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Michael Messerly sat in his car in an Omaha parking lot furtively working up the nerve to open the door. Through the window, he could see the storefront for Limitless Male, a clinic he’d seen advertising weight loss, but in that moment it might as well have been on the moon.
He had good reason for being there; since 2020 he had battled heart issues, diagnosed after he’d gone into the hospital with a gallbladder problem. In the time since his atrial fibrillation (AFib) became a hook in his chest, that, when twisted, would bring the 45-year-old sports and music hospitality professional to his knees.
“Over the course of three-and-a-half to four years, I had AFib issues that I could not get rid of,” he said. “I had three cardiac ablations, which are basically heart surgeries. I've also been shocked with a defibrillator 19 times.”
Messerly’s latest heart episodes included his doctor prescribing yet another surgical procedure and a spell that caused him to pass out at home just a few hours before arriving in this parking lot, staring at that clinic, ready for a change.
That is, if could just force himself to open the car door.
“The day before, I collapsed at home. I was 6’3”, 355 pounds, I was prediabetic and I was pretty much of the mind that if I didn’t do something drastic soon, I'm probably not here, or I'm probably on a wait list for a transplant,” he said. “At the same time, I was demoralized; I've done other diets. I've done a liquid diet, I've done a keto diet, I've done every single other diet you can probably think of and nothing has worked.”
Messerly sat frozen in his car, his thoughts spinning.
“My mindset was like, is this really going to work, because everything I've ever done in my life as far as weight loss has failed,” he said. “Honestly, man, I sat in my car for five minutes just trying to psych myself up, like, I don't know if I can do this.”
Messerly found the nerve to make the short walk across the parking lot, and, a little more than a year later, is down 135 pounds thanks to Mounjaro, an injectable weight loss drug that is one of a class of pharmaceuticals turning the medical industry on its head one, 10, and even 100 pounds at a time.
“My goal weight now is 200 pounds just because I want to have that,” Messerly said. “I know that I'll probably, the rest of my life, be on this medication to help me lose weight, if I'm being really honest with myself. I can see myself being on a maintenance dose the rest of my life where I won't probably need it every week, but like every two weeks.”
According to WebMD.com, the new drugs fall under the classification of GLP-1 agonist; GLP standing for glucagon-like peptide 1, a hormone produced in the small intestine regulating blood sugar. In greatly simplified terms, GLP-1 agonists may make the patient feel less hungry by keeping food in the GI tract longer and may also send signals to the brain that tell it to feel full.
The drugs collectively called semaglutide include the brand names Ozempic and Wegovy, while a more recent version, tirzepatide, is marketed as Mounjaro and Zepbound. Tirzepatide matches semaglutide’s GLP-1 receptor, while adding a GIP receptor agonist, short for glucose-dependent insulinotropic polypeptide. That hormone also contributes to the feeling of fullness.
Given the often-plodding pace at which new drugs are approved and enter the market, the emergence of this classification has happened with lightning speed. This might be due to the fact that the drugs have their origins in other usage, namely the treatment of diabetes, and most of the main agents today are still used for other purposes in addition to weight loss. It’s been something doctors in the diabetes, endocrinology, and metabolism realm have been watching for years.
“The first GLP-1 receptor agonist, exenatide—Byetta—was approved in 2005, and since then, this class of drugs has expanded,” said Preethi Polavarapu, assistant professor of medicine, Division of Diabetes, Endocrinology and Metabolism at the University of Nebraska Medical Center. “However, starting in the mid-2010s, researchers noticed that these drugs also contributed to significant weight loss, sparking interest in their potential for treating obesity.”
She continued, “As a result, semaglutide was FDA-approved for weight loss under the brand name Wegovy in June 2021. Wegovy is a higher-dose version of Ozempic, which had been approved for diabetes in 2017. The GLP/GIP agonist called tirzepatide was also approved for both diabetes as Mounjaro in May 2022, and for weight loss as Zepbound in June 2023. There are also several agents in the pipeline and we may see them in the market in the future once FDA clears them.”
All told, Mounjaro is also prescribed for Type 2 diabetes in addition to weight loss as is Ozempic, the latter also being issued for heart disease prevention. Wegovy’s other use is also in heart disease prevention—but not diabetes—while Zepbound is prescribed solely for weight loss.
While Polavarapu admitted to some initial reservations about one drug doing the work of many, she said she has been intrigued all along about the potential for semaglutide in the weight loss space.
“As a physician, my initial reaction to semaglutide being used for weight loss was a mix of cautious optimism and curiosity,” she said. “I was excited about its potential to help patients achieve significant weight loss which could improve chronic conditions like Type 2 diabetes, hypertension, sleep apnea, and many others. However, I was also mindful of potential side effects, such as gastrointestinal issues, pancreatitis, and rare thyroid concerns.
“If semaglutide could help patients achieve lasting weight loss, it could significantly improve both their quality of life and long-term health outcomes. This will also reduce health care costs in the long run by preventing cardiovascular disease and other conditions. So, the benefits were clear, but I knew that careful monitoring and patient education would be essential for safe and effective use.
All drugs carry some risk of side effects, and while cautionary headlines were considerable leading up to the drugs’ FDA approval specifically for weight loss, Polavarapu is satisfied the drugs perform their function with minimal side effects in most cases. This is not just for weight loss, but for overall health, as well.
“Semaglutide offers significant benefits. It can lower HbA1c by 1.5% to 2% in patients with Type 2 diabetes and reduces the risk of cardiovascular events,” she said. “For obesity, semaglutide has been shown to help patients lose up to 15% to 20% of body weight, making it highly effective for both conditions. Overall, while side effects are possible, they tend to be mild and temporary for many patients.
“The benefits often outweigh the risks and regular monitoring and dose adjustments can help mitigate side effects. Overall, I see it as a promising tool in managing obesity, particularly for patients who have struggled with traditional weight-loss methods.”
Many patients also report relatively mild side effects. Jordan Frum, sales manager at Oriental Trading Co., is a former amateur bodybuilder who started taking the drug after gaining weight following a back injury that limited his workouts. He said nothing about his new regimen is hard to manage or gives him any major discomfort now, although he does caution people that the first month is an adjustment.
“That first month, the body is going to reject a lot of that old toxins and fat and stuff like that,” he said. “I did experience some GI issues, you know, like diarrhea and stuff like that, kind of right out the gate. If you keep trying to just eat the same amount and the same things through that first month, it is going to cause you some tummy problems because your body has had a whole lifetime of getting used to them.”
He continued, “What you’re doing is trying to train your body to not like those things that are bad for you. It's not healthy for us to eat things high in fat or all these processed foods, so the body gets rid of it. Early on, I'd say carry an extra pair of underwear just in case. I was fortunate that I didn't have that issue, but there were times where I was like, ‘Oh, I gotta go to the bathroom.’ After that, you start to adjust; by the end of the month, my body kind of started to normalize.”
Frum, who’s down more than 50 pounds since March, got onto his program through Absolute Medical & Aesthetics. His monthly regimen includes office visits to monitor his progress and identify any issues, at which time he buys a month’s worth of medications.
“I buy four injections at a time and I take one a week,” he said. “My schedule is every Monday, I take an injection, I give it to myself and that's it.”
Costs vary but Frum put his at $45 per shot in the starter phase and $65 when he stepped up the dosage. The roughly $200 office visit is covered by insurance. For some patients, however, the cost of the drug is a concern as it is either not covered by insurance or only covered under narrow medical parameters.
“My insurance doesn't touch it,” said Kevin Reiner, a 47-year-old video producer in Omaha. “[Zepbound] was so cost prohibitive that I didn't even go too far down that path. My doctor was trying to find things for me and he was going to have me go see another place that helps with the price a little. But even at that price, the estimates were $1,000 a month and I probably can't swing $500 a month. I’ve got two kids in high school, you know, and that’s just not part of the budget.”
It’s a budgetary problem that affects many, and cost considerations have led many patients online looking for lower-cost options. This can be a dangerous proposition, said nurse practitioner Kris Epps-Martinez, co-owner of InVita Health & Wellness who has also been taking weight loss medication for the past two years.
“You can go online and people are getting the meds that they have to mix themselves,” she said. “In fact, if you look at the label warning on them, it literally says, ‘Not for human or animal consumption, research purposes only.’ The thing is, people are constantly telling other people, like on Facebook and chat groups, that that's the route they should go because it's cheaper.”
The prohibitive cost prompted the Biden administration to propose an expansion Medicare and Medicaid coverage to include semaglutides like Wegovy and Zepbound. The initiative, led by the Department of Health and Human Services, would classify obesity as a treatable disease to reduce associated health risks.
Regardless of this proposal, Epps-Martinez said even when checking out local providers, patients should ask a lot of questions about any clinic advertising weight loss drugs. This includes being very specific about both the medical expertise that’s available through the practice and the follow-up regimen that’s involved during treatment.
“It's terrifying to me that people would use a provider who doesn't check on you or who you as the patient don't have access to, or who doesn't expect you to have labs prior to starting the medications,” she said. “We require labs within the last 60 days before you start with us and if you don't have current ones, you have to get current ones."
Epps-Martinez continued, “Our patients have to do 90-day check-ins with us so we can see how it's going. They have access to our email or (can) text anytime and we'll get back to them. It's just wild to me that these people will go use providers who are like, ‘Oh yeah, sure, you can start, here you go.’”
Epps-Martinez said patients should also be wary of practices that keep pushing higher doses of drugs and never discuss diet or lifestyle with people who aren’t achieving the desired results.
“If a patient comes to me and says, ‘Hey Kris, I'm not losing weight. Is it time to increase?’ I always say, ‘Let's go back to basics,’” said the former collegiate soccer player. “I want to know what you’re doing on your end that is going to help move you forward in this journey, because if you are not doing those things I want you to do them for two weeks and come back to me. I never just go, ‘Oh, yeah, OK, let's go ahead and increase.’”
She stressed that even though it’s the hottest thing in weight loss right now, it’s not an end-all-be-all. “It’s a symbiotic relationship; I'm not giving you a magic medication, I'm giving you a tool in the toolbox. Now I need you to do your part and let's work together to get you healthy. Doing that, it's really amazing to see the changes that people achieve when they’re working towards health.”
Omaha Magazine encourages readers to consult their primary care physicians for more information on any medication, including the semaglutides listed in this article.
This article originally appeared in the January/February 2025 issue of Omaha Magazine. To receive the magazine, click here to subscribe.
