GLP-1s weight loss medications

We’re talking about the glucagon like peptide-1 receptor agonists or GLP-1s for short. While this class of medications has been around for over 20 years, you’re just hearing about Ozempic (semaglutide) FDA-approved for type 2 diabetes in 2017, Wegovy (semaglutide) FDA-approved for weight loss in 2021 and Mounjaro (tirzepatide) FDA-approved for type 2 diabetes and for obesity by the end of 2023. The reason you’re just hearing about these medications even though other name brands within this class also contributed to weight loss over the last 20 years, is because these newer medications are weekly rather than daily injections.

The medications enhance secretion of insulin from the pancreas which drives sugar into the cells to be used for energy. This is why these medications were first used to treat type 2 diabetes, the form of diabetes mostly associated with overweight and obesity. During study trials and in the real world, they were also found to be highly effective at appetite suppression and weight loss.

Despite the amazing weight loss and relatively good safety profile compared to weight loss meds that came before it, the media is always looking for a chink in the armor. Success apparently doesn’t generate as many clicks as scandal. And that’s why the media often highlights side effects associated with Ozempic even though these are side effects we’ve known about for over 20 years.

Success apparently doesn’t generate as many clicks as scandal.

And they often attach a clever name to the side effect to capture more eyes. Below we’ll review the main “complications” of these medications even though they’re really known side effects that, in some cases, are features of the medication, not a bug.

Stomach paralysis

This is just a scarier term for delayed gastric emptying. One way these medications help you lose weight is through delayed gastric emptying, meaning food moves more slowly from the stomach to the intestine. This results in a feeling of fullness so the patient eats less and loses weight.

Ileus

This is similar to delayed gastric emptying. These medications affect and slow motility or movement throughout the entire gastrointestinal track. This could lead to ileus, a slowing of the intestines so food stops moving forward and in the worse of circumstances leads to a bowel blockage. But that’s not common. What’s more common are the other GI side effects like nausea, vomiting, diarrhea or constipation. All treatable ailments if they occur and one option is to switch to tirzepatide which has fewer side effects compared to semaglutide as seen in independent studies below.

Pancreatitis

Also a known rare side effect. These medications, even when approved for type 2 diabetes work to stimulate or enhance insulin secretion from a “burned out” pancreas in a type 2 diabetic state. They work for weight loss by stimulating the pancreas to release insulin which contributes to a feeling of satiety (less hungry, eat less). Out of 2,116 patients studied in the Wegovy trial that was ultimately submitted to the FDA for approval, 4 patients taking the active ingredient semaglutide and 1 patient taking the placebo or inactive ingredient for comparison had pancreatitis. So the risk isn’t high in developing pancreatitis in general, but can still occur, even in a patient not taking the medication (placebo)!

Medullary thyroid cancer

When these medications were first being studied on lab rats in the lab, some rats contracted a rare form of thyroid cancer, medullary thyroid cancer. But even some of the rats taking the placebo, the nonactive medication, developed medullary thyroid cancer. So it’s not clear what that association is and the FDA even states they’re not sure of the significance in humans. Even though the incidence of medullary thyroid cancer in humans has been rare and unchanged for the last 30+ years despite these medications being available on the market for human use since 2005, we still recommend our patients examine the middle of their neck to ensure there are no lumps and bumps around the neck that weren’t there the month before.

Suicidal ideations

There is a risk of suicide with all weight loss medications. This isn’t specific to Ozempic, Wegovy or Mounjaro. It’s not clear yet what the association is, possibly pre-existing depression, but patients on weight loss medications are known to consider suicide. There’s no evidence this is specific to or worse for patients on Ozempic or Wegovy. But the drug manufacturer isn’t attempting to hide this. It was in the FDA application for approval.

This won’t be all. The media will look at other side effects and act like they’re new or riskier than they are. For the next trending risk, my money is on alopecia. 3% of patients taking the medication had some alopecia but the placebo group still had 1% incidence of alopecia. This isn’t specific to the medication. Any stressor, like weight loss, can lead to hair loss. It’s called telogen effluvium.

Nothing new here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyHealth.

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We’re very excited to release our October weight loss data from our weight management program that includes semaglutide (the active ingredient found in Ozempic and Wegovy) and tirzepatide (the active ingredient in Mounjaro). The medications we offer come from a compounding pharmacy which by law, must be a duplicate of these name brand active ingredients while Ozempic, Wegovy and Mounjaro are on the FDA shortage list.

Weight loss on semaglutide after 8 months

This first graph shows the effects of semaglutie on our patients over the last 8 months. As you can see, the average weight loss is 7.59 pounds in the first month, 12.86 pounds over the first two months, 18.23 pounds over the first three months, 23.49 pounds over the first four months, 27.27 pounds over the first five months, 32.83 pounds over the first six months, 38.49 pounds over the first seven months and then 40.92 pounds over the first eight months. At eight months, that weight loss equates to 27% of the patient’s body weight! According to the FDA submission for Wegovy approval (the weight loss medication produced by NovoNordisk that contains the active ingredient semaglutide), the average weight loss over 1 year and 4 months was 15.1%! We’re not saying our semaglutide is better than their semaglutide, we’re just saying that our compounded version of semaglutide is the real deal!

When semaglutide patients switch to tirzepatide

In the graph below, you can see that patients who switched from semaglutide to tirzepatide, either because of greater side effects on semaglutide or because they felt they hit a plateau on semaglutide, they continued to lose weight on tirzepatide. Not necessarily at a faster rate but the graph shows that weight loss of both medications follows the same downward trend that we want to see when it comes to weight loss.

Weight loss on tirzepatide after 4 months

So is tirzepatide better than semaglutide when it comes to weight loss? As described above, with semaglutide, the average weight loss is 7.59 pounds in the first month, 12.86 pounds over the first two months, 18.23 pounds over the first three months, 23.49 pounds over the first four months.

For tirzepatide, the average weight loss is 8.31 pounds in the first month, (not even a pound greater than semaglutide), 15.73 pounds over the first two months (almost three pounds more than semaglutide), 19.34 pounds over the first three months (a pound greater than semaglutide) and 26.40 pounds over the first four months (three pounds more than semaglutide).

Semaglutide is $500 per month in our practice and tirzepatide is $600 per month. You may not think that difference in weight loss is enough to spend $100 more on tirzepatide. But as the graphs below show, the side effects occur less often in patients who’ve switched from semaglutide to tirzepatide. Which will you choose?!

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While some rules regarding telemedicine were relaxed during the pandemic, those waivers have expired. Now, providers offering services in other states via telemedicine are required to have a license in the state they’re practicing, even if that practice of medicine is virtual through FaceTime, ZOOM, etc.

So if you’re considering the latest weight loss medications Ozempic, Wegovy or Moujaro, we offer the active ingredients from a compounding pharmacy found in these meds. Specifically, we have semaglutide, the active ingredient in Ozempic/Wegovy or tirzepatide, the active ingredient in Mounjaro. The first step is to schedule a consultation to find which medication may be appropriate for you. After getting baseline labs, you’ll sign up for one these once-per-week injections online, similar to a Netflix subscription. Every 28 days you’ll be charged for the medication of choice and we’ll ship them to your doorstep.

While these medications are paid out of pocket and not covered by insurance when getting them through our office, you’re benefiting from the convenience of getting these meds delivered to you rather than having to deal with the hassle of finding a pharmacy that 1) has the name brand drug and 2) has the dosage you need. Not to mention the hassle of trying to get insurance to cover these medications, which statistically will not happen.

So if you’re in California, Arizona, Hawaii or Florida, start by scheduling a consultation here.

The post Weight management now available for patients in California, Arizona, Hawaii and Florida first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Results of weight loss program

The data is in! Based on the results of our weight management program, our patients have lost an average of 7.7 pounds in only 4 weeks on the lowest, introductory dose of semaglutide!

We’ll continue to track all of our patients with surveys and follow up appointments to get the most complete “picture” of weight loss, but the initial results are very exciting. Keep in mind that every 28 days, our patients get the next higher dose of semaglutide in 4 prefilled syringes for their once-per-week injection.

Extreme weight loss

So with each higher dose, we should continue to see more and more weight loss. Remember that this is the average weight loss. We did have patients who lost a moderate amount but we also had patients losing over 15 pounds and even over 20 pounds in the first month! Pretty amazing and we wish everyone could see those same results.

It’s impossible to know for sure what makes one patient lose more than another but certainly diet, exercise and avoiding high carb and highly refined sugars helps. We’ll continue to track this data and publish it every month.

Where we get our semaglutide

We are getting semaglutide, the active ingredient in Ozempic and Wegovy, from a compounding pharmacy. These results would not be possible if the semaglutide we’re sourcing wasn’t a duplicate of the active ingredient found in the name brand drugs. And I don’t believe this large number of patients in our program would lose that much weight with diet and exercise alone in such a short period of time. So in other words, any doubts people may have about semaglutide from a compounding pharmacy should be put to rest.

Mounjaro (tirzepatide) on tap?

The compounding pharmacy we’re working with is also working on a duplicate of Mounjaro’s active ingredient, tirzepatide. Once that is available, we will offer it to our current and new patients since the data suggests an even greater appetite suppressant effect from Mounjaro due to the combination of a GLP-1 (glucagon like peptide) receptor agonist and GIP (glucose dependent insulinotropic polypeptide). Time will tell.

Pricing

For pricing on our weight management program, click here. For pricing on the medication subscription monthly fee, click here. And if you’d like to schedule a consultation, you can pay for the $100 consultation fee here and it will go towards the cost of the weight management program.

Lastly, if you do lose weight and eventually decide you would like body contouring surgery, the weight management program fee will go towards the cost of surgery. To check pricing on all of our body contouring procedures, click here.

The post Weight Loss Results after 4 weeks on Semaglutide first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Ozempic was first approved in 2017 as a medication for Type 2 Diabetes. Type 2 diabetes is associated with obesity, compared to type 1 diabetes which is often associated with a genetic cause of diabetes seen in juveniles that are not necessarily overweight. In the process of reducing blood sugar and regulating insulin, Ozempic was found to also help patients lose weight.

While it’s legally permissible to use Ozempic for its weight loss benefits rather than to treat type 2 diabetes (off label use), the company that makes Ozempic, Novo Nordisk, also obtained FDA approval for Wegovy in 2021. So rather than obtaining Ozempic for the off label treatment of obesity, Wegovy can be prescribed for the express purpose of weight loss rather than diabetes. But treatment comes at a cost, especially if insurance coverage is not available.

The Cost of Wegovy

As you can see to the left, purchasing a month supply of Wegovy (just the medication), can cost anywhere from $1300 to $1400 per month. Insurance won’t necessarily cover this medication if you don’t have the risk factors required to be a candidate – diabetes, high blood pressure or high cholesterol. To clarify, even without these risk factors, you can still get these medications but insurance won’t cover it and you’ll need to pay out of pocket.

And since Ozempic (the sister medication to Wegovy) isn’t technically approved for the off-label use of treating obesity (remember, it’s only approved to treat type 2 diabetes), you definitely won’t have luck with insurance coverage since insurance typically only covers on-label use.

A less expensive alternative

At Pacific Heights Plastic Surgery, the semaglutide injections you receive weekly as part of our Medical Weight Management Program will be significantly less per month during the 6-month program. In addition to the medication, you’ll receive oversight and coaching by a doctor, nurse practitioner and medical assistant. Keep in mind insurance does not cover our program or the medication we provide but at least it’s a less expensive alternative than purchasing the brand name medications without coverage.

Our Plan vs Purchasing the brand name medications without a program (No Plan)

You can purchase the six-month Weight Management Program online today. Semaglutide injections will be charged separately each month after confirming you’re a candidate. Limited spots available in each weight loss cohort.

We’re sure you have lots of questions so don’t hesitate – call/text (415) 923-3005 or email baelounge@ph-ps.com.

Click here for the original blog post written by Jonathan Kaplan for BuildMyHealth.

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We recently had a patient asking about CoolSculpting for weight loss. As you’ll see below, CoolSculpting, or non-surgical fat reduction, reduces fat but not weight.

Reasonable expectations with CoolSculpting

CoolSculpting freezes stubborn fat in the love handles, thighs, arms, abdomen and pretty much anywhere the suction cup can take hold! When the fat freezes, it “turns itself off, ” effectively dying. The fat layer can decrease by 25% so the contours of the body are improved. But this doesn’t necessarily translate to weight loss.

That’s why when the patient follows up 2 months after treatment, the main outcome measure is photos of the body from 8 different angles. If there is an improvement, it will be seen in the photos, not the scale. The doctor’s office will weigh the patient before and after treatment to see if there’s been a wild shift in weight, not to see if the patient has lost weight due to treatment.

Even liposuction which can remove several liters of fat at a time isn’t meant for weight loss. Liposuction, like CoolSculpting, can also improve contours but will do so more aggressively and to a much greater extent. But still at the end of the day, neither of these should be considered a weight loss treatment.

Diet, exercise or some type of restrictive or absorptive surgical procedure will be the best options for weight loss.

To check pricing on CoolSculpting from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post CoolSculpting is not for weight loss first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

As more consumers research cosmetic surgery online and watch surgery on social media, there’s one thing they keep hearing. That their plastic surgeon won’t operate on them if their BMI (body mass index) is greater than 30. BMI refers to the “magic number” that takes into account your weight in kilograms and your height in centimeters.

BMI has its advantages in the sense that it doesn’t rely solely on your weight to determine if you’re high-risk for surgery. For example, being 300 pounds may sound obese (and increase your risk of wound-healing issues after surgery), but if you’re Shaquille O’Neal, that number may be reasonable since you’re over 7 feet tall. That’s why doctors use BMI instead of just weight to assess your level of obesity and subsequent surgical risk.

Why BMI isn’t enough

But at the end of the day, BMI is still just a number. What about the patient’s overall health? If a patient has a low BMI (good) but also has high blood pressure and diabetes (bad), they’re still high risk for an elective, cosmetic procedure. They could still have problems during surgery or problems with wound healing after surgery.

That’s why we take the whole patient into account when deciding whether they’re a candidate for surgery. Specifically, when it comes to patients that have had a lot of weight loss, they may still have a high BMI. But what are they supposed to do with all of the extra skin that’s left behind? If every doctor turns them down to have their excess skin removed, then it’s sort of bittersweet to lose all of that weight but still not be able to fit into smaller clothes because of the extra skin. And since they lost that extra weight, they probably also cured their high blood pressure and diabetes.

But we do have a limit

So while we may remove the extra skin and fat on someone with a high BMI, we still have to put safety first. That means we limit the amount of fat we remove during each surgical stage. We try to keep the liposuction and fat removal to a 5-liter limit.

The risk of removing too much fat during liposuction is a severe form of dehydration called hypovolemic shock. So the high-BMI patient must understand that while we’ll get them started on their journey (when other doctors may not), it may take several stages of surgery to reach their goal because of the 5-liter limit during each stage.

Take the patient above (and below) as an example. Her BMI is above 30 but there’s no question she benefitted from having her excess skin and fat removed during her tummy tuck procedure. Due to our fat removal limit, she will come back for a second stage to address her thighs.

Check out this video to hear my BMI soapbox!

Just to be clear, a patient with a lower BMI and no medical problems is definitely at a lower surgical risk that one with a high BMI. But if the high-BMI patient is healthy and without those other medical conditions (diabetes, high blood pressure), they can still go through surgery safely. It just may take more than one procedure.

If you want to check your BMI, click here. And if you want to check pricing on various body contouring (skin/fat removal) procedures from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Why we look at more than just BMI [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.