These are the current FDA approved drugs for weight loss. Many insurance companies require failure on one of these medications often Contrave or Qsymia to be eligible for a GLP/GIP receptor agonist.

Weight loss drug combining an appetite suppressant ( phentermine) with a mood stabilizer to help reduce cravings (Topiramate). Insurance requires patients with a BMI > 30 or BMI > 27 with a co-morbidity like HTN, T2DM, or high cholesterol to help patients lose weight. This is in combination with a reduced calorie diet, exercise, and sleep to help maximize results and change behavior.

This medication starts with bupropion (Wellbutrin) commonly used for depression and smoking cessation, it also helps reduce appetite. Coupled with Naltrexone, used to treat opioid and alcohol dependence, has been found to alter the reward system in the brain allowing patients to control their cravings for food.

BMI > 30 or BMI > 27 with a co-morbidity. A low calorie, increased exercise and sleep hygiene help to achieve long lasting results.

SGLT 2 inhibitors also including Jardiance and Farxiga help people lose weight by inhibiting glucose reabsorption in the kidneys leading to increased urinary output of glucose (1 gm = 4 kcal). It also induces osmotic diuresis resulting in a increase in sodium loss and reduces water retention. In a meta-analysis the weight loss effects were observed with or without diabetes. FDA found reduction in CVD and renal disease. It is estimated the drug can dispell 50-100 gm of glucose daily ~ 200-400 KCAL.

This first-generation GLP-1 RA was brought to market in 2005 and was originally called Byetta (exenatide). It has a short half life and needed to be taken twice a day. It acts on the central nervous system to reduce appetite, slow gastric emptying, and promote the feeling of fullness. While it improves glycemic control by increasing insulin sensitivity it indirectly supports weight loss efforts. If your insurance does not cover the high cost of Ozempic or Tirzepitide this is an excellent choice. This is also administered once weekly.

A second in class GLP-1 RA; it Increases insulin secretion in a glucose-dependent manner, decreases glucagon secretion, inhibits appetite, induces satiety through activation of areas in the hindbrain, and possibly preserves free leptin levels. This is given every day in doses of 0.6mg, 1.2mg, and 1.8 mg. The weight loss dose goes up to 3 mg (Saxenda). Other benefits include reduced blood pressure, lipid profile, waist circumference, and the class effect of improved cardiovascular and renal function.

GLP-1 RAs like Trulicity work by modulating mechanisms that regulate body weight through control of energy balance. These medications may help address the dysregulation of weight control mechanisms seen in obesity. Higher doses of Trulicity (3.0 mg and 4.5 mg) have shown superior weight reduction compared to the standard 1.5 mg dose used in T2DM management. The pen device is the same as Mounjaro/Zepbound both made by Eli LIlly. Higher doses are needed for a weight loss benefit. It has CVD and renal benefits as appears to be a class effect of all GLP1s.

Formerly the most popular GLP 1 RA, Ozempic (semaglutide) was made popular by celebrities due to their extreme weight loss. Ozempic has indications for only TYPE 2DM and will not be approved for weight loss. You must have a BMI > 27 with 1 co-morbidity with insurance that doesn’t have a plan exclusion for Wegovy. I can help navigate that space before you go with compounding pharmacies. Common side effects include gastrointestinal side effects, nausea, diarrhea, and constipation due to delayed gastric emptying. FDA announced favorable cardiovascular and renal outcomes. New data shows reduced inflammation in osteoarthritis, addiction, alcoholism, and PCOS. Dosing can start as low as 0.25 mg up to 2.4 mg. I have 20 years of experience with this class of drugs and we can initiate special dosing with even 0.12 mg dosed more frequently to help reduce side effects and see substantial benefits,

The first dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist. In the SURPASS-2 trial, all doses of Tirzepatide (5mg, 10mg, 15mg) showed greater reductions in HbA1c compared to semaglutide 1mg. Tirzepatide showed greater weight reduction compared to semaglutide in clinical studies - up to 26 lb in vs 13 lb in a 40-week trial. Available doses: 2.5 mg, 5mg, 10mg, 15mg. Tirzepatide has demonstrated improvements in β-cell function and insulin sensitivity which could lead to the prevention of T2DM. FDA also found positive outcomes for Cardiovascular and Renal benefits. In my experience, patients have fewer GI side effects on a dual agonist due to GIP affecting the gut less than GLP 1. Compounding pharmacies were allowed to distribute this drug during the nationwide shortage. This ended on Oct. 3, 2024, which puts this option in jeopardy. Only a select few compounding pharmacies are allowed to dispense.

Byetta has two strengths: 5 & 10 micrograms (mcg) per pen with 60 doses. Starting dosage of Byetta will likely be 5 mcg injected twice per day, one hour before each of your two main meals. If you don’t eat much breakfast, you could choose to have your first injection in the hour before lunch. Your second injection would still be in the hour before your dinner, as long as these meals are at least 6 hours apart.

After 4 weeks, may increase your dosage to 10 mcg twice per day. This will depend on blood sugar and weight loss response to Byetta injections.

Ipamorelin: This peptide can help increase metabolism and promote lean muscle growth. 

CJC-1295: This peptide can help boost growth hormone secretion and IGF-1 levels. 

Tesamorelin: This peptide can help reduce visceral fat, especially in the abdomen. 

MOTS-C: This peptide can help enhance insulin sensitivity and energy metabolism. 

BPC-157: This peptide can help promote muscle growth. 

AOD 9604: This peptide can help target fat cells directly and promote lipolysis. 

Utilizing a skill set learned over years as a professional athlete and combining it with the latest scientific advances. I can design an advanced program utilizing peptides and oral medications - if we find the root cause is food addiction or confusion between hunger and satiety. Everyone eats for different reasons and often years of dieting results in lost muscle and a lower metabolism. My job is to find out why you are experiencing challenges and create a solution. Be open-minded and forget about how many times you might have lost or gained weight. Now is the time to find a permanent solution.