Frequently Asked Questions

We do NOT prescribe compounded GLP-1 medications at Cedar Weight Loss. Although compounded GLP-1s may be effective for many, and are often less expensive, I prioritize patient safety and efficacy above all else and only prescribe FDA-approved GLP-1 medications. Here are the primary concerns with compounded GLP-1:

• Lack of FDA Oversight: Compounded semaglutide and tirzepatide are not FDA-approved. The FDA does not verify their safety, effectiveness, or manufacturing quality. Although there are many generic medications that can be compounded with an FDA-approved molecule (like hormones, naltrexone, antibiotics and others), this is not the case for these medications yet. 
• Unknown Efficacy and Purity: I cannot guarantee the purity, potency, or stability of a compounded drug. This means the medication may not contain the advertised dose, may be less effective, or could even contain harmful impurities.
• Legal and Regulatory Risks: The use of compounded versions of GLP-1 drugs has been the subject of regulatory scrutiny and legal challenges. I choose to avoid this uncertainty to protect myself and my patients.

At Cedar Weight Loss, we believe in a highly personalized and medically comprehensive approach to your health journey. Here we are focused on your overall health and quality of life, not a number on a scale nor a cost membership fee. Here's what sets us apart:

• Experienced, One-on-One Care: You will work directly with a very experienced Family Nurse Practitioner (FNP). This means you receive individualized attention and a treatment plan tailored specifically to you, your health conditions and preferences, not a one-size-fits-all approach. 
• Holistic Health Assessment: Your clinician's extensive experience allows her to see the bigger picture of your health. Before developing any weight loss plan, she will take the time to understand all of your existing health conditions, current medications and goals.
• Safety-First Approach: Our comprehensive review is crucial for your safety. Our practitioner can identify potential medication interactions, anticipate and help manage possible side effects, and ensure your weight management plan complements your overall health, rather than complicating it. 
• Limited patient panel: Our commitment is to your well-being, providing expert guidance that is both effective and safe. We accept a limited number of new patients every month to ensure you receive high quality care and support.

This is a common and important question. We approach overweight and obesity as chronic medical conditions, much like high blood pressure, high cholesterol, or diabetes. For these conditions, long-term management is often necessary to maintain health and prevent complications. Treatment does not stop or end once the condition is in control, but continues to prevent relapse or complications.

Thus, long-term treatment is generally recommended to help you sustain your weight goal. This treatment may or may not include the long-term use of medications.

YES! This is invaluable for any individual working on weight reduction and maintenance. There is a very high risk of significant muscle loss while losing weight. Body composition monitoring can help you and your provider make sure you are prioritizing fat loss and muscle preservation. 

Options for body composition monitoring can range from home monitoring, body composition testing at clinical settings or scheduling a DXA (Dual-Energy X-ray Absorptiometry) scan. These are all excellent options. 

- DXA ("DEXA") is the "gold standard" for measuring body composition. This is a low-dose X-ray that differentiates between fat mass, lean muscle, and bone density- a powerful tool for tracking progress. It confirms that the weight you're losing is mostly fat rather than muscle, which is crucial for maintaining a healthy metabolism. It can also reveal continued fat loss and success even when the number on the scale or a measuring tape doesn't seem to be changing, helping you stay motivated and on track. This may be available at some gyms, radiology groups, or private companies without a referral. A baseline scan can be repeated every 3-6 months, and can be very helpful in the initial weight loss and maintenance phases.

- Other Options for measuring body composition include:

• Body composition home scales (such as from Renpho), easiest for at-home monitoring. If you can afford it, get one with the handle for more accurate measurements.
• Bioelectrical Impedance Analysis (BIA)
• Air Displacement Plethysmography (Bod Pod)
• Hydrostatic Weighing (Underwater Weighing)
• Skinfold Calipers (far less accurate)

For effective and personalized medical care, baseline FASTING labs are recommended (fasting means you only drink water for 8-12 hours prior to your blood draw, no food or other drinks). These help assess your current health status and guides recommendations.  These can be ordered by your PCP if not recently completed, in which case you can use your insurance. Otherwise you can pay $100-$120 for the entire panel below out-of-pocket (I place a courtesy order, you pay the company directly and go to Labcorp or Quest).

If we find abnormal results, we'll discuss them with you and offer appropriate recommendations. If we identify a new condition that needs to be managed, we'll direct you to your primary care provider to ensure you get the care you need. Depending on your unique health, other labs may be recommended. 

 The lab panel:

• CBC (Complete Blood Count): Measures your red and white blood cells and platelets to check for conditions like anemia or infection.
• CMP (Complete Metabolic Panel): Evaluates your kidney and liver function, blood sugar, and electrolytes.
• TSH w/reflex to free T4 (Thyroid Stimulating Hormone): Screens for thyroid disorders, which can affect metabolism.
• Lipid Panel: Measures your cholesterol levels (total, HDL, and LDL) and triglycerides to assess your cardiovascular health.
• A1C (Glycosylated Hemoglobin): Provides an average of your blood sugar levels over the past 2-3 months to screen for pre-diabetes and diabetes.
• Fasting Insulin: Measures the level of insulin in your blood after fasting, which helps us assess for insulin resistance. 
• CRP-hs (High-sensitivity C-reactive protein): A marker that helps us identify underlying inflammation in your body.
• Uric Acid: Measures the amount of uric acid in your blood.
• Vitamin D: Checks your body's vitamin D level, which is important for overall health.
• UA (Complete Urinalysis): A urine test that can help detect early signs of certain diseases. Please note: this is NOT a drug or pregnancy screen.

Meal replacements are pre-portioned, nutritionally-balanced products like shakes, bars, and prepared meals that serve as a substitute for a full meal. They're designed to help with weight management by simplifying calorie and portion control and providing a quick, convenient option for busy lifestyles. Many products are high in protein and fiber, which help promote a feeling of fullness and curb cravings. These are considered a processed food.

ARE MEAL REPLACEMENTS HELPFUL?

Yes, meal replacements can be helpful when working on weight loss or maintenance, especially if you're taking a GLP-1 like semaglutide or tirzepatide. GLP-1 medications can reduce appetite, making it difficult to consume enough food to get the necessary nutrients. Meal replacements offer a simple way to ensure you're getting adequate protein, vitamins, and minerals, which helps prevent nutrient deficiencies and preserve muscle mass during weight loss.

WHAT ARE POSSIBLE RISKS OF MEAL REPLACEMENTS?

While helpful, meal replacements have potential drawbacks, some of which include:

• Nutrient Deficiencies Some products may lack essential vitamins and minerals, especially if they are not designed to be a complete meal replacement.
• Digestive Issues Ingredients like lactose or whey protein, sugar alcohols, artificial sweeteners, and certain types of fiber can cause bloating, gas, or other digestive discomfort.
• Reliance on Processed Foods Over-relying on highly processed meal replacements can hinder the development of long-term healthy eating habits and may lead to weight regain once you stop using them.
• Excessive Sugar Many products, especially bars and shakes, can be loaded with added sugars, which can undermine your weight loss goals.
• Potential for Disordered Eating: In some cases, rigid reliance on meal replacements can contribute to a cycle of restrictive eating and a poor relationship with food. 

To mitigate these risks, it's best to choose high-quality products with a balanced nutrient profile and minimal added sugars. It's also important to use them as a tool within a broader healthy lifestyle, not as a complete replacement for whole foods.

WHAT ARE SOME MEAL REPLACEMENT OPTIONS? (not an exhaustive list)

MEDICALLY SUPERVISED PROGRAMS

These programs use structured meal replacements and should be overseen by a healthcare professional. Examples include HMR (Health Management Resources), Bariatrix, Ideal Protein, and Robard (New Direction). 

PREPARED MEAL DELIVERY SERVICES

These services offer a convenient, "whole-food" alternative to shakes and bars. They deliver pre-cooked, portion-controlled meals directly to your door. Some popular options include CookUnity, Factor, EatClean and Trifecta. Check macronutrient and sodium content to ensure they align with your needs. Many pre-made meals can have extremely high sodium or carb levels.

NON-MEDICAL MEAL REPLACEMENT SHAKES AND BARS

These are widely available products that prioritize a good balance of protein and nutrients. There are many, but just a few examples include Huel, Soylent, and Ka'Chava. Check macronutrient and sodium content to ensure they align with your needs. There are new companies and new testing on them all time. Do your research.

Having an underlying health condition is precisely why weight reduction or maintenance under the care of a licensed medical professional can be so beneficial. We view medical weight loss as an important for preventing, improving, and treating a wide range of chronic medical conditions. We know that modest weight loss of 5-10% leads to substantial improvements in health and reduces the risk or severity of many chronic diseases.

A 5-10% weight reduction can significantly improve or prevent conditions such as:

• Cardiovascular disease, including high blood pressure and cholesterol
• Type 2 diabetes
• MAFLD (metabolic-associated fatty liver disease, previously known as NAFLD)
• Liver fibrosis
• Sleep apnea
• Asthma
• Knee osteoarthritis and other joint pain
• Autoimmune conditions
• GERD/reflux
• Reducing the risk of and improving outcomes for certain cancers

During your health review, we take all of your medical conditions and current medications into account to create a comprehensive plan or recommendations that support your goals and overall health.

Due to safety concerns, we do not recommend weight loss medications to individuals who are pregnant, breastfeeding, or actively trying for a pregnancy. If you become pregnant while on medication, please inform your prescribing provider or PCP immediately, as the medication will need to be discontinued. For those planning a pregnancy, all weight loss medications should be stopped at least 2-3 months before attempting to conceive. 

It is important to note that achieving a healthier weight can often improve fertility and increase the chances of a healthy pregnancy.  

Cedar Weight Loss is a cash-based clinic and does not bill insurance companies. This allows us to focus entirely on your personalized care without the constraints of insurance-mandated visit times or treatment restrictions. This means you get more time with your clinician and a plan truly tailored to your unique needs.

We can provide you with an invoice, often called a "Superbill," that you can submit to your insurance company for potential reimbursement. We recommend contacting your insurance provider to inquire about your "out-of-network" benefits for medical care. Be aware that some insurance plans do not cover obesity care, and it may be "exempt" from your plan. 

Working with your primary care provider (PCP) can be an excellent and cost-effective decision for long-term weight management. At Cedar Weight Loss, our services are designed to give you a strong start with a personalized plan, offering the extended time that you deserve. I can fax our visit and lab records to your PCP to ensure a smooth handoff. Please note it may take at least 3 months to get an appointment with your PCP, please plan for this in advance. 

We advise seeing your PCP, prescribing provider and/or a registered dietician monthly for weight management until you have maintained your goal weight for at least 6-9 months, then possibly dropping to quarterly follow-ups if preferred. Weight management is a chronic condition that benefits from routine, ongoing care. If you notice a weight gain of 5 pounds or more during your maintenance phase, it’s important to schedule a follow-up visit with your provider. You are always welcome to return to Cedar Weight Loss for support or care.