We don’t use any of the old weight loss medications such as Phen-Phen, phentermine or amphetamines that make you jittery, keep you awake and don’t produce sufficient or lasting weight loss. What we use are medications that were developed to treat diabetes.

This class of medications, incretins, were developed about 20 years ago and have a track record of safety and efficacy. They originally had a side effect of weight loss and as they were further developed, they produced greater weight loss and some of these compounds received FDA approval for the treatment of weight loss. For example, you may have seen the commercials for semaglutide used to treat diabetes and producing the side effect of weight loss or semaglutide used to treat obesity because it produces weight loss. The latest medication for diabetes is tirzepatide. Tirzepatide is expected to get FDA approval for the treatment of obesity by the end of this year. It produces greater weight loss because it has a dual effect and is called a dual agonist while semaglutide is a mono agonist.

Tirzepatide is a dual agonist because it has a hormonal effect in addition to the gastric effect of semaglutide

The way these medications work is first, with semaglutide, by slowing the passage of food through the stomach making you feel full sooner and longer. This sends a signal to the brain that there is no room for food in the stomach. The brain responds by decreasing your appetite, decreasing your hunger and removing your cravings. This is an exceedingly pleasant feeling…unless you eat too much, even very little, since your brain thinks you’re already full. If you do then your brain will respond by trying to remove what it thinks is excess food by producing nausea, vomiting, diarrhea or reflux. It tries to expel what it thinks is the excess food in your stomach.

These symptoms can be treated with medications such as Zofran or Lomotil, but it is better to use the symptoms to learn what your new food tolerance is, and then eat less. We help you do this in two ways. First, we start at a low dose and increase slowly dependent upon your response to the medication. Secondly, we recommend intermittent fasting. What we mean by intermittent is no food after midnight, and upon awakening try to continue fasting. If you are not hungry then don’t eat. There is no reason to have scheduled feedings such as breakfast, lunch, and dinner. No reason to supplement with protein drinks. If you get hungry then simply eat, but go slowly and stop when you are full. Don’t make yourself sick by force-feeding.

When you do eat it is recommended that you eat fatty foods from animals rather than foods from plants. For example, fish, chicken, beef, dairy, cheeses, etc. There is plenty of good food to eat. Foods from animals have better amino acids and the fat decreases your appetite, while foods from plants, fruits and vegetables stimulate your appetite and are mainly carbohydrates which we want to avoid because they stimulate your appetite and fiber. We still want the fiber to keep your colon moving and prevent constipation while the weight loss medications slow stomach movement. however, the over the counter (OTC) fiber products are preferred as they provide non absorbable fiber that produce some degree of fullness without weight gain. We suggest more than is recommended on the bottle but not all at once, to prevent stretching the stomach too much. The increased amount of non-absorbable fiber should be spread throughout the day with powders, wafers, gummies, etc. If your stomach rumbles, then cut back on the fiber to prevent diarrhea and then restart to find the optimal amount for you.

It is also recommended that your take a daily multivitamin. Any once a day over the counter (OTC) multivitamin supplement should be sufficient as you learn to eat properly to achieve and maintain an optimal healthy weight. This would be a Body Mass Index (BMI) between 18 and 25. When you reach a BMI of 25, blood tests are recommended to check your overall health. You should also continue with any routine cancer and other screening recommended by your primary care physician.

The hormonal effect of tirzepatide adds to the gastric effect for more weight loss, faster weight loss and less adverse symptoms. When we eat, our pancreas immediately begins secreting the hormone insulin. Insulin drives nutrients into cells and then stores the excess in fat cells as sugars. When we are not eating our pancreas secretes the hormone glucagon. Glucagon reverses the process taking sugars from the fat stores and providing them to the cells for energy. However, glucagon from the pancreas may last less than two minutes in the blood. The glucagon effect of tirzepatide lasts five days. Therefore, more energy is derived from the fat stores rather than the grocery stores. The groceries are actually slowed by the gastric effect of the medication. So there is faster and greater weight loss with tirzepatide than semaglutide.

Studies show that recommended maximum doses of semaglutide produce 15% reduction in body weight while maximum recommended doses of tirzepatide produce 22% reduction in body weight.

No. The medications are not like the older weight loss drugs that speed you up and keep you awake. They are basically primarily diabetes medications that control blood sugar and hunger.

No. This class of medications were first FDA approved in 2005. Successive forms have come out since then with increasing weight loss as their side effect and became the primary effect for some forms.

Weekly. On an empty stomach and when you haven’t eaten too much the night before. Remember, because of the medication your stomach can still be full from the night before. 

Nausea , vomiting, diarrhea and constipation. They occur primarily with eating when your body is telling your not to. There is no room in the stomach for more food.  The constipation may come from slowing of the bowels or no food so you should take non-absorbable fiber products to keep things moving.

The goal will be to achieve a healthy weight as soon as possible and maintain it. The medication will be increased initially and when the healthy weight is reached the medication may be decreased for maintenance of the healthy weight.

Not really. You can do intermittent fasting. You can live off what you have stored up. The medication will take nutrients and sugar for energy from your fat cells rather than the grocery store.

We like to see patients monthly, check weight on the same scale and adjust medications. You can come in more often at no additional charge. We also have a weekly program that includes medication for people whose insurance does not cover the medication.

Eat. But don’t overeat. Go slow and stop when you’re satisfied. You’ll get satisfied faster with fatty food instead of carbs, food from animals instead of plants. 

Individualize. Don’t use if you don’t need them, use more if you need more. Adjust to what works for you. Benefiber: No taste or color and dissolves completely. You can put some in all of your drinks. Metamucil wafers: Two or three packets a day. Crunchy or can be softened by dunking in a drink. The chocolate flavor softens the fastest. Metamucil gummies: Best if taken later. Like gummie multivitamins, they taste like candy, so there is a tendency to keep eating them all day.

They may need to be adjusted. Diabetes medicine needs to be decreased right away. Blood pressure medications need to be decreased as weight decreases. Birth control medications may not be as effective. 

The first change is loss of the anger and irritability associated with hunger. Later, self esteem increases as you realize that diet and exercise as well as will power are not effective because there is actually a hormonal imbalance that needs to be corrected. 

Bariatric Medicine Tirzepatide. Tirzepatide works in two ways. Actually, three, if you count the effect on the brain.

• 1. Stomach
• 2. Pancreas-Hormone Glucagon

A. Slows passage of food in the stomach
This makes you feel full sooner and longer.
The stomach is stretched sending a signal to the brain that the stomach is full. No more room for food. Brain – Don’t send more food — stop hunger.
This is where the side effects come from;
Nausea, Vomiting, Diarrhea and Constipation
Also slows colon like stomach — no food and no movement.
Keep things moving with fiber; non-absorbable fiber. 
FASTING PREVENTS SIDE EFFECTS IN GENERAL

B. Pancreas releases glucagon when you are not eating
When you eat: The pancreas secretes insulin to drive sugar into cells for energy and storage. When you are not eating: The pancreas secretes glucagon to pull sugar out of fat cells for energy. This raises blood sugar so you have energy and shuts off your appetite.

GLUCAGON releases sugar from fat cells and gives you energy and prevents hunger and fatigue.

Take Mounjaro or Tirzepatide each week in the morning on an empty stomach, wait, and then
start to eatslowly if at all. Don’t eat if you are not hungry. listen to what your body is telling you. If it is saying you are not hungry and you eat anyway then you pay a price with the side effects.

Remember, fasting is good, it’s healthy. You won’t get malnourished with intermittent fasting such as 16 hours per day, 20 hours per day or even fasting every other day. You will still feel fine with the energy produced from the sugar released from your fat cells.

Bariatric Medicine (Semaglutide)

Semaglutide  slows passage of food in the stomach.
This makes you feel full sooner and longer.
The stomach is stretched sending a signal to the brain that the stomach is full.

No more room for food. The Brain– Don’t send more food- stop hunger.
This is where the side effects come from:
Nausea, Vomiting, Diarrhea and Constipation
Also slows colon like stomach – no food and no movement.
Keep things moving with fiber; non-absorbable fiber.

FASTING PREVENTS SIDE EFFECTS IN GENERAL.

Take Semaglutide each week in the morning on an empty stomach, wait, and then start to eat slowly if at all. Don’t eat if you are not hungry. Listen to what your body is telling you. If it is saying you are not hungry and you eat anyway then you pay a price with the side effects.

Remember, fasting is good, it’s healthy. You won’t get malnourished with intermittent
fasting such as16 hours per day, 20 hours per day or even fasting every other day.

Tirzepatide is the best medication for weight loss but it is only FDA approved for diabetes. If you have diabetes and your insurance covers tirzepatide for diabetes then it will be easy to get it. However if you don’t have diabetes the pharmacy may still give it to you if your insurance company does not require a Prior Authorization (PA). If they require a PA you won’t get it unless you can prove you have diabetes; usually with a high HgbA1C. or a history of being on insulin or other diabetes medicine like metformin. You could also buy it but it would cost around $500-$1,000 depending on what discount coupons you can get.

Semaglutide is the next best weight loss medication and it is approved by the FDA for weight loss. If your insurance covers weight loss drugs you should be able to get semaglutide. If they require a Prior Authorization (PA) your BMI must be over 30 or over 27 with at least one comorbidity. Semaglutide is too expensive to buy.

Semaglutide is for weight loss but is only FDA approved for diabetes. If you have diabetes and your insurance covers Tirzepatide for diabetes then it will be easy to get it. However if you don’t have diabetes the pharmacy may still give it to you. if your insurance company does not require a Prior Authorization (PA). If they require a PA you won’t get it unless you can prove you have diabetes; usually with a high HgbA1C. or a history of being on insulin or other diabetes medicine like metformin. You can also buy Semaglutide online for about $350 per month for 1 mg per week.

Most prior medications produce 5% reduction in body weight
2.4 mg of semaglutide produces 15% reduction in body weight
5 mg of tirzepatide produces 15% reduction in body weight
10 mg of tirzepatide  produces 19% reduction in body weight
15 mg of tirzepatide  produces 22% reduction in body weight

People taking incretins including semaglutide and tirzepatide lose mostly fat or adipose tissue. They also lose muscle tissue. It is recommended that the muscle tissue be restored. Particularly for those over 60 years of age. Muscle tissue can be restored by resistance training. Weight lifting is the best resistance training. Young people can be more aggressive with their weight lifting but older people need to be more careful. It is recommended that older people avoid barbells and dumbbells and instead use machines and cables to move the weights. 

A weight lifting program for people over 60 years of age only needs to be 20-30 minutes three times per week. There should be a push day, a pull day and a leg and abdominal or core day.

Push Day—This will primarily work the muscles of the chest, shoulders and the back of the arms by pushing the weight away from your body in different directions with each exercise.

Pull Day— This will primarily work the muscles of the back and the front of the arms by pulling the weight toward your body from different directions with each exercise

Leg and Abdominal/core Day— Leg extension and flexion and sit ups/crunches

Do different exercises but do one set of each exercise with 8-20 repetitions of the movement. do the exercises with NO weight for 2-4 weeks and then begin adding weight. The more reps that you do means that you can add weight and decrease reps. Then start building up the reps again till you can add weight. Spend 20-30 minutes lifting weights on your exercise days and walk a mile or two on the other days.