WEIGHT LOSS

Our weight loss pathway will work for anyone who is ready to drop the extra pounds and start feeling better.

We combine dietary advice, an exercise program and medications to help patients lose weight.  We typically prescribe phentermine or topiramate to help suppress appetite, allowing patients to stay on a very low calorie diet.  Your body is designed to make sure you don’t lose weight, but medicine can stack the deck in your favor.  If your Body Mass Index (BMI) is over 30 (or 28 with certain medical conditions), you qualify.  Calculate your BMI here.

Our weight loss program costs $44/month. You can cancel any time.*

WEIGHT LOSS LEVEL 1

$44 / Month

Doctor visits

every 3 months over video chat

Medications to your Home

we utilize generic versions of Phentermine (written prescription to the pharmacy), Topiramate, and Bupropion (free, mailed to your home) for weight loss results Click here to learn more about these medications

$44 / Month

CHOOSE PATH
*Our one time visit fee is $85, we will just bill you $85 for the first visit if you cancel before the second month.  All patients in our weight loss program are automatically a part of Big Tree Virtual Medical Home, allowing us to deal with whatever issues come up.

An online weight loss program, seriously? Here is our way too long explanation for why we want to try. This is a fight for your life. The National Institute of Health places obesity as the #2 cause of preventable death in the U.S., leading to 300,000 deaths a year. While there are real issues with each medication discussed below, we believe these pale in comparison to the potential impact.

Every year in the U.S., as many people die from the complications of obesity as soldiers that died in ANY WAR that the U.S. has fought, including the Civil War or World War 2.

If we had a pill that could have prevented most of the war deaths in US history, for us not to use it, we should be considered evil, or at least cowardly. Take a look at our summary of the medications below and see if you think the downsides justify not making an attempt to save 300,000 lives a year.

Everyone knows that you have to eat less and move more to lose weight. So why is it so hard? Why do so many people suffer from the complications of obesity, the social stigma associated with being overweight and the guilt that they “did this to themselves?”

It turns out that it is not quite as easy as just eating less and moving more. Our brains are hard-wired to get us as many calorie reserves as possible (i.e. fat). Our brains don’t want us to starve, so in times of “plenty,” we pack on the extra. And in times of “famine,” our bodies tell us to eat more, trying to take us back to that body-fat set-point that it had created previously during a time of plenty. Our bodies use hormones and brain chemicals in a time of “famine” (i.e. dieting) that were designed to push us to work harder to get back to that heavier state.

And while such a system helped us survive the dramatic swings of “plenty” and “famine,” it has combined with our current food system in very dangerous ways. From our body’s perspective, 21st century America is a GREAT time to pack on the pounds! There is so much food, so little need to move, what a great time to store up! Except our bodies are unlikely to ever see the famine time, and the extra fat can actually become dangerous. The extra pounds are weighing down our joints, contributing to arthritis. Our metabolism can’t handle the excess calories, and when it starts to burn out it is called diabetes (type 2). The excess clogs up our arteries and we get heart attacks and strokes.

So, it is not so simple as just eat less and exercise more. The more you lose, the more your body pushes you to get back to your heavier weight. It is not a fair fight. And all this is before you consider the effects of the media, social stigma, personal mental health issues, the positive mental health effects of eating (which get taken away when you are in starvation mode) and a thousand other societal and personal interactions with our bodies and food. It is physiologically easier for a thin person to say no to extra food than it is for an obese person to say no.

It is physiologically easier for a thin person to say no to extra food than it is for an obese person to say no.

So how can we deal with obesity (For our purposes, obesity is a BMI over 30 and overweight is a BMI over 25. Google “BMI calculator” if you need one)? How can we deal with the problem of our bodies always wanting to pull us back to a heavier weight? If it is a neuro-hormonal problem, then we need a neuro-hormonal solution. Bariatric surgery is so often effective, in part, because it changes how the hormones created in your intestines effect the brain. More people should be getting surgery for their obesity. But, too few people are willing to get surgery.

We can also effect things in the brain. We can put chemicals in the brain (by taking a pill) that interfere with the messages that the brain is processing to try and get you to eat more. The effect is that you feel content only eating 1,200 calories per day, or at least a lot more content that you would just trying it without the medicine.

Therapy works in a similar way. A trained therapist uses brain hacks to help reprogram how the nerves in your brain interact. Our therapy-based tricks are not as good as we would like, but the effects are often long lasting, if they work.

So, unless you want your weight to limit your life, you have 4 options:

  1. surgery,
  2. therapy,
  3. medicine,
  4. or trying to lose weight by will power alone.

Surgery and therapy are great options, though expensive and labor-intensive. The will power method can be helped along by various groups (Weight Watchers) and meal plans but is rarely effective.

Medicines can be helpful. They can have side effects. They come in a variety of prices. They require seeing a doctor. We lack the long term studies that we wish we had on many of them. THEY ARE WAY UNDERUTILIZED. 90% of overweight individuals should either have surgery, be in long term therapy or be on medicine. There are scattered individuals out there that have a reason not to be on medicine (a contraindication). Each medicine has its own reasons why they should not be on it, so we can pick from the menu and find one that fits nearly everyone. At Big Tree, we think of obesity as a chronic disease. We often recommend keeping people on medicine long term, despite the fact that the FDA has not evaluated such a plan. Many other weight loss programs do so. Once we get an asthma patient breathing better, we don’t stop their medicine, we realize that we have a plan that works and we keep it going. So too with weight loss. Once we get your appetite appropriately suppressed, we keep going. If we stop, we would expect the hormones to once again push you to a heavier weight.  For more information, check out this video.

FAQ:

Is talking to your team as good as going to the Mayo Clinic or some other fancy health system?

Yes and no. In the end, everyone treats diabetes and depression with the same few medications. From a diagnostics perspective, I wish everyone could get care from the top internists at Mayo. Unfortunately, that is not possible. Countries must either ration health care by price or by making you stand in line (Uwe Reinhardt, if I remember right). Our country rations by price. The more you pay, the better your care, and, there are no cheaper options. We are just trying to leverage mobile technology, mid-level providers and generic medications to help lower the cost of care. If you are a multi-millionaire, then head up to Mayo and buy your medications at Walgreens. Or we can prescribe you the same exact medication for a much cheaper price. An insurance broker compares this to buying Busch beer at a Cardinals game or at a gas station across the street from the stadium. Same beer. Different price.

Are the medicines and supplies from foreign countries?

We use the same FDA approved suppliers as any use pharmacy would use. Though it is legal for individual patients to buy up to 90 days of medicine from out of the country (like you can do at pharmacychecker.com), it is not legal for us to purchase medications that are not approved by the FDA. This is all legit.

Who are your doctors and nurses?

Adam Wheeler M.D. is the attending physician, who designs the programs and oversees several assistant physicians. Helena Galstian M.D., Megan Ellis R.N., and Noe Rusaya help patients apply the care pathways. Though this is a new idea, our team has coordinated care for thousands of people in many complex and diverse environments.

What if, after talking to the doctor and nurse, I don’t want to follow one of the care pathways? What if they don’t think they are appropriate for me?

There is no charge.

How long do I have to commit to the program?

We mail you a month of medication at a time. You can cancel any time.