Medical Weight Loss Program

At a Glance

• What it is: A physician-led program combining anti-obesity medication, nutrition, activity and behavioral support, with body-composition tracking
• Who it is for: Adults with a BMI of 30 or higher, or 27 or higher with a weight-related condition, and patients preparing for or after bariatric surgery
• Results: Modern medications produce average weight loss of about 15–21% in major trials (see Landmark Evidence below)
• Main trade-off: Weight is usually regained when medication is stopped, so treatment is typically long term
• Visits: In person or by telehealth, with regular monitoring

Obesity is a chronic, relapsing disease, not a willpower problem. Like high blood pressure or diabetes, it responds to medical treatment and comes back when treatment stops.

Evidence-based obesity care rests on five pillars (Elmaleh-Sachs et al., JAMA, 2023):

• Behavioral therapy

• Nutrition

• Physical activity

• Medication

• Metabolic and bariatric procedures

A true medical weight loss program combines the right pillars for each patient and escalates treatment when needed.

The field has been transformed. Nutrient-stimulated hormone therapies (GLP-1 and dual GIP/GLP-1 medications) now produce 15–21% weight loss in clinical trials and improve blood pressure, cholesterol, blood sugar, and inflammation (Ndumele et al., AHA/ACC/ADA/ASN Guideline, 2026).

The American College of Physicians' 2026 living guideline names semaglutide and tirzepatide as first-line medications for adults with obesity (Qaseem et al., ACP Living Clinical Guideline, 2026).

Our program offers the full range of FDA-approved options:

• Injectable: tirzepatide (Zepbound) and semaglutide (Wegovy)

• Oral: oral semaglutide (Wegovy tablets) and orforglipron (Foundayo)

• Older agents: phentermine-topiramate (Qsymia) and naltrexone-bupropion (Contrave)

• Genetic obesity: setmelanotide (Imcivree) for rare genetic forms

Because the program is led by a bariatric surgeon who is also board-certified in obesity medicine, every patient has a seamless path to Gastric Balloon, Endoscopic Sleeve Gastroplasty (ESG), Sleeve Gastrectomy, or Gastric Bypass (RYGB) if medication alone isn't enough.

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Medication is one part of a broader plan. See Obesity Treatment in Miami, FL for how medical, endoscopic and surgical options fit together.

For a closer look at the older pill-based options, read Phentermine, Qsymia, Contrave, Orlistat: Understanding Oral Weight Loss Medications, and for newer drugs still in development, see The Future of GLP-1 Medications: Pills, Triple Agonists, and What's Coming Next.

GLP-1 medications mimic a natural gut hormone that signals fullness to the brain, slows stomach emptying, and helps the body release insulin when blood sugar rises (Gilbert et al., ACC Expert Consensus, 2025).

Tirzepatide adds a second hormone, GIP. GIP acts on appetite centers in the brain and on fat tissue. That dual mechanism likely explains its greater weight loss (Gilbert et al., ACC Expert Consensus, 2025).

The result:

• Less hunger and "food noise"

• Earlier fullness

• Lower calorie intake, without white-knuckle dieting

Medication is the engine. The program around it is what makes results healthy and lasting:

• Protein-forward nutrition to protect muscle and limit side effects

• Resistance training to preserve lean mass

• Body composition tracking that measures fat lost vs muscle lost, not just weight

• Dose titration and side-effect management

• A long-term maintenance plan, because benefits reverse when medication stops (Ndumele et al., AHA/ACC/ADA/ASN Guideline, 2026)

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• Significant weight loss without surgery:
  • Tirzepatide: 20.2% at 72 weeks in the head-to-head SURMOUNT-5 trial
  • Semaglutide: 13.7% in the same trial (Aronne et al., New England Journal of Medicine, 2025)
• Oral options for patients who prefer pills:
  • Oral semaglutide 25 mg: 13.6% weight loss at 64 weeks (Wharton et al., New England Journal of Medicine, 2025)
  • Orforglipron: up to 11.2% at 72 weeks (Wharton et al., New England Journal of Medicine, 2025)

• Heart protection. Semaglutide with lifestyle changes reduced all-cause mortality and major cardiovascular events (Qaseem et al., ACP Living Clinical Guideline, 2026).

• Better metabolic health. Just 5–10% weight loss lowers systolic blood pressure by about 3 mm Hg and HbA1c by 0.6–1% in people with diabetes (Elmaleh-Sachs et al., JAMA, 2023).
• Treatment of related diseases:
  • Tirzepatide is FDA-approved for moderate to severe obstructive sleep apnea in adults with obesity.
  • Semaglutide is FDA-approved for MASH (fatty liver disease) with moderate to advanced fibrosis and for cardiovascular risk reduction in people with established heart disease (U.S. Food and Drug Administration, 2025).

• Better quality of life and physical function (Qaseem et al., ACP Living Clinical Guideline, 2026)

• A clear escalation path to procedures or surgery, all within one program

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FDA labels and major guidelines support medication for adults with (American Diabetes Association, Standards of Care, 2026; Qaseem et al., ACP Living Clinical Guideline, 2026):

• BMI ≥30 kg/m², or

• BMI ≥27 kg/m² with at least one weight-related condition: type 2 diabetes, high blood pressure, high cholesterol, sleep apnea, or cardiovascular disease

• Lower BMI thresholds for Asian patients (BMI ≥25–27.5) (Elmaleh-Sachs et al., JAMA, 2023)

Medical weight loss is also ideal for:

• Patients who aren't ready for surgery, or who don't meet surgical criteria

• Patients with BMI over 50, to lower surgical risk before an operation

• Patients regaining weight after bariatric surgery (Elmaleh-Sachs et al., JAMA, 2023)

• Teens 12 and older with obesity, for specific approved medications

GLP-1 and GIP/GLP-1 medications are not used in patients with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 (MEN2) (Gilbert et al., ACC Expert Consensus, 2025).

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1. Comprehensive obesity medicine evaluation. Medical history, weight history, medication review, and labs. Medications that cause weight gain are identified and swapped when possible, such as certain antidepressants, glyburide, and insulin (Elmaleh-Sachs et al., JAMA, 2023).
2. Body composition baseline. InBody or DEXA measures fat mass, muscle mass, and visceral fat.
3. Personalized medication selection, based on (Qaseem et al., ACP Living Clinical Guideline, 2026):
   • Weight goals
   • Other conditions
   • Cost and insurance coverage
   • Preference for injections or pills
4. Slow dose titration. Doses go up gradually to minimize nausea and GI side effects. If side effects occur, the dose drops back to the last tolerated level (Gilbert et al., ACC Expert Consensus, 2025).
5. Nutrition and exercise prescription, with a protein target and a resistance training plan.
6. Regular follow-up visits for weight, body composition, side effects, and lab monitoring.
7. Reassessment at 3–6 months. Patients who don't respond are switched to a different medication or offered procedures or surgery (Ndumele et al., AHA/ACC/ADA/ASN Guideline, 2026).
8. Long-term maintenance phase. Ongoing treatment, because obesity is chronic.

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• GI side effects are the most common: nausea, vomiting, diarrhea, constipation, and abdominal pain. They occur mainly during dose escalation (Moiz et al., Annals of Internal Medicine, 2025).

• Discontinuation for side effects is uncommon: 4.3% to 7.1% in clinical trials (Gilbert et al., ACC Expert Consensus, 2025).

• Gallstones (Qaseem et al., ACP Living Clinical Guideline, 2026).

• Pancreatitis, kidney injury from dehydration, and worsening diabetic retinopathy in patients with diabetes (VA/DoD Clinical Practice Guideline, 2025).

• Low blood sugar when combined with insulin or sulfonylureas.

• Boxed warning: thyroid C-cell tumors seen in rodents. Contraindicated with MTC or MEN2 (Qaseem et al., ACP Living Clinical Guideline, 2026).

• Muscle loss. Lean mass makes up roughly 25–39% of weight lost on GLP-1 medications (Mesinovic et al., Reviews in Endocrine and Metabolic Disorders, 2025).
• Pregnancy:
  • Semaglutide should be stopped at least 2 months before a planned pregnancy (VA/DoD Clinical Practice Guideline, 2025).
  • Phentermine-topiramate requires monthly pregnancy tests and is avoided in patients with cardiovascular disease (Qaseem et al., ACP Living Clinical Guideline, 2026).

• Compounded GLP-1s are discouraged because of dosing errors, impurities, and counterfeit products (Gilbert et al., ACC Expert Consensus, 2025).

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There is no surgical recovery. Patients keep working and living normally. The "adjustment period" is the first 2–4 months of dose escalation, when GI side effects are most likely:

• Eat small portions and stop at the first sign of fullness.

• Avoid greasy, fried, and very sweet foods.

• Hydrate aggressively to prevent constipation and kidney strain.

• Call the team for persistent vomiting, severe abdominal pain, or inability to keep fluids down.

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Medication works as long as you take it. The key trials are clear:

• STEP 1 extension: after stopping semaglutide, participants regained about two-thirds of the weight they had lost within one year (Moiz et al., EClinicalMedicine, 2026).

• SURMOUNT-4: patients switched from tirzepatide to placebo regained 14% of body weight. Those who continued lost an additional 5.5% (Moiz et al., EClinicalMedicine, 2026).

• Health gains reverse too. Blood pressure, blood sugar, waist size, and cholesterol worsen after stopping (Moiz et al., EClinicalMedicine, 2026).

Real-world adherence is the biggest challenge:

• Trials vs real life: adherence was 83–88% in trials, but only 33–50% at 1 year and 15% at 2 years in practice (Mozaffarian et al., Joint Advisory, 2025).

• Patients without diabetes: 50–65% stop within the first year (Moiz et al., EClinicalMedicine, 2026).

Our program is built to keep you on track: structured follow-up, side-effect management, coverage support, and a plan B before you ever need it.

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Landmark Evidence

• SURMOUNT-1: tirzepatide produced average weight loss of 15.0%, 19.5% and 20.9% at the 5, 10 and 15 mg doses over 72 weeks, versus 3.1% with placebo (Jastreboff et al., New England Journal of Medicine, 2022).
• STEP 1: semaglutide 2.4 mg produced 14.9% average weight loss at 68 weeks versus 2.4% with placebo (Wilding et al., New England Journal of Medicine, 2021).
• SELECT: in 17,604 adults with cardiovascular disease and overweight or obesity without diabetes, semaglutide reduced heart attack, stroke and cardiovascular death by 20% (Lincoff et al., New England Journal of Medicine, 2023).
• Medication and surgery together: anti-obesity medication combined with endoscopic outlet reduction achieved weight loss similar to surgical revision after gastric bypass, with fewer serious adverse events (Jirapinyo and Thompson, Gastrointestinal Endoscopy, 2023).

How It Compares

• Versus bariatric surgery: medication avoids an operation, but surgery produces larger and more durable weight loss and is the stronger option at higher BMIs. Many patients benefit from both.
• Versus ESG: ESG is a one-time procedure. Medication requires ongoing use but can be adjusted.

More in Bariatric Surgery Procedures

Related procedures: Robotic Surgery, Sleeve Gastrectomy, Gastric Bypass, One‑Anastomosis Gastric Bypass, SADI-S, Duodenal Switch. For an overview of all options, see Bariatric Surgery.

Conditions our medical program helps manage: Obesity, Metabolic Syndrome, Type 2 Diabetes, High Blood Pressure, Sleep Apnea, Metabolic Dysfunction–Associated Steatohepatitis.

Dr. Nestor de la Cruz-Muñoz, MD, FACS, DABOM is one of few physicians who are both a board-certified obesity medicine specialist (DABOM) and a high-volume metabolic and bariatric surgeon. That means every treatment option, from medication to endoscopy to surgery to revision, is available under one roof from a physician who has no bias toward any single approach.

• The complete obesity continuum:
  • Medication
  • Gastric Balloon, including Allurion and Orbera
  • Endoscopic Sleeve Gastroplasty (ESG)
  • Sleeve Gastrectomy
  • Gastric Bypass (RYGB)
  • One-Anastomosis Gastric Bypass (OAGB)
  • SADI-S
  • Duodenal Switch
  • MagDI
  • Revisional Bariatric Surgery

• Educator of physicians. He served for 10 years as a fellowship program director, training surgeons in modern metabolic and bariatric care.

• Muscle-first philosophy. Body composition tracking is built into every program, so results are measured by fat lost and muscle kept, not just pounds.

• Honest guidance. When medication isn't the best long-term tool for you, he will tell you, and explain why.

• Combination care. GLP-1s are used before surgery to lower risk and after surgery to treat weight regain.

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Because Dr. de la Cruz-Muñoz is also a bariatric surgeon, with over 25 years in the field and more than 9,000 bariatric operations performed, a volume few surgeons reach, medical patients can move to surgery seamlessly if they ever need it.

Authored by Nestor de la Cruz-Muñoz, MD, FACS, DABOM. Last updated November 2026.

Typical weight loss over 12–24 months (Elmaleh-Sachs et al., JAMA, 2023; Aronne et al., New England Journal of Medicine, 2025; Wharton et al., New England Journal of Medicine, 2025):

• Intensive lifestyle therapy alone: 5–10%. More than 25% of patients regain weight by 2 years.

• Naltrexone-bupropion and other older agents: about 5% or more

• Orforglipron, oral: up to 11.2% at 72 weeks

• Oral semaglutide 25 mg: 13.6% at 64 weeks

• Semaglutide 2.4 mg injection: 13.7–15%

• Tirzepatide injection: 20–21%

• For comparison, sleeve gastrectomy or gastric bypass: 25–35%

Patients with type 2 diabetes lose less weight on the same medications. Success is measured as weight loss plus better glucose control, lower insulin needs, and heart protection (American Diabetes Association, Standards of Care, 2026).

Real-world results run lower than trials. In one large U.S. study, mean weight loss at 12 months was 11.4% with tirzepatide and 6.2% with semaglutide (Rodriguez et al., JAMA Internal Medicine, 2024).

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• Blood sugar. Tirzepatide lowered HbA1c by about 1.6% more than placebo in people with type 2 diabetes. Semaglutide lowered it 1.2% more than placebo (American Diabetes Association, Standards of Care, 2026).

• Prevention of diabetes in people with prediabetes (American Diabetes Association, Standards of Care, 2026).

• Blood pressure, triglycerides, LDL, and inflammation (hs-CRP) all improve (Ndumele et al., AHA/ACC/ADA/ASN Guideline, 2026).

• Fatty liver disease (MASLD/MASH), sleep apnea, and heart failure symptoms improve (American Diabetes Association, Standards of Care, 2026).

• Waist circumference. Tirzepatide reduced waist size by 18.4 cm in SURMOUNT-5 (Aronne et al., New England Journal of Medicine, 2025).

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• Plan for long-term therapy. Guidelines support ongoing anti-obesity medication, as with other chronic diseases (Elmaleh-Sachs et al., JAMA, 2023).

• Maintenance dosing, individualized to the lowest dose that holds results.

• More than 200 minutes per week of physical activity, which is associated with better weight maintenance (Elmaleh-Sachs et al., JAMA, 2023).

• Regular self-weighing and food tracking. These are among the strongest predictors of maintenance success (Tejera et al., Reviews in Endocrine and Metabolic Disorders, 2026).

• A backup plan for coverage loss or shortages. Missed doses are managed with a structured re-titration protocol (Gilbert et al., ACC Expert Consensus, 2025).

• Early escalation. Inadequate response or regain triggers a switch to another medication, a procedure, or surgery (Ndumele et al., AHA/ACC/ADA/ASN Guideline, 2026).

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• GERD is a listed side effect of semaglutide and tirzepatide (Yanovski and Yanovski, JAMA Internal Medicine, 2024).

• Slowed stomach emptying can worsen heartburn, regurgitation, and bloating, especially at higher doses.

• Weight loss itself often improves reflux. Persistent or new reflux on medication should be evaluated. See GERD / Acid Reflux and Hiatal Hernia Repair.

• Before any procedure or anesthesia, tell your team you take a GLP-1. These drugs slow stomach emptying (Strong and Driscoll, American Journal of Clinical Dermatology, 2025).

• Patients with severe reflux and obesity may do better with Gastric Bypass (RYGB), the antireflux operation of choice in obesity. See Gastric Bypass (Roux-en-Y) for GERD.

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For medical weight loss, this field covers escalation options when medication isn't enough:

• Switch medications. Semaglutide and tirzepatide can be interchanged based on clinical judgment (Gilbert et al., ACC Expert Consensus, 2025).

• Add or change to oral agents for patients who can't tolerate injections.

• Endoscopic therapy: Gastric Balloon or Endoscopic Sleeve Gastroplasty (ESG)

• Metabolic and bariatric surgery: guidelines direct patients with inadequate weight loss or regain on GLP-1 therapy to referral for alternative medication or surgery (Ndumele et al., AHA/ACC/ADA/ASN Guideline, 2026). See Bariatric Surgery.

• After prior bariatric surgery. Medication is a first step for regain, before Revision Bariatric Surgery, Gastric Bypass Revision for Weight Regain, or TORE.

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• Not all weight lost is fat. Across 20 randomized trials, lean mass made up about 26.5% of weight lost on incretin therapy (Eisa and Barood, Diabetes, Obesity and Metabolism, 2026):
  • Semaglutide: about 35%
  • Tirzepatide: about 25%

• Resistance training changes that. Lifestyle plus resistance training cut lean mass loss to 17.5% of total weight lost (Eisa and Barood, Diabetes, Obesity and Metabolism, 2026).

• Exercise plus medication works best. Liraglutide combined with exercise cut lean mass loss to just 12% of weight lost (Eisa and Barood, Diabetes, Obesity and Metabolism, 2026).

• Protein matters. Because appetite falls, protein intake can drop too low (Jalleh et al., Journal of Clinical Investigation, 2026). Our dietitians set a daily protein target consistent with the joint nutrition advisory for GLP-1 therapy (Mozaffarian et al., Joint Advisory, 2025).

• InBody or DEXA tracking at baseline and throughout treatment, so muscle loss is caught early and corrected.

To understand why the scale can stall while your measurements keep shrinking, read Why You’re Losing Inches but Not Pounds: Understanding Body Recomposition.

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• Commercial insurance: coverage varies widely. Most plans require prior authorization, documented BMI and comorbidities, and sometimes step therapy.

• Medicare: has historically not covered medications used only for weight loss (Strong and Driscoll, American Journal of Clinical Dermatology, 2025). FDA indications for sleep apnea (tirzepatide), cardiovascular risk reduction, and MASH (semaglutide) may open coverage pathways. Our team checks current benefits.

• Diabetes medications such as Mounjaro, Ozempic, and Rybelsus are covered under diabetes benefits for patients with type 2 diabetes.

• Self-pay options: manufacturer pricing programs have lowered self-pay costs substantially. Our team reviews the most affordable route for you.

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For medical weight loss, this field covers preparing for your first visit:

• Bring a full medication list. Some medications cause weight gain.

• Bring recent labs: HbA1c, lipids, kidney and liver function, and thyroid tests.

• Gather your weight history and previous weight loss attempts.
• Disclose any history of:
  • Pancreatitis, gallbladder disease, or diabetic eye disease
  • Medullary thyroid cancer or MEN2 in you or your family

• Women: bring pregnancy plans and contraception information.

• Insurance card, so our team can begin prior authorization.

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For medical weight loss, this field covers nutrition during treatment:

• Protein first at every meal. Lean meats, fish, eggs, Greek yogurt, and protein shakes as needed.

• Calorie targets: generally 1,200–1,500 kcal/day for women and 1,500–1,800 for men, individualized. Very low-calorie diets (under 800 kcal/day) require medical supervision (Elmaleh-Sachs et al., JAMA, 2023).

• Low-energy-density, high-fiber foods: vegetables, fruits, and whole grains (Tejera et al., Reviews in Endocrine and Metabolic Disorders, 2026).

• Limit ultra-processed foods, sugary drinks, and alcohol.

• Hydration: 64+ oz of fluid daily to reduce constipation and nausea.

• Small, slow meals to prevent GI side effects.

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For medical weight loss, this field covers exercise during treatment (Elmaleh-Sachs et al., JAMA, 2023):

• At least 150 minutes per week of moderate activity, such as brisk walking or cycling.

• Resistance training 2–3 times per week, the single most important habit for protecting muscle.

• More than 200 minutes per week for long-term weight maintenance.

• Reduce sitting time.

• Start where you are and build gradually. Exercise is tailored to joint problems and fitness level.

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The medical weight-loss program works well remotely. Visits, coaching and monitoring can largely be virtual. For international patients, prescriptions and lab monitoring must follow the rules of their home country, so we coordinate with a local physician to manage medications safely.