GLP-1 Weight Loss and the evolving role for Med Spas
The GLP-1 Revolution is here to stay. The medical community has wakened to the reality that these new treatments are game changers for many obese patients who have struggled with their weight. In the past, health care providers had a limited toolbox of medications to help with hunger and metabolism. Patients are now seeing their providers with increased frequency to obtain GLP-1 medication.
This blog shares my views on the role for med spas in the new GLP-1 world.
Drug Shortages and Limited Access to brand name GLP-1 medications
As a med spa owner, I am responding to the evolving needs of patients. When brand name GLP-1’s were in short supply, compounding pharmacies responded quickly, and we were able to offer reliably sourced semaglutide and tirzepatide. The pharmaceutical industry has ramped up production and are meeting the world demand for GLP-1’s. Despite this, some patients are still finding access to these medications challenging. Sometimes the obstacle has been getting their insurance company to approve brand name products. When they are approved it may be for a limited time basis, or only while they have a BMI defined diagnosis of obesity. Time will tell if insurance companies accept the growing body of opinion that as a chronic, relapsing disease obesity needs to be treated long term with medications, and that includes the GLP-1 drugs. When access proves to be a problem, med spas offer an option of self-pay, which can be as affordable or more affordable than the brand name options. As an owner that has battled my own weight over the years, I understand the chronic nature of obesity and the need for lifelong support.
The need for nutritional guidance
I am concerned that many people who are receiving GLP-1 drugs are not receiving adequate nutritional guidance. Yes, they are losing weight, but for some people it is because they are eating less of the wrong foods, the foods that contributed to their obesity in the first place. We know that a balanced low calorie diet of healthy foods is the best choice. Food behavior change is never easy, but for over 18 years I have offered a weight loss plan based on a healthy food diet of approximately 800 calories per day. We combine this way of eating, branded as The Omaha Weight Loss Diet, or OWL Diet for short, with Phentermine, and occasionally topiramate. Today the combination of Phentermine with either Semaglutide or Tirzepatide is how our patients are achieving sustained weight loss results. What is the downside of losing weight quickly, but not eating a healthy balanced diet of protein, fruits and vegetables? All patients who lose more than 50 pounds will notice volume loss in the face, laxity of skin and loss of muscle mass. But is it worse when people are eating poorly while losing weight? I suspect the answer is yes.
Med Spa owners need to do more than simply offer weekly visits for GLP-1 injections. We need to offer a healthy way of eating to go along with the medication.
Burning fat and muscle on a LCD, and the role of dietary protein and supplements
On a low calorie diet, the body will preferentially burn fat over muscle to make up the deficit and protect organ health. There is a concern with all diets that people lose skeletal muscle mass. Is this happening more with GLP-1 dieters? Perhaps over time, science will answer that question.
Recently people are talking about ensuring that GLP-1 dieters consume enough protein every day. What is bantered around is that 60gm of protein is the magic number. How does that translate into food portions? In simple terms, it equates to approximately 7 ounces of beef, chicken or seafood per day. This has been the food allowance on The Omaha Weight Loss Diet since it evolved over 18 years ago. Most Americans are raised to eat more than 7 ounces of protein a day, so is lack of protein in the diet truly the issue with today’s GLP-1 dieters?
What is the role of exercise to maintain muscle mass? On a low calorie diet, such as my OWL Diet, you will consume on average 800 calories per day. You cannot do very much exercise, or you will feel weak, lightheaded and could even faint. In addition, on 800 calories per day you will be experiencing ketosis, with it’s inherent potassium shifts, and too much exercise could trigger heart rhythm concerns that could be serious. Certainly low level excercise should be encouraged and perhaps more emphasis on resistance training. I feel I should learn more about resistance training and offer some simple exercises that our dieters could follow.
Med Spa owners can also offer injectable blends of Amino Acids that may help boost production of new muscle.
Treatment solutions for Skin Laxity and Persistent Fat Deposits
We are going to be seeing more people who have success at losing 50+ pounds. These people need to know that the aesthetics industry is ready to help them with volume loss in the face, skin laxity and regional stubborn fat deposits.
I have invested heavily in Radiofrequency technology, and I am glad that I did. I now have the tools to offer non-surgical solutions that really work! Morpheus8 is RF microneedling and it works beautifully on the face and neck to tighten skin. If there are stubborn fat pads in the neck or face that persist despite the weight loss, then we can up the power settings to destroy those fat cells at the same time as building new collagen and elastin for firmer skin. InMode, the manufacturer of Morpheus, then developed a handpiece and treatment program to treat body areas. We have the body handpiece and the most popular area to treat has been the abdomen. In body areas, Morpheus rarely disappoints. I believe it is important to follow InMode’s treatment protocols, which take time. My providers know not to take shortcuts. What is the barrier to Morpheus? I would say cost, as the equipment is expensive to purchase and that impacts the price per treatment. Secondly, RF microneedling is painful. We offer Zimmer chiller, which delivers a continous flow of cold area over the treatment area and this helps. We also offer ProNox, a mix of nitrous oxide and oxygen, which also alleviates pain and anxiety that can be associated with longer more intense procedures.
Mild skin laxity in body areas is targeted with EvolveX technology, again using bipolar RF energy to tighten skin. This works on the upper arms, buttocks and thighs as well as the abdomen. Once again, we can dial in the settings to achieve pure skin tightening, or a mix of both skin tightening and fat reduction.
Volume loss in the Face
Weight loss will result in a change in facial appearance. The youthful face is supported by fat pads. Even in normal weight individuals, these fat pads will melt away over time. With GLP-1 weight loss, this process may be magnified. What solution does the med spa offer? We can target those areas of volume loss with injectable prodcuts. We add volume instantly with hyaluronic acid fillers, such as Juvederm Voluma and Restylane Lyft. The collagen stimulator Sculptra takes more time to see the results, working to trigger your body to produce collagen for a result that typically lasts twice as long. Cost remains a barrier to care and adequate volume correction may cost several thousand dollars.
Weight stigma and shaming
Negative attitudes and stereotypes towards individuals based on their weight persist, contributing to weight stigma. Weight stigma and bias against people who are overweight may lead to mistreatment and social devaluation. People then suffer emotionally, when support and understanding are what is really needed. Overweight and obese people may feel any of the following from others, including health care providers: dislike, blame, shaming, unfair assumptions and disrespectful communication.
I don’t want patients who have battled obesity to be afraid of coming to my med spa. The stereotypical med spa client is a beautiful young woman. The reality is that yes, we see a few of those clients, but the vast majority of our clients are people you will meet in day-to-day life. They are just like you, wanting to improve some aspect of their life. We welcome all people, of all shapes and sizes, to come to Omaha Med Spa.
What can be do better as med spa owners?
Talk to our staff about weight stigma and shaming. We all need to honestly evaluate our feelings about obese people, and work to eliminate our unfair judgmental beliefs if they exist.
Include images of overweight and obese people on our websites and in social media posts. We need to break free of reinforcing the false stereotype that only beautiful normal weight people come to the med spa.
Hire staff that reflect the diversity that exists in our culture. Overweight and obese employees have a place in the med spa workplace.
Have chairs in the reception area that are approved to support up to 500 pounds.
Power tables that support up to 500 pounds.
Large blood pressure cuffs
These are bariatric chairs in the reception area at Omaha Med Spa, proof that style and function can co-exist