Lose Weight Without Breaking the Bank

To qualify for GLP-1 weight loss treatment, you typically need:

• A BMI of 30 or higher (obesity), OR
• A BMI of 27 or higher with at least one weight-related health condition (such as high blood pressure, type 2 diabetes, or high cholesterol)

During your consultation, Josh will review your medical history, current medications, and weight loss goals to determine if GLP-1 treatment is clinically appropriate for you.

Your initial consultation includes:

• Comprehensive review of your medical history and current medications
• Discussion of your weight loss goals and previous attempts
• Education about GLP-1 medications (semaglutide vs tirzepatide)
• Review of potential side effects and how to manage them
• Creation of your personalized treatment plan

The consultation typically takes 30-45 minutes and can be done via telehealth or in-person at our Gretna, Nebraska location.

If clinically appropriate, your prescription can be submitted immediately after your consultation. Most patients receive their medication within 5-7 business days via free shipping. We ship directly to your door with all necessary supplies included.

Semaglutide (brand names: Ozempic, Wegovy) is a GLP-1 receptor agonist that helps with weight loss by reducing appetite and slowing gastric emptying. Clinical trials show an average of 10-15% body weight loss.

Tirzepatide (brand names: Mounjaro, Zepbound) is a dual GLP-1 and GIP receptor agonist, offering a more potent mechanism. Clinical trials show an average of 15-22% body weight loss.

Both are weekly injections. Tirzepatide tends to produce greater weight loss but costs more. During your consultation, we'll discuss which medication is best for your goals and budget.

Dose titration means starting at a low dose and gradually increasing over time. This is critical for GLP-1 medications to:

• Minimize side effects like nausea and GI discomfort
• Allow your body to adjust to the medication
• Find your optimal therapeutic dose

Most patients follow a 12-16 week titration schedule, slowly increasing the dose every 4 weeks until reaching their maintenance dose. This approach significantly reduces side effects while maximizing weight loss results.

GLP-1 medications have a specific half-life (the time it takes for half the medication to leave your system):

• Semaglutide: ~7 days half-life
• Tirzepatide: ~5 days half-life

As medication levels naturally decline toward the end of the week (days 5-7), you may notice:

• Increased appetite returning
• Reduced satiety (fullness)
• More food thoughts or cravings

Why this happens: Your body is adjusting to the medication, and at lower starting doses, the effects may not last the full 7 days. As your dose increases during titration, you'll experience more consistent appetite suppression throughout the week.

This "wearing off" effect typically improves significantly as you reach your maintenance dose.

If you miss a dose:

• Within 5 days: Take the missed dose as soon as you remember, then resume your regular weekly schedule
• More than 5 days: Skip the missed dose and take your next dose on your regularly scheduled day

Never take two doses within 72 hours of each other. If you frequently miss doses, contact Josh to discuss strategies for staying on schedule.

No. Compounded semaglutide and tirzepatide are not FDA-approved for weight loss. FDA-approved brand-name medications (Wegovy, Zepbound) are recommended as first-line treatment for obesity.

Compounded medications may be prescribed when clinically appropriate, offering:

• Significant cost savings ($149-233/month vs $1,000-1,400/month for brand name)
• Flexible dosing tailored to your needs
• Addition of Vitamin B6 to minimize nausea

All compounded medications are prepared by licensed, US-based compounding pharmacies following strict quality standards.

The most common side effects are gastrointestinal and typically mild:

• Nausea (usually improves after 2-4 weeks)
• Diarrhea or constipation
• Abdominal discomfort or bloating
• Decreased appetite (this is therapeutic!)
• Fatigue in the first few weeks

Tips to minimize side effects:

• Follow the slow titration schedule
• Eat smaller, more frequent meals
• Avoid high-fat, greasy foods
• Stay well-hydrated
• Take your injection at bedtime

Most side effects resolve within the first month as your body adjusts to the medication.

Common and normal reactions:

• Mild redness at injection site (pea-sized or smaller)
• Slight tenderness or bruising
• Small raised bump that resolves within 24-48 hours
• Mild itching

These reactions are normal and usually resolve on their own within 1-3 days.

Prevention tips: Rotate injection sites weekly, use proper injection technique, and ensure medication is at room temperature before injecting.

GLP-1 medications are not appropriate if you have:

• Personal or family history of medullary thyroid carcinoma (MTC)
• Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
• History of pancreatitis
• Severe gastroparesis or GI motility disorders
• Currently pregnant, trying to conceive, or breastfeeding
• History of eating disorders (requires careful evaluation)

During your consultation, Josh will review your complete medical history to ensure GLP-1 treatment is safe for you.

Storage guidelines:

• Store in original packaging in the refrigerator
• Keep away from the freezer section (do NOT freeze)
• Protect from direct light
• Do not store in refrigerator door (temperature fluctuates)
• Keep out of reach of children and pets

If medication freezes: Do not use it. Contact us for a replacement.

Before injection: Remove medication from refrigerator 15-30 minutes before injecting to bring to room temperature. This reduces injection site discomfort.

Yes! GLP-1 medications can travel with you. Here's how:

Air Travel (Carry-On):

• Pack medication in an insulated cooling bag with ice packs
• TSA allows medically necessary liquids and cooling packs
• Keep in original packaging with your prescription label
• Inform TSA agents it's refrigerated medication
• Never check refrigerated medication in luggage

Hotel stays:

• Store in hotel mini-fridge immediately upon arrival
• If no fridge available, use a cooler with ice packs (replace ice daily)
• Request a room with refrigerator when booking

Car travel:

• Use insulated cooler with ice packs
• Monitor temperature (should stay below 46°F)
• Never leave medication in hot car

International travel: Carry a copy of your prescription and a letter from your provider confirming medical necessity.

If left at room temperature (up to 77°F):

• Less than 24 hours: Generally safe to use - return to refrigerator immediately
• 24-48 hours: Contact Josh for guidance
• More than 48 hours: Do not use - medication may have degraded

When in doubt, contact us. It's better to get a replacement than risk using degraded medication.

Compounded medication pricing:

• Semaglutide: Starting at $149/month
• Tirzepatide: Starting at $233/month

Initial consultation: $50 (due at scheduling)

Follow-up visits: Included in your treatment plan for active patients

Pricing includes:

• Medication
• All injection supplies (syringes, alcohol wipes, sharps container)
• Free shipping
• Unlimited messaging with your provider

No hidden fees. No membership costs. Just transparent, affordable pricing.

We do not accept insurance for GLP-1 weight loss medications. However, our compounded medication pricing ($149-233/month) is significantly more affordable than brand-name options, even with insurance copays.

Why cash-pay is often better:

• No prior authorization delays (start treatment immediately)
• No insurance denials or coverage changes
• Lower cost than most insurance copays
• Flexible dosing not restricted by insurance protocols

We can provide a superbill for you to submit to your insurance for potential reimbursement, though coverage is rare for weight loss medications.

Before starting treatment:

• We thoroughly discuss your treatment plan and expectations
• You can ask unlimited questions during your consultation
• We ensure you understand the commitment before prescribing

If you need a replacement vial due to damage or storage issues: Contact Josh directly. We evaluate replacement requests on a case-by-case basis and may offer a one-time replacement for eligible circumstances.

Results vary by individual and medication:

Semaglutide: Average 10-15% of body weight over 12-16 months

Tirzepatide: Average 15-22% of body weight over 12-16 months

Example: Someone starting at 200 lbs could expect to lose 20-30 lbs on semaglutide or 30-44 lbs on tirzepatide.

Weight loss is typically:

• Weeks 1-4: Minimal loss (titration phase)
• Months 2-6: Steady 1-2 lbs per week
• Months 6-12: Continued but slower loss
• After 12 months: Maintenance phase

Results improve with healthy eating habits and regular physical activity.

GLP-1 medications are typically a long-term treatment for obesity. Most patients continue treatment for 12-24+ months to reach and maintain their goal weight.

Important to know: Many patients regain weight if they stop medication before establishing sustainable lifestyle changes. The best approach is to:

• Use medication as a tool while building healthy habits
• Work with a registered dietitian (like Elizabeth Berry through our Nourish partnership)
• Establish consistent exercise routines
• Address emotional eating patterns

Some patients successfully transition off medication after 18-24 months, while others continue at a maintenance dose long-term. This decision is individualized and made with your provider.

Plateaus are normal and common during weight loss. Strategies to overcome them:

• Dose adjustment: Josh may increase your dose if you've plateaued at sub-maximum dosing
• Review habits: Reassess food intake, portion sizes, and activity levels
• Increase movement: Add or intensify physical activity
• Consider switching medications: Some patients switch from semaglutide to tirzepatide for enhanced results
• Nutrition support: Work with Elizabeth Berry, RDN to optimize your diet

Plateaus lasting 2-4 weeks are normal. If lasting longer, contact Josh to discuss adjustments.

Injection sites: Abdomen, thigh, or upper arm (rotate weekly)

Step-by-step:

• Wash hands thoroughly
• Clean injection site with alcohol wipe
• Draw prescribed dose into syringe
• Pinch skin to create a small fold
• Insert needle at 90-degree angle
• Inject medication slowly
• Remove needle and dispose in sharps container
• Apply pressure if needed (no rubbing)

Detailed video instructions and injection demonstrations are provided with your first shipment. You can also schedule a virtual injection tutorial with Josh if needed.

Used needles and syringes must be disposed of properly:

• Place immediately in FDA-approved sharps container (included with your first shipment)
• Never recap needles
• Never put loose needles in trash or recycling
• When container is 2/3 full, seal and dispose according to local regulations

Disposal options:

• Household hazardous waste collection sites
• Mail-back programs
• Pharmacy take-back programs

Check your local regulations at: safeneedledisposal.org