Weight Loss Treatment Plan
Your doctor has prescribed you a weight loss product, SVELTIQUE, for your condition. Be sure to take your time and read everything below. It is essential for you to understand the potential risks and benefits of treatment. Please do not hesitate to reach out to our medical support team if you have ANY questions. The following represents a plan that details how you can optimize your weight. This medication works for the vast majority of patients and it usually does so without causing side effects—and that’s great. However, if a trusting relationship is to work, then it must be open, meaning that we must share more than how everything can go according to plan. Sometimes, the plan doesn’t work. No drug is a magic bullet. Just as no drug works on everyone, no drug is 100% safe. It is important that you learn as much as you can about your treatment. The more you read, the more questions will be answered and the better the plan can work.
Telemedicine has the advantage of convenience, but it relies on your honesty and involvement in the process. If your health should change, should you have a side effect, should the medicine not work or stop working with time, please contact us. We are here for you. You’ve taken a big step and you are not alone. We have done the legwork and put together information so you can do it right. First, you read your plan, which is followed by information about the process of losing weight. Lastly, read the detailed information about the medication prescribed by your doctor. We suggest that you read it, the package insert and the official prescribers’ digital reference (PDR). Being fully informed is a way for you to know if this plan suits your needs and if you want to accept it as presented. You may reject the treatment plan or you may want to request a modification to the plan.
The prescription medicine we are giving you to help with your weight concerns is a compounded formula with multiple ingredients called Sveltique. There is a topiramate-free version called Sveltique- lite in case you cannot tolerate the topiramate. The usual effective dose is one capsule daily for weeks 1 & 2 then increase to one capsule twice daily for weeks 3 & 4. Increase the dose to two capsules in the morning and one capsule in the evening for weeks 5&6. Then you increase to two capsules twice daily from that point forward. You will remain on this dosage for long term maintenance but should adjust to the dose that is most effective for you. When starting Sveltique, it may take some time to notice a reduction in your weight. It is typical to see maximum improvement after several months of use. Contact your doctor if deciding to stop medicine and if tapering off the medicine is necessary. We’ve asked you about your medical history and the medicines you take to determine if it’s safe and appropriate to prescribe Sveltique to you. Only by knowing the risks and alternatives can you make an informed decision about whether you want to accept our treatment plan. When starting Sveltique, common side effects may include mild nausea or loose stools. Usually these symptoms will gradually improve over 2 weeks. These side effects can possibly occur if taking the medicine on a daily basis.
WEIGHT LOSS OVERVIEW
Excessive weight is determined using the body mass index (BMI). Because it is difficult to measure obesity, the use of BMI should be used as a guide, along with waist size, to help estimate the amount of body fat. Because BMI estimates a healthy weight based on your height and weight, it is a more accurate guide than body weight alone. To calculate your BMI: 1) Multiply your weight in pounds by 703, 2) Divide that answer by your height in inches, 3) Divide that answer by your height in inches again. Then use the following ranges to see what category your BMI falls: <18.5 underweight, 18.5-24.9 healthy, 25-29.9 overweight, 30-39.9 obese, >40 morbidly obese. Obesity can shorten your life and put you at risk of developing a number of conditions, including high blood pressure, diabetes, heart disease, and some forms of cancer. Many other health risks are higher for people who are obese, and these risks may increase as the degree of obesity increases. Additionally, people who carry extra weight around their waist may be more likely to experience health problems caused by obesity than those who carry it in their legs and thighs. People become overweight for a number of reasons; often, several of the following factors are involved:
- Genetics (FTO gene)
- Physiological influences (age, sex, body size, metabolic rate)
- Food intake and eating disorders (binge-eating)
- Lifestyle (sedentary lifestyle)
- Stress (see below)
- Weight history: If you were overweight as a child or adolescent, you are more likely to be obese as an adult.
- Pregnancy can contribute to obesity. Many women weigh more after each pregnancy.
- Drugs can cause obesity. These include steroid hormones and many drugs used to treat psychiatric conditions.
The primary warning sign of obesity is an above-average body weight. If you are overweight, you may also experience trouble sleeping, sleep apnea, shortness of breath, varicose veins, skin disorders, gallstones, and osteoarthritis. Obesity increases your risk for high blood pressure, high levels of blood sugar (diabetes), high cholesterol, and elevated triglycerides. Women with a waist more than 35 inches or men with a waist more than 40 inches are at increased risk. Obesity is often a lifelong problem. Once excess weight is gained, it is not easy to lose, and once lost, you will have to work at maintaining your healthier weight. The length of time it takes to reach your weight goal depends on how much you have to lose, your activity level, and the type of treatment or weight-loss program you choose. Diseases and conditions caused by obesity often improve as you lose weight. To prevent obesity and maintain a healthy body weight, eat a well-balanced diet and exercise regularly.
Stress and Weight Gain
Feeling stressed for any reason can have emotional and psychological repercussions that affect your weight. The stress response is the body’s way of keeping us safe. When the brain senses danger, it alerts the adrenal glands to release stress hormones. These stress molecules cause your heart to pound, blood pressure to rise, and blood vessels to constrict in order to send more blood to your brain and muscles to better fight or faster flight. Stress increases your respiratory rate to get oxygen to your muscles, and sends fat and sugar into the bloodstream to boost your energy.
The stress response may be helpful in the short term as it enables you to get through a difficult situation.
But triggering the stress response repeatedly, known as chronic stress, can contribute to depression, anxiety, high blood pressure, diabetes, heart disease, heartburn, and many other health problems—including weight gain.
Stress reduction and health tips for weight loss:
- Exercise can help us deal with stress and also increases our metabolism and burns fat. Exercise at least 30 minutes daily on most days of the week. Some examples of exercise include walking, riding a bicycle, dancing, and swimming. Meet with an exercise “buddy” who will help you stay active.
- Relaxation response is a well-studied physiological change that can help lower your blood pressure, heart rate, breathing rate, oxygen consumption, adrenaline levels, and levels of the stress hormone cortisol.
- guided imagery
- Tai Chi
- deep breathing exercises
- Proper nutrition is essential to addressing stress and weight loss. The Mediterranean diet has been shown to be effective as it supports a health microbiome in our intestinal tract. Other dietary measures include eliminating soda and sugary drinks and focusing on food quality rather than simply on calories.
- Keep a food record for three days. Track all the food and beverages you eat along with the portions. Identify how often you are eating away from home, eating takeout, or buying food on the run.
- Set a goal and make a plan. What is your goal? Do you want to lose weight to improve your health? Do you dream of fitting into an old pair of jeans? How will you achieve your goal? Will you cook more meals at home? Will you eat smaller portions? Be specific and start small.
- Identify barriers to your goals — and ways to overcome them. Could a busy schedule get in the way of going to the gym? Wake up an hour earlier. Has an empty pantry prevented you from cooking at home? Look up some healthy recipes, then head to the grocery store armed with a list of ingredients you’ll need to prepare them. But don’t go to the store hungry; this could lead you to purchasing food items that are unhealthy.
- Identify current habits that lead to unhealthy eating. Do you relax and reward yourself by snacking in front of the TV? Do you skip lunch only to feel starved by midafternoon, ready to eat anything in sight? Do you finish everything on your plate even after you start to feel full?
- Eat smaller portions. Refamiliarize yourself with standard serving sizes. Did you know that one serving of poultry or meat is 4 ounces, or the size of a deck of playing cards? Or that one serving of pasta is only 1/2 cup? Use a small plate with smaller servings and avoid second helpings. When out to eat, ask for a to-go box and put half of your food in it before eating. Replace high calorie snacks with healthier, low calorie snacks.
- Identify hunger and satiety cues. Be aware of physical versus emotional hunger. Do you eat when you feel something physical in your body that responds to food? Or do you eat when you are stressed, bored, tired, sad, or anxious? Try to stop eating BEFORE getting full (it takes about 20 minutes for your brain to register “stop eating” signals from your stomach). Foods that can help you feel fuller include high-fiber foods such as vegetables, whole grains, beans, and legumes; protein (fish, poultry, eggs); and water.
- Focus on the positive changes. Changing behavior takes time — at least three months. Don’t give up if you slip up along the way. Get support from others and take the time to acknowledge the changes you have made.
- Go with the 80/20 rule. Stay on track 80% of the time, but leave some room for a few indulgences. You don’t want to feel deprived or guilty.
- Focus on overall health. Walk, dance, bike, rake leaves, garden — find activities you enjoy and do them every day. Ditch the “diet” aisle and focus on seasonal, whole, high-quality foods.
- Eat slowly and mindfully. Enjoy the entire experience of eating. Take the time to appreciate the aromas, tastes, and textures of the meal in front of you.
ALTERNATIVE TREATMENT OPTIONS There are alternative treatments to the medicine we’ve prescribed:
- Non-prescription orlistat (Alli). Orlistat inhibits fat absorption in the intestine. Originally, this medication was only available by prescription (Xenical). The over-the-counter medicine is sold at a lower dose than Xenical, but the active ingredient is the same.
- Over-the-counter diet pills often contain ingredients that can increase heart rate and blood pressure. It is not clear how effective they are in producing weight loss that can be maintained over time. Common side effects include feeling jittery and nervous and having heart palpitations. Some experts believe they may be associated with an increased risk of stroke.
- Surgery. In general, weight-loss surgery (called bariatric surgery) may be considered if your BMI is 40 or greater, or your BMI is 30-35 or greater and you have at least one medical condition directly related to obesity. In addition, you must have participated in a structured weight loss program without success.
- Gastroplasty – also known as stomach stapling. A surgeon creates a small pouch in the stomach that allows only limited amounts of food to be eaten at one time.
- Laparoscopic adjustable gastric banding. A surgeon places an adjustable band around the stomach with minimally invasive surgery.
- Gastric bypass. This is the most effective weight loss surgery. However, it also carries a greater risk of complications, both short term and long term. A surgeon creates a small pouch in the upper part of the stomach. A hole is made in the small intestine beyond the normal stomach attachment. The pouch is attached to the hole, bypassing the rest of the stomach and the top part of the small intestine.
- Acupuncture is the traditional Chinese medical practice of stimulating specific points on the body, primarily with the insertion of very thin needles through the skin.
- A personal “coach” can be a helpful part of your short and long term weight loss program.
- Hypnosis is a state of inner absorption and concentration, like being in a trance. Hypnosis is usually done with the help of a hypnotherapist using verbal repetition and mental images. When you’re under hypnosis, your attention is highly focused, and you’re more responsive to suggestions, including behavior changes that can help you lose weight.
The ingredients of the Sveltique formulas are as follows:
Naltrexone – an opioid receptor antagonist with a high affinity for the mu opioid receptor, naltrexone also influences eating behavior by stimulating a region of the hypothalamus called pro-opiomelanocortin (POMC) cells that produce ɑ-melanocyte stimulating hormone (ɑ-MSH), which binds to MC4R receptor which produces an overall anorexic effect, increasing energy expenditure and decreasing appetite.
Bupropion – a dopamine and norepinephrine reuptake inhibitor, this antidepressant helps blunt the feeling of hunger and increases energy expenditure without causing an increase in food intake. Like naltrexone, bupropion also stimulates POMC cells to release ɑ-MSH.
Topiramate – stimulates gamma-aminobutyric acid (GABA) release which has an inhibitory effect of NPY/AGRP, thereby reducing feelings of hunger normally precipitated by stimulation of this pathway. (this ingredient is not in Sveltique-Lite)
Chromium picolinate- This is a well absorbed form of Chromium, which has a well-documented role in insulin action and glucose metabolism. Studies have shown effects ranging from modulating blood sugar levels to decreasing appetite, hunger cravings, and binge-eating episodes.
For best results, combine this with exercise and dietary changes. Avoid drinking alcohol when taking this medicine and only take the medicine as prescribed. Depending on your response to treatment, there may be a time we recommend that you see a doctor or weight-loss specialist in person rather than using our service.
ADVERSE REACTIONS If any aspect of your health changes, please make sure to review the medicines you take with a professional. Speak with your provider if you’ve taken opiate-containing medications during the previous 14 days.
POSSIBLE SIDE EFFECTS
- Rapid Heart rate
- Dry Mouth
- Abdominal pain/cramping
- Abnormal Serum bicarbonate
- Loss of appetite
- Feeling nervous
- Impaired cognition
- Reduced concentration
INFREQUENT SIDE EFFECTS
- Cardiac dysrhythmia
- Angle closure glaucoma
- Withdrawal symptom
- Metabolic acidosis
- Increased body temperature
- Suicidal thoughts
EMERGENT SIDE EFFECTS Important warning signs of these severe side effects are listed below. If you have any of the dangerous side effects in the list below, please call us or seek immediate medical attention. Stop taking the medicine because these symptoms may be caused by an allergic reaction or they represent an unusual but severe reaction to the medicine. Once you’ve received medical attention, please let us know by sending us a message.
- Severe skin rash
- Shortness of breath
- Swelling of face, tongue, throat
CAUTION WITH PREEXISTING MEDICAL CONDITIONS Please contact us if you have any of the following conditions so that we may properly assess your medical needs:
- Pregnant or Lactating
- Metabolic acidosis with metformin use
- Concomitant opioid use/dependency
- Acute opioid withdrawal
- Concomitant MAOI use within 14 days
- Seizure disorders
- Bulimia or anorexia diagnosis
ALLERGIES Send us a message and don’t take this medicine if you have any of the following allergies: bupropion, naltrexone, topiramate, Folic Acid (B9), cobalamin (B12) or gelatin.
MEDICATIONS THAT MAY INTERACT Please discuss this medication with your doctors because, while rare, the following drug interactions may apply to you. Be sure to talk with a doctor before starting any new medicines that might interfere with your current ones. Send us a message and let us know if you’re taking any of the following medicines:
- Tranquilizers (eszopiclone)
- Sedatives (zolpidem)
- Select Tricyclic antidepressants
- Steroids (lower seizure threshold)
- Hormonal contraceptives
- Gabapentin, pregabalin
- Dorzolamide, acetazolamide
Improving Your Overall Health There are things that you must do to improve your health including eating healthier foods, stopping smoking if you smoke, reducing alcohol consumption, and exercising regularly. If you have health problems such as high blood pressure, cholesterol or diabetes, it’s also important to make sure they’re under good control. At a minimum, check your blood pressure once a year. It should be less than 140/90 and ideally under 120/80. Patients aged 40 or older should have a fasting blood sugar test to screen for diabetes.
RISK OF MISDIAGNOSIS We rely on symptoms and your answers to our health questions to diagnose you with a weight disorder. It’s possible that we may diagnose and treat you for a weight disorder even though you don’t have one, and that another condition is present that the medicine we prescribed won’t treat. It’s also possible that other potential physical causes of weight gain would be identified and investigated further if you were to see a doctor in person. As a result, you may end up taking this medicine unnecessarily and take on the risk of side effects from this medicine without any clear benefit. We try to minimize this risk by using the latest medical guidelines and evidence to determine when it’s appropriate to treat you. If you’re having serious side effects, you should see a doctor in person and keep us informed.
RISK THAT THE MEDICINE WON’T WORK Prescription medicines used to help with weight loss may not work effectively if there are other prescription medicines you’re taking, or you have medical conditions that interfere with their ability to be effective. It’s very important that you answer our health questions accurately because the questions we asked you helped us identify pertinent health conditions and the appropriate medicine. If your symptoms aren’t improving with the medicine, or seem to be changing or worsening, you should stop taking the medicine we’ve prescribed and send us a message. If you’re having serious side effects, you should discontinue the medication, see a doctor in person and keep us informed of your progress.