Spring 2025
By Lauren Hurwitz
“If you can’t wait to lose some weight, the rising popularity of GLP-1 medications may bring you the results you’re looking for faster than you ever imagined,” says Dr. Sue Decotiis, MD who is a triple board-certified weight loss specialist and owner of her own medical weight loss practice in NYC with a virtual office in Scarsdale.
Glucagon-Like Peptides, also known as GLP-1, are a category of drugs that occur in the gut and also cycle back to the brain responsible for controlling appetite and the way insulin works that were originally approved by the FDA to treat Type 2 Diabetes with commercial drugs like Mounjoro and Ozempic. “It was later realized that these medications cause tremendous weight loss, so the drug companies including Novo Nordisk and Eli Lilly said, ‘let’s call these drugs something else and get it approved for weight loss,’ and that’s how they came up with Wegovy (Novo Nordisk) and Zetbound (Lilly),” Dr. Decotiis shares.
“Many people are getting these drugs online through apps or a platform and aren’t being monitored carefully, and that leads to problems,” she warns. First, the dosage may not be right. The commercial product ordered online comes in the lowest dose possible with four pens – one injection per week of the same dose for the entire month – with the hope that each month the doctor will raise the dose. “It will take you a long time to lose weight doing it this way and will be expensive because it’s often not covered by insurance unless you’re obese. It can cost a lot of money to try and get to the dose where you’re going to see results,” Dr. Decotiis says. “The other problem is availability. The drug company isn’t stupid – they don’t make as much of the higher dose because it’s more expensive for them and they don’t charge more for the higher dose, so they’re not making as much on the high doses. Lilly recently came out with (the lowest dose) vials of 2.5 ounces and 5 ounces. You’d have to take three or four of the fives to get what you need to burn fat,” she shares, adding it’s important to be working with doctors who are following you carefully.
Dr. Decotiis follows her patients on a body composition scale whereas a lot of other scales at the gym or through an online calculator are not as accurate calculating fat measurements. “I’m most concerned about a patient losing body fat and maintaining or increasing muscle. You shouldn’t lose muscle on these medications,” she says. “The key to success on these drugs is drinking a tremendous amount of water, otherwise you’re going to lose a lot of muscle. These drugs are avid and efficient at fat burning. Your fat is made mostly of water, so when you burn fat you’re losing water and the body sees that as a warning sign that you’re losing water, and the body knows you can die of dehydration faster than you’ll die of starvation. If the body can’t burn fat, it needs to burn muscle. When people aren’t hungry, it’s easy not to drink water. I monitor my patients by my body composition scale which can tell me where your water is, and you don’t get that from an online doctor. If you remember BMI (weight divided by height), you could lose a lot of fat – but what’s your body composition? Most of what you lose isn’t fat – it’s like fake weight loss and you’re going to gain all of it back and become very hungry again once you’re off the medication because you didn’t achieve the real results you wanted to achieve. Once we get rid of the fat cells that are toxic that cause problems, there are also far-reaching effects like decreased alcohol, smoking, reduced gambling and being able to get off anti-anxiety medications and antidepressants,” she says.
Dr. Decotiis obtains medications from a highly-regarded pharmacy where the dose can be customized and tailored to patient’s needs. “The compounded medications are roughly what the commercial is at a low dose. But with my patients, I combine the cost of my care into the cost of the drug. It’s pretty economical when you get my expertise and I see you every couple of weeks. In addition, we have calls once or twice a week. If you go up on the dose, it will cost more…possibly a few thousand a month but chances are you won’t need to be on it very long once we get that body fat down,” she shares.
Long term, she sees patients’ whole relationship with food change. Not only do they get fuller and are not eating as much, but later down the line the brain will be rebooted – food desire changes and patients are more sensitive to food taste. Many things that you used to love – sweets and fatty food may no longer be as appealing. There is an innate control long-term. Even veggies start tasting better – now patient crave healthy foods more. Dr. Decotiis also sees many GLP-1 users drastically cutting back on alcohol intake and smoking, adding, “once we control insulin, it reboots metabolism and wires your brain for long-term weight control and a much healthier life.”