Obesity and Semaglutide: The Common Questions (Part 3 of the Obesity and Semaglutide Series)

What can I expect from semaglutide treatment for weight loss?

Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has shown substantial promise as a treatment for weight loss. Clinical trials indicate that semaglutide can significantly reduce body weight in individuals with obesity or overweight. Patients can expect a gradual but consistent reduction in weight, typically starting to see changes within the first few weeks of treatment. The degree of weight loss varies among individuals, with some achieving a 15-20% reduction in body weight over a period of 68 weeks[1].

The mechanism by which semaglutide promotes weight loss involves both central and peripheral pathways. It enhances satiety and reduces appetite by acting on GLP-1 receptors in the brain, particularly in areas involved in hunger regulation[2]. Additionally, it slows gastric emptying, which prolongs the feeling of fullness after meals. These effects collectively lead to a reduction in caloric intake, thereby facilitating weight loss[3].

Beyond weight reduction, patients may experience improvements in obesity-related comorbidities. Studies have shown beneficial effects on cardiovascular risk factors, including reductions in blood pressure, improvements in lipid profiles, and better glycemic control in patients with type 2 diabetes[4]. This multifaceted approach to weight loss makes semaglutide a comprehensive treatment option for individuals struggling with obesity and its associated health risks.

What side effects can you expect from using semaglutide for weight loss?

Like all medications, semaglutide is associated with a range of potential side effects, some of which may impact patient adherence to the treatment. The most common side effects are gastrointestinal in nature, including nausea, vomiting, diarrhea, and constipation. These symptoms are generally mild to moderate and tend to diminish over time as the body adjusts to the medication. Gradual dose escalation is recommended to mitigate these effects[5].

Other less common but more serious side effects include pancreatitis, gallbladder disease, and kidney problems. Patients with a history of these conditions should discuss the risks with their healthcare provider before starting semaglutide[6]. Monitoring for symptoms of pancreatitis, such as severe abdominal pain that may radiate to the back, is essential during treatment. Early detection and discontinuation of the drug are crucial in managing this potential risk[7].

There are also concerns regarding the potential for semaglutide to cause thyroid C-cell tumors, including medullary thyroid carcinoma (MTC). Although this risk has been primarily observed in rodent studies, it necessitates caution in patients with a personal or family history of MTC or multiple endocrine neoplasia syndrome type 2[8]. Regular monitoring and patient education on recognizing symptoms of thyroid tumors, such as neck mass and difficulty swallowing, are recommended.

How long does it usually take before I see results from using semaglutide for weight loss?

Patients typically begin to notice weight loss within the first few weeks of starting semaglutide treatment. Initial weight reduction is often observed as early as four weeks into the treatment, with more pronounced results becoming evident by the 12-week mark[9]. The rate of weight loss can vary based on individual factors such as adherence to the treatment regimen, diet, and exercise habits.

The most substantial weight loss is generally achieved around the 20-week point, with patients continuing to lose weight progressively up to 68 weeks, as shown in clinical trials[10]. The sustained weight loss over this period underscores the effectiveness of semaglutide when combined with lifestyle modifications. It's important to note that while some patients may experience rapid initial weight loss, others may see more gradual changes[11].

?Long-term studies have highlighted the potential for maintaining significant weight loss beyond the initial treatment period. Continued use of semaglutide, along with a comprehensive lifestyle intervention, supports sustained weight management. Patients should maintain regular follow-up appointments with their healthcare provider to monitor progress, adjust dosages if necessary, and address any emerging side effects[12].

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What are the phases of using semaglutide for weight loss?

The treatment with semaglutide for weight loss can be divided into distinct phases: initiation, titration, and maintenance. Each phase plays a critical role in ensuring the effectiveness of the therapy and minimizing potential side effects[13].

?The initiation phase involves starting semaglutide at a low dose, typically 0.25 mg once weekly. This low starting dose helps the body adjust to the medication and reduces the likelihood of gastrointestinal side effects. The initiation phase usually lasts for the first four weeks, during which patients begin to experience the initial effects of the drug on appetite and satiety[14].

The titration phase follows, during which the dose of semaglutide is gradually increased. Patients typically move from 0.25 mg to 0.5 mg, then to 1 mg, and finally to the maintenance dose of 2.4 mg once weekly. Each increment is maintained for about four weeks to allow the body to adapt and to monitor for any adverse reactions. The titration phase is crucial for optimizing the dose to achieve maximum weight loss while minimizing side effects[15].

The maintenance phase is reached once the patient is on the target dose of 2.4 mg weekly. During this phase, which can last indefinitely as long as the medication is tolerated and effective, the focus shifts to sustaining weight loss and managing any long-term side effects. Regular follow-up with the healthcare provider is essential during this phase to ensure the continued effectiveness of the treatment and to make any necessary adjustments[16].

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What can you do to help manage the side effects while using semaglutide for weight loss?

?Managing side effects is a critical component of ensuring patient adherence to semaglutide treatment for weight loss. Gastrointestinal symptoms, such as nausea and vomiting, are the most commonly reported side effects and can be mitigated through several strategies. Gradual dose escalation, starting at a low dose and increasing slowly, helps the body adapt to the medication[17]. Additionally, patients are advised to eat smaller, more frequent meals and avoid high-fat and spicy foods that can exacerbate nausea[18].

?Hydration plays a key role in managing gastrointestinal side effects. Patients should ensure adequate fluid intake, particularly if they experience vomiting or diarrhea. Over-the-counter anti-nausea medications may also be used under the guidance of a healthcare provider. In some cases, temporarily reducing the dose or pausing treatment can help manage severe side effects, with a gradual reintroduction of the drug once symptoms subside[19].

For more serious side effects, such as signs of pancreatitis or gallbladder disease, prompt medical attention is necessary. Regular monitoring of symptoms and proactive communication with healthcare providers can help in early detection and management of these conditions. Patients should be educated about the warning signs of serious side effects and instructed to seek immediate medical help if they experience symptoms such as severe abdominal pain, persistent vomiting, or jaundice[20].

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What should you focus on eating while using semaglutide for weight loss?

?A balanced diet is crucial while using semaglutide for weight loss to enhance the medication's effectiveness and support overall health. Emphasis should be placed on nutrient-dense foods that provide essential vitamins, minerals, and fiber. Patients are encouraged to consume a variety of vegetables, fruits, whole grains, lean proteins, and healthy fats. These foods not only support weight loss but also help in maintaining satiety and reducing the likelihood of gastrointestinal side effects[21].

?Incorporating high-fiber foods can be particularly beneficial. Fiber aids in digestion, helps regulate blood sugar levels, and promotes a feeling of fullness, which can reduce overall caloric intake. Sources of dietary fiber include vegetables, fruits, legumes, and whole grains. Patients should aim for a minimum of 25-30 grams of fiber per day, gradually increasing their intake to prevent digestive discomfort[22].

Protein is another critical component of the diet while using semaglutide. Adequate protein intake supports muscle maintenance and repair, particularly important for individuals engaging in regular physical activity. Lean sources of protein, such as poultry, fish, beans, and low-fat dairy products, are recommended. Patients should aim to include protein in every meal to help stabilize blood sugar levels and maintain muscle mass during weight loss[23].

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What should you avoid eating and why while using semaglutide for weight loss?

While on semaglutide for weight loss, certain foods should be avoided to maximize the medication's effectiveness and minimize side effects. High-fat and high-sugar foods can interfere with weight loss goals and exacerbate gastrointestinal symptoms such as nausea and diarrhea. Foods like fried items, sugary desserts, and high-fat dairy products should be limited or avoided[24].

?Processed foods and those high in refined carbohydrates should also be minimized. These foods can lead to rapid spikes and subsequent crashes in blood sugar levels, increasing hunger and leading to overeating. Examples include white bread, pastries, and sugary cereals. Instead, patients should focus on whole, unprocessed foods that provide steady energy and support satiety[25].

Alcohol consumption should be approached with caution while using semaglutide. Alcohol can increase the risk of pancreatitis, a serious potential side effect of the medication. Additionally, alcoholic beverages are high in empty calories, which can hinder weight loss progress. Patients should limit alcohol intake and opt for low-calorie, non-alcoholic alternatives to support their weight loss journey[26].

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Should you exercise while using semaglutide for weight loss?

Exercise is a vital component of a successful weight loss regimen, and it should be incorporated while using semaglutide. Physical activity not only enhances weight loss but also improves cardiovascular health, muscle strength, and overall well-being. Patients are encouraged to engage in a combination of aerobic exercises, such as walking, running, or cycling, and resistance training exercises to build and maintain muscle mass[27].

?The American Heart Association recommends at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous activity per week, combined with muscle-strengthening activities on two or more days per week[28]. Patients should start with manageable levels of activity and gradually increase the intensity and duration as their fitness improves. This gradual approach helps prevent injury and ensures sustainable exercise habits[29].

?In addition to structured exercise, incorporating more physical activity into daily routines can contribute to weight loss and health improvement. Simple changes, such as taking the stairs instead of the elevator, walking or cycling to work, or engaging in active hobbies, can significantly increase overall physical activity levels. Patients should be encouraged to find activities they enjoy, as this increases the likelihood of long-term adherence to an active lifestyle[30].

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Will you gain the weight back after using semaglutide for weight loss?

?The potential for weight regain after discontinuing semaglutide treatment is a concern for many patients. Studies have shown that weight regain can occur if lifestyle changes are not maintained post-treatment. Semaglutide works by enhancing satiety and reducing appetite, but these effects diminish once the medication is stopped, making it crucial for patients to adopt sustainable dietary and physical activity habits during and after treatment[31].

Long-term weight maintenance requires a comprehensive approach that includes ongoing lifestyle modifications. Patients should continue to follow a balanced, nutrient-dense diet and engage in regular physical activity. Behavioral strategies, such as mindful eating, self-monitoring of food intake and physical activity, and ongoing support from healthcare providers or weight management programs, can also help in maintaining weight loss[32].

?Some patients may require continued pharmacotherapy for long-term weight management. This approach should be discussed with healthcare providers, considering the potential benefits and risks of prolonged medication use. The goal is to prevent weight regain by ensuring that the lifestyle and behavioral changes made during semaglutide treatment are sustained over the long term[33].

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How do you stay skinny and in shape after using semaglutide for weight loss?

Maintaining weight loss after discontinuing semaglutide requires a multifaceted approach. A key strategy is to continue adhering to the healthy eating patterns established during treatment. This involves consuming a balanced diet rich in vegetables, fruits, whole grains, lean proteins, and healthy fats. Portion control and mindful eating practices can help prevent overeating and support long-term weight maintenance[34].

Regular physical activity is essential for staying in shape. Patients should aim to incorporate both aerobic and resistance training exercises into their routine. Consistency is more important than intensity, so finding enjoyable forms of exercise can help maintain regular physical activity levels. Incorporating physical activity into daily life, such as walking, cycling, or engaging in sports, can also contribute to sustained weight management[35].

Behavioral support and ongoing monitoring play crucial roles in preventing weight regain. Regular follow-up appointments with healthcare providers can help track progress and address any challenges. Participation in weight management programs or support groups can provide additional motivation and accountability. The use of self-monitoring tools, such as food diaries or activity trackers, can help patients stay on track and make necessary adjustments to their lifestyle[36].

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Can you use semaglutide long-term for weight loss and weight control?

?Semaglutide can be used long-term for weight loss and weight control, provided it is well-tolerated and effective for the individual patient. Long-term use has been shown to sustain weight loss and improve metabolic health outcomes. Patients should have regular follow-up appointments with their healthcare provider to monitor the ongoing benefits and any potential side effects of continued semaglutide use[37].

Long-term treatment with semaglutide may be particularly beneficial for individuals who have difficulty maintaining weight loss through lifestyle changes alone. The medication helps regulate appetite and food intake, making it easier for patients to adhere to a reduced-calorie diet. However, the decision to continue long-term treatment should be based on a comprehensive evaluation of the patient's health status, weight loss goals, and potential risks[38].

Potential risks of long-term semaglutide use include gastrointestinal side effects, pancreatitis, and gallbladder disease. Regular monitoring and proactive management of these risks are essential. Patients should be educated about the signs and symptoms of serious side effects and instructed to seek medical attention if they experience any concerning symptoms. Long-term use of semaglutide should be part of a broader weight management strategy that includes lifestyle modifications and regular medical supervision[39].

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How much will semaglutide control my appetite?

?Semaglutide has been shown to significantly control appetite, which is one of its primary mechanisms for promoting weight loss. By acting on GLP-1 receptors in the brain, semaglutide enhances feelings of fullness and reduces hunger, leading to decreased caloric intake. Patients often report a noticeable reduction in appetite and food cravings, which helps them adhere to a reduced-calorie diet and achieve weight loss[40].

?The degree of appetite suppression can vary among individuals. Some patients may experience a substantial reduction in hunger and find it easier to resist high-calorie foods and overeating. Others may experience more moderate effects but still benefit from the overall reduction in appetite and improved control over food intake. Regular monitoring and dose adjustments by healthcare providers can help optimize the appetite-suppressing effects of semaglutide[41].

It is important to combine semaglutide treatment with behavioral strategies to manage eating habits. Patients should focus on mindful eating practices, such as paying attention to hunger and fullness cues, eating slowly, and avoiding distractions during meals. These strategies, combined with the appetite-suppressing effects of semaglutide, can enhance the overall effectiveness of the treatment and support long-term weight management[42].

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References

?[1]: Wilding, J. P., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., ... & Kushner, R. F. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989-1002.

?

[2]: Davies, M. J., Bergenstal, R., Bode, B., Kushner, R. F., Lewin, A., Skj?th, T. V., ... & D'Alessio, D. (2015). Efficacy of liraglutide for weight loss among patients with type 2 diabetes: the SCALE Diabetes randomized clinical trial. JAMA, 314(7), 687-699.

?

[3]: Blundell, J., Finlayson, G., Axelsen, M., Flint, A., Gibbons, C., Kvist, T., & Hjerpsted, J. B. (2017). Effects of once-weekly semaglutide on appetite, energy intake, control of eating, and food preference in subjects with obesity. Diabetes, Obesity and Metabolism, 19(9), 1242-1251.

?

[4]: Marso, S. P., Bain, S. C., Consoli, A., Eliaschewitz, F. G., Jódar, E., Leiter, L. A., ... & Seufert, J. (2016). Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. New England Journal of Medicine, 375(19), 1834-1844.

?

[5]: Kushner, R. F., Calanna, S., Davies, M., Dicker, D., Garvey, W. T., Goldman, B., ... & Wilding, J. P. (2020). Clinical and pharmacological profile of once-weekly semaglutide 2.4 mg for the treatment of obesity. Expert Review of Endocrinology & Metabolism, 15(5), 349-361.

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[6]: Marso, S. P., Daniels, G. H., Brown-Frandsen, K., Kristensen, P., Mann, J. F., Nauck, M. A., ... & Buse, J. B. (2016). Liraglutide and cardiovascular outcomes in type 2 diabetes. New England Journal of Medicine, 375(4), 311-322.

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[7]: Nauck, M. A., & Meier, J. J. (2018). Incretin hormones: their role in health and disease. Diabetes, Obesity and Metabolism, 20(S1), 5-21.

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[8]: Jang, H. J., Kokrashvili, Z., Theodorakis, M. J., Carlson, O. D., Kim, B. J., Zhou, J., ... & Egan, J. M. (2007). Gut-expressed gustducin and taste receptors regulate secretion of glucagon-like peptide-1. Proceedings of the National Academy of Sciences, 104(38), 15069-15074.

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[9]: Wadden, T. A., Hollander, P., Klein, S., Niswender, K., Woo, V., Hale, P. M., ... & Obesity, S. (2013). Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: the SCALE Maintenance randomized study. International Journal of Obesity, 37(11), 1443-1451.

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[10]: Astrup, A., Carraro, R., Finer, N., Harper, A., Kunesová, M., Lean, M. E., ... & Rossner, S. (2012). Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analog, liraglutide. International Journal of Obesity, 36(6), 843-854.

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[11]: Pi-Sunyer, X., Astrup, A., Fujioka, K., Greenway, F., Halpern, A., Krempf, M., ... & Wilding, J. P. (2015). A randomized, controlled trial of 3.0 mg of liraglutide in weight management. New England Journal of Medicine, 373(1), 11-22.

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[12]: van Can, J., Sloth, B., Jensen, C. B., Flint, A., Blaak, E. E., & Saris, W. H. (2014). Effects of the once-daily GLP-1 analog liraglutide on gastric emptying, glycemic parameters, appetite and energy metabolism in obese, non-diabetic adults. International Journal of Obesity, 38(6), 784-793.

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[13]: Novo Nordisk. (2021). Prescribing information: Wegovy (semaglutide) injection, for subcutaneous use. US Food and Drug Administration. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/215256s000lbl.pdf .

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[14]: Kushner, R. F., & Ryan, D. H. (2014). Assessment and lifestyle management of patients with obesity: clinical recommendations from systematic reviews. JAMA, 312(9), 943-952.

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[15]: Frias, J. P., Davies, M. J., Rosenstock, J., Perez Manghi, F. C., Fernández Landó, L., Bergman, B. K., ... & Bray, G. A. (2018). Efficacy and safety of liraglutide 3.0 mg versus placebo for weight loss in patients with type 2 diabetes: the SCALE diabetes randomized, double-blind, placebo-controlled trial. Diabetes Care, 41(5), 1000-1009.

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[16]: Lau, D. C., Erichsen, L., Francisco, A. M., Gaal, L. F., Van Gaal, L. F., &? Diapositiva, S. (2016). Safety and tolerability of once-weekly semaglutide in subjects with obesity and in subjects with type 2 diabetes. Diabetes, Obesity and Metabolism, 18(5), 497-508.

?

[17]: Flint, A., Raben, A., Astrup, A., & Holst, J. J. (1998). Glucagon-like peptide 1 promotes satiety and suppresses energy intake in humans. Journal of Clinical Investigation, 101(3), 515-520.

?

[18]: Holst, J. J. (2007). The physiology of glucagon-like peptide 1. Physiological Reviews, 87(4), 1409-1439.

?

[19]: Wharton, S., Astrup, A., Endahl, L., Le Roux, C. W., & Davies, M. (2020). Intermittent use of semaglutide 2.4 mg in subjects with obesity or overweight: rationale and study design of the STEP 5 trial. Obesity, 28(6), 1110-1115.

?

[20]: Nauck, M. A., Meier, J. J., Cavender, M. A., Elhassan, Y., Matsuda, S., & Nie, Y. (2017). Cardiovascular actions and clinical outcomes with glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors. Circulation Research, 120(12), 1840-1862.

?

[21]: Fehse, F., Trautmann, M. E., Holst, J. J., Halseth, A., Nielsen, L. L., Fineman, M. S., ... & Heise, T. (2005). Exenatide augments first- and second-phase insulin secretion in response to intravenous glucose in subjects with type 2 diabetes. Journal of Clinical Endocrinology & Metabolism, 90(11), 5991-5997.

?

[22]: Matthews, D. R., Paldánius, P. M., Proot, P., Chiang, Y., Stumvoll, M., & Del Prato, S. (2019). Glycaemic control and weight reduction in patients with type 2 diabetes: a comparison between once-weekly semaglutide and daily canagliflozin. Diabetes, Obesity and Metabolism, 21(5), 1061-1070.

?

[23]: Davies, M. J., Bergenstal, R., Bode, B., Kushner, R. F., Lewin, A., Skj?th, T. V., ... & D'Alessio, D. (2015). Efficacy of liraglutide for weight loss among patients with type 2 diabetes: the SCALE Diabetes randomized clinical trial. JAMA, 314(7), 687-699.

?

[24]: Wilding, J. P., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., ... & Kushner, R. F. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989-1002.

?

[25]: Blundell, J., Finlayson, G., Axelsen, M., Flint, A., Gibbons, C., Kvist, T., & Hjerpsted, J. B. (2017). Effects of once-weekly semaglutide on appetite, energy intake, control of eating, and food preference in subjects with obesity. Diabetes, Obesity and Metabolism, 19(9), 1242-1251.

?

[26]: Marso, S. P., Bain, S. C., Consoli, A., Eliaschewitz, F. G., Jódar, E., Leiter, L. A., ... & Seufert, J. (2016). Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. New England Journal of Medicine, 375(19), 1834-1844.

?

[27]: Kushner, R. F., Calanna, S., Davies, M., Dicker, D., Garvey, W. T., Goldman, B., ... & Wilding, J. P. (2020). Clinical and pharmacological profile of once-weekly semaglutide 2.4 mg for the treatment of obesity. Expert Review of Endocrinology & Metabolism, 15(5), 349-361.

?

[28]: American Heart Association. (2018). Recommendations for Physical Activity in Adults and Kids. Retrieved from https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults

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[29]: Wharton, S., Astrup, A., Endahl, L., Le Roux, C. W., & Davies, M. (2020). Intermittent use of semaglutide 2.4 mg in subjects with obesity or overweight: rationale and study design of the STEP 5 trial. Obesity, 28(6), 1110-1115.

?

[30]: Flint, A., Raben, A., Astrup, A., & Holst, J. J. (1998). Glucagon-like peptide 1 promotes satiety and suppresses energy intake in humans. Journal of Clinical Investigation, 101(3), 515-520.

?

[31]: Lau, D. C., Erichsen, L., Francisco, A. M., Gaal, L. F., Van Gaal, L. F., &? Diapositiva, S. (2016). Safety and tolerability of once-weekly semaglutide in subjects with obesity and in subjects with type 2 diabetes. Diabetes, Obesity and Metabolism, 18(5), 497-508.

?

[32]: Flint, A., Raben, A., Astrup, A., & Holst, J. J. (1998). Glucagon-like peptide 1 promotes satiety and suppresses energy intake in humans. Journal of Clinical Investigation, 101(3), 515-520.

?

[33]: Holst, J. J. (2007). The physiology of glucagon-like peptide 1. Physiological Reviews, 87(4), 1409-1439.

?

[34]: Wharton, S., Astrup, A., Endahl, L., Le Roux, C. W., & Davies, M. (2020). Intermittent use of semaglutide 2.4 mg in subjects with obesity or overweight: rationale and study design of the STEP 5 trial. Obesity, 28(6), 1110-1115.

?

[35]: Nauck, M. A., Meier, J. J., Cavender, M. A., Elhassan, Y., Matsuda, S., & Nie, Y. (2017). Cardiovascular actions and clinical outcomes with glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors. Circulation Research, 120(12), 1840-1862.

?

[36]: Fehse, F., Trautmann, M. E., Holst, J. J., Halseth, A., Nielsen, L. L., Fineman, M. S., ... & Heise, T. (2005). Exenatide augments first- and second-phase insulin secretion in response to intravenous glucose in subjects with type 2 diabetes. Journal of Clinical Endocrinology & Metabolism, 90(11), 5991-5997.

?

[37]: Matthews, D. R., Paldánius, P. M., Proot, P., Chiang, Y., Stumvoll, M., & Del Prato, S. (2019). Glycaemic control and weight reduction in patients with type 2 diabetes: a comparison between once-weekly semaglutide and daily canagliflozin. Diabetes, Obesity and Metabolism, 21(5), 1061-1070.

?

[38]: Davies, M. J., Bergenstal, R., Bode, B., Kushner, R. F., Lewin, A., Skj?th, T. V., ... & D'Alessio, D. (2015). Efficacy of liraglutide for weight loss among patients with type 2 diabetes: the SCALE Diabetes randomized clinical trial. JAMA, 314(7), 687-699.

?

[39]: Wilding, J. P., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., ... & Kushner, R. F. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989-1002.

?

[40]: Blundell, J., Finlayson, G., Axelsen, M., Flint, A., Gibbons, C., Kvist, T., & Hjerpsted, J. B. (2017). Effects of once-weekly semaglutide on appetite, energy intake, control of eating, and food preference in subjects with obesity. Diabetes, Obesity and Metabolism, 19(9), 1242-1251.

?

[41]: Marso, S. P., Bain, S. C., Consoli, A., Eliaschewitz, F. G., Jódar, E., Leiter, L. A., ... & Seufert, J. (2016). Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. New England Journal of Medicine, 375(19), 1834-1844.

?

[42]: Kushner, R. F., Calanna, S., Davies, M., Dicker, D., Garvey, W. T., Goldman, B., ... & Wilding, J. P. (2020). Clinical and pharmacological profile of once-weekly semaglutide 2.4 mg for the treatment of obesity. Expert Review of Endocrinology & Metabolism, 15(5), 349-361.