Ozempic/Wegovy

aggie06

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Aggie
Anyone know pilots using these? Am I reading the Basic Med requirements correctly that using one of these weight loss drugs wouldn’t fall under the special issuance requirement? Or is there some underlying required diagnosis to get the prescription that would require a new SI under Basic Med?

I would assume that a 3rd class is out of the question without a lot of work after getting on one of these drugs.
 
Not so much. Have your doc, do the diabetes worksheet and satisfy the "currency" and timing on the sheet, of the HbA1c.

Ozempic and Wegovy are okay for diabetes, pre diabetes....If you don't have diabetes FAA will issue a special for use of medication.
 
With a good note and labs you can get approved for Ozempic/Wegovy for diabetes and/or weight loss.
 
Not so much. Have your doc, do the diabetes worksheet and satisfy the "currency" and timing on the sheet, of the HbA1c.

Ozempic and Wegovy are okay for diabetes, pre diabetes....If you don't have diabetes FAA will issue a special for use of medication.
Just out of curiosity, why the diabetes worksheet? Wegovy is not approved for diabetes. Maybe the FAA allows it, but that would be an off-label use, right?

Just trying to understand why a SI would be required for an on-label medication that isn’t on the do not fly or do not issue list
 
Wegovy is semaglutide which is a GLP -1 inhibitior and it IS approved @ FAA for non-insulin requriing diabetes. If you have a DM worksheet and it sez you don't have diabetes (have a normal HbA1c) the FAA does interpret that PROPERLY. If you do have it it's required. So it works as a "one-covers all". I've had attending phyiscians write on it "doesn't have diabetes, used for weight loss". Either way, it works.
 
Wegovy is semaglutide which is a GLP -1 inhibitior and it IS approved @ FAA for non-insulin requriing diabetes. If you have a DM worksheet and it sez you don't have diabetes (have a normal HbA1c) the FAA does interpret that PROPERLY. If you do have it it's required. So it works as a "one-covers all". I've had attending phyiscians write on it "doesn't have diabetes, used for weight loss". Either way, it works.
With the cost factor and supply problems plaguing Wegovy, I know people who are using a compounding pharmacy supplied Semaglutide. Is the FAA focused on the trade names of Ozempic or Wegovy, or does the rule cover any "semaglutide" such as those done by compounding.
 
Wegovy is semaglutide which is a GLP -1 inhibitior and it IS approved @ FAA for non-insulin requriing diabetes. If you have a DM worksheet and it sez you don't have diabetes (have a normal HbA1c) the FAA does interpret that PROPERLY. If you do have it it's required. So it works as a "one-covers all". I've had attending phyiscians write on it "doesn't have diabetes, used for weight loss". Either way, it works.
I hear what you’re saying, and you’re an actual doc, so I’ll take your word for it. I’ve read that diabetics are to be prescribed ozempic. Technically, as I understand it, using Wegovy to treat diabetes would be an off-label use and not FDA approved.

That’s where my question comes from. Are there other medications that are totally kosher with the FAA on-label, but you have to prove you’re not using it for another off-label reason?

I know the opposite is true, that there are on-label do not issue meds, that extend to off-label as well, but this is the first time I’ve heard of the FAA requiring an SI for on-label use because its possible someone was prescribed it for off-label use.
 
I'm baffled why anyone would take any drug when it's not for specific medical issues.
 
I'm baffled why anyone would take any drug when it's not for specific medical issues.

Tell me you don't struggle with weight management without telling me :)

It's not a panacea, but semaglutide does something to interrupt my snack-seeking brain when it is at its worst. While "calories in, calories out" is the usual refrain, semaglutide (and my current liraglutide, to a less extent) helps control the calories-in bit, when your entire brain/biome/lack of self-control (pick your favorite excuse) is working against you. It chills the manic eater inside.

It's not a mystery why people are raiding the stuff. It's sort of on-brand in a gallows humor way. ;)
 
I wonder why guys who take the little blue pill don’t have to have a complete heart work-up.
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Sleep well then! Obesity is a specific medical issue and number 5 on the list of premature death.
That's not the issue I was inferring....I agree with the problems of obesity (I admit I'm overweight and diabetic, type 2) but unless morbidly overweight, I worry that we're in the mode of "better living thru modern chemistry", and assume drugs can solve any problem. I'm seeing local walk-in clinics blatantly advertise semaglutide, among others and testosterone treatments. Can you really tell me this is practicing responsible medicine?
 
That's not the issue I was inferring....I agree with the problems of obesity (I admit I'm overweight and diabetic, type 2) but unless morbidly overweight, I worry that we're in the mode of "better living thru modern chemistry", and assume drugs can solve any problem.
It's not an assumption in this case. This class of drugs is proven in multiple studies to help people lose weight.
 
I'm baffled why anyone would take any drug when it's not for specific medical issues.
Years back, and currently, acetaminophen (Tylenol) overdose was treated with large amounts of a drug called acetylcysteine. The FDA approved use was for thinning respiratory secretions...commonly used in breathing treatments by respiratory therapists. Use for reducing/preventing liver damage in acetaminophen overdose was strictly 'off label' administration. Just one example of using a drug for a condition that it was not approved for. SInce then it has been approved by the FDA for acet. OD. If we were to abide by using drugs only in instances that had FDA approval many acetaminophen overdose patients would have unnecessarily died. This is just one example of perfectly ethical 'off label' use of drugs.
 
The glaucoma drops I use as a side effect cause eyelashes to grow thicker and longer. It is now marketed to women for that purpose even though most don’t have the disease.
 
How did you find this out? What is the frequency of problems versus patients w/o problems? Is this a listed side effect? Risk/ benefit analysis? Your credentials (are you a MD or researcher)?

-Skip
 
When the secondary use is some vanity thing like weight loss, hair regrowth, or erectile dysfunction, people will flock to it. As soon as we find some drug that cause breast enlargement as a side effect, big pharma will have their next winner.
 
I'm baffled why anyone would take any drug when it's not for specific medical issues.
All of my past diet attempts (some half successful, some not) have involved incredible amounts of willpower and fighting myself. Limiting my portions but getting hungry for weeks, sometimes months all the time. Fighting yourself because it is trivially easy to consume more calories than a non-athlete can burn through exercise.

Since using a GLP-1 (for it's actual purpose), I actually feel full and satisfied with smaller meals. My appetite is a shadow of it's former self. I can't really explain it well, but it's a game changer not constantly telling yourself "no".
 
You might also ask about Zepbound if your intention is weight loss.

Zepbound is the same as Mounjaro (Eli Lilly’s drug in the same class), but it is specifically for weight loss without diabetes. It may avoid future questions about why you got a drug for diabetes, say on a future life insurance application.
 
All of my past diet attempts (some half successful, some not) have involved incredible amounts of willpower and fighting myself. Limiting my portions but getting hungry for weeks, sometimes months all the time. Fighting yourself because it is trivially easy to consume more calories than a non-athlete can burn through exercise.

Since using a GLP-1 (for it's actual purpose), I actually feel full and satisfied with smaller meals. My appetite is a shadow of it's former self. I can't really explain it well, but it's a game changer not constantly telling yourself "no".
I've struggled through that willpower test many times...sometimes successfully and often not...I was never really able to lose a lot, but the weight when I was able to lose some always came back.

Several years back I went on a drug called Contrave (I wasn't flying then) for a time, it helped to limit that craving appetite but it still required a huge amount of discipline and willpower. Still, it was a game changer for sure, but probably not as much of one as these new GLP-1 agonists are... I did lose a lot but when the drug stopped, the weight slowly trended back on over a few years time even though I was trying hard. The same thing happens with these GLP-1 agonists, as I understand it. The other issue with contrave was that the weight loss was too fast and not managed well enough, resulting in some muscle loss. Losing weight too fast while still eating an unhealthy diet. Ditto, this is also a problem as I understand it with the GLP-1 agonists.

about 2 years ago, I went low carb. Extremely low carb...an animal-based diet. My intent wasn't for weight loss, even though I had weight to lose. I was trying to do a temporary elimination experiment to help with GERD.

An unintended result was the weight fell off EASY. My body was getting the nutrition it needed, and as a result I felt satisfied with smaller/fewer meals. I was only just focusing on content, and not hardly at all on weight or weight loss. My weight fell off without my even trying.

Even more surprising to me was something I noticed later. I lost weight without even trying really, but then at some point it just leveled off. In hindsight, I found that my weight had leveled off right at the MIDPOINT of what "THEY" say is my "ideal" BMI range" based on my height! It's stayed right in that ballpark for about 1-1/2 years now, without much effort at all. The only real effort being that it's hard to eat a clean diet when eating out, when traveling, etc... I am totally convinced that a proper diet for a human is the real and absolute game changer!

full disclosure, my wife has gone on one of these GLP-1 drugs and it has been a game-changer for her. Even though I have had amazing results, she's a carb addict and can't get past all the years of brainwashing about the food triangle, veggies are "good for you", fat is bad for you, and all of that. The point is, these drugs seem to work very well, and if that's what it takes then it seems like a good thing. Losing the weight is a really good thing!

I'm only concerned about the muscle loss and the weight rebound after the drug, because the underlying problems of carb addiction and generally poor nutrition from a "standard diet" aren't being addressed at all...
 
because the underlying problems of carb addiction and generally poor nutrition from a "standard diet" aren't being addressed at all...
That rabbit hole goes deep. The whole "bliss point" things is wild. Not just carbs, but a magic ratio of carbs, salt, and fat that light up certain parts of the brain.

The worry I'm kicking down the road if this is yet another drug I'll have to do for the foreseeable future.
 
You might also ask about Zepbound if your intention is weight loss.

Zepbound is the same as Mounjaro (Eli Lilly’s drug in the same class), but it is specifically for weight loss without diabetes. It may avoid future questions about why you got a drug for diabetes, say on a future life insurance application.

I was told by my Doc that the action mechanism for Zepbound is that it slows the emptying of the stomach so you feel full longer.

-Skip
 
Yes, all three drugs work the same way. Mounjaro/Zepbound is a considered a little more effective.
 
That rabbit hole goes deep. The whole "bliss point" things is wild. Not just carbs, but a magic ratio of carbs, salt, and fat that light up certain parts of the brain.

The worry I'm kicking down the road if this is yet another drug I'll have to do for the foreseeable future.
Bliss point, or magic ratio of those three things are not anything I've heard of.... and I have been extremely deep down the rabbit hole of metabolic health, I've backed off for a while now but for a very long time I was devouring any info I could find on the topic, reading journal studies and books, listing to college professor lectures, presentations, and interviews by and of MD's and other healthcare professionals, etc...

I will say that salt is an interesting thing. I heard or read somewhere the idea that salt can squelch cravings. The idea is that if you're hungry take a lick of salt. What I do is take a granule or two of coarse pink salt. If you're still hungry a few minutes later then you are legit hungry and should eat. If you're not it was just a craving. It seems to be a real thing.

And yeah, that big ribeye I had a few days ago after a hectic morning moving my son into his apartment for college. It was cooked to warm-rare perfection with nothing but a little salt and butter on it...yeah that lit up something in my brain. That was a bliss point for sure!
 
Some clinics are practicing responsible medicine some aren’t. Ozempic prescribed appropriately can reduce risk of stroke and heart attack more than most heart specific drugs among other hard endpoint health benefits. Testosterone properly prescribed can improve muscle mass, bone density, memory, concentration, reduce risk of dementia, improve sexual health and even reduce risk of stroke and heart attack, which goes against old school wisdom. The new real data is changing that landscape, but even physicians Re typically practicing medicine 5-10 years behind current data. I would just recommend working with a physician that is an expert in the field. There are a lot of clinics out there that may not have the appropriate expertise, just winging it. Like most things, the answer is it depends.
I'm seeing local walk-in clinics blatantly advertise semaglutide, among others and testosterone treatments. Can you really tell me this is practicing responsible
 
Bliss point, or magic ratio of those three things are not anything I've heard of.... and I have been extremely deep down the rabbit hole of metabolic health,
There are a lot of online references to the bliss point, but if you are looking at metabolic health references, that’s about the last place you’d find them. I first ran across the term in a food science article (that I can’t find right now) about the development of Cheetos. A LOT of work went into finding the bliss point for that snack-making people want to eat a lot of them—while also engineering them to be largely air, so one was unlikely to ever feel full. It was eye-opening and a little disturbing to see how much effort went into it.
 
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Did it help with GERD?
I think it was helping... I'm convinced that it would have at least significantly improved it. I had it bad. It's really hard to say with certainty because the same time I started it, I also started down the path to get a surgical solution, so I only had about 4 months of diet alone. I ended up getting a TIF procedure done, and that was around the same time that my weight was down enough to have made a real difference.

I do think that the low-carb diet would have at least nearly taken care of it...and along with the resulting weight loss...I'm fairly sure that I could have gotten off my nexium and been at least nearly symptom-free. As it is though, I'm still glad I had the tif procedure too, because, as I said, I had it bad. I have been convinced for a long time that the gerd and resulting respiratory issues were going to be the end of me.
 
I can resist anything...

...except temptation.
 
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