Medical Weight Management — A Practical Guide to GLP-1 and Beyond

Semaglutide is a GLP-1 receptor agonist — it mimics a hormone your gut releases after eating, which signals fullness to the brain and slows gastric emptying. The result: meaningful appetite suppression, smaller portions feeling satisfying, and reduced food noise. Branded as Wegovy for weight loss and Ozempic for diabetes (same molecule), it produces ~15% average body weight loss over 12–18 months when paired with protocol-driven dose escalation.

Tirzepatide (Mounjaro/Zepbound) hits both GLP-1 and GIP receptors and shows higher average weight loss in head-to-head studies — ~22% vs ~15% over 18 months. It also tends to have somewhat better GI tolerability at equivalent efficacy. Tirzepatide is typically more expensive when paying cash. Both work; the best one is whichever you can sustain at therapeutic dose with manageable side effects under proper monitoring.

For most patients, indefinitely or with a planned maintenance dose. Obesity is increasingly understood as a chronic condition with biological set points — stopping medication usually means weight returns toward baseline. Some patients successfully taper to lower maintenance doses (e.g., 1mg semaglutide weekly) and hold loss with intensive lifestyle support. Few fully stop without regain. Plan for chronic treatment, similar to blood pressure medication.

Partial. Ozempic and Mounjaro are typically covered for type 2 diabetes with prior authorization. Wegovy and Zepbound (same molecules, weight-loss indication) face stricter coverage — many plans exclude obesity treatment, others require BMI thresholds and documented lifestyle attempts. Medicare doesn't cover anti-obesity medications under standard plans. Cash-pay branded GLP-1s run $900–$1,500/month; compounded versions $200–$500/month with the regulatory caveat noted above.

Research peptides marketed as "semaglutide" online are not regulated, not tested for purity or sterility, and not legal for human use. The risk profile is significantly higher than pharmacy-compounded or branded product: contamination, incorrect dosing, no clinical oversight if something goes wrong. Cash-pay telehealth with proper labs and clinician monitoring is more expensive but vastly safer. The cost gap is real; the safety gap is larger.