The Case:  Hadley has been struggling with weight loss for years and is now in perimenopause. She’s tried many diets but the results were temporary. She eats mindfully avoiding gluten, processed foods, and sugar. She was intrigued by the hype around Ozempic (semaglutide) but wanted to make sure it was safe and that there weren’t other issues at play in her weight mystery.   Weight Loss Struggles and Hormone Changes in Perimenopause Hadley’s struggle is so common. Perhaps it’s familiar to you too? You hear about the latest trend in weight loss and wonder (hope) that it’s going to be what helps you get your metabolism working in your favor so you can drop those last few pounds and keep them off. Ozempic has put semaglutide in the news with so many people talking about its popular side effect of weight loss with ease. But, like Hadley, you may have wondered - is it safe and does semaglutide really work for weight loss?  The Functional Medicine View of Ozempic for Weight Loss Emily Sadri is a long-time friend of the show. She joined us on episode 107 to share all kinds of eye-opening information about birth control pills and thyroid.  Because of that informative episode, I knew she was just the person to talk to about Hadley’s case and this trend of using semaglutide for weight loss purposes. Emily is a board-certified Women's Health Nurse Practitioner, and hormone and weight loss expert. She owns and operates a boutique women’s functional medicine practice in Cleveland, Ohio, and helps women everywhere live more balanced, healthier lives. What is Semaglutide (originally marketed as Ozempic)? Semaglutide is a peptide drug that was initially marketed as a medication for diabetes. Developed by Novo Nordisk in 2012, semaglutide was later found to have the potential for weight loss. The drug is now available under the commercial name Wegovy and is prescribed for obesity. How does Semaglutide Work? One of the most impressive things about semaglutide is its multi-faceted approach to weight loss. Unlike many weight loss medications that rely on appetite suppression or stimulants, semaglutide works by slowing down digestion and promoting a feeling of fullness. In this episode, Emily explains that by slowing gastric emptying, semaglutide delays the movement of food from the stomach into the small intestines, which helps to control appetite and reduce food intake. The drug also acts on the hypothalamus, a part of the brain that regulates signaling for many different functions. The hypothalamus controls sympathetic nervous system signaling, and semaglutide modulates and increases sympathetic output just enough to stimulate lipolysis or fat breakdown. This action raises people's basal metabolic rate slightly, which over time results in weight loss. What did the Clinical Studies on Semaglutide Find? Clinical studies have shown that people treated with semaglutide for weight loss have an average of 15% body weight loss, which is a remarkable achievement. This weight loss was achieved without significant lifestyle or diet counseling, making semaglutide seem like exactly what the weight loss market has been waiting for.  But… As a practitioner who primarily works with women aged 35 to 55 who often have a thyroid issue or Hashimoto’s, I'm sensitive to anything that stimulates stress pathways. Emily agrees with my caution but says semaglutide is an appealing option for women who are looking to lose weight but want to avoid the side effects of stimulant-based medications. Unlike stimulants, semaglutide doesn't suppress appetite in the same way, which is better for metabolism in the long term. However, sustainable weight loss isn’t just about eating less.  Exploring the Emotional Component of Weight Loss In this episode, we also discussed the emotional component of weight loss and how important it is to acknowledge and address it. We talked about how people need reassurance to feel confident about the weight loss process and how feedback c