Your Weight Management Questions, Answered

This is the million-dollar question! The choice is ultimately yours. Research shows that many people regain weight after stopping medications, often exceeding their previous weight. However, this doesn't mean you can't try tapering off to see how your body responds. Many of my patients find these medications life-changing and choose to continue with a maintenance dose that helps them feel energized while maintaining a balanced relationship with hunger, satiety, stress management, and movement.

When you're within 5-10 pounds of your goal weight, we'll begin tailoring your medication schedule for long-term maintenance. This might involve reducing your dose amount while maintaining weekly administration, or extending the interval between doses (perhaps to every 10 days). But maintenance is about much more than just the number on the scale—it's about how you feel overall, your metabolic health markers, and your body composition. We'll work together to find the right balance that helps you maintain optimal health across all these dimensions while ensuring you continue to feel good in your daily life.

Yes, some degree of muscle loss typically occurs during any weight loss process, including when using medications. Research shows that on average, about 25% of total weight lost comes from fat-free mass with Zepbound (Tirzepatide), and a little bit higher with Semaglutide (Wegovy). Data is similar across the board for someone who loses weight without medications PENDING they aren't prioritizing strength training, protein intake, adequate recovery, etc. You can help mitigate this decrease by optimizing nutrition quality, sleeping 6-8 hours a night, and doing a progressive strength training program.

The good news is we can monitor these changes through body composition testing and implement strategies to minimize muscle loss. The most effective approaches include regular strength training (2-4 times weekly), ensuring adequate protein intake, and maintaining a moderate pace of weight loss (0.5-2 pounds per week). These strategies help preserve your metabolically active muscle tissue, which is important for maintaining your energy expenditure and long-term weight management success.

Yes, I work with most Blue Cross Blue Shield, United Healthcare, Cigna, UMR, and Tricare plans. As always, confirm with your insurance that Lupo Preventative Medicine is in-network for your specific plan. I am out of network with all Aetna, Medicare, and Medicaid plans. If you are out-of-network, I offer cash pay rates.

No. I only prescribe FDA-approved medications where purity, safety, and efficacy have been verified through rigorous testing. Compounded medications lack this regulatory oversight and may contain unknown ingredients or incorrect dosages.

You'll want to check your prescription coverage directly with your insurance carrier to see if they cover medications like Saxenda, Wegovy, Zepbound, Qsymia, or Contrave. During our first appointment, I'll help you navigate this process and explore options based on your coverage.

A continuous glucose monitor (CGM) is a tool we use to measure your blood sugar and look at how your body responds to different inputs. Insurance may or may not cover it (another one of those things where we have to explore your benefit coverage), but there are cash pay options if you want to use this method through different companies.

A prior authorization is a requirement from your insurance company to verify that a prescribed medication is medically necessary before they'll cover it. Many weight management medications require this extra step. Here's how it works: I'll send your prescription to the pharmacy, who will then notify us if a prior authorization is needed. I recommend keeping an eye on your prescription status as soon as I send it—if you see "prior authorization required," please message me directly on Spruce to let me know so I can take immediate action. I'll complete the necessary paperwork, which may include answering specific questions about your case or submitting chart notes to demonstrate your need for the medication. While most prior authorizations are processed promptly, occasional delays happen. If you don't hear about your prescription within a week, please call your pharmacy and ask them to refax the prior authorization to me at 402-698-8033, as sometimes these requests are sent to incorrect numbers.

Yes, I screen for and treat binge eating disorder. Binge eating disorder requires a comprehensive approach, usually working directly with a dietitian and therapist, and we have FDA-approved medication to also treat binge eating disorder.

Yes, I provide comprehensive body composition analysis using the medical-grade Seca device. This advanced testing examines over 15 different health markers, giving us valuable insights beyond what a standard scale can offer. The assessment measures key indicators including body fat percentage, visceral adipose tissue (fat surrounding your internal organs), skeletal muscle mass, segmental muscle distribution, and overall body composition. The analysis also estimates your total energy expenditure based on your lean muscle mass, helping us tailor treatment plans to your specific metabolic rate. This detailed information allows us to track meaningful changes in your body composition throughout your weight management journey.

I recommend establishing a regular eating pattern (every 3-5 hours) and focusing on nutrition quality rather than just calories. Build balanced meals with protein, complex carbohydrates, healthy fats, and fiber. I often suggest working with a registered dietitian while starting this journey to optimize your nutrition plan.

I recommend finding movement you genuinely enjoy rather than forcing yourself through workouts you dread. Ideally, combine cardiovascular exercise with strength training 2-4 times weekly to help preserve muscle mass during weight loss. Research shows successful long-term weight management typically involves about 5 hours of weekly movement, but start wherever you are, establish consistency, and gradually build from there. If you don’t know where to start, it could be good to find a physical therapist to help you learn basic strength exercises to ensure your form and movement are optimal.

Weight management is a chronic condition requiring ongoing care. Many of my clients will work with me forever. We’ll meet on a monthly basis until we both think you’re ready to spread visits out to every 2-3 months. My goal is to provide long-term support to help you maintain results and overall wellbeing. Monthly visits ensure you're feeling good, managing hunger appropriately, maintaining energy, and addressing any other factors affecting your health.

If you are not able to keep an appointment, please provide a 24-hour cancellation notice. If this does not occur, a no-show/late cancel fee of $100.00 will be billed. If there are three no-shows within one year, you will be asked to transfer to a different practice.

If you are running more than 15 minutes late for your appointment, I’ll do my best to accommodate you. However, on certain days it may be necessary to reschedule your appointment.

I serve patients local to Bennington (where my practice is located), Omaha, Elkhorn, and surrounding areas. Due to licensing regulations, I can only provide care to patients physically located in Nebraska.

All initial consultations must be conducted in person at my private practice in Bennington, Nebraska. Follow-up appointments may be available via telehealth for established patients.

I order a comprehensive panel of biomarker labs to assess your overall health and identify factors that may influence your weight management journey. This typically includes:

Inflammation Labs

• High-sensitivity C-reactive protein (hsCRP)

• Complete blood count (CBC)

• Hemoglobin A1c

• Insulin

• Lipids profile

Heart Health

• Total Cholesterol

• HDL (high-density lipoprotein cholesterol)

• LDL (low-density lipoprotein cholesterol)

• Triglycerides

Hormone Health | Metabolism

• Thyroid stimulating hormone (TSH)

• Thyroid antibodies

• Fasting insulin

• Vitamin D

• Comprehensive metabolic panel

• Hemoglobin A1c

Sleep | Cognition | Recovery

• Vitamin B12

• Vitamin D

• Magnesium

• Sodium

Endurance

• Ferritin

• Hematocrit

• Hemoglobin

• B12

• Total iron binding capacity (TIBC)

While I don't routinely order cortisol testing or comprehensive hormone panels related to peri-/menopause, I have trusted specialists I can refer you to if you're interested in further hormone assessment. These comprehensive baseline labs provide us with the essential information needed to develop your personalized weight management plan.

I partner with established laboratory facilities for all diagnostic testing. After our initial consultation, I'll order comprehensive baseline labs through either Quest Diagnostics (located near Westroads) or Regional Pathology Services (with convenient locations at UNMC, Oakview, Village Pointe, Lincoln, and Bellevue). You can complete these labs at your convenience, and once your results are available, we'll schedule a follow-up appointment to review the findings and develop your personalized treatment plan.