EXERCISE IS KING, DIET IS QUEEN

We like to have exercise, healthy diet and attention to all other metabolic regulators such as hormones, thyroid, adrenals, and blood sugar attended to before reaching for a GLP-1.  However, many people are doing everything right and still can't lose weight.

GLP-1 Wonder Drugs (with some caveats)

We are huge fans of Semaglutide and Tirzepatide in particular. With once weekly dosing, they are convenient.

• Semaglutide (brand names Ozempic, Wegovy) has a good track record and results.  On average, patients lose 15%-19% of their total body weight over 68 to 72 weeks.  We do find the side effects of nausea, vomiting and abdominal pain to be frequent enough that a fair number of people quit before they reach their weight goal.
• Tirzepatide (brand names Mounjaro, Zepbound) is hands down our favorite.  It has far fewer adverse side effects reported, and typically results in 15-21% loss of overall body weight.

Muscle Loss
It's a real problem with the GLP-1's.  The more fat one has to lose, the more fat and relatively less muscle mass is lost, but in people with only a few pounds to shed, much more of it comes from muscle loss.  To avoid winding up "skinny-fat", here's what we require:

• Weight bearing exercise 30-45' three times per week, or hard weight/resistance workouts totalling at least 1.5 hours per week.
• Growth hormone analog peptides such as Sermorelin or CJC-1295/Ipamorelin.  One of these is REQUIRED for patients who cannot promise to meet the weight-bearing exercise goals.  One of these will be prescribed along the GLP-1 to ensure weight loss is fat, not muscle.

DO I HAVE TO STAY ON IT FOREVER?

The answer is typically NO, unless one is diabetic.  Once patients reach their weight goal, if they stick to their exercise and diet plans, most stay at their target weight.  Occasionally the holidays or other life events happen, resulting in weight gain.  In these cases, we'll typically do "touch ups" until one is back to their target weight.

DIET PILLS, THE LAST DITCH

When all else fails, for patients who are doing other things such as exercise and diet, taking their hormones, Phentermine is another wonder drug.  We see great results with this medication, particularly in those who cannot tolerate the GLP-1's.  We typically keep patients on this one long term.