Dr. Spencer Nadolsky

And that is a combination of fentramine and topiramate. Topiramate works in GABA. They think that's part of why it works for appetite suppression. But think about different receptors, lower doses of each, so you get fewer side effects. The fentramine can cause people to have insomnia, dry mouth, heart palpitation.

And that is a combination of fentramine and topiramate. Topiramate works in GABA. They think that's part of why it works for appetite suppression. But think about different receptors, lower doses of each, so you get fewer side effects. The fentramine can cause people to have insomnia, dry mouth, heart palpitation.

So you try to use lower doses and then add it to something else that has a little bit of appetite suppression, which is topiramate, doesn't work in the same pathway. So that was approved, and that was for chronic patients. And that was, that kind of, you know, the highest dose gets around 10% total body weight loss. So not bad, but side effects.

So you try to use lower doses and then add it to something else that has a little bit of appetite suppression, which is topiramate, doesn't work in the same pathway. So that was approved, and that was for chronic patients. And that was, that kind of, you know, the highest dose gets around 10% total body weight loss. So not bad, but side effects.

So you try to use lower doses and then add it to something else that has a little bit of appetite suppression, which is topiramate, doesn't work in the same pathway. So that was approved, and that was for chronic patients. And that was, that kind of, you know, the highest dose gets around 10% total body weight loss. So not bad, but side effects.

The other one was, if you remember, lorcaserin with Belvique. It was actually similar to fenfluramine, but it had the... It had a different serotonergic receptor, more specific. Actually got taken off because of, we don't know why exactly, but some concerns for cancer. Very mild weight loss effect though, around like five or something percent total body weight loss.

The other one was, if you remember, lorcaserin with Belvique. It was actually similar to fenfluramine, but it had the... It had a different serotonergic receptor, more specific. Actually got taken off because of, we don't know why exactly, but some concerns for cancer. Very mild weight loss effect though, around like five or something percent total body weight loss.

The other one was, if you remember, lorcaserin with Belvique. It was actually similar to fenfluramine, but it had the... It had a different serotonergic receptor, more specific. Actually got taken off because of, we don't know why exactly, but some concerns for cancer. Very mild weight loss effect though, around like five or something percent total body weight loss.

There was Contrave that came out in 2014, bupropion naltrexone combination. Not that great, still out right now, 6%, maybe 5, 6% total body weight loss. And when you think about like good diet and exercise, intensive coaching, you're going to get around five or 6% total body weight loss on average. People are like listening, going, I lost a hundred pounds. And it's like, yeah, yeah.

There was Contrave that came out in 2014, bupropion naltrexone combination. Not that great, still out right now, 6%, maybe 5, 6% total body weight loss. And when you think about like good diet and exercise, intensive coaching, you're going to get around five or 6% total body weight loss on average. People are like listening, going, I lost a hundred pounds. And it's like, yeah, yeah.

There was Contrave that came out in 2014, bupropion naltrexone combination. Not that great, still out right now, 6%, maybe 5, 6% total body weight loss. And when you think about like good diet and exercise, intensive coaching, you're going to get around five or 6% total body weight loss on average. People are like listening, going, I lost a hundred pounds. And it's like, yeah, yeah.

Like I'm saying on a population average, we're looking at that, that number. So contrave or bupropion, naltrexone wasn't that great. So it was very frustrating, you know, in residency, I'm like, I'm going to be an obesity doctor. I'm trying, you know, trying to try to do my thing. And those are the drugs that I had. It was 2014 and, I believe it was Saxenda liraglutide, if people remember Victoza.

Like I'm saying on a population average, we're looking at that, that number. So contrave or bupropion, naltrexone wasn't that great. So it was very frustrating, you know, in residency, I'm like, I'm going to be an obesity doctor. I'm trying, you know, trying to try to do my thing. And those are the drugs that I had. It was 2014 and, I believe it was Saxenda liraglutide, if people remember Victoza.

Like I'm saying on a population average, we're looking at that, that number. So contrave or bupropion, naltrexone wasn't that great. So it was very frustrating, you know, in residency, I'm like, I'm going to be an obesity doctor. I'm trying, you know, trying to try to do my thing. And those are the drugs that I had. It was 2014 and, I believe it was Saxenda liraglutide, if people remember Victoza.

So liraglutide was the second GLP-1 receptor agonist that came out in like whatever it was, 2009 or something for type 2 diabetes. But 2014, they cranked the dose up to three milligrams. Now liraglutide is a once daily injection. And that high dose liraglutide in 2014, they promoted as Saxenda, it was around like seven or 8% total body weight loss. So like

So liraglutide was the second GLP-1 receptor agonist that came out in like whatever it was, 2009 or something for type 2 diabetes. But 2014, they cranked the dose up to three milligrams. Now liraglutide is a once daily injection. And that high dose liraglutide in 2014, they promoted as Saxenda, it was around like seven or 8% total body weight loss. So like

So liraglutide was the second GLP-1 receptor agonist that came out in like whatever it was, 2009 or something for type 2 diabetes. But 2014, they cranked the dose up to three milligrams. Now liraglutide is a once daily injection. And that high dose liraglutide in 2014, they promoted as Saxenda, it was around like seven or 8% total body weight loss. So like

It's okay, but it's like a $1,200, you know, $1,000 drug for more side effects, daily injections, and overall not that great amount of weight loss. So that was like the, you know, we went from lifestyle, trying behavior, behavior, behavior with some high side effect drugs that some of them, some people responded to. And then you jump all the way from that to bariatric surgery.

It's okay, but it's like a $1,200, you know, $1,000 drug for more side effects, daily injections, and overall not that great amount of weight loss. So that was like the, you know, we went from lifestyle, trying behavior, behavior, behavior with some high side effect drugs that some of them, some people responded to. And then you jump all the way from that to bariatric surgery.

It's okay, but it's like a $1,200, you know, $1,000 drug for more side effects, daily injections, and overall not that great amount of weight loss. So that was like the, you know, we went from lifestyle, trying behavior, behavior, behavior with some high side effect drugs that some of them, some people responded to. And then you jump all the way from that to bariatric surgery.