Medications That Work!

Weight loss medications are powerful tools that significantly improve the quality of life for individuals striving to attain a healthier weight. While medications like Wegovy and Ozempic have been making headlines, these are only a fraction of the amazing medical tools we have to work with. Here are some common weight loss medications I use in my practice:

Wegovy/Ozempic (semaglutide) - Part of a class of medications called incretin-mimetics. They work by mimicking a hormone that naturally occurs in the body that regulates appetite, digestion, and metabolism (GLP-1). When fatty tissues become unhealthy you stop producing enough of this hormone, which is why it is such a profound tool for weight loss. Trials show that semaglutide is able to produce an average of 15% body weight reduction at 68-weeks, with many real world patients seeing far more. They require careful, expert dose titration and side effect monitoring for the greatest success. These medications come in easy to administer, once weekly pen injectors that deliver medicine into the fat just under the skin.

Mounjaro (terzepitide) - Another incretin-mimetic that contains two weight loss hormones rather than just one (GLP-1 and GIP). Early trials reveal an average of 20.9% body weight reduction at 72-weeks. Again, this needs careful monitoring and dose titration for greatest effects. It is similarly packaged in a pen injector, delivered once per week. Note - this medication has not yet received FDA-approval status for the specific use in weight loss.

Qsymia (Phentermine-Topirimate) - This is an oral medication that works by decreasing  appetite and increasing the amount of energy the body uses. This medication needs careful monitoring for side effects and dose titration.

Contrave (Naltrexone-Bupropion) - This is an oral medication that targets the brain to reduce cravings and decrease the urge to eat. Dose titration is again very important and needs careful monitoring.

Phentermine and other sympathomimetics - These medications work to suppress appetite and have been around the longest. These are oral medications with several different durations of action. Dose titration is much simpler, but side effect monitoring is important.

*This is just a partial list of the many impressive medications to supplement weight loss. Additionally, there are many more medications undergoing trials as we speak!

Why Seek An Expert Prescriber?

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Rapid weight loss may lead to muscle loss if not monitored.
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Open communication is critical.
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The use of tracking technology leads to greater success.
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Regular dose adjustments are required early on.
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Health and safety are a priority.
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Proper side effect education helps improve tolerability.

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Medications FAQ

How much does medication cost?
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Weight loss medications vary substantially in price. Without insurance, the newer 'weight loss shots' can cost upwards of $1,300 per month, while the older more established medications can be less than $20 per month! Due to the extreme financially restrictive nature of these medications cost does play a large role in deciding which medication is right for you. I will do everything I can to work with your insurance provider to get the medications at the lowest price possible. I do not compound or sell medications or supplements myself.

What if I don't have insurance, can I still take the 'shot'?
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While it is tempting to want to dish out the hefty fee as long as you get the best medication, remember, these medications take 68-72 weeks to reach their peak effect, and often need to be continued even longer. Without reliable insurance coverage, I will likely recommend a less expensive, but still well studied and effective medication.

Who should receive weight loss medication?
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Weight loss medications can be a valuable tool for anyone experiencing even early health consequences of excess body weight. Typically medications are reserved for individuals with a Body Mass Index (BMI) of 30 and higher, or 27 and higher if they also have weight-related health conditions such as high blood pressure, type 2 diabetes, or high cholesterol. However, it is possible that you may meet other metabolic criteria (such as visceral or abdominal adiposity, genetic predisposition, or serious metabolic health risks) that indicate the need for medication. Additionally, those who are dealing with the health consequences of excess weight and need a more structured, medical approach to weight loss could benefit from these medications. This is why I perform a comprehensive weight wellness visit for every patient starting at my practice.

Will these medications make me lose muscle?
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Certain weight loss medications can inadvertently lead to muscle loss due to a reduction in overall body mass, including both fat and lean muscle. This is because when your body is in a calorie-deficit state, it may use muscle tissue for energy, especially if not enough protein is consumed. It's essential to pair these medications with a balanced diet and regular physical activity, specifically resistance and strength training exercises, to protect and build muscle mass while losing weight.

How long do I need to be on medication?
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Weight loss medications work by altering certain biological pathways or processes related to appetite, metabolism, or fat absorption. Once you stop taking the medications, those pathways or processes may revert back to their previous state, which generally leads to weight regain. Just as how chronic conditions like hypertension or diabetes may require lifelong medication for optimal management, so too might obesity. Therefore, for some individuals, maintaining weight loss may involve long-term use of weight management medications as part of a comprehensive treatment plan. Remember, each person's treatment plan is unique, and the duration of medication use should always be guided by an expert.

Do you use compounding or on-site pharmacies?
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For the safety and welfare of my patients, I firmly advocate the use of FDA-approved medications, such as Wegovy, from regulated pharmacies, rather than compounding pharmacies. Compounding pharmacies, although they can provide valuable services in certain circumstances, lack the stringent oversight and consistent production processes that come with FDA-approved pharmaceuticals. This can lead to variations in dosage and purity, which could affect efficacy and safety. As for selling my own medications, it could potentially create a conflict of interest. My primary role is to provide you with the best medical advice, not to sell you products. Thus, I believe prescriptions should be filled independently to maintain the integrity of our patient-physician relationship.

How do you choose which medication to use?
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Prescribing the right weight management medication is an art that requires in-depth knowledge and understanding of each patient's unique health and social profile. It's not a 'one-size-fits-all' approach. Each medication has its own unique mechanism of action, potential side effects, and interactions. Additionally cost and coverage issues can be an unfortunate limiting factor. As an expert in this field, I consider various factors such as your medical history, current health status, lifestyle, personal preferences, and insurance coverage/costs when choosing the most suitable medication for you. The goal is to optimize efficacy while minimizing potential risks, to support your journey towards sustainable weight loss and improved health.

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