We are truly at revolutionary times for weight loss medications. In the past, medical weight loss has been only semi-effective at best. With the FDA’s 2021 decision to allow Wegovy (semaglutide) to treat chronic weight management, it opened the door for truly effective treatment of weight. In our program, we utilize semaglutide and tirzepatide – both in multiple forms including Wegovy, Zepbound and more. GLP-1RA (Glucagon-like peptide-1 receptor agonist) drugs that help regulate blood sugar levels have been around for close to 20 years and have been primarily used in diabetes treatment. With the evolving list of medications that indicate an additional use of weight loss, we are seeing healthier, happier people whose general health is dramatically improved by the medications.
Here are the weight loss shots that you need to know starting with the GLP-1 receptor agonists. Side bar: An agonist, by definition, is a substance that binds to a receptor in a cell and produces the same action as the natural substance that normally binds to that receptor – in this case, a GLP-1 agonist actions of the endogenous incretin hormone GLP-1 that is released by the gut after eating. Here are the current GLP1s.
- Semaglutide - Semaglutide is a GLP-1 receptor agonist and is the active ingredient in Wegovy and Ozempic. Semaglutide works in 3 main ways: delaying gastric emptying, reducing glucagon release, decreasing food noise (via the satiety and reward pathways) and finally, metabolic optimization (this is: increasing insulin secretion and controlling blood sugar, managing lipid metabolism, and regulating the development of fat ). Semaglutide is our typical first line of prescription. It’s cost effectiveness combined with its results make it an incredible resource for helping our patients reach their weight loss goals. On average, at our practice, patients see a loss of over 24% after one year. Learn more about our weight wellness programs and offerings here: https://www.theaestheticconcierge.co/about-treatments
- Tirzepatide - Tirzepatide is dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist and is the active ingredient in Mounjaro and Zepbound. Similar to semaglutide, it works by metabolic optimization (by increasing insulin secretion), delaying gastric emptying, reducing glucagon release and decreasing food noise (via the satiety and reward pathways). The biggest difference between tirzepatide and semaglutide is that trizepatide mimics both the GLP-1 hormone and another metabolic hormone called GIP. The dual agonist offers an additional component of loss, but long-term data shows similar loss especially in patients who want to lose around 17% - 25% – in line with our internal loss velocity data. We prescribe tirzepatide medications as both an introductory treatment to weight loss and a follow up to plateaued loss on semaglutide after the projected leveling of loss velocity after week 60. Learn more about our weight wellness programs and treatments here: https://www.theaestheticconcierge.co/about-treatments
- Retatrutide - Not fully approved by the FDA yet, retatrutide is a triple agonist of the glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and glucagon receptors. Phase two study results published in The New England Journal of Medicine show the investigational molecule achieved up to 17.5% loss – which is also inline with semaglutide and tirzepatide. Should retatrutide get cleared by the FDA, we’ll likely prescribe it, but in the meantime similar results can be achieved with FDA approved weight loss solutions semaglutide and tirzepatide. Learn more about those treatments and out weight wellness programs here: https://www.theaestheticconcierge.co/about-treatments
- Liraglutide - Like semaglutide, liraglutide is a GLP-1 receptor agonist, but instead of a once weekly injection, it’s injected once daily. This is because semaglutide has a longer elimination half-life, meaning it stays in the body longer. Liraglutide lasts 13 to 15 hours while Semaglutide lasts 165 hours. This means that the feeling of fullness lasts longer and is more pronounced in once weekly subcutaneous semaglutide injections. In the STEP trials, the mean weight change from baseline was –15.8% with semaglutide vs –6.4% with liraglutide. Both groups saw similar side effects. Knowing that we have better results on semaglutide and tirzepatide, we typically do not prescribe liraglutide at The Aesthetic Concierge. Learn more about the treatments and our weight wellness programs here: https://www.theaestheticconcierge.co/about-treatments
There are a few more like dulaglutide, exenatide and lixisenatide, but you don’t hear about those as often.
Before weight loss injections, weight loss drugs were far less effective, and even a bit more risky. We do not prescribe either of these options at our practice, but both are still in circulation today.
- Metformin - Metformin is a diabetes medication used off label for weight loss. Typical loss is 2 -3 % after one year and about one-third of people lose more than 5% of their baseline body weight in the first year. At 15 years, the average weight loss is 6.2%. The thought behind the loss includes its mechanism in helping manage glucose and more nuanced, a Stanford Medicine study found that metformin stimulates production of lac-phe, a molecule abundant after exercise.
- Phentermine - Phentermine is a prescription stimulant and appetite suppressant and an appetite suppressant, which means it may work by itself as a short-term treatment for weight loss and weight management alongside exercise and reducing calorie intake. It may help people lose weight in other ways, such as effects on your brain or your metabolism. It’s only approved to be used by itself for a few weeks. Concerns about longer-term phentermine use include increased risk of cardiovascular disease and potential for addiction.
- Topiramate - Topiramate is a medication that’s typically used for migraines and epilepsy. According to a 2023 literature review, an off-label use for topiramate is weight loss, as it may help reduce calorie intake, reduce fat gain, and lower cholesterol and triglyceride levels. Topamax is only FDA approved for weight loss when combined with another medication called phentermine. This combination is available under the brand name Qsymia (phentermine / topiramate). As mentioned, Topamax can be taken for weight loss on its own, but this is considered an off-label use.
We are thrilled with the results that we’ve seen on our weight wellness program. Notably we helped MirandainCharlotte lose over 27% of her body weight, and on the same note, we help patients every day get closer and closer to their goals with an average internal loss around 24% of body weight lost.
Have questions about which weight loss injection may be best for you? Email us at info@theaestheticconcierge.co for more information about medications we employ and why our program helps make those medications both effective and without side effects.
