Weight Loss Program

Dr Anuja Garg, a Board Certified in Internal Medicine and Obesity medicine, closely monitors our Weight Loss program. We have many patients who have lost 20-40 pounds in a span of few months and have been able to keep it like that while they transitioned to normal food. Our program has a phased approach to Weight Loss.

What patients are saying about our weight loss program?

We have achieved great results with our comprehensive weight loss program and weight loss medicines. Dr Garg is board-certified in Obesity Medicine; hence she helps guide patients from both medicine and weight loss program perspective.

Table of Contents

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Weight Loss Program Phase 1: Intensive weight loss phase

This phase is usually for 8 – 12 weeks, and on average, a patient loses 3-5 pounds in a week; hence, you can lose around 50 pounds in 12 weeks. Patients are advised to take mean replacements during this phase to control their calorie intake. We advise patients to take four meal replacement shakes or soups daily and one lean and green meal.

We will provide lean and green meal recipes and ingredients you can make at home. This will help increase the patient’s calorie intake to 800 – 900 calories daily. We also encourage patients to exercise mild-moderate or join our Yoga sessions on Zoom, which happen daily on weekdays in the morning or evenings.

During all the phases, we closely monitor the patient by ordering the relevant labs, performing EKG, and doing body composition analysis so that we can guide the patients appropriately. All the labs EKG will be covered through your insurance. The body composition analysis is available in bulk at a discount of $199 for ten sessions as part of the registration fees.

Regular Monitoring and Follow-Up

During this phase, you will meet with the doctor weekly for an initial 4 weeks. Post that, you will be meeting every two weeks. During the visit, we will do the EKG, order labs, and perform body composition analysis. Your insurance can cover all the labs and doctor visits as office visits. We have attractive cash pay prices, too, if you don’t have commercial insurance that we don’t take, like Kaiser, etc. Here is the list of insurance and plans we take in our clinic.

Education and Support

• • Nutritional counseling: We will provide you with material to follow for each phase, which will help guide you during the phase. This will also guide you in maintaining a healthy diet and making sustainable lifestyle changes.
  • The doctor will perform behavior counseling to ensure patients make lifestyle changes to maintain healthy habits and monitor their weight daily. We also encourage patients to register and use the MyHealthy Journey app from Robard Corporation to log their daily food, weight, and blood pressure.

Lifestyle Modification

• • Reducing Sugary and Processed Foods: Decrease the consumption of foods and beverages high in added sugars, refined carbohydrates, and unhealthy fats.
  • Stress management: Learn techniques to prevent emotional eating and reduce stress-related weight gain.
  • Sleep management: Addressing sleep patterns and quality can be crucial for weight management.
  • Physical Activity:
    • Regular Exercise: Incorporate regular physical activity into your routine, aiming for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week.
    • Strength Training: Include strength training exercises to build lean muscle mass, boost metabolism and aid in weight loss.
    • Active Lifestyle: Find ways to be more active throughout the day, such as walking or taking the stairs instead of the elevator
  • Sleep Improvement:
    • Sleep Hygiene: Establish a consistent sleep schedule and create a comfortable sleep environment.
    • Adequate Sleep: Aim for 7-9 hours of quality sleep per night, as inadequate sleep can disrupt metabolism and increase cravings for unhealthy foods.
  • Hydration:
    • Water Intake: Drink plenty of water throughout the day to stay hydrated and prevent confusion of thirst with hunger.
  • Social Support:
    • Support System: Seek support from family, friends, or weight loss groups to stay motivated and accountable.

Behavioral Changes

• • Goal Setting: Set realistic and achievable weight loss goals and track your progress. Patients often set realistic weight loss goals, learn strategies to stay motivated, and overcome barriers to success.
  • Self-Monitoring: Keep a food diary or use a mobile app to track your food intake, exercise, and progress.
  • Identify Triggers: Identify emotional or situational triggers for overeating and develop strategies to manage them.

Medical Assessment

• • Initial medical evaluation during kick-off visit: Clinics often start with a thorough assessment of the patient’s health, including medical history, current medications, and any underlying health conditions that may affect weight loss efforts.
  • Ongoing medical evaluation: The doctor will order labs, perform an EKG, and review patient concerns during the visit. She will also review material for behavior counseling, lifestyle modification, education, and support. She will also go over the progress made so far and plan to be followed by the patient for the next few weeks.
  • Body composition analysis may measure body fat percentage, muscle mass, and other relevant metrics.

Weight Loss Program Phase 2: Transition phase with reducing meal replacement with normal meals

This phase usually lasts 12 weeks, where you will see the doctor every 4 weeks. You are expected to lose 1-2 pounds weekly during this phase. The weight loss is reduced as we transition you to normal food and guide you on portion control and maintaining a healthy lifestyle. The transition from meal replacements to normal meals in a weight loss program is critical because it helps individuals gradually reintegrate regular foods into their diets while maintaining their weight loss progress.

The process is typically designed to ensure a smooth transition and to help individuals build sustainable eating habits. Here’s a typical process for transitioning from meal replacements to normal meals in a weight loss program:

Assessment and Planning

The transition process begins with assessing the individual’s progress, goals, and readiness to transition. The doctor reviews the patient’s meal replacement plan and discusses the upcoming transition.

Education and Guidance

Patients are educated about the importance of transitioning gradually and how to make healthy food choices. They receive portion control, balanced nutrition, and meal planning information.

Gradual Reduction of Meal Replacements

The clinic typically starts by gradually reducing the number of weekly meal replacements. Again, the pace of reducing meal replacements also depends on how well you are performing. We might need to adjust the plan if we see a weight increase.

For example, if someone consumes three meal replacements a day, they may reduce to two for some time, then one, and eventually none.

Introduction of Whole Foods

Whole foods like fruits, vegetables, lean proteins, and whole grains are slowly introduced into the diet. Patients are encouraged to choose nutrient-dense foods and to limit processed or high-calorie options. We strongly advise patients to take protein shakes or supplements 1 mg per pound to keep the body full longer and reduce carb intake.

Protein shakes can offer several benefits during weight maintenance, helping individuals sustain weight loss and promote overall health. Here are some of the benefits of including protein shakes in the diet during this phase:

• Satiety and Appetite Control: Protein is highly satiating, meaning it helps you feel full and satisfied. Including protein shakes in your diet can help control hunger and prevent overeating, which is crucial for maintaining weight loss.
• Muscle Maintenance: Protein is essential for preserving and repairing lean muscle mass. During weight loss, some muscle loss can occur along with fat loss. Protein shakes can support muscle maintenance and recovery, helping to prevent a decrease in metabolism.
• Metabolism Support: A higher protein intake can boost your metabolism slightly due to the thermic effect of food (TEF), which is the energy expenditure required to digest, absorb, and metabolize nutrients. Protein has a higher TEF compared to carbohydrates and fats.
• Nutrient Density: Protein shakes can be convenient and nutrient-dense, providing essential amino acids, vitamins, and minerals without excessive calories or unhealthy additives.
• Improved Muscle Recovery: If you’re engaging in regular physical activity or strength training to maintain weight loss, protein shakes can aid in muscle recovery and reduce post-exercise soreness.
• Balanced Nutrition: Protein shakes can complement a well-balanced diet by providing an additional source of high-quality protein, which can be especially helpful if you have dietary restrictions or preferences that limit your protein intake from whole foods.
• Prevent Muscle Loss: Protein shakes can help prevent muscle loss that may occur if you inadvertently reduce your protein intake during the weight maintenance phase.

Meal Planning and Tracking

Patients are taught to plan balanced meals with protein, fiber, healthy fats, and various nutrients. Keeping a food journal or using a meal-tracking app can help individuals monitor their food intake and stay on track.

Regular Clinic Visits

Patients continue to have regular follow-up appointments once every month at the weight loss clinic to monitor progress and receive guidance. Clinicians may adjust the transition plan based on individual needs and responses.

Behavioral Support

Behavioral counseling and support are essential during the transition phase to address any emotional or psychological challenges that may arise.

Support System

During the transition, encouragement from friends, family, or support groups can be beneficial. Patients are encouraged to share their experiences and seek support when needed.

Stress Management

Stress management techniques are emphasized to help patients cope with potential challenges and emotional triggers during the transition.

Weight Loss Program Phase 3: Weight maintenance

This phase typically starts after 24 months in the program, where you have transitioned to normal meals and protein supplements/shakes. At this point, you can see the doctor every 2-3 months as needed. We recommend daily monitoring of the weight and consulting a doctor if you see a more than 5-pound increase in weight as it might need adjustment in your food intake or getting medicines prescribed to maintain a healthy weight.

1. Monitor Your Weight: Monitor your weight regularly. Weigh yourself daily to stay within your target range of goal weight + 5 pounds.
2. Balanced Diet: Maintain a balanced and nutritious diet. Continue to emphasize whole foods, including fruits, vegetables, lean proteins, whole grains, and healthy fats.
3. Portion Control: Practice portion control to prevent overeating. Be mindful of serving sizes and avoid the temptation to return to larger portion sizes.
4. Regular Meals: Stick to regular meal times and avoid skipping meals. Eating consistently throughout the day can help regulate hunger and prevent overindulging.
5. Mindful Eating: Continue practicing mindful eating by paying attention to hunger and fullness cues, savoring your meals, and avoiding distractions while eating.
6. Stay Hydrated: Maintain adequate hydration by drinking plenty of water throughout the day. Sometimes, thirst can be confused with hunger.
7. Regular Physical Activity: Keep up with regular physical activity. As health guidelines recommend, aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity aerobic exercise per week.
8. Strength Training: Include strength training exercises in your fitness routine to preserve lean muscle mass and support a healthy metabolism.
9. Stress Management: Continue to manage stress through relaxation techniques, mindfulness, or other stress reduction strategies to prevent emotional eating.
10. Sleep: Prioritize good sleep hygiene and aim for 7-9 hours of quality sleep per night to support your metabolism and overall well-being.
11. Behavioral Support: Consider continuing with behavioral counseling or support groups to address any emotional or psychological factors affecting your eating habits.
12. Celebrate Success: Celebrate your achievements and milestones, but do so in ways that don’t involve food. Reward yourself with non-food treats or activities.
13. Regular Clinic Visits: Maintain regular follow-up appointments with your weight loss clinic or healthcare provider. These visits can help you stay on track, receive guidance, and address any challenges that may arise.
14. Long-Term Mindset: Shift your mindset from short-term dieting to a long-term commitment to a healthy lifestyle. Understand that maintaining weight loss is an ongoing process.
15. Flexibility: Be flexible with your eating patterns and allow occasional indulgences or special occasions. The key is to balance these treats with a generally healthy diet.

When do you prescribe medicines for weight loss?

Prescription medications for weight loss are typically considered based on the following:

1. Diet and Lifestyle Modifications Aren’t Sufficient: When individuals have made concerted efforts to lose weight through dietary changes, increased physical activity, and behavioral modifications but have not achieved the desired results, healthcare providers may consider prescription weight loss medications.
2. BMI Criteria: Prescription weight loss medications are often prescribed to individuals who meet specific body mass index (BMI) criteria. These criteria may include individuals with a BMI of 30 or greater (obesity) or those with a BMI of 27 or greater with at least one weight-related comorbidity, such as type 2 diabetes or high blood pressure.
3. Health Risk Assessment: Healthcare providers assess the overall health risks associated with obesity, considering cardiovascular risk, diabetes risk, and other obesity-related conditions. If the risks are substantial, they may consider prescription medications to help manage weight and reduce those risks.
4. Lack of Response to Other Interventions: Individuals who have not responded adequately to non-pharmacological interventions, such as diet and exercise, may be candidates for weight loss medications.
5. Patient Preferences and Goals: When considering weight loss medications, healthcare providers consider the individual’s preferences, goals, and willingness to adhere to a prescribed medication regimen.
6. Exclusion of Other Factors: Healthcare providers ensure that underlying medical or psychological factors contributing to weight gain have been adequately addressed or ruled out before prescribing weight loss medications.

It’s important to note that prescription weight loss medications are not a one-size-fits-all solution, and their use should be carefully considered on a case-by-case basis. They are typically recommended as part of a comprehensive weight management plan that includes dietary changes, increased physical activity, and behavioral counseling. Additionally, prescription weight loss medications are generally intended for short-term use and should be used under the supervision of a healthcare provider.

Before considering weight loss medications, individuals should consult with a healthcare provider who can assess their specific medical needs, discuss potential benefits and risks, and help determine the most appropriate approach to weight management based on their unique circumstances.

What are the medicines prescribed at your clinic for weight loss?

Prescription medications for weight loss may be considered in the following typical conditions or situations:

1. Obesity (BMI ≥ 30): Prescription weight loss medications are often prescribed to individuals with a body mass index (BMI) of 30 or greater, which is considered obesity. These medications can help individuals with obesity lose weight and improve their overall health.
2. Overweight with Comorbidities (BMI ≥ 27): In some cases, prescription weight loss medications may be considered for individuals with a BMI of 27 or greater if they have at least one weight-related comorbidity, such as type 2 diabetes, high blood pressure, or dyslipidemia (abnormal cholesterol levels). These medications can help manage both weight and comorbid conditions.
3. Type 2 Diabetes: Some weight loss medications, such as GLP-1 receptor agonists like semaglutide (e.g., Ozempic) and liraglutide (e.g., Saxenda), are also approved for treating type 2 diabetes. These medications can help lower blood sugar levels and support weight loss, making them suitable options for individuals with type 2 diabetes who struggle with weight management.
4. Cardiovascular Risk Reduction: In cases where individuals have a high risk of cardiovascular events (e.g., heart attack or stroke) due to obesity or other risk factors, prescription weight loss medications may be considered as a strategy to reduce cardiovascular risk.
5. Lack of Response to Lifestyle Modifications: When individuals have made substantial efforts to lose weight through diet, exercise, and behavior modification but have not achieved significant weight loss, prescription medications may be considered to enhance the effectiveness of these interventions.
6. Medical Necessity: In some situations, where obesity poses a severe risk to an individual’s health and well-being, healthcare providers may prescribe weight loss medications as a medical necessity.

It’s important to note that weight loss medications are typically part of a comprehensive weight management plan that includes dietary changes, increased physical activity, and behavioral counseling. The decision to prescribe such medications should be based on a thorough assessment of an individual’s unique medical needs, health risks, and treatment goals. Additionally, prescription weight loss medications are generally intended for short-term use and should be used under the supervision of a healthcare provider. Below are all the medicines prescribed at our weight loss clinic. Dr Garg prescribes the weight loss medicines mostly during Phase 2 and 3 of the weight loss program during the transition and weight maintenance phases.

Metformin

Metformin is a medication commonly used to manage blood sugar levels in individuals with type 2 diabetes. While its primary purpose is not weight loss, some people with diabetes who take Metformin may experience modest weight loss as a side effect. Here’s how Metformin may influence weight:

1. Appetite Suppression: Metformin may help reduce appetite in some individuals, leading to decreased calorie intake and, consequently, weight loss.
2. Improved Insulin Sensitivity: Metformin improves insulin sensitivity, leading to better blood sugar control and, in some cases, weight loss. When insulin resistance contributes to weight gain, addressing it with Metformin can help.
3. Reduced Fat Absorption: Some studies suggest that Metformin may reduce the absorption of dietary fat in the intestines, which can lead to a reduction in calorie intake and potential weight loss.
4. Changes in Gut Microbiota: Metformin may alter the composition of gut bacteria, which can impact metabolism and body weight regulation.

It’s important to note that the weight loss effects of Metformin are generally modest, and not everyone who takes Metformin will experience weight loss. The amount of weight lost varies among individuals, and it’s usually in the range of 1-2 kilograms (2-4 pounds) on average. Additionally, any weight loss achieved with Metformin may be more pronounced in the early stages of treatment and may stabilize over time.

Metformin is not a standalone weight loss solution; its primary purpose is to manage blood sugar levels in individuals with diabetes. It should only be used under the guidance of a healthcare provider and as part of a comprehensive diabetes management plan. Metformin is not recommended or prescribed solely for weight loss in individuals without diabetes.

Before considering Metformin or any other medication for weight management, it’s essential to consult with a healthcare provider. They can assess your specific health needs, evaluate potential risks and benefits, and provide guidance on appropriate treatment options tailored to your circumstances.

Wegovy

Wegovy is a new weight loss medication that can cost 1000+ dollars if taken without insurance for a month; hence, usually, people take it using their health insurance. Getting Wegovy (semaglutide 2.4 mg) approved through insurance can vary depending on several factors, including your insurance provider, specific insurance plan, and individual medical circumstances. Here are some factors to consider:

1. Insurance Provider: Different insurance providers may have varying policies and guidelines for covering prescription medications, including those for weight management. Some insurance providers may have specific criteria that must be met for coverage.
2. Coverage Policies: Insurance plans often have specific criteria and coverage policies for weight loss medications. These criteria may include factors such as your BMI, weight-related comorbidities (e.g., type 2 diabetes, high blood pressure), and prior attempts at weight loss through lifestyle modifications.
3. Prior Authorization: In some cases, we may need prior authorization from your insurance company before prescribing Wegovy. This typically involves submitting documentation to demonstrate the medical necessity of the medication.
4. Patient Responsibility: Even if your insurance covers Wegovy, you may still have out-of-pocket costs, such as copayments or deductibles, depending on your insurance plan. Be sure to review your plan’s coverage details and cost-sharing responsibilities.
5. Medical Necessity: Insurance coverage for Wegovy is more likely when it is considered medically necessary for treating obesity or overweight individuals with weight-related comorbidities.

As for the effectiveness of Wegovy for weight loss, clinical trials have demonstrated its potential to lead to substantial weight loss in individuals with obesity or overweight individuals with specific weight-related comorbidities. In these trials, individuals using Wegovy, in combination with lifestyle modifications, achieved significant reductions in body weight compared to those using a placebo.

Wegovy belongs to the class of medications known as glucagon-like peptide-1 receptor agonists (GLP-1 RAs). It works by increasing feelings of fullness, reducing appetite, and slowing down gastric emptying. The weight loss observed with Wegovy is often more pronounced and faster than with many other weight loss medications.

Wegovy is started in small doses like .25 mg and then increased over time; hence, it might take a few months to realize any weight loss. Once you reach the recommended dosage for Wegovy for weight loss, you might see 20-30 pounds of weight loss in the initial month. Wegovy is usually taken for the long term, and you might regain weight once it is stopped. The side effects of Wegovy include vomiting, which might be worsened by drinking alcohol. Wegovy is only recommended for patients with BMI over 27.

Wegovy (semaglutide 2.4 mg) is a prescription medication used for weight management in adults with obesity or overweight individuals with certain weight-related comorbidities. The recommended dosage and administration of Wegovy are as follows:

Dosage:

• The recommended dosage of Wegovy is 2.4 mg once weekly. It is recommended to start slowly, like .25 mg per week, then slowly increase the dosage to ensure your body gets enough time to adapt to this medicine. Please talk to your healthcare provider for details.

Administration

Wegovy is administered by subcutaneous injection, which is injected under the skin.

• You can self-administer Wegovy using a pre-filled pen injector provided by your healthcare provider.
• Here are general steps for how to take Wegovy:
  1. Ensure that the Wegovy pen is at room temperature before using it. Allow it to sit out for approximately 30 minutes.
  2. Choose an injection site on your body, such as the abdomen, thigh, or upper arm.
  3. Clean the injection site with an alcohol swab.
  4. Remove the cap from the Wegovy pen.
  5. Insert the needle into the injection site at a 90-degree angle.
  6. Press the button on the pen to deliver the medication. You should hear a click when it starts.
  7. Press the button for 5 seconds to ensure you receive the full dose.
  8. Remove the needle from your skin and dispose of it safely.
  9. Replace the pen cap and store the pen as directed in the medication’s instructions.
• Wegovy should be injected conveniently on the same day each week. It is important to maintain a consistent schedule.
• Your healthcare provider will provide detailed instructions on using Wegovy, and following their guidance closely is essential.

Ozempic

Ozempic (semaglutide) is a prescription medication to help control blood sugar levels in adults with type 2 diabetes. It belongs to a class of medications known as glucagon-like peptide-1 receptor agonists (GLP-1 RAs). In addition to its primary use in diabetes management, Ozempic has also been evaluated for its potential as a weight loss medication.

Here is some information about Ozempic, including its recommended dosage and common side effects:

Recommended Dosage

• The recommended starting dose of Ozempic for most adults with type 2 diabetes is typically 0.25 mg once weekly.
• After at least 4 weeks at the 0.25 mg dose, the healthcare provider may increase the dosage to 0.5 mg once weekly for additional blood sugar control if necessary.
• Some individuals may eventually require a further dose increase to 1 mg once weekly, but this should be determined by a healthcare provider based on individual needs.

Administration

• Ozempic is administered by subcutaneous injection (under the skin) using a pre-filled pen injector provided by your healthcare provider.
• It should be injected once weekly on the same day each week, at a convenient time.

Common Side Effects of Ozempic

• Like any medication, Ozempic can cause side effects. Common side effects may include:
  • Nausea
  • Diarrhea
  • Vomiting
  • Abdominal pain
  • Decreased appetite
  • Fatigue
• These side effects are often temporary and may improve as your body adjusts to the medication.

Serious Side Effects

• While uncommon, Ozempic may also cause more serious side effects. Contact your healthcare provider immediately if you experience any of the following:
  • Severe allergic reactions (e.g., rash, itching, swelling of the face, lips, tongue, or throat)
  • Severe gastrointestinal reactions (e.g., pancreatitis, gallbladder problems)
  • Low blood sugar (hypoglycemia) if used in combination with certain other diabetes medications

It’s important to note that Ozempic may have additional uses and side effects when used specifically for weight management. The dosage and use of Ozempic for weight loss may differ from its use in diabetes management.

Expected weight loss

Ozempic (semaglutide) has been evaluated in clinical trials for its potential to promote weight loss and its primary use in managing blood sugar levels in adults with type 2 diabetes. The extent of weight loss achieved with Ozempic can vary among individuals and depends on several factors, including the individual’s baseline weight, adherence to treatment, and other individual characteristics.

In clinical trials, individuals using Ozempic typically achieved the following weight loss results:

• Percentage of Weight Loss: On average, participants in clinical trials experienced weight loss in the range of 4-6% of their initial body weight when using Ozempic. This is considered a significant and clinically meaningful amount of weight loss.
• Absolute Weight Loss: The amount lost varies based on an individual’s starting weight. For example, if someone initially weighed 200 pounds, a 4-6% weight loss would equate to a reduction of approximately 8-12 pounds.
• Time Frame: Weight loss with Ozempic is often more pronounced in the early stages of treatment and may continue over time. The duration of treatment can also influence the total amount of weight loss.

It’s important to note that individual responses to medications can vary, and the effectiveness of Ozempic may depend on factors such as adherence to the prescribed treatment plan, lifestyle modifications (e.g., dietary changes and increased physical activity), and other individual characteristics.

The weight loss achieved with Ozempic can be significant and may provide health benefits beyond diabetes management. However, discussing the use of Ozempic, including its potential for weight loss, with your healthcare provider is essential. They can provide personalized guidance based on your medical history and health needs. Additionally, they can help monitor your progress and adjust your treatment plan as necessary to achieve the desired outcomes.

Liraglutide (Saxenda)

While primarily used for diabetes management, liraglutide has been approved for weight management. It affects appetite regulation and slows gastric emptying.

Saxenda is a brand name for a prescription medication called liraglutide. It is used to manage obesity and weight loss in adults with a body mass index (BMI) of 30 or greater or in overweight individuals with a BMI of 27 or greater who have at least one weight-related comorbidity (e.g., high blood pressure, type 2 diabetes).

Here is some information about Saxenda, including dosage, administration, side effects, and expected weight loss:

Dosage

• The starting dose of Saxenda is typically 0.6 mg injected subcutaneously (under the skin) once daily.
• The dosage is increased gradually over several weeks to minimize side effects. The recommended maintenance dose is usually 3 mg once daily.

Administration

• Saxenda is administered using a pre-filled, multi-dose pen injector. It is injected under the skin (subcutaneously), typically in the abdomen, thigh, or upper arm.
• The injection can be performed at any time, with or without food, but it should be administered at approximately the same time each day.

Side Effects

Common side effects of Saxenda may include:

• • Nausea
  • Diarrhea
  • Vomiting
  • Constipation
  • Decreased appetite
  • Indigestion
  • Headache

Saxenda is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) and may have gastrointestinal side effects, especially when the dosage increases.

Expected Weight Loss:

• The amount of weight loss achieved with Saxenda can vary among individuals. Individuals using Saxenda may expect to lose 5-10% of their initial body weight.
• The effectiveness of Saxenda may depend on factors such as adherence to the prescribed treatment plan, lifestyle modifications, and individual characteristics.

Saxenda is typically prescribed as part of a comprehensive weight management program that includes dietary changes, increased physical activity, and behavioral counseling. It is intended for long-term use and should be supervised by a healthcare provider.

Mounjaro

Mounjaro, which received FDA approval last year for the treatment of Type 2 diabetes, is an injectable medication administered every week. This medicine is not approved by FDA for weight loss hence it is prescribed by doctors for weight loss as off-label use only if you have diabetes. Typically, healthcare professionals initiate the treatment with a conservative dose of the injection and subsequently adjust the dosage after four weeks, considering how your body responds.

The key component found in Mounjaro, Tirzepatide, functions by activating two naturally occurring hormones within the body: glucagon-like peptide-1, or GLP-1, and glucose-dependent insulinotropic polypeptide, or GIP. This combination is reported to decelerate gastric emptying, extending the sensation of fullness and diminishing appetite by retarding hunger signals within the brain.

For individuals with Type 2 diabetes, Mounjaro is recommended with dietary adjustments and physical activity to enhance blood sugar control. It is crucial to note that Mounjaro should not be prescribed to patients with specific medical conditions, including medullary thyroid cancer, pancreatitis, or gallstones.

Prior studies among people with obesity without Type 2 diabetes have shown a weight loss within the range of 15% to 21%, depending on the dose of the medication given.

Dosage:

Mounjaro injection, available in 2.5 mg to 15 mg doses, is a prescription injectable medication employed for the following purposes:

• In conjunction with dietary adjustments and physical activity, it enhances blood sugar (glucose) control in adults diagnosed with type 2 diabetes.
• It is utilized to diminish the likelihood of significant cardiovascular events, such as heart attacks, strokes, or fatalities, in adults with type 2 diabetes with a documented history of heart disease.

Administration

Mounjaro is injected subcutaneously on the stomach, thigh, or upper arm.

Side effects:

The most frequently encountered side effects of Mounjaro include nausea, diarrhea, reduced appetite, vomiting, constipation, indigestion, and abdominal discomfort. There are also infrequent but severe side effects to be aware of. These include pancreatitis, low blood sugar, kidney impairment, allergic reactions, and gallbladder complications.

Patients must be informed that the use of Mounjaro may carry a risk of thyroid tumors, particularly among individuals with a familial history of a specific type of thyroid cancer known as medullary thyroid carcinoma. As a result, such individuals should refrain from using this medication.

Orlistat

Orlistat is a prescription medication used for weight loss. It belongs to a class of drugs known as lipase inhibitors. Orlistat works by blocking the absorption of dietary fat in the digestive system, which can reduce the number of calories absorbed from the fats in the food you eat. This leads to a reduction in overall calorie intake, which can aid in weight loss.

Mechanism of Action:

• Orlistat works by inhibiting the action of lipase enzymes in the gastrointestinal tract. Lipase enzymes are responsible for breaking down dietary fats into smaller molecules that the body can absorb.
• When Orlistat is taken with a meal, it prevents some dietary fat from being digested and absorbed. Instead, the undigested fat passes through the digestive system and is excreted in the stool.

Dosage and Administration:

• Orlistat is typically taken orally in the form of capsules with meals that contain fat.
• The recommended dosage can vary, but it is often taken three times daily with each main meal containing fat.

Side Effects:

• Common side effects of Orlistat may include:
  • Oily spotting or discharge from the rectum
  • Gas with discharge
  • Urgent or increased bowel movements
  • Fatty or oily stools
  • Abdominal cramping or discomfort
  • Headache
• Orlistat reduces fat absorption, and these side effects are often related to the unabsorbed fat passing through the digestive system.

Expected Weight Loss:

• The amount of weight loss achieved with Orlistat can vary among individuals. Individuals using Orlistat may expect to lose a modest amount of weight compared to diet and lifestyle changes alone.
• Weight loss results can be influenced by factors such as adherence to the prescribed treatment plan, dietary choices, and physical activity levels.

Orlistat is typically recommended as part of a comprehensive weight management program that includes dietary changes, increased physical activity, and behavioral counseling. It is important to follow a healthcare provider’s prescribed dosing instructions and dietary recommendations.

Before considering Orlistat or any other weight loss medication, it’s essential to consult with a healthcare provider who can assess your specific medical needs, discuss potential benefits and risks, and help determine whether Orlistat is an appropriate option for you based on your unique circumstances. Additionally, they can provide guidance and support throughout your weight management journey.

Phentermine (Adipex-P, Lomaira)

Phentermine is one of the most widely prescribed appetite suppressants. It works by stimulating the release of certain chemicals in the brain that help reduce appetite. Phentermine is typically prescribed for short-term use due to the potential for tolerance development.

Lomaira is a brand name for a prescription medication, phentermine hydrochloride, used as an appetite suppressant for weight loss. Phentermine is among the most commonly prescribed weight loss medications in the United States.

How Lomaira Works for Weight Loss?

Phentermine is a sympathomimetic amine that stimulates the release of norepinephrine in the brain. This stimulation can lead to a reduction in appetite and an increase in the feeling of fullness, ultimately helping to reduce calorie intake. Phentermine is typically used as a short-term adjunct to lifestyle modifications for weight management.

Dosage

Lomaira comes in low-dose tablets of 8 mg and is intended for short-term use. The recommended dosage may vary depending on the individual’s response and the healthcare provider’s assessment, but it is typically taken one to three times per day, 30 minutes before meals.

Side Effects

Common side effects of phentermine (including Lomaira) may include:

1. Increased Heart Rate: Phentermine can stimulate the heart, leading to an increased heart rate or palpitations. Individuals with pre-existing heart conditions need to use phentermine cautiously and under medical supervision.
2. Dry Mouth: Dry mouth is a common side effect of phentermine use.
3. Insomnia: Phentermine is a stimulant and can lead to difficulty sleeping, especially when taken later in the day.
4. Nervousness or Restlessness: Some individuals may experience feelings of nervousness or restlessness when taking phentermine.
5. High Blood Pressure: Phentermine can raise blood pressure in some individuals, so regular monitoring is important.
6. Gastrointestinal Disturbances: This may include constipation, diarrhea, or upset stomach.
7. Dizziness: Some people may experience dizziness or lightheadedness while taking phentermine.
8. Headache: Headaches can be a side effect for some individuals.

It’s important to note that phentermine should be used under the supervision of a healthcare provider, and the decision to prescribe it should be made based on an individual’s specific medical history and needs. Phentermine is typically recommended for short-term use (usually a few weeks to a few months) as part of a comprehensive weight management program that includes dietary changes and increased physical activity.

Long-term use of phentermine is generally not recommended due to the potential for tolerance development, and it is classified as a controlled substance due to its potential for abuse. It should not be used in individuals with a history of substance abuse.

Expected weight loss

The weight loss that can be expected from Lomaira (phentermine hydrochloride) varies among individuals and depends on several factors, including the individual’s baseline weight, adherence to the prescribed treatment plan, lifestyle modifications, and other individual characteristics. The following factors can influence weight loss results with Lomaira:

1. Starting Weight: Individuals with a higher initial body weight may experience more significant weight loss than those closer to their target weight.
2. Adherence to Treatment: Consistently taking Lomaira as prescribed and following the healthcare provider’s recommendations is crucial for achieving and maintaining weight loss.
3. Lifestyle Modifications: Lomaira is typically prescribed as part of a comprehensive weight management program that includes dietary changes, increased physical activity, and behavior modifications. The extent to which these lifestyle changes are adopted can influence the overall weight loss results.
4. Individual Response: Individual responses to medications can vary. Some people may experience more pronounced appetite suppression and weight loss, while others may respond more moderately.
5. Duration of Use: Lomaira is typically intended for short-term use, usually a few weeks to a few months. Weight loss results may be more pronounced during the time it is actively used.
6. Medical History: An individual’s medical history, including any underlying health conditions, can influence weight loss outcomes.

It’s important to note that Lomaira, like other appetite suppressants, is not a stand-alone solution for weight loss. It is prescribed as part of a broader weight management plan and is most effective when combined with dietary modifications, increased physical activity, and behavioral counseling.

On average, individuals using phentermine (including Lomaira) as part of a comprehensive program may achieve weight loss in the range of 5-10% of their initial body weight. However, individual results can vary widely.

Phentermine-Topiramate (Qsymia)

This combination of medication includes phentermine and topiramate. It helps reduce appetite and increase feelings of fullness. Qsymia is prescribed for individuals with obesity or overweight individuals with weight-related comorbidities.

Qsymia is a prescription medication used for weight management in adults who are overweight or obese and have at least one weight-related comorbidity. It is a combination medication that contains two active ingredients: phentermine and topiramate. These two drugs work together to help control appetite and promote weight loss.

Here is some information about Qsymia, including dosage, administration, side effects, and expected weight loss:

Dosage

• The dosage of Qsymia can vary depending on the specific formulation (Qsymia or Qsymia Extended-Release) and the healthcare provider’s assessment of the individual’s needs.
• The typical starting dose of Qsymia is usually the lower-dose formulation, which contains 3.75 mg of phentermine and 23 mg of topiramate. This may be increased to the higher dose, which contains 7.5 mg of phentermine and 46 mg of topiramate, after a certain period if weight loss results are insufficient.
• The extended-release formulation, Qsymia Extended-Release (ER), is available in different strengths, and the dosage should be adjusted according to the healthcare provider’s recommendations.

Administration

• Qsymia is typically taken orally as a once-daily medication. The extended-release formulation is taken once daily in the morning.

Side Effects

• Common side effects of Qsymia may include:
  • Increased heart rate
  • Numbness or tingling in the hands or feet
  • Dizziness
  • Dry mouth
  • Constipation
  • Changes in taste
  • Difficulty sleeping (insomnia)
  • Mood changes
  • Concentration problems
• Serious side effects, including increased heart rate, eye problems, and cognitive or psychiatric effects, can occur. It’s important to promptly report any unusual or severe side effects to a healthcare provider.

Expected Weight Loss

• The amount of weight loss achieved with Qsymia can vary among individuals. Individuals using Qsymia may expect to lose 5-10% of their initial body weight.
• It’s important to remember that individual responses to medications can vary widely, and the effectiveness of Qsymia may depend on factors such as adherence to the prescribed treatment plan, lifestyle modifications, and other individual characteristics.

Qsymia is generally prescribed as part of a comprehensive weight management program that includes dietary changes, increased physical activity, and behavioral counseling. The medication is intended for use over a specified duration and should be used under the supervision of a healthcare provider.

Buproprion-Naltrexone (Contrave)

Contrave combines bupropion, an antidepressant, and naltrexone, which is used to treat addiction. Together, they affect the brain’s reward system and appetite control centers, helping to reduce food cravings and promote weight loss.

Contrave is a prescription medication for weight management in adults with obesity or overweight individuals with weight-related comorbidities. It is a combination medication that contains two active ingredients: bupropion and naltrexone. Contrave works through a combination of mechanisms in the brain to reduce appetite and food cravings while increasing the feeling of fullness, ultimately helping to control calorie intake and promote weight loss.

Here is some information about Contrave, including dosage, administration, side effects, and expected weight loss:

Dosage

• The recommended dosage of Contrave may vary depending on the individual’s response and the healthcare provider’s assessment. It typically starts at a lower dose and gradually increases to the target dose over a few weeks.
• The target dose of Contrave contains 8 mg of naltrexone and 90 mg of bupropion, and it is usually taken as one tablet in the morning and one tablet in the evening.

Administration

• Contrave is taken orally as a tablet, typically twice daily.
• Following the healthcare provider’s instructions regarding the dosing schedule is essential.

Side Effects

• Common side effects of Contrave may include:
  • Nausea
  • Constipation
  • Headache
  • Dizziness
  • Dry mouth
  • Insomnia
  • Increased blood pressure and heart rate
• Contrave has a boxed warning about the risk of suicidal thoughts and behaviors associated with bupropion, one of its active ingredients. Individuals taking Contrave should be monitored for mood changes and suicidal ideation.

Expected Weight Loss

• The amount of weight loss achieved with Contrave can vary among individuals. Individuals using Contrave may expect to lose 5-10% of their initial body weight.
• The effectiveness of Contrave may depend on factors such as adherence to the prescribed treatment plan, lifestyle modifications, and other individual characteristics.

Contrave is generally prescribed as part of a comprehensive weight management program that includes dietary changes, increased physical activity, and behavioral counseling. The medication is intended for use over a specified duration and should be used under the supervision of a healthcare provider.

Before considering Contrave or any other weight loss medication, it’s essential to consult with a healthcare provider who can assess your specific medical needs, discuss potential benefits and risks, and help determine whether Contrave is an appropriate option for you based on your unique circumstances. Additionally, they can provide guidance and support throughout your weight management journey.

How much will it cost me to do this program?

There will be a $199 registration fee, which covers the nine body composition analyses. There will be a charge of $15 for each phase material/booklet. All visits with the doctor will be billed to the insurance if we are in the network. You can check with your insurance if we are in the network. You can see the list of all the insurance we accept on this page. Otherwise, for cash-pay patients, the first three visits until kickstart will be charged at $125, and post-kickstart visits will be charged at $99. The meal replacements can be ordered from the Robard store at this link.

On average, meal replacement will cost around $20 for one pack, and you will need 4 boxes weekly for $100 per week, including shipping, as we do a 4+1 program in Phase 1. Your insurance can cover all the medications a doctor prescribes, or you can use the Goodrx website to get self-pay coupons.

How frequently do I need to see the doctor during this program?

You will visit the doctor once weekly for the initial 4 weeks. Post that, it will be once every two weeks for the next four weeks. It will be once a month for 3 – 6 months. After 6 months, you will be in the weight maintenance phase and need to see a doctor once every 2-3 months if you run into issues or gain weight.

How can I order the meal replacement packets? How soon will they be delivered?

After you pay for registration, we will schedule a few initial visits where the doctor performs your EKG and reviews your medical history. She will also order relevant labs and discuss the results with you. You can order a variety pack from our office or online to taste a few meal replacement options to see if you like them. After trying some products, you can decide what you like and order from the Robard store.

What happens if I run out of meal replacement packets?

We have a few sample boxes of Robary variety packs and some other flavors at our office; hence, you can visit our office and see if you want to purchase a few boxes from us until you get the Robard order. We can also help track your order as needed.

What is the best way for me to sign up for the weight loss program at your clinic?

We recommend you call our clinic at this number 925-263-9547 and make an appointment for the first visit and provide you with forms you need to fill out and bring to the first visit. The doctor will go over your history and weight loss goals. She will also order labs during this visit and perform EKG as needed.