For people dealing with hypothyroidism or Hashimoto's, managing their weight can become a real challenge. No matter how much you exercise or eat well, it's frustrating when the scale doesn't budge. Let's look at how thyroid health affects weight and learn about a new drug called semaglutide that might help with weight management.
Understanding Hypothyroidism and Its Weighty Impact
Weight gain is an unwelcome companion of hypothyroidism, a state caused by a deficiency of thyroid hormones. The process of weight gain is influenced by various factors including energy balance (storing more than what you utilize), metabolism, hormonal regulation, and individual differences in body composition. The thyroid gland is our body's response mechanism to thyroid-stimulating hormone, releasing the thyroid hormone which plays an important role in our bodies' growth, development, metabolism, and muscle control. Also, it significantly influences how our bodies metabolize fat, carbohydrates, and protein. It's important to note that while the thyroid gland is a crucial component of metabolic regulation, it is not the sole determinant of metabolic processes in the body. Other factors, such as diet, physical activity, and other diseases, also contribute significantly to metabolism.
As hypothyroidism sets in, the thyroid becomes underactive and can't muster enough thyroid hormone to cater to the body's needs. The mechanisms through which an underactive thyroid results in weight gain or presents hurdles to weight loss are not fully understood.
However, a couple of theories do exist:
- Reduction in metabolic rate
- Energy or fatigue-induced decrease in activity levels
- Alterations to the metabolism of fat and blood sugar
- Accumulation of salt and water retention in tissues resulting in weight gain
Researchers have observed that some patients experience weight loss upon initiating thyroid replacement medication with T4, although the extent and composition of this weight loss can vary. While it's been suggested that initial weight loss may be due to the loss of excess water, continued use of thyroid replacement medication can lead to changes in body composition, including reductions in body fat over time. Additionally, thyroid hormones can influence metabolism and, in some cases, appetite. However, attributing changes in appetite and caloric intake solely to thyroid hormones oversimplifies the relationship, as these effects may vary among individuals and depend on factors beyond thyroid hormone levels.
Shedding weight when dealing with hypothyroidism can be a challenging task. For some patients cutting down on alcohol, dietary modifications, and increased physical activity levels alone may be enough to reach their target (optimal) weight. However, for some others, additional support in the form of medication may prove useful. It is important to note here that your target weight should ideally be set in consultation with your healthcare provider and should be a number that is healthy for your body in terms of heart and other metabolic disease risks.
Semaglutide for weight loss
Semaglutide is a member of the glucose-like peptide 1 (GLP-1) receptor agonists class of drugs. It imitates the action of the GLP-1 hormone that is naturally released from your gut when you eat. One of its actions is to prompt the body to produce more insulin, which reduces blood glucose (sugar). Therefore, Semaglutide and other GLP-1 agonists have long been used in the management of blood sugar in certain patients with diabetes.
Research has also shown that Semaglutide also interacts with parts of your brain that reduce your appetite and signal a feeling of fullness. This action paves the way for decreased food intake and likely results in weight loss.
Semaglutide goes by the market names Ozempic, Rybelsus, and Wegovy. Wegovy is the only Semaglutide-containing medication brand that has been approved by the US Food and Drug Administration (FDA) for the management of excess weight in certain individuals (FDA Press Release, March 2024). Talk to your healthcare provider if you think you meet the FDA criteria for using Wegovy for weight loss:
- You have a body mass index (BMI) of 27 or higher and have a weight-related health problem, like high blood pressure, Type 2 diabetes, or high cholesterol. Or,
- You have a BMI of 30 or higher.
Ozempic and Rybelsus are medications that have been FDA-approved to treat diabetes but have not been approved for weight loss. However, healthcare providers may still prescribe it for weight loss if they feel you may benefit from it (this is called an “off-label” use). Our partner Certainly Health can be a resource for finding a practitioner that can advise if GLP1s are for you that's also covered by insurance. Public interest is tilting toward the off-label use of Ozempic for cosmetic weight loss, as depicted in a study by Sabrina H Han et al. (2023). However, there are growing concerns around Ozempic including its potential misuse without proper medical supervision or its prescription off-label for weight loss leading to prescription shortages (Magda Wojtara et al., 2023).
Administering and Dosing Semaglutide
Semaglutide operates as a weekly subcutaneous injection, which is applied just beneath the skin. It is advised to increase the weekly dose slowly over several weeks to give your body time to get used to the medicine
Efficacy of Semaglutide in Weight Management
The majority of studies evaluating semaglutide's effectiveness in weight loss management and treatment have incorporated lifestyle modifications. One such study conducted in 2021 studied semaglutide with lifestyle modifications vs placebo with lifestyle modifications on over 1900 participants (Wilding, 2021). The results offered promising insights. By week 68, people in the semaglutide group lost an average of 14.9% of their body weight, while on placebo lost only 2.4%. This means semaglutide helped people lose about 12.4% more weight than just taking the placebo. The average weight loss translated to roughly 34 pounds from the initial body weight among participants taking semaglutide, compared to only 6 pounds among those in the placebo group. Since then, further studies have shown similar results. However, they also found that participants often regain the lost weight after they stop taking semaglutide. This goes to show that Semaglutide medications cannot replace a healthy diet and exercise. They should be used in conjunction with a healthy lifestyle. These medications can have side effects (US FDA Medication Guide) so you should discuss weight management needs in detail with your healthcare provider.
Let's Talk Safety: Semaglutide and Its Side Effects
The most common issues are stomach problems like nausea, vomiting, diarrhea, and constipation. These side effects are usually mild and can be reduced by slowly increasing the dosage. Other possible side effects include headaches, tiredness, dizziness, and indigestion. In rare cases, semaglutide can cause more serious problems like pancreatitis (inflammation of the pancreas) and gallstones. People with type 2 diabetes need to be careful because semaglutide can sometimes cause low blood sugar, especially if taken with other diabetes medications.
Semaglutide is not to be given to patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). There is also a concern from rodent studies that semaglutide might increase the risk of thyroid cancer. Because of this, anyone with a history of MTC is not prescribed semaglutide.
Overall, semaglutide can be effective for weight loss if used correctly and with proper medical guidance.
Holistic Thyroid Care at Eureka:
As we delve deeper into the vast ocean of knowledge surrounding thyroid health and weight management, we've anchored our attention upon semaglutide. However, we, at Eureka, believe that the cornerstone of health and weight management remains a positive shift in diet and lifestyle. Medications such as semaglutide should be considered supplementary, to be implemented when lifestyle changes do not bear the desired fruit.
For those struggling with hypothyroidism, dietary changes aimed at reducing inflammation and embracing a pure, whole foods-based diet can steer you toward successful weight management. If you are still wrapping your head around making these diet and lifestyle modifications, drop an anchor at our port. Our Eureka nutrition experts are on deck to guide you and explore potential food sensitivities or gastrointestinal issues that may have been overlooked and should be rectified via your diet.
Remember, this article is your gateway to a swarm of free recommendations through Eureka, an oasis where you can rejuvenate your thyroid health. Let's sail through the waves of health together!
References
- US FDA Press Release: Wegovy, Semaglutide containing medication approved for weight management for certain indications. Read more.
- Once-Weekly Semaglutide in Adults with Overweight or Obesity. A trial showing participants with overweight or obesity, 2.4 mg of semaglutide once weekly plus lifestyle intervention was associated with sustained, clinically relevant reduction in body weight. Read more.
- US FDA Medication Guide for Wegovy (Semaglutide) for weight loss. Read more.
- Public Interest in the Off-Label Use of Glucagon-Like Peptide 1 Agonists (Ozempic) for Cosmetic Weight Loss: A Google Trends Analysis by Sabrina H Han et al. (2023). This study explores the rising popularity of Ozempic for weight loss and indirectly raises the need for awareness around potential side effects, including on thyroid health. Read more.
- Examining Off-Label Prescribing of Ozempic for Weight-Loss by Magda Wojtara et al. (2023). This analysis discusses the off-label use of Ozempic for weight loss, emphasizing the need for careful monitoring of side effects, including potential thyroid issues. Read more.
