When David Soliman began researching weight-loss surgery, he noticed some parents at his child’s school who had lost a lot of weight.
His wife investigated and found that the local mother’s secret to her dramatic weight loss was a telemedicine company that delivers hard-to-find injectable GLP-1 receptor agonists, known under names such as Wegovy, Zepbound, Mounjaro and Ozempic.
In the first 30 days, Soliman lost 15 pounds, but she was nervous about giving birth without the close supervision of a medical team.
“I’ve never texted a drug dealer before, but that’s exactly what this process felt like,” said Soliman, the New Orleans-area wealth management adviser.
Additionally, the treatment was expensive and not covered by insurance, and local medical spas charged even more.As he booked appointments at weight loss clinics, he realized he saw a business opportunity.
“That’s when it clicked for me,” Soliman said. “As a financial advisor, I’m always researching and looking at things that are disrupting the markets. This was something that completely turned the tables on an entire medical specialty and really caught my attention.”
What started as a personal quest to lose 70 pounds has become a business. Soliman is one of many entrepreneurs who saw an opportunity in the telemedicine business amid a national craze for GLP-1 drugs. His company, Big Easy Weight Loss, has served about 100 clients in Louisiana so far. In the coming weeks, the company plans to expand to 13 other states.
Obesity Opportunities in Louisiana
Louisiana represents a large potential market for weight-loss drugs: Four in 10 Louisiana adults are obese. One of three states with adult obesity rates above 40%According to the Centers for Disease Control and Prevention. Other estimates put the obesity rate, or a body mass index of 30 or higher, at about 50 percent of Louisianans..
GLP-1 receptor agonists are fascinating but expensive drugs that act to suppress appetite and also reduce inflammation.
“Game changer” is a term that obesity researchers, including North Shore cardiologist Dr. Gabriel LaSala, medical director of Big Easy Weight Loss, routinely use to describe the drug’s effects.
Clinical trials have shown that these drugs can help people lose 15 to 20 percent of their body weight. But dozens of studies are underway to see if they may have other benefits. Already, Wegobi has been approved to reduce the risk of heart disease. Semaglutide, the ingredient in Ozempic, has been shown to protect the kidneys and reduce heart problems in people with chronic kidney disease and diabetes. Tirzepatide, the ingredient in Munjaro and Zepbound, has been shown to improve symptoms of sleep apnea.
There are drawbacks: The uncovered drug can cost about $1,000 a month, and some doctors consider it a lifelong medication. Many people regain the weight when they stop taking it, but some are able to maintain the weight loss without the drug or by using fewer injections.
These drugs can also cause side effects such as nausea, vomiting, diarrhea, and constipation. In rare cases, they can cause gallstones or malnutrition, making it difficult to eat.
But demand shows no sign of slowing: A nationwide shortage has led telemedicine companies to get increasingly creative, turning to compounding pharmacies that make counterfeit versions of GLP-1.
Compounding medicines to meet demand
Big Easy Weight Loss has agreements with five compounding pharmacies that can compound the injectables using the same active ingredients as the brand-name drug and deliver them ice-cold to prescribers’ doorsteps. Patients pay between $240 and $390 a month through the group, depending on the prescription they want. They can also contact doctors through a portal and access a community of other people who are using the drug to lose weight.
Compounding pharmacists compound medicines for patients whose needs are not met by existing medications (for example, infants who require liquid tablets).
Compounding pharmacies are normally prohibited from making copies of over-the-counter drugs, but a loophole allows them to do so during shortages: Compounding pharmacies get around patent laws by adding extra vitamins, such as vitamin B12.
Though convenient and inexpensive, some doctors warn that patients should be cautious when considering combination doses of the drug, which are not approved by the Food and Drug Administration, which has sent warning letters to companies found to be selling fraudulent weight-loss injections containing different ingredients.
In theory, synthetic drugs could be a viable option if they have the same molecular formula as a pharmaceutical drug and are prescribed to patients who meet the prescription requirements, said Dr. Tanya de Silva, an endocrinologist at Louisiana State University in New Orleans who frequently treats patients with diabetes and obesity. But she noted that only the formulations made by pharmaceutical companies have been thoroughly tested in clinical trials.
Patients should also discuss with their prescribing physician whether the drug is right for them, as they are knowledgeable about drugs that affect multiple body systems. People with a history of thyroid cancer or intestinal paralysis should not take the drug.
“You have to be careful about who you meet with and make sure that they are actually knowledgeable about the risk-benefit profile,” de Silva said.
Big Easy Weight Loss says its compounding pharmacies test every batch for purity and potency. Compounding pharmacies are required to source ingredients from FDA-registered facilities. Medical director LaSala said he has been using compounding pharmacies for the past eight years to prescribe GLP-1 medications to patients for cardiovascular health. He turned to compounding pharmacies to help him lose a stubborn 20 pounds and was able to keep the weight off without continuing to take the medication.
Before GLP-1 drugs were approved for weight loss over the past decade, one of the few options for treating obesity was weight-loss surgery. Demand for the injections is high, but they may not be effective for people with a high BMI and a lot of weight to lose, says Dr. Michael Cook, a surgeon at the University Medical Center’s Center for Weight Loss and Bariatric Surgery.
When it comes to weight loss, injections are approved for those with a BMI of 27 or higher, and weight loss surgery is approved for those with a BMI of 30 or higher, although weight loss surgery is more common for those with a BMI of 35 or higher. For those looking to lose significant weight, Cook said, as with many ailments, the long-term solution may be a multi-pronged approach.
“When we look at cancer patients, sometimes they only need one surgery,” Cook said, “and sometimes they only need medication. But a lot of times it’s a combination of both.”
In a Facebook group that’s swelled to more than 800 members, Big Easy Weight Loss members share before-and-after photos and answer each other’s questions about side effects, goals, starting injections and more. Soliman says much of the growth has come from word of mouth. Providing patients with the reassurance of a doctor also helps.
“There’s an incredible viral element to these photos – people see you’re losing weight and they want to know what you’re doing,” Soliman said. “It’s hard to find a legitimate business that’s doctor-sponsored and isn’t a fad-run operation. I think that’s how people perceive us and are drawn to us.”
