages and food items such as packaged fruit juices, cakes, pastries, cookies, doughnuts and other bakery products.
  
  

Physical activity

• Supplemental benefits can be procured if medication is coupled with exercise.
  
  
• Exercise can help improve the tensile strength of muscles making it strong and lean.
  
  
• Weight loss can result in sagging and loose skin. Exercise can help tighten the skin during the weight loss process.
  
  
• It can also help the individual maintain healthy physical activity processes in the long run.
  
  
• One can choose their preferred form of exercise from an exhaustive list of physical activity forms such as HIIT, swimming, sports, cycling, weight training, yoga etc.
  
  
• Having a structured fitness regime including warm up, flexibility exercises, strength training, and cool down is essential.  
    
• A weekly estimate of 30 minutes duration 6 days a week is important.
  
  
• During weight loss, some people lose muscle mass (sarcopenia) and may lead to weight plateau, hence exercising helps improve muscle mass.
  
  

Sleeping patterns

Sleep is an undermined concept in one’s weight management journey. Poor sleep can – 

• Dysregulate hormones especially the appetite controlling hormones – Leptin (satiety) and Ghrelin (hunger) leading to weight gain.
  
  
• May influence poor food choices hampering weight loss journey.
  
  
• May be a cause of conditions like depression, sleep apnoea, general well being, mood and motivation etc.
  
  
• May increase stress hormones like cortisol and in turn can lead to altered hunger and weight gain.
  
  

Stress management

Psychological changes are crucial in lifestyle changes. Making changes to one’s attitude, controlling mood swings and stress management are lifelong essential requisites. Stronger the mind, stronger the body.  

Emotional intelligence, which is the emotional capacity with which one processes emotions and feelings can influence their lifestyle choices. Strengthening one’s ability to cope with emotions has a key role in your weight loss journey. Being conscious of emotions and preventing any hindrance to health. 

When the body is put in a state of stress, which impairs cognitive ability and hormones involved in appetite and hunger management. This may lead to weight gain.

Addictive lifestyle habits

Smoking, vaping, and alcohol consumption are strictly restricted when on the prescription drug, Wegovy. 

Alcohol provides empty calories which have negligent nutritional value. It may also worsen gastrointestinal symptoms such as indigestion and heartburn. Alcohol can lower blood sugar levels which when coupled with Wegovy, may result in hypoglycaemia (low blood sugar levels). This can be manifested as symptoms like – dizziness or lightheadedness.

Nicotine present in cigarettes can make individuals nauseous. The gastrointestinal side effects of Wegovy work in a way which may trigger severe nausea. Smoking and vaping must be strictly restricted when on Wegovy.

Basic tips to follow, to reduce side effects of Wegovy

• Plan your exercise and meals ahead of time.
  
  
• Practise consistency
  
  
• Make gradual and small changes to diet patterns over a period of time.
  
  
• Eat mindfully and practise portion control.
  
  
• Drink plenty of fluids.
  
  
• Join a support group of like minded individuals or find a health partner.
  
  
• Stay motivated even if results are time taking.
  
  
• Reduce portion size.
  
  
• Avoid spicy and fried food.
  
  

However medications do not come without any complications. Some of the expected complications as listed in the safety information of Wegovy. The common side effects are nausea, constipation and heartburn. The uncommon complications include:

• Diabetic retinopathy
  
  
• Risk of thyroid C-cell tumours
  
  
• Hypoglycaemia in diabetic individuals
  
  
• Interaction with other drugs
  
  
• Acute pancreatitis
  
  
• Dehydration
  
  
• Acute gallbladder disease
  
  
• Acute kidney injury
  
  
• Hypersensitivity reactions
  
  
• Tachycardia (rapid heart rate)
  
  
• Ideation of suicide
  
  

It is of importance to note the general information suggested above can vary from individual to individual. Consulting a doctor and a dietitian before and during your weight loss journey helps to reduce side effects and also improves your chance of success. It is important you are provided personalised advice based on your individual medical conditions. 

Following consistent and sustainable lifestyle changes can help individuals come off Wegovy when they have lost weight. This also helps prevent weight regain once Wegovy is discontinued.