Around the time he started looking into weight loss surgery, David Soliman noticed some of the parents at his child’s school were losing a lot of weight.
His wife investigated. Soon, a local mom told him the secret to their dramatic weight loss: a telehealth company that delivered GLP-1 receptor agonists, the hard-to-find injections known by names like Wegovy, Zepbound, Mounjaro and Ozempic.
In the first 30 days, Soliman lost 15 pounds. But he felt uneasy about the delivery, which wasn’t closely overseen by a medical team.
“I have never text messaged a drug dealer before for illegal drugs, but that is very much what this process felt like,” said Soliman, a wealth management advisor in the New Orleans area.
It was also expensive and not covered by insurance, and local med spas charged even more. He was at a weight loss clinic appointment when he realized he was staring down a business opportunity.
“That's when it kind of clicked for me,” said Soliman. “As a financial advisor, I'm constantly researching and looking at things that are disrupting markets. This really got my attention, that it completely flipped things on its head, as far as an entire specialty within medicine.”
What began as a personal quest resulting in a loss of 70 pounds has become a business. Soliman is one of the many entrepreneurs who saw an opening for a telehealth business amid a national frenzy for GLP-1 drugs. His company, Big Easy Weight Loss, has about 100 clients in Louisiana so far. In a couple of weeks, they’ll expand to 13 other states.
Louisiana’s obesity opportunity
Louisiana has a large potential market for weight loss drugs. About 4 in 10 adults are obese in Louisiana, one of three states with an adult obesity rate over 40%, according to the Centers for Disease Control and Prevention. Other estimates peg the rate of obesity, defined as a body mass index over 30, as around 50% of Louisianans.
Enter GLP-1 receptor agonists, a remarkable but expensive class of drugs that work by suppressing appetite, and, some researchers think, suppressing inflammation.
“Gamechanger” is the word routinely used by obesity researchers to describe the effects of the drugs, including Big Easy Weight Loss Medical Director Dr. Gabriel Lasala, a cardiologist on the Northshore.
The drugs have been shown to help people shed between 15% to 20% of their bodyweight in clinical trials. But dozens of studies are researching whether they might have other benefits, too. Already, Wegovy has been approved to reduce the risk of heart problems. Semaglutide, the ingredient in Ozempic, has been shown to protect the kidneys and reduce heart issues in those with chronic kidney disease and diabetes. Tirzepatide, the compound in Mounjaro and Zepbound, has been found to improve sleep apnea symptoms.
There are downsides. The drugs can cost around $1,000 per month without insurance coverage. And some doctors see it as a lifetime drug. People who stop taking it often gain the weight back, though some are able to maintain their weight loss without the drugs, or with a less frequent injection.
The drugs also come with side effects like nausea, vomiting, diarrhea and constipation. Rarely, people can develop gallstones or conditions that cause them to eat so little they become malnourished.
But that has not tamped down the demand. And in light of the national shortage, telehealth companies are getting increasingly creative, turning to compounding pharmacies that make GLP-1 knockoffs.
Compounding drugs to meet demand
Big Easy Weight Loss has contracts with five compounding pharmacies, which are able to make the injections and deliver them on ice to a prescriber’s doorstep using the same active ingredient in the brand-name drugs. They cost between $240 to $390 monthly through the group, depending on the formulation the patient wants. That also comes with access to physicians through a portal and a community of other people using the drugs for weight loss.
Compounding pharmacists tailor drugs for patients who have a need that isn’t met by available drugs – like an infant who needs a pill drug in a liquid form, for example.
Though compounding pharmacies are typically restricted from making copies of commercially available drugs, there is a loophole that allows it during a shortage. They get around patent laws by adding a vitamin such as B12.
Although it is convenient and cheaper, some doctors warn that patients should proceed with caution if they’re looking at compounded formulations of the drug, which are not subject to approval the Food & Drug Administration. The agency has sent warning letters to companies who were found to market fraudulent weight loss injections that contained different ingredients.
In theory, compounded drugs could be a viable option when prescribed for patients who qualify for them, if they are the same molecular formula as the manufacturer drugs, said Dr. Taniya De Silva, an endocrinologist at LSU Health New Orleans who frequently treats patients with diabetes and obesity. But the only formulation that has been extensively tested in clinical trials are those manufactured by the drug companies, she pointed out.
Patients should also make sure they’re discussing whether the drug is right for them with a prescriber who is familiar with the medications, which act on multiple body systems. People with a history of thyroid cancer or gut paralysis should not take the drugs.
“You do have to be careful about who you're seeing and make sure that they're actually knowledgeable about all the risk-benefit profiles,” said De Silva.
Big Easy Weight Loss says its pharmacies test every batch for purity and potency. Compounding pharmacies are required to source ingredients from facilities registered with the FDA. Lasala, the medical director, said he has used compounding pharmacies for the last 8 years to get his patients GLP-1 drugs for cardiovascular health. He took them himself to lose a stubborn 20 pounds, which he has managed to keep off without continued use of the drugs.
Prior to approval of GLP-1 drugs for weight loss over the last decade, bariatric surgery was one of the few options for obesity treatment. Though the injections are in high demand, they might not work for people who have a high BMI and a lot of weight to lose, said Dr. Michael Cook, a surgeon at University Medical Center’s Center for Weight Loss and Bariatric Surgery.
For weight loss, the injections are approved for people with a BMI of 27 and above, and weight loss surgery is approved for a BMI of 30 and above, though it’s more common among people with with a BMI over 35. For people looking to lose significant weight, a long-term solution might a multi-pronged approach, as with many diseases, said Cook.
“If you look at patients who have cancer, sometimes a single surgery is all they need,” said Cook. “Sometimes medication is all they need. But more often, there is a combination of the two.”
In a Facebook group that has ballooned to over 800 people, members of Big Easy Weight Loss share before and after pictures and answer each others' questions about side effects, goals and starting the shots. A lot of the growth is simply word of mouth, said Soliman. It helps that they can offer patients the reassurance of a physician, too.
"There's an incredibly viral component to these shots, where people see you losing weight, they want to know what you're doing," said Soliman. "It's hard to find legitimate businesses backed by doctors that aren't some fly-by-night-type shop. I think people see that about us, and they're drawn to it as well."