People struggling with weight loss have been presented with many different options over the years ranging from a plethora of diet and exercise regimens to various dietary supplements (so-called “fat-burners”), to drugs, and even surgical intervention. In recent years, a family of medications known as GLP-1 agonists, or glucagon-like peptide 1 agonists, have become popular under the generic names Semaglutide (Ozempic®) and Tirzepatide (Mounjaro®). Zepbound® and Wegovy® are other popular trade names.
GLP-1 agonist medications are often prescribed for weight loss but may also be prescribed for controlling Type 2 diabetes. The medications mimic GLP-1, a hormone produced in the small intestine that triggers the release of insulin (which converts food into energy and lowers the amount of glucose (sugar) in the blood), blocks glucagon (a hormone the body produces to raise the blood sugar levels), slows digestion leaving the stomach fuller longer (which also leads to less glucose entering the bloodstream), and reduces hunger by promoting a full feeling in the brain.
By triggering the pancreas to release more insulin, Type 2 diabetics are able to control their blood sugar levels while the slower digestion helps to decrease the occurrence of blood sugar spikes.
Michele Haege, PA-C (Physicians Assistant-Certified), has undergone specialized training to administer GLP-1 medications, and with Ann Leland, MSN CRNA ARNP (Master’s degree in Nursing, Certified Registered Nurse Anesthetist, Advanced Registered Nurse Practitioner) provides GLP-1 injections at Sashy Aesthetic Boutique in Solon.
Semaglutide was the first GLP-1 medication developed and is significantly cheaper than Tirzepatide, she said.
“Tirzepatide was developed because people had comorbidities (other factors impacting their health such as hypertension and/or diabetes). Tirzepatide is stronger and was also developed because some people will have side effects to Semaglutide such as severe nausea and vomiting, and they couldn’t get over it.” Tirzepatide is believed to have less side effects than Semaglutide.
“What we see is that some people were started on Tirzepatide because insurance would cover that, but now a lot of insurance companies who were covering it are saying they’re not anymore, which is just crazy to me. These meds could help so many people with other stuff going on. Weight is such a compounding factor in so many things.”
Haege said when a client comes in to start Tirzepatide, but insurance won’t cover it, she suggests starting on Semaglutide. “It’s a third of the cost for you and you weren’t necessarily started on Tirzepatide because of something.” Almost all of her clients have switched to Semaglutide, Haege noted, and of the few on Tirzepatide, one wasn’t seeing the desired effects with Semaglutide.
Case studies
*Editor’s note – A public request for subjects willing to be interviewed was made on social media with four respondents. To provide confidentiality, they will only be identified by initial, age, and sex.
M, 55-year-old female – “ I had heard about these via social media, TV ads, etc. and brought it up with my doctor after gaining weight after being sick in 2023.” Her doctor suggested Zepbound®, which she started last June. Since then she has lost 60 pounds. “The drug is life changing,” she said pointing to other benefits such as inflammation reduction, reduced anxiety, and an overall sense of well-being. “I no longer feel like I need to wait for my body to warm up each morning like an old car.”
She said she plans to continue to take it after her desired weight loss for the other benefits, and side effects have been minimal. “I get a little nauseous and tired sometimes but nothing worse than how I feel without it.” But she cautioned, “You do have to really ensure you are hydrated and getting enough of the right calories or the side effects can be much worse.”
One effect of the GLP-1 medications is cancelling out the so-called “food noise,” that creates a desire in the mind for food.
“Food noise is something I didn’t even know I had until it was gone,” she said. “People who don’t struggle could never understand. It’s this constant inner discussion about what to eat next and when. It is berating yourself for eating all the wrong things. It is justifying eating the bad stuff anyway because you are fat and nothing changes it.”
M said the first dose calmed her mind significantly. “I no longer think about pizza or Coca-Cola. I don’t want those things anymore and if I do have it, I can eat like a ‘normal person’ because my body and mind now tell me when to quit.”
To get the results takes more than just the shot however. “There is a lot of judgement around these drugs because people think it is the easy way out. It is not. You still have to put in the work, but now your body is working with you instead of against you. It is almost magic.”
M added her insurance does not cover weight loss meds so she uses a coupon provided by the pharmaceutical company that cuts the cost to $550/month, which she pays through Health Savings Account (HAS) funds. “That helps, but it definitely hurts the wallet. There are cheaper ways to get it but none of them have been approved by the FDA, so I haven’t looked into them. That’s not to say I won’t in the future.”
C, 54-year old female – “I have been on Ozempic® and am now on Mounjaro®.” She has Type 2 diabetes and her healthcare provider thought it would help her to have better control over her diabetes with the added benefit of weight loss. “When she put me on it, she probably had the idea of the weight loss also assisting with my diabetes, however at that point (2018), I really didn’t think that it would help specifically with weight loss. At the time C weighed 213-217 and now is 163 and still losing and maintaining weight loss.
Like M, some nausea was experienced. She also had a sense of sadness in the beginning, but they alleviated themselves. “I noticed I physically felt better after I started taking it, but it was assisting and controlling my A1c until about eight months ago after a bout with Covid.”
She agreed losing weight is a struggle requiring commitment. “You do have to do the dietary changes, but what I found is when I started taking the drug I wasn’t as hungry. I was able to make better choices with what I was eating. It also has some conditioning type behavior if you eat foods that you should not eat for your body and your body type, you will throw them up.”
C’s advice – “Do the drug. If you let it, it will train you to eat better because you don’t like to be sick. When you resist the drug’s persuasion, meaning you’re eating food you shouldn’t, you will pay the consequences. I believe it does work for me. I am not always hungry.”
Between her insurance and a coupon from the pharmaceutical company, her cost is only $25.00.
“I buy higher quality food that doesn’t make me sick and I spend more money on things that have higher nutrition and recently started on a nutritional supplement called Relenza. It is a GLP.-1 support product they have the daily replenisher and also has the daily nutritional supplements because I do not get enough of the daily intake of vitamins and minerals and probiotics that I need because I simply just do not eat enough to do that.”
She added she thinks the drug gave her an opportunity to live a healthier lifestyle. C echoed the need for hydration. “I would say stay hydrated like force yourself to hydrate. Along with your lack of desire to eat, you also have a lack of desire to drink water. I can tell you that’s probably been my biggest hurdle. Eat lots of roughage, squashes, cabbage, kale. Eat good healthy proteins. And look for good quality supplements and take them daily. If you take these drugs and you don’t do it appropriately, you can cause all kinds of health problems that are related more to starvation which, as we know, isn’t really any better for your body than being overweight or having diabetes.”
J, 48-year-old female – “I’ve been taking Mounjaro® for nearly a year now. I scheduled my annual physical with my doctor early Jan 2024. I had a few health concerns I wanted to talk to her about – one being my weight as I’d gained about 50 lbs. since March 2020 when my job went remote due to Covid (it’s remained remote since). My doctor suggested those types of meds as an option as she had other patients successfully using them.”
J described her experience as, “Great and successful,” and added she started taking the Mounjaro® in order to see if her insurance would cover it. “I did a fasting A1C test as it was suspected I could be type 2 diabetic. My test results came back that I was just .2 from being diabetic so definitely pre-diabetic. Ultimately, my insurance approved coverage so we started with the lowest does – 2.5mg weekly injection. My doctor has recommended a slow & steady approach so after starting on Mounjaro® in late January 2024 at the lowest does, I’ll just started (last week) the highest dose of 15mg injection per week. I’ve lost 60 lbs. as of (last week).”
J said she hasn’t experienced any negative side effects but also has had quieting of the ‘food noise.’
“I’d say the biggest win for me is it disrupting the ‘need’ or ‘thoughts’ of food. Don’t get me wrong, I enjoy good food but snacking or meals aren’t a nagging thought like they used to be. I’ve cut down on portion size too during meals and don’t feel wasteful when doing so. With the weight loss it’s been easier to be more active, so more (moderate) exercise. No other benefits I can specifically think of other than the general better health you feel when not carrying so much extra weight – I’ve still got a ways to go. I started at 296 lbs. – am currently at 236. Would like to get to under 200. I appreciate the slow & steady approach my doctor recommended. As an example, I was on some doses of Mounjaro for 3 months vs just dosing up fast each week. I’m guessing that’s how some experience the drastic losses and changes to appearance.”
As with any medication, not everybody will experience the same results as evidenced by H, a 51-year-old female – “I took Semaglutide. I got weekly shots at a ‘health clinic’ that did Botox and stuff like that for three months, and I lost eight pounds.”
As the dose increased for H, not only did the weight not come off, but the side effects worsened. “Once they got to the biggest dose, it made me super sick, like I couldn’t get out of bed because of the stomach ache, so I quit. I wasn’t losing much weight, if any, and I couldn’t function.”
She first heard of the meds through commercials and tried to get Wegovy® or Ozempic®, but the $1,300 cost was prohibitive. “So I went to a clinic and it was $300/month. Everybody said it was a miracle. Nope.”
H said it did decrease her appetite, “…and made my beloved Coke Zero® taste awful, but then the stomach aches started.” She now takes another medication to promote weight loss.
If GLP-1 meds are right for you…
“They’re a weekly injection,” said Haege. “It’s subcutaneous (injected just under the skin), and it’s a very tiny needle. We have people come here and we’ll do the first one to show you how to do it, I would say 80% of people are fine taking them for the month and doing them (themselves) at home and we have a good 10-20% that just come here and have them done.”
Sashy has been providing these meds to Solonites for about a year, and Haege said she and Leland were initially hesitant. “If you had asked me four years ago I would have discouraged it.” She spoke of patients she had seen in local emergency rooms suffering from extreme side effects ranging from stomach issues (such as H’s experience), pancreatitis, and more. “But then, we received education on the medications and administration, and I decided to try them because I didn’t want to put somebody on them and not know what they’ll feel like. So, I tried them and, they are amazing.” Now, she added, ER visits from GLP-1 users are rare.
“The only thing I can corelate it is, these drugs have been approved by the FDA for 14 years, went big in the last seven years for diabetes, and then went mainstream for weight loss four years ago. Now there’s hundreds of thousands more people on them than four years ago and we’re hardly seeing anyone (in the ER).” Her theory is back then people were unintentionally overdosing, which has led to much lower starting doses.
“It’s a big, big thing for your system. It’s affecting insulin, it’s affecting noise in your head, it’s affecting how soon you get full, there’s just a lot going on. We start everyone at the lowest dose, and everyone should do that, no matter what.”
Patient education is important, as is the source
There are many avenues for accessing GLP-1 medications, including online pharmacies. While convenient, critical patient education in the use, dosing, administration, side effects, and precautions may not be communicated. And that concerns Haege greatly, who has seen what can happen.
“I had a lady (recently) who ordered online, which is a very scary avenue and I do not understand how they’re doing that (purchasing online without a prescription). It’s crazy to me and I’m hoping this year some of those regulations will start coming down (on them), not because we’re dying for their business but people are getting a product that’s not 100% Semaglutide, God only knows what’s in them. And, you’re getting a vial of medicine and instructions how to draw it up (fill the syringe to the desired level). I think it’s crazy we’re giving people vials of medicine with no medical background.”
Her ER patient was profoundly constipated with a perforated bowel. As it turned out, she had ordered online and in an effort to drop weight quickly and figured higher doses would do the trick. Major surgery and two weeks in the hospital taught her otherwise.
“We order directly from the pharmacy so we know it’s 100%, we do not compound it with anything, we do not put anything else in it.”
The bottom line
“These meds are amazing, they’re not going anywhere, they’re getting used for more and more conditions (including alcoholics, gamblers, and opioid abusers to quiet the noise of their addiction). People who take it for weight loss are finding their blood pressure has gone down, their lipids are much better, their cholesterol has improved. Their skin looks better, they just look better and they feel better overall.
For more information
All bookings (for appointments) are available at www.sashy.com (or by phone at 319-855-1915).
“You can come in or we can do a phone consultation. Obviously if you’re in-person and you want to get started, we can do the first injection at that time.”
Sashy is located in the lower level of the Literary Hotel at 130 S. Dubuque St. in Suite 106.
Final thoughts
“It is very fun to watch people lose weight,” said Haege. “They’re just happy and it works. I’m just so happy that it’s not the next gimmick or some pill or shake. It works. It really works.”