It was a cruise photo that finally pushed Joel Potter’s weight loss journey over the edge.
She was on a trip with a close friend and excitedly signed up for a photo package that gave her a choice of 100 photos. There was just one problem: she didn’t like any of the photos.
“They showed me how big I was,” she recalled.
When she returned home from her trip in December 2022, she decided she had had enough. At the time, she had a daughter who was almost 4 years old and twin sons who were soon to be 14.
“I just said, ‘I need to do something that will not only help me lose weight but also help with the health issues that I have,'” she said.
Potter has polycystic ovary syndrome, a hormonal disorder that she says causes weight gain and insulin resistance, but she said stress and a series of family deaths caused her weight to rise to 186 pounds on her 4-foot-11 height.
When exercise, diet and even other medications didn’t work, she decided to try something different: combined semaglutide treatment, which helped her lose about 50 pounds in 17 months, something that had eluded traditional diet and exercise.
According to a Kaiser Family Foundation survey, one in eight Americans have tried expensive drugs to lose weight and overcome their battle with obesity since Ozempic and Wegovy were approved by the FDA as weight-loss drugs and hit the market in 2021. The drugs use a key ingredient called semaglutide, which is so effective that Ozempic and Wegovy are in short supply across the country.
Eager users of the drug are turning to other medications, namely combined semaglutide treatments, which are touted as versions of the key ingredients in Ozempic and Wegovy, mixed with vitamins, saline and other additives.
But doctors and medical experts advise caution about compounded versions of non-FDA-approved weight-loss drugs that are selling for a fraction of the price of the brand-name drugs despite a surge in demand. Compounded versions of these drugs, which help suppress appetite and have led to significant weight loss for many users, are largely untested.
A doctor can prescribe the combination treatment, but in the Dallas-Fort Worth area, many medical aesthetic spas and telemedicine clinics are meeting the growing demand for combined semaglutide.
What is a medical spa and how can combined semaglutide treatment be prescribed?
Potter is receiving her combined semaglutide treatment through the D-FW-based telemedicine clinic TrimmOff, but a common place patients go to get the combined treatment is a medical spa that offers non-surgical cosmetic medical procedures.
Dr. Praveen Gantipali opened Sanjiva Medical Spa in late 2022 after working in leadership positions at a hospital. He began researching medical spas about five years ago, inspired by friends who had bad experiences with procedures like lip fillers, Botox injections and infusions. Dr. Gantipali estimates the medical spa sees 1,500 patients a year, with 20-30% of patients using semaglutide for weight loss.
“Dallas is one of the top markets when it comes to skin care and other injectables,” says Gantipalli, an internist certified in bariatric medicine.
Gantipalli said part of that is because the Dallas-Fort Worth area is one of the fastest-growing metropolitan areas in the country, but also because people there simply feel they can look better: Just over a third of Dallas County residents were obese as of 2021, according to data from the Centers for Disease Control and Prevention.
Josanne Stevens, owner of Spa in the City on West Lovers Lane, said that like Gantipali, her medical spa has seen 10 to 20 percent growth year over year since it opened in 2010.
About a tenth of Spa in the City’s clients prefer the combined semaglutide treatment, according to Stevens. He said the spa follows prescribing guidelines, but some people want it because “they think they need to lose five pounds and they want semaglutide to do that for them.”
“But that’s not what we do,” she added.
What people may not realize is that it’s important to “put in the effort” while taking the drug, said Carolina Vigil, co-founder and chief operating officer of TrimOff, where Potter gets her injections. Vigil is not a doctor, but she has been taking semaglutide treatment for weight loss.
“Instead of fast food, eat healthier foods, add fruits and vegetables to your diet and get some exercise,” she said.
Vigil says when he schedules consultations with people who want to know if they’ll gain weight if they stop taking their medication, he always reminds them that lifestyle changes are key to sustained weight loss and keeping it off.
“It’s important to treat this medication as an aid to developing healthy habits,” she said.
What is semaglutide and combined semaglutide treatment?
Semaglutide is the active ingredient in weight-loss drugs such as Novo Nordisk’s Ozempic and Wegobi, and has been hailed as a “miracle drug” for treating obesity as well as weight-related diseases such as diabetes and high blood pressure. Semaglutide acts as an agonist (“a substance that mimics the action of a neurotransmitter or hormone,” according to the Health Research Council’s National Medicines Library) on the brain’s GLP-1 receptors. These receptors regulate blood sugar levels in the body by stimulating the production of insulin to convert glucose, or sugar, into energy.
The compound has been found to benefit the intestine by slowing digestion, and also benefit the brain by “making you feel fuller faster,” said Katherine Litten, assistant professor of clinical pharmacy at the University of Texas at Austin’s College of Pharmacy.
For doctors to prescribe the drug, patients must have a BMI of 30 or above, or 27 or above if they have weight-related conditions. But soaring demand for the brand-name semaglutide treatment has led to supply shortages.
Medications can also be expensive. A one-month supply of Ozempic, for example, can cost nearly $1,000 if you don’t have insurance. Even the brand-name semaglutide formulation may not be covered. Even among those with insurance, more than half say it’s “very difficult to afford medication.”
“There are so many moving parts that go into developing a drug,” Litten says, “so once a drug is on the market, it costs a lot of money to cover all the research and development that went into developing that drug.”
Litten said high drug prices typically last for the 20 years that manufacturers must sell the drug under their own brand name before a generic version can come to market.
Combined semaglutide treatments, which are not FDA approved, are promoted as semaglutide mixed with other ingredients or excipients. Combined semaglutide treatments were developed to address the lack of brand-name semaglutide options.
Combined semaglutide treatment is cheaper than the brand-name semaglutide drug. Potter says she spends less than $150 a month on her treatment, but says it’s important to consider that she’s a long-time user and has requested a three-month file.
For fellow TrimOff patient Shannon Hanrahan, choosing the semaglutide combination over a name brand was “100% because of the price”.
“It was going to cost me $1,200 a month,” Hanrahan said, “and I just couldn’t afford it.”
Litten said one of the reasons compounded medications are so cheap, especially compared to those sold at medical spas and compounding pharmacies, is because the medications come in small vials and must be injected with a syringe.
“The medication you receive at the pharmacy comes in a dosing pin so you can control the dose, and it’s tested and it’s safe,” Litten said.
Is combined semaglutide treatment safe?
Litten said the best advice for people interested in combined semaglutide treatment is to “go to trusted sources.” Patients can use the Food and Drug Administration’s BeSafeRx tool to look for red flags. According to the Texas Medical Board, all medical spas are required to have a physician with a supervisory license on staff.
“Red flags are all over the place – no prescription required, no need to consult a doctor or nurse or advanced medical professional, incredibly low prices,” Litten said. “The product you receive may look different to what you expected.”
Litten also recommends asking where the medications are coming from and finding out if the pharmacy is licensed by the Texas Board of Pharmacy, though he said compounding pharmacies may be less well-monitored during times of drug shortages.
“The risk is, the FDA has no oversight of these pharmacies and their development,” Litten said.
There have also been cases of contamination that could have adverse effects on patients, she added. Some versions of semaglutide combination treatments also use salt formulations that have not been well studied, she said.
Before starting any treatment, Potter said she sought advice from her husband’s medical friends and looked for clinics with multiple online reviews. Her insurance covers the brand-name drug, but requires patients to try four other drugs first.
She now receives the combined semaglutide treatment every Monday night, allowing her to sleep through the initial effects. By Tuesday morning, she says she’s “a little tired and a little nauseous,” which GoodRx says is a common side effect of the semaglutide drug.
“But it’s not really that bad,” she says, but makes sure to stay properly hydrated to minimise side effects.
Ms Potter said that since starting the combined semaglutide treatment she no longer had the desire to eat such large portions.
“I realised I had this noise in my head,” she says. “If I’m bored, ‘Okay, I’ll have some chips,’ or if I’m bored, ‘Let’s eat.’ It was the same as boredom eating or stress eating.”
Potter said she hopes to lose another seven pounds, but has recently purchased an extra-small bikini.
“I can’t even remember the last time I wanted to wear a bikini,” she said.
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