It was photos from a cruise trip that finally pushed Joelle Potter to the breaking point in her weight loss journey.
She’d gone on the trip with a close friend and excitedly had done a photo package where she could pick out 100 photos. There was just one problem — she hated all of them.
“They just showed how big I was,” she recalled.
When she came home from the trip, which she’d taken in December 2022, she decided that she’d had enough. She had a daughter who was about to turn four and twin sons who were about to turn 14 at the time.
“I just said, ‘I need to do something that’s going to help me lose weight but also correct some health issues I have,’” she said.
Potter has polycystic ovarian syndrome, a hormonal disorder that can cause weight gain and insulin resistance, she said. But stress and a string of deaths in the family, she said, pushed her 4′11″ frame to 186 pounds.
When working out, dieting and even turning to other medications didn’t help, she decided to try something different: compounded semaglutide treatment. It’s helped her lose almost 50 pounds in 17 months, weight she struggled to lose through traditional dieting and exercise.
Since Ozempic and Wegovy burst onto the market in 2021 after gaining FDA approval for weight loss, 1 in 8 Americans have tried the pricey medications to cut pounds and overcome fights with obesity, according to a Kaiser Family Foundation study. The drugs utilize a key ingredient — semaglutide — that has worked so effectively that there have been shortages of Ozempic and Wegovy across the country.
Those eager to utilize the medication have turned elsewhere — to compounded semaglutide treatment, advertised as a combined version of the key ingredient found in Ozempic and Wegovy with vitamins, saline or other additives included.
But doctors and medical professionals are advising caution about the non-FDA-approved compounded versions of weight loss drugs, offered at a fraction of the price of their brand name counterparts, even while demand soars. The compounded versions of these drugs, which help lower appetite and have resulted in major weight loss in many users, have seen scant testing.
Doctors can prescribe compounded treatments, but in the Dallas-Fort Worth area many medical aesthetic spas and telehealth clinics have responded to the growing demand for compounded semaglutide.
What are medical spas and how can they prescribe compounded semaglutide treatments?
Potter receives her compounded semaglutide treatment via D-FW-based telehealth clinic TrimmOff, but a common place patients can go to receive compounded treatments are medical spas, which handle nonsurgical aesthetic medical procedures.
Dr. Praveen Guntipalli opened Sanjiva Medical Spa in late 2022 after working in leadership at a hospital. He started looking into medical spas about five years ago and was inspired by friends who said they had poor experiences with procedures like lip fillers, Botox injections and IV infusions. Guntipalli, who estimates the medical spa has 1,500 patient visits annually, says 20% to 30% of his patients are using semaglutide for weight loss.
“When it comes to skincare, when it comes to other injectables, Dallas is one of the top markets,” Guntipalli, an internal medicine physician certified in obesity medicine, said.
That’s in part because D-FW is one of the fastest-growing metro areas in the country, Guntipalli said, and also simply because people in the area feel they can look better. A little more than a third of Dallas County residents were obese as of 2021, according to data from the Centers for Disease Control.
Josanne Stephens is the owner of Spa in the City on West Lovers Lane. Like Guntipalli, Stephens said her medical spa has seen 10% to 20% year-over-year growth since its opening in 2010.
About a tenth of Spa in the City’s clients gravitate toward compounded semaglutide treatments, Stephens said. She said that while the spa follows prescription guidelines, there are people who want semaglutide treatments because they “think they need to lose five pounds and want to do it with semaglutide.”
“But that’s not something we do,” she added.
Something that people might not realize is that even while taking the drug, it’s important to “put in the work,” said Carolina Vigil, who is the co-founder and chief operating officer of TrimmOff, where Potter goes for her injections. Although Vigil is not a doctor, she has used semaglutide treatment for weight loss.
“Instead of that fast food, get something healthier, put some fruit in there, add some vegetables and then do some type of exercise,” she said.
When she talks to people who want to book consultations and are curious whether they will gain weight after they stop using the drug, Vigil said she always says it’s important to change lifestyle habits for sustainable weight loss — and to keep the weight off.
“It’s about treating this medication as an assistant to help you form those healthy habits,” she said.
What are semaglutide and compounded semaglutide treatments?
Semaglutide is the active ingredient in weight loss drugs like Novo Nordisk’s Ozempic and Wegovy, which have been hailed as “miracle drugs” for not only treating obesity but also treating weight-related ailments like diabetes and high blood pressure. It works as an agonist — “a substance that mimics the actions of a neurotransmitter or hormone,” per the Health Research Board’s National Drugs Library — to the brain’s GLP-1 receptors. These receptors regulate the body’s blood sugar levels by stimulating the production of insulin to convert glucose, or sugar, into energy.
The ingredient was also found to help in the gut by slowing down digestion and in the brain by making “you feel fuller faster,” said Kathryn Litten, a clinical assistant professor of pharmacy practice at the University of Texas at Austin College of Pharmacy.
Patients must have a body mass index over 30, or over 27 with a weight-related condition, for doctors to prescribe the drug. Roaring demand for brand-name semaglutide treatments, however, has led to short supply.
The drugs can be expensive, too — without insurance, for instance, a month’s worth of Ozempic can cost almost $1,000. In some cases, insurance doesn’t even cover brand-name semaglutide formulations. Even for those with insurance, more than half say the medications are “very difficult to afford.”
“So many things go into developing a drug,” Litten said. “And so when it comes on the market, it is expensive to help pay for all of the research and the development that went into that drug.”
Litten said that high prices for drugs can typically last for the 20 years that manufacturers have to market the drug under their brand before generic products are allowed to hit the market.
Compounded semaglutide treatments, which are not FDA-approved, are advertised as semaglutide mixed with other ingredients or additives. Compounded semaglutide treatments were developed to address the shortage in brand-name semaglutide options.
Compounded semaglutide treatments are also cheaper than brand-name semaglutide medications. Potter said she spends less than $150 a month for her treatment, though she said it’s important to consider that she’s a longtime user and requests a three-month file.
For Shannon Hanrahan, also a TrimmOff patient, the choice to use the compounded version of semaglutide treatment over a name-brand was “100% because of pricing.”
“It was going to be $1,200 a month,” Hanrahan said. “And I just couldn’t afford that.”
One of the reasons the compounded version of the drug is so much cheaper — particularly from medical spas or compounding pharmacies — is because it comes in a vial and has to be drawn with a syringe, Litten said.
“The drug that you get in the pharmacy will be in a delivery pin where you can dial up your dose and it’s been tested and it’s safe,” Litten said.
Are compounded semaglutide treatments safe?
The best advice for people interested in compounded semaglutide treatments, Litten said, is “going to a reputable source.” Patients can use the Food and Drug Administration’s BeSafeRx tool to look for red flags. All medical spas are required to have a supervising licensed physician, according to the Texas Medical Board.
“Red flags can be anywhere from maybe they don’t require you to have a prescription; they don’t require you to consult with a physician or even a nurse practitioner or advanced practitioner; it’s a low, low price that seems too good to be true,” Litten said. “Maybe the product looks different when you receive it than what you were expecting.”
Litten also recommends inquiring about where drugs are sourced from and looking up whether a pharmacy is approved by the Texas State Board of Pharmacy. However, Litten said, in times of shortage there can be less oversight in compounding pharmacies.
“There are risks — the FDA can’t oversee these pharmacies and the development of them,” Litten said.
There have been instances of contamination, she added, that can cause adverse effects in patients. Some versions of compounded semaglutide treatments also use salt formulations that haven’t been well-studied, she said.
Potter said that before she started her treatment, she asked one of her husband’s friends with a medical background for guidance. She also looked for a clinic with multiple reviews online. Her insurance does cover brand-name drugs, but requires patients to try four other drugs beforehand.
She now uses her compounded semaglutide treatment every Monday night so she can sleep through the initial effects. On Tuesday mornings, she said she can feel “kind of tired and a little nauseous,” which are common side effects of semaglutide drugs, according to GoodRx.
“But it’s really not bad,” she said, though she makes sure she’s properly hydrated to minimize the side effects.
Potter said that since she began using compounded semaglutide treatments, she doesn’t feel as inclined to eat larger portion sizes.
“I realized I had that noise in my head,” she said. “That if I was bored, ‘then eat some chips,’ if I’m bored, ‘eat’ — it was just like boredom eating or stress eating.”
Potter said she is looking to drop about another seven pounds. But she recently bought a bikini – in a size extra-small.
“I can’t even tell you the last time I wanted to wear a bikini,” she said.
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