About Dr. Ryan

Your first appointment will be approximately an hour in length. We will review your medical and weight history, recent labs and current medications. We will discuss your goals and what has worked or not worked for you in the past. We will discuss options available and recommendations.  

To prepare for your first appointment we ask that you register as a new patient on our patient portal and complete all of the Forms/Questionnaires under Weight Health. 

Link to portal: harmonymedical.md-hq.com

Prior to your visit consider contacting your insurance to see if you have coverage for anti-obesity medications.  

No. Medication for weight loss can be a powerful tool to aid in sustained weight loss, however they are not for everyone. They are indicated for use in those with a BMI >30, or a BMI of 27 or above with a risk factor (such as diabetes or cardiovascular disease). If you are planning to start on a medication for weight loss it is likely that you will need to be on the medication long term to maintain your weight.  

Remember that anything that helps you lose weight, likely needs to be continued long term to keep weight off. This is true of medications as well. As long as they are safe, not causing side effects, and working to help you lose weight or maintain the weight lost from the medication, they should be continued long term- otherwise you are likely to regain weight. Medications will have best results when they are used with healthy diets and movement 

Phentermine

• Suppresses appetite
• Take once in morning (though a shorter acting version is an option)
• Commonly prescribed weight loss medication in the last 60 years
• Affordable
• Average weight loss around 8% but variable responses
• It is a stimulant and controlled substance. We require appointments for refills of this medication. If it is lost  or stolen it cannot be replaced. FDA approval from 1959 was for 3 months of use. The FDA has approved  this dose and in combination for long term use. Specialty organizations with expertise in these medications recommend long term use as stopping the medication leads to weight regain and there is no evidence of harm staying the medication long term.
• Possible side effects:
  • Nervousness (those who can tolerate caffeine can usually do fine)
  • Increased blood pressure
  • Dry mouth
  • Constipation

Diethylpropion

• Suppresses appetite
• Take 2-3 times a day (though a longer acting version is an option)
• Affordable
• It is a stimulant and controlled substance. We require appointments for refills of this medication. If it is lost or stolen it cannot be replaced. FDA approval is only for 3 months. Long term use is often considered reasonable by experts.
• Some people who have side effects on phentermine do not have them with diethylpropion, but similar side effect profile

Qsymia- (Phentermine/Topiramate ER combination)

• Appetite suppressant combination
• Combination is more costly, but may be able to take generics separately
• Average weight loss around 10%
• In some people it can reduce soda cravings by making carbonation taste flat
• Can help more with evening hunger symptoms
• Possible side effects:
  • Feeling tired or fuzzy
  • Numbness or tingling, most often in hands
  • Nervousness
  • Increased blood pressure
  • Dry mouth
  • Constipation
• Serious but less common side effects:
  • BIRTH DEFECTS- women should not get pregnant while taking this medication and need to be on a strong form of birth control and do pregnancy test monthly
  • Eye problems
  • Kidney stone

Contrave- (Naltrexone/Bupropion Combination)

• A combination of anti-addiction medications; works best on cravings and thoughts about food
  • Naltrexone can be used to treat alcohol or opioid addiction
  • Bupropion is an antidepressant as well as a smoking cessation aid
• Not a controlled substance
• More expensive
• Not recommended for those with seizure history or risk of seizure, or for those who are taking opioids
• Boxed warning risk of suicidal thoughts
• Common side effects:
  • Most common is nausea, which can get better with time. To avoid, start with one pill per day and take with protein.
  • Dizziness
  • Headache
• Serious but less common side effects:
  • Seizure
  • Mood Changes

Saxenda- Liraglutide

• Works hormonally on a hormone called GLP-1
• Causes increased fullness
• Daily injection
• Average weight loss around 7%
• If not covered by insurance, very expensive
• Cannot take if family history of medullary thyroid cancer, MEN2 syndrome
• Boxed warning risk of thyroid cancer based on animal studies
• Common side effects:
  • May reduce effectiveness of medications that are taken at the same time
  • Low blood sugar
  • Abdominal pain
  • Nausea, vomiting, diarrhea, constipation
     

Wegovy- Semaglutide

• Works hormonally on a hormone called GLP-1
• Causes increased fullness
• Weekly injection
• Average weight loss of 15%
• If not covered by insurance, very expensive
• Cannot take if family history of medullary thyroid cancer, MEN2 syndrome
• Boxed warning risk of thyroid cancer based on animal studies
• Common side effects:
  • May reduce effectiveness of medications that are taken at the same time
  • Low blood sugar
  • Abdominal pain
  • Nausea, vomiting, diarrhea, constipation
     

Zepbound- Tirzepatide 

• Works hormonally on a hormones GLP-1 and GIP
• Causes increased fullness
• Weekly injection
• Average weight loss of 15% on 5mg and 20% on 10mg or 15mg
• If not covered by insurance, very expensive
• Cannot take if family history of medullary thyroid cancer, MEN2 syndrome
• Boxed warning risk of thyroid cancer based on animal studies 
• Common side effects:
  • DECREASES effectiveness of BIRTH CONTROL PILLS
  • Low blood sugar
  • Abdominal pain
  • Nausea, vomiting, diarrhea, constipation
     

Orlistat

• Causes loss of fat in stool
• Take 3 times a day before meals
• Must be used with low fat diet
• Affordable
• Common side effects:
  • Interacts with MANY other medications
  • Oily stools, anal leakage, urgent bowel movements
• Serious but less common side effects:
  • Kidney stones
  • Liver disease
     

Vyvanse- Lisdexamfetamine

• Helps treat Binge Eating Disorder, not for weight loss
• Stimulant, and controlled substance. Requires appointments for refills.
• If not covered by insurance, can be expensive
• Common side effects:
  • Decreased appetite
  • Anxiety or jittery feeling
  • Dry mouth
     

Metformin

• Not approved for weight loss, approved for diabetes
• Helps metabolic issues, decreases insulin response, can help “level the playing field”
• Appears to decrease appetite a few different ways
• Reduces chance of getting diabetes
• Can reduce risk of some cancers including: colon, lung, ovary, breast, prostate
• Possible side effects:
  • Most common is stomach upset/diarrhea, so we often will start with lower dose and increase slowly
  • May need to take 1000mcg B12 daily when you start this medication

Starting a GLP1 or GIP/ GLP1 Injectable
 

Victoza or Saxenda (liraglutide)

Ozempic or Wegovy (semaglutide)

Mounjaro or Zepbound (tirzepatide)
 

GLP1 and GIP/GLP1 agonists are a type of medication that work by increasing incretin, a hormone found in the gut. Incretins help to produce more insulin when needed and reduce how much blood sugar is produced when it’s not needed. These medications improve our physiologic response to food. They also affect how quickly food travels through the digestive system, which can lead to feeling fuller faster and more satisfied in-between meals. Many people find they think less about food because of this.
 

Side Effects?

Because these medications affect your gut hormones, you may experience side effects anywhere along the

digestive tract. Common symptoms include:
 

• Constipation

• Diarrhea

• Bloating

• Excessive burping, Sulfur burps

• Nausea

• Heartburn
 

Most side effects are temporary and tend to improve as you continue the medication. To lessen these effects, the medication is started low and gradually increased. Depending on the medication you start, expect to be at the same dose for 1-4 weeks before a dose increase.
 

Some people do continue to experience side effects regardless of how long they’ve been on the medication. Our goal is to keep these side effects at a minimum and not significantly impact day-to-day life.
 

In multiple studies, less than 5% of individuals stop their medication due to side effects!
 

Methods to reduce side effects

- Eat slowly. These medications slow down digestion. By eating meals slowly and with intention, we

can better recognize our satiety cues. You can practice this by using your non-dominant hand or

setting your utensil down between every 1-2 bites. Some people even prefer using smaller sized

utensils (think kid sizes).
 

- Eat smaller meals. Remember the old adage: your eyes are bigger than your stomach! With the

medication, this is especially true. Start by putting less on your plate that you think you’re hungry for.

Most patients feel fuller with even 50-75% of their average meal. Having less food available can

reduce the urge to over eat or finish our plate. Consider even using smaller plates/ bowls to practice.- Drink plenty of water! Increasing water intake can improve gut health, help break down foods, and prevent dehydration. Consider different temperature of fluids – ex. warmer (soups, tea, etc.) or colder (ice-cold water, sugar-free popsicles, etc.), especially if you’re struggling to stay hydrated.
 

- Regular meals with protein. Protein is essential for weight loss and maintenance. Getting enough

protein means we are less hungry in-between meals. Some people even find adding in addition 10-20g of protein the days before injection can help reducing side effects throughout the week.
 

- Don’t eat close to bedtime. Because your body is taking longer to digest foods, lying flat slow things

down even further. Consider waiting 1-2 hours between your last meal and falling asleep.

- Avoid eating/ drinking at the same time. Some people find that drinking & eating together causes

feeling of over-fullness and bloating. If you’re experiencing any discomfort, consider waiting 10-20

minutes after eating to start drinking water.
 

- Limit digestive irritants, such as caffeine/ coffee, acidic or citrus foods (tomatoes, oranges, lemons,

spicy, etc.), alcohol, carbonation, dairy products, and fatty/ fried foods. Tums can also help, just don’t take more than a few times a week.
 

- Increase fiber intake. Focus on plant-based products like chia seeds, flaxseeds, non-starch

vegetables, complex carbohydrates/ whole grains, beans, lentils, etc. or Over-the-Counter powders,

like Metamucil, Citrucel, and Benefiber. *Note – Increase fiber slowly. Too much, too quickly can cause

temporary upset stomach and bloating. Instead, aim to gradually increase fiber intake and be sure to

drink plenty of water. General fiber goals: 20-25g daily for women, 30-35g daily for men.
 

-Drink electrolytes. These can help with fatigue, headaches and muscle aches. Consider a low sugar or sugar free option. 

- Add probiotics. Probiotics are live healthy bacteria, typically found in fermented foods, or in capsule

or liquid form as supplements. Probiotics improve and maintain the gut microbiome, which has benefit

in additional weight loss. When starting a probiotic, look for at least 1 billion CFU containing

Lactobacillus, Bifidobacterium or Saccharomyces strains. Popular brands are Seed, Culturelle, and

Align. Fermented foods include sauerkraut, kimchi, yogurt, kombucha.

- Add a stool softener. Stool softeners do just that – they soften the stool by increasing how much

water & fat you absorb so you can have an easier time stooling. Look for the active ingredient:

docusate sodium.
 

- Reduce sugar intake and ultra-processed foods. These foods don’t always align with health goals

and can often cause upset stomach or irritating symptoms while on their injectable medication.

Interestingly, many people are less interested in these foods anyway, especially the longer they use

the medication.
 

- Change the time of day you are injecting. If you have been taking the medication in the morning,

consider trying an evening dose instead, and vice versa.
 

- Try a different injection site. Some people find that injecting into a different area of the body (upper

arm, abdomen, thigh) can significantly improve side effects.
 

- Start a multivitamin. Not only does this ensure you are meeting vitamin and mineral goals, but even improve feeling fatigued when losing weight.
 

Not all bodies respond the same way. If you’re struggling to manage symptoms, don’t hesitate to contact your

prescriber to discuss further.

Initial consultation $350. Follow up visits $200.  As weight management is an ongoing process that requires frequent follow up we offer membership for $175/month. This includes subsequent office visits and access to our patient portal for messaging and remote management of care. In the initial phase of your care we recommend that you have a visit every month. As we move from active initiation of care, typically 9-12 months after starting treatment, to more maintenance care we require visits every 3 month for follow up. Medication cost is not included in this price. We do not accept insurance at this time.

We're located in the heart of downtown Verona 

271 S. Main Street, Verona, WI 53593

Ready to schedule your appointment? Book online or give us a call. We look forward to helping you achieve your weight health goals!