We do weight loss differently at Performance Health.
Memberships are required for weight loss. This can be a basic hormone membership or a direct primary care membership. ​
​
At Performance Health, weight management is treated like any other medical condition, and medications are managed through a structured clinical relationship. Because these medications require ongoing monitoring, dose adjustments, and safety oversight, an active membership is now required for all GLP-1 therapy, including tirzepatide and semaglutide.
​
We do not source medications from questionable suppliers or mark up products from unverified “wellness” vendors. All prescriptions are filled through reputable compounding pharmacies with established quality standards. Patients always pay those pharmacies directly, unless they elect the added convenience of in-office pickup or delivery.
​
How much are medications? Find out here.
​
How does it work then?
Weight loss patients are required to undergo a thorough initial evaluation. Because we generally spend about an hour discussing your health, goals and the risks and benefits of the medications we may prescribe - this is considered a "complex" visit (See Pricing Here). Subsequent visits are considered "moderate" for behavior-focused 30 minute appointments or "simple" if patients just want to do a simple checkin.
Do I need labs?
This depends on your health, prior labs and preferences. We require basic lab work within the last 3-6 months to start any medications. If you want to check hormones, nutrient levels etc. we are happy to order those labs for you. They are often covered by insurance, or you can elect to pay cash- this is around $100 to $250 for a full panel, depending on what you want to have checked.
Frequency of visits after the initial appointment
We require patients to be seen (virtual or office) every 4-6 weeks until stable on a dosage.
Once stable on a dose for more than 6 weeks, we require patients to be seen every 6 months but strongly recommend you continue to follow up every 4-6 weeks to stay on track.
​
Subsequent labs
As long as patients do not appear to have any side effects, labs can be done at 3 months then every 6-12 months thereafter. Yes, we will accept labs done by your PCP.
The hard truth about weight Loss
Some people try to explain weight gain or failed weight loss by blaming things other than their caloric intake. But the core principle is simple: weight change depends on energy balance—calories in versus calories out. This applies to virtually everyone under normal conditions.
​
Yes, metabolism, hormones, and genetics can influence how that balance plays out. For example, genetic factors explain substantial portions of inter-individual variation in obesity risk and resting metabolic rate (RMR) (Bouchard, 1997; see also Redman et al., 2007). But once you adjust for body mass and composition, the additional variance in basal metabolic rate tends to be modest (Redman et al., 2007; Poehlman et al., 2007). In practice, extremely large deviations in metabolism (beyond ~20–30 %) are uncommon unless someone has a serious metabolic disease (e.g. severe hypothyroidism or Addison’s disease). Like... In the ICU serious.
​
The success of bariatric surgery underscores a practical truth: its efficacy largely depends on forcing a chronic reduction in caloric intake.
​
One incontrovertible point is this: a healthy adult cannot gain or maintain substantial body mass while consuming only ~1,000 kcal/day, unless their metabolic rate is extraordinarily low (which is exceedingly rare). In all tightly controlled feeding studies, when intake is held chronically below expenditure, participants lose weight (Redman et al., 2007; also see Redman et al., 2009). Yes, it's true, caloric restriction typically triggers a decline in energy expenditure beyond what would be expected based on lost lean and fat mass, a phenomenon called “metabolic adaptation” (Redman et al., 2009; Speakman, 2005)- and it is a whopping 6%. Ergo - starvation mode is not a thing.
​
So why does it often feel like you are “not losing on a deficit”? Because over time, you may not actually be in a consistent deficit. Even a small excess of 100 kcal per day - say from a snack, translates to ~10 lb of gain in a year, assuming ~3,800 kcal per pound of fat (Alderman, 2011 estimate). That illustrates how tight and delicate the human energy balance is. An error of just 10 % in estimating intake or expenditure is enough to derail progress completely.
​
The hard truth about weight loss medications
All drugs for weight loss operate via a few mechanisms: increasing metabolism (e.g. stimulants), suppressing appetite (e.g. GLP-1 agents, other central agents), or reducing nutrient absorption (e.g. fat blockers). GLP-1–based drugs (e.g. semaglutide, tirzepatide) are very popular now, but many people underestimate their risks and limitations.
Known risks include gastrointestinal side effects, gallbladder disease, potential for pancreatitis, and possibly other adverse long-term effects yet to be fully understood. History shows that widely adopted “wonder drugs” often reveal previously unrecognized downsides over time.
​
Beyond side effects, my primary concern, based from my own experience of losing 50lb and keeping it off for 15 years, is that reliance on appetite suppression may lead people to skip resistance training. That is a mistake, because muscle tissue is metabolically costly to maintain - which is a good thing when you want to keep fat off.
​
Estimates suggest that 1 kg of skeletal muscle consumes ~13 kcal/day at rest (≈ 3 kcal per pound), while adipose tissue (fat) consumes ~4.5 kcal/day per kg (≈ 1.1 kcal per pound) (Hall, 2008). Thus, muscle is far more metabolically active per unit mass.
Additionally, when weight loss occurs too rapidly and without resistance training, a disproportionately large share of the loss can be from muscle (and bone). A 2024 meta-analysis found that skeletal muscle loss constituted ~25–28 % of total weight loss, even under rigorous interventions (Anyiam et al., 2024). Similarly, modest calorie restriction (~7 % body weight loss) has been shown to reduce lean mass (~2–4 %) and VOâ‚‚max, unless exercise is added (Weiss et al., 2017).
​
Because appetite suppression may push people into overly aggressive caloric restriction, the risk of accelerated muscle (and bone) loss is higher than if weight loss were slower, more deliberate, and combined with strength training and sufficient protein intake.
​
In short, weight loss medications should be seen as tools, not solutions. They should be used to support behavioral change-rewiring habits, reinforcing dietary discipline, encouraging strength training-otherwise gains will reverse when the medication is stopped.
Use this time to investigate your habits, your patterns, and why you do what you do.
​
And go to the gym :)
​​​
References
Alderman, R. B. (2011). Perspectives on weight and energy balance. [Estimate of 3,800 kcal per pound basis].
Anyiam, O., Abdul Rashid, R. S., Bhatti, A., Khan-Madni, S., Ogunyemi, O., Ardavani, A., & Idris, I. (2024). A systematic review and meta-analysis of the effect of caloric restriction on skeletal muscle mass in individuals with, and without, type 2 diabetes. Nutrients, 16(19), 3328. https://doi.org/10.3390/nu16193328
​
Hall, K. D. (2008). What is the required energy imbalance for weight loss? International Journal of Obesity.
Redman, L. M., Heilbronn, L. K., Martin, C. K., Alfonso, A., Smith, S. R., Ravussin, E., et al. (2007). Effect of calorie restriction with or without exercise on body composition and fat distribution. Journal of Clinical Endocrinology & Metabolism, 92(3), 865–872. https://doi.org/10.1210/jc.2006-2184
​
Redman, L. M., Smith, S. R., Burton, J. H., Martin, C. K., Il’yasova, D., Ravussin, E., & Williamson, D. A. (2009). Metabolic and behavioral compensations in response to caloric restriction: implications for the maintenance of weight loss. PLoS ONE, 4(2), e4377. https://doi.org/10.1371/journal.pone.0004377
​
Speakman, J. R. (2005). Body size, energy metabolism and lifespan. Journal of Experimental Biology.
Weiss, E. P., Racette, S. B., Villareal, D. T., Fontana, L., Steger-May, K., Schechtman, K. B., et al. (2017). Effects of weight loss on lean mass, strength, bone, and VOâ‚‚max. Medicine & Science in Sports & Exercise, 49(2), 206–217. https://pubmed.ncbi.nlm.nih.gov/27580151