Medical weight management for women
If losing weight is harder than it used to be, that is not a character problem. Appetite signals, insulin resistance, sleep, stress, medications, muscle loss, perimenopause, menopause and low testosterone all change the maths. We look at the whole picture, then treat it like the medical problem it is.
The honest version, before the detail
Everything below expands on these points, with sources.
- 01This is a monitored programme with baseline labs, gradual dose changes and structured follow up. Where medicine is appropriate, it is usually prescribed at your first visit.
- 02Care is led by Elizabeth G. Bagan, APRN, a nurse practitioner.
- 03We will name the exact product, its exact approved indication and its approval status before anything is prescribed for you.
- 04Results vary by medicine and by person, so rather than quote one average we go through the real results for your specific medicine in consultation.
- 05Every medicine is named clearly, including whether it is FDA approved or compounded, so you always know exactly what you are taking.
- 06Obesity is a chronic disease, so treatment is long term. We plan your maintenance phase with you from the start.
What actually changed in your forties
Midlife changes sleep, appetite, insulin sensitivity, muscle and where your body stores fat. Perimenopause, menopause and low testosterone can all contribute, and so can thyroid disease, medications, stress and sleep apnoea.
Insulin is the hormone that moves sugar out of your blood and into your cells. When cells stop responding well, the body makes more of it. That shows up as more hunger and weight gain around the middle, and it is common well before anyone mentions diabetes.
Obesity also rarely travels alone. It sits alongside insulin resistance, blood pressure, cholesterol, fatty liver, sleep apnoea, joint pain and mood. Treating the whole person works better than treating the scale.
The constant pull toward food
Food noise is the mental soundtrack: thinking about the next meal, negotiating with yourself, grazing, being unable to stop when you want to.
Many patients say GLP-1 based treatment quiets that noise, and it is often the first time they have felt in control of cravings. Response varies, and the medicine works best as part of the whole plan.
That is worth naming, because it is the part people are most embarrassed about and it is biology, not weakness.
A programme, not a prescription
Care is delivered by Elizabeth G. Bagan, APRN, a nurse practitioner. Medicine is one component alongside nutrition, activity, sleep and the management of any contributing condition.
Eligibility depends on your health history, your current medications, your weight history and relevant lab results. Where a contributing condition is found, we treat it alongside your weight programme.
What the first three months look like
Initial consultation and baseline labs
History, medications, prior attempts, relevant conditions, and baseline bloods drawn in house. Lab work is not billed to insurance, and you get the price first.
Eligibility and options
We go through which options are appropriate for you, what each involves, expected side effects, and what monitoring each requires.
Starting and titrating
If medicine is appropriate, doses are increased gradually to manage side effects, with contact points in between.
Structured follow up
Practice protocol repeats labs at every ten percent change in body weight, or every three months, whichever comes first.
Maintenance
Obesity is a chronic disease, so treatment continues into a maintenance phase. We plan that phase with you from the start.
Losing fat without losing strength
Some lean mass comes off during any real weight loss. The job is to keep that as small as possible, because the muscle you carry into your sixties and seventies is what keeps you independent.
That means enough protein, resistance training, sleep and a sensible pace. We generally recommend a good multivitamin and creatine to support nutrition and training, and we check kidney health, medications and product quality first.
truFlex muscle stimulation is available alongside the programme for the same reason. Cardio is good for your heart, but it is resistance work that tells your body to keep muscle.
The main routes, compared honestly
| Option | What it involves | Monitoring | Main trade-offs |
|---|---|---|---|
| Nutrition and activity support alone | A structured plan without medicine | Reviewed at follow up | No medication side effects. Slower, and harder to sustain without support |
| FDA approved GLP-1 based medicine | Injectable or oral, dose increased gradually alongside lifestyle change | Baseline labs, then every 10% weight change or 3 months | Significant, sustained weight reduction alongside lifestyle change. Nausea and other stomach side effects are common while the dose is increased and usually settle |
| Other approved anti-obesity medicine | Oral or injectable, based on your history | Same schedule | A different side effect profile. May suit where a GLP-1 is not appropriate, or be used in conjunction with GLP-1s |
| Treating a contributing condition | For example sleep apnoea, thyroid disease, or a medication that promotes weight gain | Depends on the condition | Treated in conjunction with GLP-1 medicines, and frequently overlooked |
| Bariatric surgical assessment | Referral to a surgical service | Managed by that service | A larger and more durable effect for some people, with surgical risk |
Eligibility depends on your health history, current medications, weight history and relevant lab results.
Knowing exactly what you are taking
Semaglutide and tirzepatide are active ingredients, and the brand name tells you what the product is approved to treat. Wegovy is approved for chronic weight management. Ozempic, which is the same active ingredient, is approved for type 2 diabetes. Zepbound is approved for chronic weight management and for obesity with moderate to severe obstructive sleep apnoea. Mounjaro, the same active ingredient, is approved for type 2 diabetes.
Before anything is prescribed, we tell you the exact product, what it is approved for and whether it is FDA approved or compounded, and we give you the manufacturer's patient information.
Results vary by medicine and by person, so rather than quote an average we go through the real trial results for the medicine chosen for you.
Benefits, risks, alternatives and candidacy
This appears before the booking button on purpose. You should be able to decide with the risks in front of you.
What it may do
- For people who are eligible, GLP-1 based medicines are the gold standard of medical weight management, producing meaningful weight reduction alongside diet and activity changes.
- Weight reduction can improve blood pressure, blood glucose, lipids, sleep apnoea and joint pain.
- Response varies between individuals. A small percentage of people do not respond, and that is identified through monitoring.
Risks and side effects
- Nausea, vomiting, diarrhoea, constipation and reflux are common, particularly while the dose is being increased.
- Rare but serious risks include pancreatitis, gallbladder disease and kidney injury from dehydration. For some products the labelling warns about thyroid C-cell tumours, which have been seen in lab rodents; it is not known whether this happens in people.
- Losing muscle alongside fat is a genuine concern, which is why protein intake, resistance training and truFlex muscle stimulation are part of the programme.
- Stopping treatment can lead to weight regain, which is why obesity is managed long term.
- If a compounded medicine is ever part of your plan, it is named as compounded and we explain why it was chosen.
Alternatives, including doing nothing
- Structured nutrition and activity support without medicine.
- Treating a contributing condition such as sleep apnoea, thyroid disease or a medication that promotes weight gain.
- Other classes of anti-obesity medicine, oral or injectable.
- Referral for bariatric surgical assessment where that is a more appropriate option.
- Choosing not to treat, with monitoring.
Who may not be a candidate
- Pregnancy or planning pregnancy, a personal or family history of medullary thyroid carcinoma or MEN2, a history of pancreatitis, certain gastrointestinal conditions, and some medication combinations are among the situations that change or exclude this option.
Answered before you ask
What does the first visit cost?
Can my weight visits be virtual?
Will I lose muscle?
How often are labs repeated?
Who supervises the programme?
What happens if I stop the medication?
Where this information comes from
Primary sources only: regulator publications, specialty society patient guidance and manufacturer information. Not marketing pages.
- 01U.S. Food and Drug Administration, FDA's Concerns with Unapproved GLP-1 Drugs Used for Weight Loss
- 02U.S. Food and Drug Administration, prescribing information for approved GLP-1 medicines
- 03National Institute of Diabetes and Digestive and Kidney Diseases, treatment for overweight and obesity
- 04World Health Organization, Obesity and overweight fact sheet
- 05Federal Trade Commission, Health Products Compliance Guidance
Ask about medical weight-management eligibility
A first appointment establishes whether this programme is right for you. Where medicine is appropriate, it is usually prescribed that day.