Weight Loss FAQs

Relish will design a treatment plan specifically for you.  Based on your personal history, age, weight, and associated medical conditions, Relish will prescribe medications that have been shown effective at treating your underlying causes of weight gain. Weight loss is complicated and many biological systems are involved. There are many reasons people gain weight—oftentimes happening simultaneously but a significant contributor is using food as a way to cope with toxic stress stemming from traumas in childhood and chronic stressors in adulthood. People that are overweight for long periods of time can develop hormonal imbalances, and it is not uncommon for weight gain to happen rapidly in adulthood with parenthood, professional pursuits, and related stressors. As we age, hormone levels in our bodies also change and we can become insulin resistant. That’s why Health Care Practitioners (HCPs) at Relish have been successfully treating patients with medications that work on the brain (hypothalamic-pituitary-adrenocortical [HPA] axis), and the digestive and endocrine systems.

HPA Axis

These areas of the brain are typically damaged by long-term exposure to toxic stress, such as the stress experienced as a result of adult and childhood adverse experiences. Chronic stress puts the adrenal system into extended overdrive which floods the system with cortisol. High levels of cortisol can wear down the brain’s ability to function properly. According to several studies, chronic stress impairs brain function in multiple ways. For example, it can disrupt synapse regulation¹, resulting in the loss of sociability, anxiety, impulsivity, impaired memory, mood control, and the avoidance of interactions with others.  It can kill brain cells², and reduce the size of the brain, leading to both emotional and cognitive impairment³.

Medications which can directly improve the function of these parts of the brain are used in the Relish program. These medications include naltrexone, bupropion, or Contrave® (which is the brand name of the compound of naltrexone and bupropion). These medications are used to lift mood, regulate the craving and impuse control centers of the brain and, with a reduced-calorie diet and proper exercise, help people lose weight and keep it off. Common brand names of bupropion include Wellbutrin®, Zyban®, and Aplenzin®. Common brand names of naltrexone include ReVia® and Vivitrol®.  Naltrexone is often used to treat alcohol and opioid dependence, and bupropion to treat depression, seasonal affective disorder, and as an aid in smoking cessation treatment. The two together have been compounded into a single pill, brand name Contrave® , that was approved by the FDA in 2014 after clinical trials demonstrated its safety and efficacy for weight loss.

Digestive and Endocrine Systems

The pancreas produces hormones and enzymes to help you digest food. One of those hormones is insulin. In people who have been overweight for some time and with deep visceral adipose tissue, the regulation of hormones – for example insulin – can be disrupted. Insulin works by helping the body’s cells to absorb glucose. If you carry a lot of weight around your middle, or even as a function of age, you can develop a condition known as insulin resistance. Insulin resistance is when cells in your muscles, fat, and liver don’t respond well to insulin and can’t easily take up glucose from your blood. For some Relish patients, particularly patients with a BMI ≥30 (or a BMI of ≥27 with coexisting medical complications such as high blood pressure) Relish practitioners may prescribe a medication that can help increase insulin release and suppress glucagon during times of glucose elevation.   This medication, known as human glucagon-like peptide 1 (GLP-1), has been clinically proven to significantly aid in weight loss. If your Relish practitioner believes you are a candidate for this type of medication, your individual circumstances will be reviewed prior to determining which medication from this category of medications is right for you. These medications are not a part of the core Relish program and would need to be purchased separately.

The associated risks of taking a medicine must be weighed against the good it will do. This is a decision you and your HCP will make together. Be sure to tell your HCP about your medical history, including both your personal health conditions and your family health history. Tell your HCP of any allergies you may have, if you are pregnant, planning to become pregnant, or breastfeeding, or if you have a history of mental illness, seizures, liver or kidney problems, high blood pressure, heart problems, or diabetes.

Tell your HCP about all of the other medications you may be taking including over-the-counter medications, vitamins, and (herbal) supplements as well as medicines for hypertension, seizures and other bupropion-containing products.  Your HCP will recommend a treatment plan designed specifically for you.

Your HCP will explain how to take the medications that are prescribed.

Let your HCP know what medications you are taking and he/she will adjust the Relish program to take your existing medications into consideration.

Alcohol and opioid medication should be avoided while on these medications.

According to the Prescribing Information, the most common side effects of Bupropion (one of the ingredients in Contrave® ) include agitation, dry mouth, insomnia, headache, migraine, nausea, vomiting, constipation, dizziness and trouble sleeping. According to the prescribing information, the common side effects of Naltrexone (also one of the ingredients in Contrave® ) include sleep problems, tiredness, anxiety, headache, joint and muscle pains, abdominal pain and cramps, nausea and vomiting. This is not a complete list of side effects. For a full list of potential side effects, please contact a pharmacist or ask your HCP.  Call your HCP if you are experiencing any side effects.

Do not take any other medications or supplements unless your HCP has said it is safe to do so. Tell your HCP about all medications you take, including over-the-counter medications, vitamins, and (herbal) supplements as well as medicines for hypertension, seizures and other bupropion-containing products.

A pharmacist can give you more information about these medications.

Yes, these medications are safe for travel. With respect to other aspects of the Relish program, all of the meetings are virtual and the food and fitness plans can be easily adapted to any travel situation.

Although best avoided, yes, you can drink in moderation while taking these medications.

Both bupropion and naltrexone have been used for more than three decades and have long been prescribed by physicians to treat depression, and to help people quit smoking and drinking. However, the individual medicines in Contrave®  are not FDA approved for weight loss when used on their own, and Contrave®  is not FDA approved to treat depression or other mental illnesses, alcohol or opioid dependency, or to help people quit smoking.

Antidepressants, including bupropion (bupropion is one of the ingredients in Contrave® ), may increase suicidal thoughts or actions within the first few months of taking it. If you already have depression or other mental illnesses, taking bupropion may cause it to get worse. Stop taking bupropion and call a HCP immediately if you have reactions or new symptoms.

Less than 0.5% of all HCPs in North America have been trained on how to treat overweight patients. It could be that your primary HCP is not familiar with treating weight disorders or the significant and relatively recent progress made in weight loss pharmacology.

Bupropion is a norepinephrine dopamine receptor reuptake inhibitor which blocks the satiety center in the brain. Naltrexone is an opioid antagonist which blocks the addiction center in the brain. When they are used together, as in Contrave, the naltrexone inhibits the process whereby the body becomes accustomed to, and adapts, to bupropion.