Medical Weight Management
“Never in the history of weight loss medicine has there been an intervention that could approach the success of surgery. Finally, we have medications that safely achieve the same results as surgery.”
– Dr. Daniel Rosen
Are these medications FDA approved for weight loss?
Semaglutide is FDA approved for weight loss. Tirzepatide is FDA approved for use in patients with type-2 diabetes mellitus. Tirzepatide is safe and effective for treating obesity although it is not FDA approved for weight loss at this time. We therefore prescribe tirzepatide off-label.
What are the side effects of these medications?
Side effects to semaglutide and tirzepatide are tolerable and primarily GI-based. Some patients experience bloating, constipation, diarrhea, or cramping.
Are these medications safe for weight loss?
These medications should not be taken by anyone with a history of or genetic predisposition to endocrine cancers in the MEN1 group, and specifically, medullary thyroid cancer. Also, People with a history of pancreatitis should not take these medications.
What medications are contraindicated?
There are some moderate contraindications when it comes to medications. We will thoroughly review your regimen of prescription and over-the-counter medications to ensure that it is safe for you to take semaglutide or tirzepatide.
Are these medications safe for people 18 and under?
Semaglutide is approved for ages 12 and up. Tirzepatide is approved for adults aged 18 years and older.
How do semaglutide and tirzepatide differ?
Both semaglutide and tirzepatide have a GLP1 agonist, a hormone that, in natural situations, is released by the ileum (the latter half of the intestines). When food reaches the end of the intestines, especially fat and protein (because carbohydrates are absorbed early), it triggers a release of GLP1 which travels to the brain and tells you to stop eating. Both of the medications have the GLP1 agonist. Tirzepatide is dual acting: it also has GIP, which stands for glucose dependent insulinotropic polypeptide. When glucose, or simple carbohydrates, enters the stomach and the first part of the intestine (the duodenum), it triggers GIP release which stimulates insulin secretion and metabolic function, while complementing the effect of GLP1.
How much weight can I lose if I take one of these medications?
A cohort study of overweight and obese patients treated with semaglutide showed that patients averaged a total body weight loss of 5.9% at three months, and 10.9% percent at six months. In a clinical trial where obese patients were treated with tirzepatide over 18 months, the total body weight loss averaged 20.2%.
So far, our anecdotal experience working with patients taking these injectables is that the average weight loss is 25 to 40 pounds, but we have seen patients lose up to 80 pounds and more. Also, our experience with these injectables supports the evidence that patients lose more weight with the dual-acting tirzepatide than semaglutide.
Are these injectables the right intervention for me?
In general, these medications are recommended for people with a BMI of 30 or higher, or a BMI of 27 or higher in addition to weight-related health problems. Our team of doctors will work with you to determine if one of these medications is the most appropriate intervention to achieve your goals.
How do I take the medication?
These medications come in the form of an injector pen. They are self-administered, given generally under the skin of the stomach, thighs, or upper arm.
How often do I take the medication?
Once weekly, on a day of your choosing.
How soon after starting the medication will I start to lose weight?
In general, patients start to see results within the first month of their weight loss regimen while using these injectables.
For how long must I take the medication to reach my goal weight?
The length of time to reach your goal weight will depend on many factors and varies with each individual. As a general rule you can expect 5 pounds lost per month. Some more, some less. The more you have to lose the longer it will take. This is highly personalized and depends on your own health history and goals. Your doctor will help guide you on the duration of treatment.
Do I take the same dose of the medication as I lose weight?
If you stay on the same dose of the medication, weight loss rate will slow over time. You have fat stores that can be tapped by your body to fill the gap between what you are consuming and what your body is burning. The point of using these medications is to mobilize the fat and get it metabolized. It is necessary to gradually adjust the dose to continue to mobilize and metabolize these fat stores. We work with each patient to determine their individual needs for dosage and dose increase.
Do I keep taking the medication after I lose weight?
Once goal weight is achieved, we may recommend either a half dose with weekly injections or every-other-week injections. The regimen for the maintenance phase must be individualized. The consensus is that since obesity is a chronic disease, patients may have to stay on these medications for the long term (and based on all available evidence over 15 years of FDA approval, they are safe for long-term use).
Where cost is a concern, there are surgical options to be explored which would ultimately result in potentially greater and sustained weight loss without the ongoing cost of injectable medications.
Is there a benefit to taking these medications other than weight loss?
There are many benefits! Many patients report that they have less anxiety overall when taking semaglutide or tirzepatide. For people who have the propensity to medicate with alcohol for anxiety, or turn to food in times of stress, the feeling of deprivation that accompanies dieting can provoke anxiety. With tirzepatide and semaglutide, there is no deprivation. In fact, there is a feeling of fullness and satisfaction. People frequently report that they feel less anxious when taking these medications to lose weight.
There are also physical benefits as a consequence of weight loss itself. Obesity is the impetus for inflammation in the body’s organs. Inflammation of the liver, kidneys and other organs lessens as the fat burden to these organs lessens. Also, patients experience less reflux as they lose weight.
Will my insurance cover the use of one of these medications for weight loss?
It can be difficult to get semaglutide covered by many insurances, however in some cases it is possible. Use of Tirzepatide for weight loss will not be reimbursed by insurance as it is an off-label application of a medication approved for diabetes care.
Will Medicare cover the use of one of these medications for weight loss?
At this time Medicare does not cover these medications for weight loss.
Is there a diet plan with the medication?
As a WeightZen patient, you will work with our experienced team of nutritionists to develop a diet plan that suits your individualized needs and weight loss goals. Your nutritionist will personalize your plan to your goals and lifestyle.
What foods should I avoid when taking the medication?
It is best to moderate your intake of foods that are difficult to digest while you are taking semaglutide or tirzepatide, namely foods that are high in fat and/or sugar. You might also find that some foods do not sit well in your stomach – this is something you can discuss with your nutritionist. You might find it’s best to select an alternative or moderate intake of these foods.
What foods should I eat when taking the medication?
You should focus on a high protein, high fiber diet rich in fruits and vegetables, whole grains and healthy fats. Since the medication can slow your stomach from emptying, some patients experience constipation. Hydration, fiber, and physical movement are the best remedies.
How many calories can/should I consume per day while on the medication?
We do not suggest calorie goals on a broad scale. You are much better off working with your dietitian to personalize your meal plan and nutrition goals. Additionally, the content of your calories matters much more than just the number itself.
Will the medication curb my appetite and cravings?
Yes! By design, these medications produce a feeling of fullness, and they do so early on when you eat. Therefore, when you eat, your appetite will be satisfied quickly and with lower caloric intake than normal. Many patients report experiencing significantly less “food noise” while on these medications.
Will my appetite return when I’m done taking the medication?
It is likely that your appetite will return when you are done taking the medication after achieving your goal weight. This is why we may recommend a maintenance dose regimen over the long term.
What happens if I overeat while taking the medication?
If you overeat and/or eat a lot of food that is high in fat and/or sugar while taking semaglutide or tirzepatide you will likely feel nauseous and experience indigestion. If you experience this, please discuss with your medical team so they can help you adjust your intake.
Will the medication speed up my metabolism?
Semaglutide does not impact your metabolism directly. The GIP hormone in tirzepatide has been shown to increase energy expenditure and metabolic rate. You can continue to support metabolic health by eating throughout the day, hydrating and practicing weight bearing exercise.
Dr. Daniel J. Rosen is founder and lead surgeon of Weight Zen.
Specializing in Lap-Band, Gastric Sleeve, Gastric Bypass, the Orbera Weight Loss Balloon, and Duodenal Switch, he is dedicated to helping people overcome obesity and achieve life-long weight loss. He received his medical degree from Albert Einstein College of Medicine, trained in general surgery at St. Luke’s Roosevelt Hospital Center, and completed fellowship training at New York Presbyterian Hospital.
Dr. Lael E. Forbes is a fellowship trained General Surgeon and Bariatric Surgeon.
A leading expert in obesity medicine for both adolescents and adults, she has performed over 1,500 laparoscopic weight loss procedures, including adjustable gastric banding, sleeve gastrectomy, gastric bypass, and revisional bariatric operations. Dr. Forbes offers the latest advances in non-surgical procedures and utilizes FDA-approved medications to promote sustained weight loss.
Megan Wolf MS RD CDN is a NYC Registered Dietitian.
An author, cook, and nutrition expert, Megan holds a Masters degree in Clinical Nutrition from New York University and a Bachelors degree in Anthropology from Bates College. She completed her Dietitian Internship at New York University and now specializes in weight management. Megan is an avid public speaker and recipe creator. Her cookbook, Great Meals with Greens and Grains is available now!
You can also call (866) 429-5961 to book an appointment.