Medical Weight Management
IN PORTSMOUTH, NH
At Hera Skin and Wellness, we partner with our patients to help appropriate candidates achieve sustained weight loss, optimize their metabolic function, and achieve a healthy lifestyle and aging process.
Our comprehensive program begins with a consultation to identify the patient’s candidacy for treatment, potential contraindications, as well as potential comorbidities.
Your medical provider will create a tailored plan for weight management with a focus on well-balanced nutrition, exercise, injectable weight loss medication, and supplements if appropriate.
For optimal results, we will perform laboratory monitoring and schedule weekly visits to monitor health and body composition metrics, assess any possible adverse effects, and make dose adjustments as indicated.
WHO IS A CANDIDATE?
Appropriate candidates are individuals who meet health criteria for medical weight loss treatment. These individuals have typically had difficulty with prior efforts at weight loss through diet and exercise alone due to various underlying factors. Key criteria for candidacy include:
1.) Obesity: those with a BMI of 30 or higher are generally considered candidates for medical weight loss interventions. In some cases, a BMI of 27-29.9 may qualify if the patient has weight-related health conditions.
2.) Individuals with weight-related health conditions: medical weight loss can help support treatment of weight-related health conditions such as type 2 diabetes, hypertension, or hyperlipidemia. Those who are at increased risk of conditions such as stroke, heart disease, or sleep apnea as a result of their obesity will be considered as candidates as well.
3.) Those who have tried diet and exercise without success: individuals who have been unable to achieve or maintain a healthy weight despite efforts at a well-balanced diet and exercise may be suitable candidates for medical weight loss.
4.) Those who have conditions that affect their metabolism: Conditions such as hypothyroidism, polycystic ovary syndrome (PCOS), or insulin resistance may make it harder for individuals to lose weight. Other potential contributing factors may include sleep disorders, or medication side effects.
5.) Those with psychological factors affecting weight loss: Individuals dealing with excessive stress, emotional eating, food addiction, or mental health conditions such as depression or anxiety may benefit from medical weight loss programs. We recommend incorporating psychological support or behavioral therapy in these instances to address the root causes of overeating. Those with restrictive food-related disorders are not candidates for this treatment.
EXAMPLE DOSING SCHEDULE USING SEMAGLUTIDE
Dosing schedule is subject to change per your provider’s recommendation, efficacy, and tolerability.
Phase 1:
Week 1: 0.25 mg (10 units)
Week 2: 0.25 mg (10 units)
Week 3: 0.5 mg (20 units)
Week 4: 0.5 mg (20 units)
Week 5: 0.75 mg (30 units)
Phase 2:
Week 6: 0.75 mg (30 units)
Week 7: 1.0 mg (40 units)
Week 8: 1.0 mg (40 units)
Week 9: 1.25 mg (50 units)
Week 10: 1.25 mg (50 units)
Phase 3:
Week 11: 1.5 mg (60 units)
Week 12: 1.5 mg (60 units)
Week 13: 1.75 mg (70 units)
Week 14: 1.75 mg (70 units)
Week 15: 2.0 mg (80 units)
FAQ
What are semaglutide and tirzepatide?
Semaglutide and tirzepatide are injectable medications used to treat type 2 diabetes, certain metabaolic conditions, and to aid in weight loss. They belong to a class of drugs known as glucagon-like peptide-1 receptor agonists (GLP-1 RAs), although tirzepatide also has dual action as a glucose-dependent insulinotropic polypeptide (GIP) receptor agonist.
Glucagon-like peptide 1 (GLP-1) agonists are a class of medications that mimic the action of GLP-1 hormone in the body. This hormone performs the following actions:
- Blood sugar regulation: GLP-1 increases insulin secretion in response to meals or increased glucose levels. They also decrease glucagon secretion which slows the release of sugar from stores in your liver.
- Slows gastric emptying, which makes you feel full longer.
- Appetite suppression
Glucose-dependent insulinotropic polypeptide (GIP) receptor agonists enhance insulin secretion and may further amplify weight loss and metabolic effects.
These medications are NOT insulin and are NOT stimulants.
Does semaglutide/tirzepatide curb your appetite?
Yes, it is believed that semaglutide and tirzepatide can reduce your appetite and contribute to weight loss due to improved blood sugar regulation and slowing gastric emptying, which makes you feel full longer and reduces food cravings.
How long does it take to lose weight on semaglutide/tirzepatide?
Early Weeks (0–4 Weeks):
- Initial Adjustment Period: During the first few weeks, your body adjusts to semaglutide/tirzepatide. Significant weight loss may not occur immediately as the dosage is typically started low and gradually increased to reduce side effects like nausea.
- Possible Effects: Some people may notice a reduction in appetite, leading to slight weight loss.
1–3 Months:
- Noticeable Weight Loss: By this time, many users begin to experience more consistent weight loss as the medication reaches therapeutic levels.
- Expected Weight Loss: Clinical studies show an average loss of 5-10% of body weight within the first 12 weeks for many individuals when combined with diet and exercise.
3–6 Months:
- Steady Progress: Weight loss often becomes more significant during this period. The appetite-suppressing effects of semaglutide/tirzepatide, combined with lifestyle changes, tend to yield more noticeable results.
- Expected Weight Loss: Some individuals lose up to 15% of their starting body weight by the 6-month mark.
1 Year and Beyond:
- Sustained Weight Loss: Continued weight loss or maintenance of lost weight can occur with ongoing use of semaglutide/tirzepatide, assuming adherence to a healthy diet and regular exercise.
- Clinical Data: Trials indicate that users can achieve 15-20% weight loss after one year, with some individuals experiencing even greater reductions.
Factors That Influence Results:
- Lifestyle Choices: Combining semaglutide/tirzepatide with a nutrient-dense, calorie-controlled diet and regular exercise significantly enhances weight loss.
- Adherence to Medication: Consistent use of semaglutide/tirzepatide as prescribed is crucial for optimal results.
- Individual Variation: Some people respond more quickly or significantly than others due to metabolic and genetic differences.
If you’re not noticing progress after a few months, consult your healthcare provider. They can adjust your plan or evaluate other factors that may be impacting your weight loss.
How long can I take semaglutide/tirzepatide for weight loss?
Semaglutide and tirzepatide are indicated for chronic weight management for those with qualifying conditions. Studies have shown that stopping semaglutide/tirzepatide often leads to weight regain, especially if no alternative strategies (e.g. lifestyle changes) are implemented. Semaglutide/tirzepatide are most effective as part of a long-term, holistic strategy for weight management and can be taken as long as they remain safe, effective, and necessary for managing your weight. Since obesity is a chronic condition, ongoing treatment may be required to prevent weight regain. Always consult your healthcare provider before making any changes to your medication plan.
Are semaglutide and tirzepatide safe?
Semaglutide and tirzepatide are considered safe for most individuals when used as prescribed and monitored by a healthcare provider. They have been extensively studied and shown to reduce cardiovascular risks in individuals with type 2 diabetes. However, as with any medication, there are potential risks and side effects to consider as outlined below.
What are the most common side effects?
- Nausea
- Vomiting
- Diarrhea or constipation
- Loss of appetite
- Mild fatigue
- These side effects often subside after the initial adjustment period.
What are the less common but serious risks?
- Pancreatitis: Rare but serious inflammation of the pancreas.
- Gastroparesis: delayed emptying of stomach or intestinal contents which increases the risk of blockage.
- Hypoglycemia (low blood sugar) may occur, particularly if used in combination with other diabetic medications.
- Gallbladder issues such as gallstones or cholecystitis, especially in those with rapid weight loss.
- Kidney Problems: Can potentially worsen pre-existing kidney conditions, especially if dehydration occurs due to vomiting or diarrhea. It is important to drink plenty of fluids to reduce the risk of this complication.
- Serious allergic reactions
- Thyroid Tumors: Animal studies showed an increased risk of thyroid tumors, including medullary thyroid cancer (MTC), but this has not been confirmed in humans. Semaglutide.tirzepatide are contraindicated for individuals with a personal or family history of MTC or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
What are contraindications to semaglutide/tirzepatide use?
- Personal or family history of MTC or MEN 2.
- Severe gastrointestinal disorders like gastroparesis.
- Allergy to semaglutide or its components.
Will semaglutide/tirzepatide be covered by my insurance?
No. Semaglutide/tirzepatide will not be covered by insurance when used for weight management through our office. If you wish to go through insurance, attempts can be made through your primary care provider’s office for qualifying candidates.
When to contact your healthcare provider?
Contact your healthcare provider immediately if you experience:
- Persistent nausea, heartburn, or constipation
- Signs of an allergic reaction, such as hives or rash
- Severe dehydration (persistent dry mouth, dizziness, or very dark urine).
Persistent or worsening side effects that interfere with your daily activities or quality of life.
