Who is a Good Candidate for Semaglutide? Understanding the Benefits and Limitations

Semaglutide is a powerful medication originally developed to treat type 2 diabetes. However, its efficacy in promoting significant weight loss has made it an exciting option for patients looking to address obesity and metabolic issues.

While semaglutide offers remarkable benefits for many, it is essential to determine who is a good candidate for this medication and to be aware of contraindications for its use. This post will explore both aspects, providing a comprehensive guide to help patients and practitioners make informed decisions.

What is Semaglutide?

Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1 RA). It mimics a hormone in the body that helps regulate blood sugar levels, appetite, and digestion. By slowing down gastric emptying, reducing appetite, and increasing insulin secretion in response to meals, semaglutide can significantly aid in both blood glucose control and weight reduction.

Although originally approved for diabetes management under the brand name Ozempic, semaglutide was later approved by the FDA in a higher dose under the brand name Wegovy for use in weight management. This approval opened the door for its use in individuals without diabetes who are seeking weight loss solutions.

Who is a Good Candidate for Semaglutide?

1. Individuals with Obesity (BMI ≥ 30)

One of the primary groups of individuals who may benefit from semaglutide are those classified as obese, meaning they have a body mass index (BMI) of 30 or higher. Obesity is a significant risk factor for numerous health conditions, including cardiovascular disease, diabetes, hypertension, and joint problems. Semaglutide has been shown to help these individuals lose a meaningful percentage of body weight, improving overall health outcomes and reducing obesity-related risks.

2. Overweight Individuals with Weight-Related Comorbidities (BMI ≥ 27)

For individuals who are overweight (BMI of 27 to 29.9) but not classified as obese, semaglutide may still be appropriate if they have weight-related comorbidities such as high blood pressure, type 2 diabetes, or dyslipidemia. These individuals may struggle to lose weight through diet and exercise alone, and semaglutide can offer an additional tool to help them achieve weight loss, reduce the severity of their comorbidities, and improve overall quality of life.

3. Type 2 Diabetics Needing Improved Blood Sugar Control and Weight Loss

As semaglutide was initially developed for blood sugar regulation in type 2 diabetes, it remains a strong option for individuals in this group. Patients with type 2 diabetes who struggle with obesity may benefit from the dual action of semaglutide—helping to manage their blood glucose levels while also promoting weight loss, which can further improve glycemic control and reduce insulin resistance.

4. Individuals Committed to Lifestyle Changes

Semaglutide is most effective when used in conjunction with lifestyle changes, such as a healthy diet and increased physical activity. Therefore, individuals who are committed to making these adjustments and view semaglutide as an adjunct to their efforts, rather than a stand-alone solution, are more likely to be successful. It is not a quick fix but rather a tool to support sustainable weight loss when integrated into a comprehensive health plan.

5. Patients Seeking to Avoid Bariatric Surgery

For individuals who are considering bariatric surgery but wish to explore non-surgical options first, semaglutide can be a valuable alternative. The significant weight loss achieved with semaglutide has, in some cases, been comparable to that of bariatric surgery. However, it is important to note that while semaglutide can help patients avoid surgery, it is not a permanent solution and may require long-term use for sustained results.

Who is NOT a Good Candidate for Semaglutide?

While semaglutide has shown great promise for weight loss and diabetes management, it is not suitable for everyone. Several factors can make an individual a poor candidate for this medication.

1. Patients with a History of Medullary Thyroid Carcinoma (MTC)

One of the major contraindications for semaglutide use is a personal or family history of medullary thyroid carcinoma (MTC), a rare form of thyroid cancer. In clinical studies, GLP-1 receptor agonists like semaglutide have been associated with an increased risk of developing MTC in animals, although this has not been confirmed in humans. Because of this potential risk, semaglutide is not recommended for individuals with a known history of MTC or a family history of the condition. It is important to note that this does not mean that ALL types of thyroid cancer are considered contraindications to treatment, and that this risk has NOT been demonstrated in humans, only animals whose thyroid glands respond uniquely in the presence of semaglutide from that of human thyroid glands.

2. Individuals with Multiple Endocrine Neoplasia Syndrome Type 2 (MEN 2)

Similarly, individuals with multiple endocrine neoplasia syndrome type 2 (MEN 2), a genetic condition that increases the risk of developing tumors in the endocrine system, including the thyroid, should not use semaglutide. The risk of exacerbating thyroid issues in this population outweighs the potential benefits of weight loss or blood sugar control. Once again, It is important to remember that this is just one very specific type of thyroid cancer, and that this risk has NOT been demonstrated in humans. Laboratory rodents were the subjects who experienced this phenomenon. The thyroid glands of these animals respond uniquely in the presence of semaglutide from that of human thyroid glands, so luckily is it not likely that we will begin to see the same association in humans. Out of an abundance of caution, however, we consider it a human contraindication.

3. Patients with Severe Gastrointestinal Disease

Since semaglutide slows down gastric emptying, it is not suitable for individuals with severe gastrointestinal disorders, such as gastroparesis. In individuals with these conditions, further slowing of the digestive process could worsen symptoms and lead to complications like nausea, vomiting, and abdominal discomfort.

4. Pregnant or Breastfeeding Women

Semaglutide is not recommended for use during pregnancy or while breastfeeding. Weight loss is not advised during pregnancy, as it can negatively affect the growth and development of the fetus. Additionally, there is limited data on whether semaglutide passes into breast milk, so it should be avoided during breastfeeding to prevent potential harm to the infant.

5. Individuals with a History of Pancreatitis

Patients with a history of pancreatitis, a condition characterized by inflammation of the pancreas, may not be good candidates for semaglutide. While there is no definitive evidence that semaglutide causes pancreatitis, GLP-1 receptor agonists have been associated with an increased risk of pancreatitis in some studies. Caution should be exercised in these individuals, and alternative weight loss methods may be more appropriate.

6. People with Uncontrolled Psychiatric Conditions

Weight loss medications, including semaglutide, may not be appropriate for individuals with severe, uncontrolled psychiatric disorders. In some cases, rapid weight loss can exacerbate underlying mental health issues, and certain psychiatric medications can complicate or reduce the effectiveness of weight loss treatments. It is important for these individuals to work closely with both their healthcare provider and mental health professional to determine whether semaglutide is a safe option. Luckily, for the most part, semaglutide patients are experiencing a mood improvement! Even still, it is best to be aware and to be vigilant for any changes or worsening psychiatric conditions.

Weighing the Risks and Benefits

Before starting semaglutide, patients must undergo a thorough evaluation with their healthcare provider. This process involves assessing medical history, current medications, and any potential contraindications. While semaglutide is a powerful tool for weight loss and diabetes management, it must be used under medical supervision, particularly in those with pre-existing conditions or other health risks.

Conclusion

Semaglutide offers significant promise for individuals looking to manage their weight or improve their blood sugar control, but it is not suitable for everyone. Those who are obese or overweight with comorbidities, as well as individuals with type 2 diabetes, may be good candidates for semaglutide when combined with lifestyle changes. However, contraindications like a history of medullary thyroid carcinoma, MEN 2, severe gastrointestinal disease, and other health conditions mean that careful consideration is needed before starting this medication.

If you think semaglutide might be right for you, reach out to us to consult with our Nurse Practitioner! Why not discuss your options?! Find whether this medication aligns with your health goals!

At FreshRx, consultations are always free, so make an appointment today to speak with our Nurse Practitioner to learn whether treatment with semaglutide is right for you!