Weight Loss Medications#

Body Mass Index (BMI) is a calculation from your height and weight that gives a single number to classify weight categories. It's not a perfect measure (it doesn't distinguish muscle from fat, for example), but it's the standard threshold the Canadian guideline uses.

BMI = weight (kg) / height (m) squared.

Most online BMI calculators give the same result. The clinician will confirm yours during the intake.

A few options:

• Recent measurement from a doctor's office (ask your family doctor or walk-in clinic).
• A PC Health Station at a Shoppers Drug Mart - this is a free public health kiosk that prints your weight, blood pressure, and BMI.
• A driver's license or government-issued ID that lists your height (combined with a recent weight measurement).
• A measurement signed by a pharmacist on pharmacy letterhead.

Upload a photo during your intake. We do not accept self-reported weight without a verifying source for the initial prescription.

• Patients below the BMI threshold (the medication isn't appropriate for cosmetic weight loss without the underlying medical indication).
• Patients under 18.
• Patients with a personal or strong family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 (MEN2) - these are absolute contraindications.
• Patients with a history of pancreatitis.
• Patients with severe gastrointestinal disorders (severe gastroparesis, certain inflammatory bowel disease presentations).
• Patients who are pregnant, breastfeeding, or actively trying to conceive. Discontinue the medication at least 2 months before planned conception.
• Patients with active eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder under active treatment) - the medication can worsen disordered eating patterns and is not the right tool for this population.
• Patients with severe diabetic retinopathy.

If you're not sure whether your situation fits, submit the intake - the clinician will assess.

GLP-1 (glucagon-like peptide-1) is a hormone your gut releases when you eat. It signals fullness to the brain, slows stomach emptying, and improves blood-sugar regulation by helping pancreas insulin response.

The medication is a GLP-1 receptor agonist - it mimics the action of natural GLP-1 but with a much longer duration (typically once-weekly injection). On treatment, patients typically experience:

• Reduced appetite between meals.
• Earlier fullness at meals (smaller portions feel satisfying).
• Slower gastric emptying (food stays in the stomach longer).
• Improved blood-sugar control (especially relevant for diabetes and prediabetes).
• Gradual weight loss over months as overall calorie intake decreases.

Average weight loss in clinical trials is 10-20% of starting body weight over 12-18 months, depending on the specific medication, dose, and adherence to lifestyle changes.

GLP-1 class medications were originally developed for type 2 diabetes - they significantly improve blood-sugar control. The weight-loss effect was a striking finding from those trials, and subsequent trials specifically for weight loss confirmed substantial benefit even in people without diabetes.

In Canada, certain GLP-1 medications now have specific Health Canada approval for chronic weight management in adults with obesity or overweight plus a weight-related health condition.

Most current GLP-1 class medications for weight management are given as a once-weekly subcutaneous injection with a small pre-filled pen device. The injection is into the fat under the skin (abdomen, thigh, or upper arm), uses a very small needle, and takes a few seconds.

Most patients learn the technique in minutes. The pharmacy will demonstrate it; we provide written instructions; and the clinician can walk you through any concerns.

The gut needs time to adjust to slower gastric emptying. Starting low and increasing gradually substantially reduces nausea, vomiting, and other GI side effects. Each dose increase is typically held for at least 4 weeks before going up to the next step. Some patients need longer at a given step before they're ready to increase.

The exact schedule depends on the specific medication, but a typical pattern is:

• Weeks 1-4: lowest starter dose.
• Weeks 5-8: step up to the next dose.
• Weeks 9-12: another step up.
• And so on, with new dose levels every 4 weeks until you reach the dose that's working for you.

Many patients reach a maintenance dose somewhere in the middle of the titration range without needing to go to the highest dose. The dose that works best is the one that gives you good appetite control with manageable side effects.

Slow down. If nausea, vomiting, or other side effects are significant at a new dose, stay at the current dose for longer (sometimes another 4-8 weeks) before trying to step up again. Sometimes the right move is to stay at a lower dose long-term if it's working.

Message the clinician if you're struggling with side effects - we can adjust the plan.

• If less than 5 days late: take the missed dose as soon as you remember, then continue on your usual day.
• If more than 5 days late: skip the missed dose, take your next dose on your usual day, and continue normally.
• If you've missed more than 2 weeks in a row: restart at a lower dose and re-titrate up. Don't restart at your previous high dose - the gut tolerance is lost and you risk severe nausea or vomiting. Message the clinician.

The vast majority of side effects on GLP-1 class medication are gastrointestinal and dose-dependent. They're most common in the first few weeks at each new dose and usually improve as your gut adjusts.

• Nausea - the most common side effect. Usually mild to moderate at standard doses. Tips below for management.
• Vomiting - less common than nausea but can happen, especially after large or fatty meals.
• Constipation or diarrhea - either can occur. Hydration and fibre help with constipation.
• Reduced appetite and earlier fullness - this is the medication's mechanism. Most patients describe this as a positive change, but if it leads to inadequate intake, the dose may need adjustment.
• Acid reflux or heartburn.
• Burping or bloating.
• Fatigue - mild, usually transient.
• Headache.
• Injection-site reactions - mild redness, itch, or bruising at the injection site. Rotate injection sites to reduce.

• Eat smaller meals, more often. Three or four small meals are usually better tolerated than two or three large ones.
• Avoid greasy, fried, or very rich foods, especially in the first few days after a dose.
• Stay hydrated. Sip water through the day. Dehydration makes nausea worse.
• Avoid lying flat right after eating. Stay upright for at least 30 minutes.
• Limit alcohol. Alcohol on top of GLP-1 nausea is a bad combination.
• Ginger (tea, candies, capsules) helps some patients.
• Time injections for an evening you can rest the next day if you find nausea is worst in the first 24 hours after injecting.
• If nausea is severe or you cannot keep fluids down, contact the clinician or seek urgent care. Persistent vomiting causes dehydration and may require dose adjustment or pause.

No. Most GI side effects are worst in the first 2-4 weeks at a new dose and improve as your gut adapts. Many patients on stable maintenance doses experience minimal day-to-day side effects.

GLP-1 class medications have been associated with rare cases of pancreatitis. Stop the medication and go to an emergency department if you develop:

• Severe, persistent abdominal pain, especially in the upper abdomen, often radiating to the back.
• Persistent vomiting with severe abdominal pain.

A history of pancreatitis is a relative contraindication and the clinician will assess case by case.

In rodent studies, GLP-1 class medications caused thyroid C-cell tumours. This effect has not been clearly demonstrated in humans, but as a precaution:

• Personal or family history of medullary thyroid carcinoma (MTC) is a contraindication.
• Multiple endocrine neoplasia syndrome type 2 (MEN2) is a contraindication.
• See urgent care if you develop a persistent neck lump, hoarseness, difficulty swallowing, or shortness of breath.

Rapid weight loss increases the risk of gallstones, and GLP-1 class medications have been associated with gallbladder problems (including gallstones and gallbladder inflammation). Seek care for:

• Upper-right abdominal pain, especially after meals.
• Persistent fever with abdominal pain.
• Yellowing of the skin or eyes (jaundice).

GLP-1 class medication by itself rarely causes low blood sugar in people without diabetes. However, in patients also taking insulin or sulfonylureas for diabetes, the combination can cause hypoglycemia. If you're on diabetes medications, mention this in the intake - the clinician will coordinate dose adjustments.

In patients with pre-existing diabetic retinopathy, rapid improvement in blood-sugar control can temporarily worsen retinopathy. If you have diabetic retinopathy, mention it in the intake; an ophthalmology check before starting is a good idea.

Severe vomiting or diarrhea can lead to dehydration and, rarely, kidney injury - especially in patients with reduced baseline kidney function. Stay well-hydrated and contact the clinician if you cannot keep fluids down.

Because GLP-1 medications slow gastric emptying, they can affect the absorption of other oral medications. This is usually not a major issue but worth noting for:

• Oral contraceptive pills - slightly slower absorption is possible. Use an additional method of contraception in the first 4 weeks of starting GLP-1 medication and after each dose increase if pregnancy prevention is critical.
• Older vitamin-K-antagonist blood thinners - INR may need closer monitoring during titration.
• Other narrow-therapeutic-index medications - mention all your medications in your intake.

Baseline bloodwork typically includes:

• HbA1c (average blood sugar over 3 months).
• Fasting glucose.
• Lipid panel (cholesterol).
• Liver enzymes (ALT, AST).
• Kidney function (creatinine, eGFR).
• TSH (thyroid).
• Complete blood count.
• Pregnancy test when applicable.

The clinician will write a requisition during your intake. You can complete it at any participating lab.

After the initial 3-month prescription:

• Check in every 3 months for renewal, dose adjustments, or side-effect management.
• Repeat bloodwork is generally not required at each check-in if your initial labs were normal and your overall health is stable. The clinician will discuss the appropriate cadence based on your situation - some patients with diabetes or other conditions need more frequent monitoring.
• You can request a consultation any time between check-ins if you have side effects, dose questions, or want to adjust the plan.

The clinician reviews:

• Weight trend over time (a downward trend, plateaus, or weight regain).
• Side-effect tolerability at the current dose.
• Effect on weight-related conditions (blood-pressure trends, blood-sugar trends, sleep apnea symptoms).
• Overall wellbeing (energy, mood, exercise capacity).
• Whether the current dose is right or needs adjustment.

Yes, most patients regain a significant portion of lost weight after stopping GLP-1 class medication. The medication suppresses appetite while you take it; appetite returns to its previous level when you stop. Studies have shown that within 6-12 months of stopping, most patients regain roughly half to two-thirds of the weight they lost on the medication.

This is not a willpower failure. The underlying biology of body-weight regulation pushes back against weight loss regardless of how it was achieved. Most patients who maintain significant weight loss continue some form of treatment (medication, intensive lifestyle program, bariatric surgery, or a combination).

For many patients, GLP-1 class medication is a long-term medication, like medications for high blood pressure or high cholesterol. You take it because it works while you're on it, and weight-related health risks (cardiovascular disease, diabetes complications) are reduced while it's working.

Some patients choose to stop after reaching their goal weight and accept some regain. Some patients can stay on a lower maintenance dose long-term with less weight loss but stable weight. Some patients move on to other approaches (lifestyle alone, bariatric surgery). The clinician will discuss the options with you.

Yes. The medication doesn't require a tapering schedule - it gradually leaves your system over a few weeks because of its long half-life. If you decide to stop:

• Plan to address increased appetite. A registered dietitian or a structured lifestyle program can help bridge the transition.
• Watch for weight regain and decide what you want to do about it (return to medication, lifestyle program, or in-person bariatric assessment arranged through your family doctor or a local clinician).
• Re-engage with TeleTest if you decide to restart - we can do so under the renewal panel.

Bariatric (weight-loss) surgery is more powerful than medication on average - typical weight loss is 25-35% of starting weight, with effects lasting longer. It's also a much bigger commitment: surgery, recovery, lifelong dietary changes, lifelong vitamin supplementation, and risk of surgical complications.

Surgery is most commonly considered for patients with:

• BMI 40+ (regardless of other conditions), OR
• BMI 35+ with serious weight-related health conditions.

Many patients try medication first and consider surgery if medication isn't sufficient. Some patients use medication after bariatric surgery for additional or maintenance benefit. TeleTest does not arrange bariatric-surgery referrals; if you are interested in surgical assessment, your family doctor or a local in-person clinician can arrange this.

Yes. Choose the Weight Loss Renewal panel during your TeleTest signup. You'll be asked to upload one of:

• A pharmacy receipt.
• A photo of the prescription box with your health details.
• A digital copy of your prescription.
• A photocopy of a prior prescription.

A typical renewal prescription is for 12 weeks (3 months). Repeat baseline bloodwork isn't usually required if you're stable on the medication, though the clinician may ask for it depending on how long it's been since you last had labs and your overall health.

Yes. Submit a Weight Loss Renewal consultation and mention what you'd like to change. The clinician will review your side effects, weight trend, and reasons for the switch, and discuss the safest way to make the change.

If you're switching between different GLP-1 medications, you typically need to re-titrate on the new medication - they're not directly equivalent dose-for-dose.

We don't discontinue medication that's working appropriately. Many patients use GLP-1 medication long-term for weight maintenance, similar to long-term medication for any chronic condition.

If at any point you want to stop, you can. The clinician will not stop medication on your behalf unless there's a clinical safety reason (e.g., new contraindication, serious side effect, pregnancy).

Yes. Pack the pen in your carry-on luggage - not checked baggage, where temperatures can be extreme. The pen tolerates a few hours at room temperature; just avoid extended heat, freezing, or direct sun exposure.

Bring a copy of your prescription with you for customs. For long trips, your pharmacist can advise on travel storage.

Before first use: store in the refrigerator (2-8°C / 36-46°F).

After first use: can be stored either in the fridge or at room temperature (up to 30°C / 86°F) for a defined period (typically up to 56 days / 8 weeks, depending on the specific product). Check the leaflet that came with your pen for the exact storage instructions.

Never freeze the medication. If accidentally frozen, discard it.

If you've gone more than 2 weeks without your injection, restart at the lowest dose and re-titrate up. Tolerance to side effects diminishes during a treatment gap, and resuming at a high dose can cause severe nausea and vomiting.

Message the clinician for a tailored restart plan.

TeleTest currently operates in Ontario and BC. Patients must be physically located in one of these provinces at the time of the consultation. American patients or patients in other provinces can use TeleTest only if they are temporarily in Ontario or BC at the time of the consultation.

TeleTest provides episodic care - similar to a walk-in clinic - rather than mandatory monthly check-ins. You can request a Weight Loss Renewal consultation as frequently as you like (monthly, every few months, or just at renewal time). This keeps the cost more flexible than programs that require fixed monthly billing.

Any Canadian pharmacy - local independents, Costco, Shoppers Drug Mart, Rexall, Pharmasave, and others. Some patients prefer pharmacies that deliver to the home (e.g., Pocket Pills, Pillway, Mednow, Well.ca, Telus Virtual Pharmacy). The clinician faxes the prescription to your chosen pharmacy.

Prices vary substantially between pharmacies. Independent pharmacies and warehouse pharmacies (e.g., Costco) often have lower dispensing fees than big chains. It's worth calling a few before filling.

Some private insurance plans require a drug-authorization form before they'll cover GLP-1 class medication. TeleTest can complete these forms:

1. Select the Insurance Authorization Form panel from the Weight Loss category.
2. Pay for the paperwork.
3. Attach the form during the consultation.
4. The clinician will complete the medical sections and may ask follow-up questions based on what your insurer requires.

If your insurer denies coverage initially, the clinician can sometimes provide additional documentation to support an appeal.

Insurance plans sometimes cover one GLP-1 medication but not another. If your plan denies your first choice, submit a Weight Loss Renewal consultation - the clinician can discuss switching to a covered alternative.

No. Provincial drug plans (for example, the Ontario Drug Benefit, BC Fair PharmaCare, Quebec's RAMQ-administered plan, Alberta's drug programs, and others) do not currently cover GLP-1 class medication for weight management. Coverage exists in some plans for type 2 diabetes, but not for weight loss alone.

Some do, some don't. Coverage is highly variable and is often the deciding factor for patients on whether the medication is affordable.

• Check your plan (often listed in your benefits booklet or by calling your insurer).
• Some plans require pre-authorization with a drug-authorization form (TeleTest can complete it).
• Some plans require failed alternative therapy before approving GLP-1 medication.
• Some employer plans specifically exclude weight-loss medication.

Out-of-pocket cost varies substantially by pharmacy and specific medication. A typical 4-week supply ranges from several hundred dollars at the high end down to lower prices at warehouse pharmacies (Costco often has the lowest dispensing fees).

• Call a few pharmacies before filling - prices vary more than you might expect.
• Generic versions are not yet broadly available for the newest GLP-1 medications in Canada; the market is mostly brand-name.
• Some manufacturer co-pay or savings programs exist - ask your pharmacist or the prescribing clinician.