Home/Medical Weight Loss
Prescription weight loss medication, nutrition counseling, and structured follow-up — on its own, before surgery, after surgery, or to address weight regain years later.
For most of the last two decades, a bariatric surgeon had two answers for a patient: operate, or wish them luck. The medications available now are good enough that this is no longer true.
This practice offers a full medical weight loss program — evaluation, prescription medication, nutrition counseling, and ongoing follow-up — as a standalone treatment for patients who do not want surgery or are not candidates for it, and as a companion to surgery for those who have had it or are preparing for it.
You are talking to someone with no stake in the answer. A program that only does injections will steer you toward injections. A surgeon who only operates will steer you toward the operating room. Dr. Geller offers both, which means the recommendation can simply be the one that fits you.
Four ways patients use it
You want to lose weight and you do not want an operation — or your BMI, your health, or your circumstances make surgery the wrong call right now. Medication plus real nutritional support is a legitimate treatment in its own right, not a consolation prize.
This is the largest group in the program.
Losing weight before an operation is not busywork. It shrinks the liver, which makes the laparoscopic view better and the operation safer, and it gives you a head start on the eating changes you will need afterward.
Many insurers also require a documented supervised weight loss period before they will authorize surgery. This satisfies that requirement while actually accomplishing something.
Some patients lose less than expected in the first year, and some stall well short of where they and their surgeon hoped. Adding medication during that window can move things without a second operation.
Post-operative care here also includes nutrition follow-up and lab monitoring regardless of whether medication is part of the plan.
Some regain after the low point is normal. Substantial regain, years out, is common enough that it is one of the most frequent reasons former patients come back — often embarrassed, which they should not be.
Medication frequently resolves this without revision surgery. When it does not, revision is still on the table. Starting with the less invasive option is usually the right order.
Medication alone is the version that fails. What makes the difference is the structure around it.
First visit in the office, follow-up by video. Once you have been seen in person, the rest of the program runs well by video for patients at a distance. More about telehealth visits →
These are the drugs that changed the field: semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound, Mounjaro). They mimic gut hormones that regulate appetite and blood sugar, and the effect most patients describe is not willpower but the absence of constant food preoccupation.
In the major published trials, semaglutide produced average loss of roughly 15 percent of total body weight over about 68 weeks, and tirzepatide roughly 20 percent at the higher doses over 72 weeks. Averages hide a wide spread — some patients lose a great deal more, and some respond poorly.
This practice prescribes FDA-approved brand-name products. Compounded semaglutide and tirzepatide are widely marketed and considerably cheaper, but the compounded versions are not FDA-reviewed for safety, purity, or dosing accuracy, and dosing errors with them have caused real harm. That is a trade this practice does not make.
There is now also an oral GLP-1. Foundayo (orforglipron) was approved in April 2026 and is taken as a daily tablet, with no requirement to take it on an empty stomach or to wait before eating. Average weight loss is more modest than the injectables — around 11 percent — but for patients who will not inject, that is the relevant comparison.
These remain useful, particularly when a GLP-1 is not covered, not tolerated, or not appropriate. These include phentermine, phentermine/topiramate (Qsymia), and naltrexone/bupropion (Contrave). Each has its own profile and its own set of patients it suits — phentermine, for instance, is generally avoided in uncontrolled hypertension or significant heart disease.
This is general education, not a complete list of risks or a recommendation for any individual. Whether a medication is appropriate for you depends on your medical history and will be discussed at your visit.
The options, side by side
The weight loss figures below are compiled from published trial data and manufacturer information, typically measured over 52 to 80 weeks alongside diet and exercise. They are averages. Individual results vary widely.
| Medication | Type | Available doses | Cash price | Discount price | Average weight loss | Approved |
|---|---|---|---|---|---|---|
| Retatrutide investigational not yet available | GLP-1 / GIP / GCG injection | 2, 4, 6, 9, 12 mg trial doses · weekly | not yet approved | — | ~24–28% | ~2027 |
| Zepbound tirzepatide | GLP-1 / GIP injection | 2.5, 5, 7.5, 10, 12.5, 15 mg weekly · vials and pens | ~$1,086 | $299–$449 LillyDirect | ~21–22.5% | 2023 |
| Wegovy semaglutide | GLP-1 injection | 0.25, 0.5, 1, 1.7, 2.4 mg; HD 7.2 mg weekly | ~$1,349 | $199–$349 NovoCare | ~15–20.7% | 2021 |
| Foundayo orforglipron | GLP-1 oral pill | 0.8, 2.5, 5.5, 9, 14.5, 17.2 mg daily · any time | ~$500 | $149–$349 LillyDirect | ~11% about 25 lb | 2026 |
| Saxenda liraglutide | GLP-1 injection | 0.6, 1.2, 1.8, 2.4, 3.0 mg daily · 5-pen carton | ~$1,350 | ~$372 | ~5–8% | 2014 |
| Qsymia phentermine / topiramate ER | Oral combination | 3.75/23, 7.5/46, 11.25/69, 15/92 mg | $200–$290 | $89–$98 | ~9–11% | 2012 |
| Contrave naltrexone / bupropion ER | Oral combination | 8/90 mg tablet titrate to 2 tablets twice daily | ~$740 | $99–$199 | ~5–6% | 2014 |
| Adipex-P phentermine | Oral stimulant | 15, 30, 37.5 mg short-term use | $15–$40 | $4–$14 | ~3–5% | 1959 |
| Xenical orlistat, prescription | Lipase inhibitor | 120 mg 3× daily with meals | ~$689 | ~$633 | ~3% | 1999 |
| Alli orlistat, over the counter | Lipase inhibitor | 60 mg 3× daily with meals | ~$88 | ~$88 | ~2–3% | 2007 |
Swipe the table sideways to see every column.
These are not our fees. Every price in the table is what a pharmacy, a manufacturer program or a discount service charges for the medication itself. This practice does not sell or dispense these drugs and receives nothing from their sale. Dr. Geller has no financial relationship with any drug manufacturer — no speaking fees, no advisory roles, no research funding. What you pay us is for the consultation and the follow-up care, and we will tell you that separately.
And they move constantly. Programs such as LillyDirect, NovoCare and CurAccess are generally for self-pay patients, usually cannot be combined with insurance, and change terms without much notice. Treat the figures above as an order of magnitude rather than a quote. We will check what your own plan allows.
Retatrutide is not FDA-approved and is included only for context; the figures are Phase 3 trial data and approval is not expected before 2027. Foundayo (orforglipron) was approved in April 2026 and is the first GLP-1 pill that can be taken at any time of day without food or water restrictions.
The honest comparison, without a thumb on the scale:
| Medication | Surgery | |
|---|---|---|
| Typical weight loss | Roughly 15–20% of total body weight with the newer agents, on average. | Roughly 25–35% of total body weight, depending on the operation. |
| Durability | Depends on staying on the medication. Regain is common after stopping. | Anatomic change is permanent, though some regain over years is normal. |
| Invasiveness | No operation, no anesthesia, no recovery period. | An operation, a hospital stay, and a recovery period. |
| Ongoing cost | Monthly, indefinitely. Coverage varies widely and can change. | Largely front-loaded, plus supplements and follow-up. |
| Reversible | Yes. Stop the drug and the effect stops. | Sleeve, no. Bypass, technically but rarely. |
| Best suited to | Lower BMI, patients declining surgery, pre-operative preparation, post-operative regain. | Higher BMI, significant metabolic disease, patients seeking the largest and most durable result. |
These are also not opposites. Medication before surgery, medication after surgery, and medication instead of surgery are all common paths, and plenty of patients move between them over the years.
We bill insurance when your plan covers weight loss treatment, and we offer a self-pay option when it does not.
Coverage for the GLP-1 medications specifically is the most volatile part of this. Some plans cover them well, some cover them only for diabetes, some have dropped coverage entirely, and many require prior authorization with documentation. We handle prior authorizations and will tell you early what your plan appears to allow, rather than after you have started and grown attached to the results.
Call the office at (502) 893-7151 and we can look into your specific coverage.
No. Many patients in the program have no interest in an operation and never will, and that is a perfectly good reason to be here. Nobody will spend your visit trying to talk you into surgery.
No, and you are in very good company. Regain years after a bariatric operation is common and it is not a personal failure. Come in, let us look at what is going on, and start with the least invasive thing that will work.
Yes. You do not need a referral from your original surgeon and you do not need your old records in hand, though they help if you can get them.
Possibly, and it is better to hear that now. Obesity behaves like a chronic condition, and these medications treat it the way blood pressure medication treats hypertension — while you take them. Some patients do come off successfully, particularly alongside substantial changes in eating and activity. Many do not, and plan accordingly.
No. Only FDA-approved brand-name products. Compounded versions are cheaper and widely advertised, but they are not reviewed for purity or dosing accuracy, and dosing errors with them have caused serious harm.
Not the first visit — that one is in the office. After that, almost all of the program can be run by video. Some labs will need to be drawn locally. More about telehealth →
That is a good reason to come in. A full hour with Dr. Geller, both options on the table, no pressure toward either one.
