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NICE recommends it (Technology Appraisal TA664) for a more restricted population than semaglutide specifically adults with a BMI of 35 kg/m or above (with lower thresholds for certain ethnic groups) who also have prediabetes and a high risk of cardiovascular disease, and only when used within a specialist weight management service

Marek focuses on hormone optimization with lab-driven protocols and partner clinicians - Marek is generally more expensive and expects lab testing - Not a direct substitute for a weight-loss-only GLP-1 subscription - See Marek Health reviews Pomegranate Health vs LillyDirect or Novo self-pay: - LillyDirect sells Zepbound to self-pay patients at ~$350-$550/month for FDA-approved product - Novo self-pay options for Wegovy and Ozempic are more limited but expanding - Brand products have published stability, standardized manufacturing, and no compounding regulatory question - Increasingly the default for patients without insurance coverage - See where to buy tirzepatide Pomegranate Health vs a local compounding pharmacy: - Bypasses the telehealth middleman and subscription layer - Requires you to find a PCAB-accredited local compounding pharmacy that can serve you - Usually cheaper per month once the setup is complete, but requires more self-advocacy and often an in-person prescriber - Not practical for patients without a clinician willing to write the prescription The rule of thumb: for most patients, if insurance covers brand GLP-1 use the brand

Week 10 and beyond: the new normal Some level of slower transit may persist for the duration of treatment

There are also longer-acting versions being studied, and pills specifically designed for weight loss (not just diabetes)

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PMCID: PMC10182857