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 Historically, the treatment of obesity focused almost exclusively on lifestyle-based approaches. However, evidence that diet and exercise prompt physiological counterregulatory mechanisms that limit weight reduction and impede weight maintenance has led to the realization that obesity is a complex, multicomponent metabolic disease of energy homeostasis involving central and peripheral mechanisms. Once obesity is present, those mechanisms render a return to lower weight difficult.  

 

Accordingly, several clinical guidelines now recommend treatment with antiobesity medications for people with obesity or for those with overweight and weight-related complications. Recent studies with long-acting glucagon-like peptide-1 (GLP-1) receptor agonists demonstrated that greater efficacy with acceptable safety could be achieved by targeting the pathways of endogenous nutrient-stimulated hormones. Glucose-dependent insulinotropic polypeptide (GIP), another nutrient-stimulated hormone, regulates energy balance through cell-surface receptor signaling in the brain and adipose tissue.  A molecule that combines both GIP and GLP receptor agonism theoretically may lead to greater efficacy in weight reduction.

Image by Kenny Eliason

Semaglutide​

In June 2021, the U.S. Food and Drug Administration approved semaglutide (Wegovy) injection (once weekly) for chronic weight management in adults with obesity or overweight with at least one weight-related condition (such as high blood pressure, type 2 diabetes, or high cholesterol), for use in addition to a reduced calorie diet and increased physical activity. This once weekly,  under-the-skin injection (subcutaneous) is the first approved drug for chronic weight management in adults with general obesity or overweight since 2014. The drug is indicated for chronic weight management in patients with a body mass index (BMI) of 27 or greater who have at least one weight-related ailment or in patients with a BMI of 30 or greater.

Originally used for diabetes and sold under the name Ozempic, a higher dose of the same drug was evaluated for weight loss. The results were dramatic, with the average individual losing 15(+) % of their body weight during the clinic trial. Due to such overwhelming results, it has become cost-prohibitive via insurance (average co-pay of $947/mo) or GoodRx( lowest price is $1333). 

We prescribe Semaglutide through a compounding pharmacy for a fraction of the cost with the same results!

How it works: Semaglutide works by mimicking a hormone called glucagon-like peptide-1 (GLP-1) that targets areas of the brain that regulate appetite and food intake; it is a powerful appetite suppressant. It also works by increasing the production of insulin and appears to enhance growth of β cells in the pancreas, which are the sites of insulin production. Additionally, it inhibits glucagon, which is a hormone that increases blood sugar. It has been known to aid not only in weight loss, but helps to lower glucose levels in those who are pre-diabetic or who have type 2 diabetes.

  • Delays stomach emptying, leading to a feeling of fullness and smaller meal size

  • Slows intestinal motility

  • Lowers blood sugars, in part by reducing the production of sugar in the liver

  • Stimulates insulin secretion by the pancreas

 

Semaglutide is started at a low dose which can be increased gradually to tolerate any GI symptoms.  It is common for patients to have great success with minimal side effects around 0.25 - 2.5mg weekly.

What to Expect: For your initial visit, you schedule a consultation appointment. Upon arriving for your appointment, you will have paperwork to complete and then you will have your consultation. Based on the FDA recommendations for treating obesity,  we determine if semaglutide is a safe and good option for you. We carefully screen you by evaluating your past medical history, any current medications you take and your body mass index (BMI).

 

:Contraindicated: you have any of the following: diabetic retinopathy, low blood sugar, decreased kidney function, pancreatitis, medullary thyroid cancer (or a family history of medullary thyroid carcinoma), or multiple endocrine neoplasia type 2.

 

Since the semaglutide injection does not help increase energy or boost metabolism, we recommend pairing it with  a vitamin b-12 injection. 

 Tirzepatide

 

Tirzepatide is a once-weekly subcutaneous injectable peptide (approved by the Food and Drug Administration [FDA] for type 2 diabetes) engineered from the native GIP sequence, with agonist activity at both the GIP and GLP-1 receptors. Preclinical data demonstrated that the affinity of tirzepatide for GIP receptors was equal to the affinity of native GIP for GIP receptors, whereas tirzepatide bound GLP-1 receptors with affinity approximately five times weaker than native GLP-1 bound GLP-1 receptors. GIP activation appeared to act synergistically with GLP-1 receptor activation to allow greater weight reduction in mice than that achieved with GLP-1 receptor monoagonism. In phase 2 studies in people with type 2 diabetes, tirzepatide induced clinically relevant weight reduction, warranting further investigation for the treatment of obesity. The present trial, SURMOUNT-1, evaluated the efficacy and safety of tirzepatide in adults with obesity or overweight who did not have diabetes.

In addition to treating Type 2 diabetes, tirzepatide has been shown to help with weight loss in people without diabetes. A clinical trial of over 2,500 people with obesity or overweight experienced significant weight loss with weekly tirzepatide. Those treated with tirzepatide had an average weight loss of 15% to 20% of their starting body weight over 72 weeks (about 16 and a half months). Those taking the placebo (an injection with no medication in it) only had an average of 3% weight loss.

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