Weight loss

Obesity, treated properly.

Obesity is a chronic metabolic condition, not a willpower deficit. It responds to treatment the way chronic conditions do: strongly while treated, and it tends to return when treatment stops. The evidence for medical treatment is now very good — and very specific.

What it is

Clinically, obesity is defined as a BMI of 30 or above; 27–30 with a weight-related condition (high blood pressure, insulin resistance, sleep apnea) is the threshold where medication is typically considered. BMI is a screening tool, not a verdict — it misses muscle mass and fat distribution — but it remains the number treatment decisions key off.

The biology that matters: appetite and satiety are hormonally regulated, and that regulation adapts to defend stored weight. This is why diets that rely purely on restriction show high long-term regain, and why medications that act on appetite signaling changed the field.

Who this describes

  • BMI 30+, or 27+ with a weight-related condition
  • Weight that returns after repeated diet cycles
  • Constant food preoccupation ('food noise')
  • Weight-driven conditions: prediabetes, high blood pressure, sleep apnea, joint pain

How it's diagnosed

Diagnosis is clinical: BMI plus history plus, where relevant, labs (HbA1c, lipids, thyroid). At Zappy, the intake asks for exactly this, and a U.S.-licensed clinician reviews it within 24 hours — medication is prescribed only where it's clinically appropriate.

The treatment landscape — honestly

Lifestyle change (foundation, not sufficient alone for most)

Protein-forward nutrition and resistance training preserve muscle and health regardless of path — but as a sole strategy, long-term weight outcomes are poor for most people with obesity. It pairs with medication rather than competing with it.

GLP-1 / GIP medications (the current standard for medical treatment)

Semaglutide averaged −14.9% body weight at 68 weeks (STEP 1); tirzepatide −20.9% at 72 weeks on the top dose (SURMOUNT-1). Semaglutide also cut major cardiovascular events by 20% in people with established heart disease (SELECT). These are the strongest weight-loss medication results ever published.

Bariatric surgery (largest effect, largest step)

Commonly cited results run ~25–30% total body weight for bypass, ~20–25% for sleeve, durable past five years. It remains the reference point for severe obesity — and a bigger intervention than most people need to start with. We don't perform surgery; we'll tell you when it's worth discussing.

How Zappy treats it

Semaglutide
Semaglutide
The most-prescribed starting point — compounded semaglutide, not FDA-approved. Pricing is on the treatment page.
View treatment From $199/mo
Tirzepatide
Tirzepatide
The dual GLP-1 / GIP option, compounded and not FDA-approved — for a higher starting BMI or after a semaglutide plateau.
View treatment From $349/mo
Wegovy®
Wegovy®
The FDA-branded pen, for those who want the branded product.
View treatment From $199/mo
Zepbound®
Zepbound®
Branded tirzepatide — FDA-approved for chronic weight management.
View treatment From $299/mo

Questions, answered

Do I qualify for medication?
The clinical framework: BMI 30+, or 27+ with a weight-related condition. The 2-minute quiz plus clinician review settles it case by case — BMI alone doesn't decide.
Is it safe long term?
SELECT followed 17,604 people for over three years — the largest safety dataset — alongside a boxed warning about rodent thyroid C-cell tumors whose human relevance is unknown. People with personal or family history of medullary thyroid carcinoma or MEN 2 should not take GLP-1s. Beyond ~4 years, we simply have less data, and we say so.
What happens if I stop?
In trials, most weight returns after stopping (STEP 4, SURMOUNT-4). That's the chronic-condition reality, not personal failure — and it's why stopping deserves a plan: taper, maintenance dosing, and muscle-protective habits.
Do you take insurance?
No — Zappy is cash-pay by design (most insurance excludes weight-loss medication anyway; Medicare is barred by statute from covering it). FSA/HSA cards are accepted.

Keep reading

References

  1. STEP 1 — Wilding et al., NEJM 2021 (n=1,961): −14.9% at week 68 vs −2.4% placebo
  2. SURMOUNT-1 — Jastreboff et al., NEJM 2022 (n=2,539): −20.9% at 72 weeks (15 mg) vs −3.1% placebo
  3. SELECT — Lincoff et al., NEJM 2023 (n=17,604): 20% relative MACE reduction
  4. STEP 4 — Rubino et al., JAMA 2021: regain after discontinuation
See if you qualify · 2-min quiz