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# Elective Weight Loss™
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### Elective Weight Loss™ — A No Diet Diet
**NEW! Peptide for appetite suppression now available as a tablet with vitamin B-12!**
** to download the EWL Patient Registration form.
 to download the EWL Patient Consent form.**
WHAT IS IT?
* A non-surgical tool to suppress appetite for sustained calorie restriction to get that weight off!
* A FDA approved medication for weight loss in obese and overweight individual with type 2 diabetes.
**FOR WHO?**
* Anyone who has seen their weight drift up (even as little as 8 pounds), who is having difficulty getting–and keeping–it off!
* People with a BMI of 20-30, normal weight to medically overweight.
* Otherwise healthy people with excess weight being their main medical problem.
**HOW IT NATURALLY WORKS**
* *Semaglutide* delays early postprandial (after eating) gastric emptying.
* *Semaglutide* decreases high blood glucose. This essentially stabilizes blood glucose levels and postprandial glucose levels.
* *Semaglutide* is a peptide [similar to natural GLP-1, glucagon-like peptide]. 94% of its sequence is similar to a naturally occurring peptide. It binds to your natural GLP-1 receptor. Small amino acid modifications enhance binding to the natural receptor and preserves its degradation–essentially enhancing its extended steady effect in your body.
**HOW IT NATURALLY WORKS IN YOUR BODY**
* *Semaglutide* will decrease your appetite by slowing stomach emptying. You will achieve satiety quicker resulting in eating and drinking less. This fullness will last longer, decreasing desire to eat again or consume more. Overall, your appetite will be lowered, less food and drink will be consumed, and decreased caloric intake in total.
* Maximum concentration of *semaglutide* is reached in 1-3 days. A steady state in the body is achieved after 4-5 weeks.
* Your dose will be adjusted based on your appetite suppression while minimizing discomfort.
* Taking the *semaglutide* in your abdomen, thigh, or upper arm doesn’t matter for the absorption. Change sites as you wish.
* Half of the *semaglutide* will be gone in about 1 week and will stay in your circulation for about 5 weeks after the last dose.
**COMMON ADVERSE REACTIONS**
* Nausea or feeling of acid reflux
* Constipation
* Diarrhea
* Abdominal pain
* Vomiting
Generally, if any of these reactions occur, they diminish over the first weeks. This is why I will slowly increase the dose to attain a maximum effect while diminishing adverse reactions.
**!
Listen to Dr. Giese talk with Dr. Robi Ludwig about the benefits and side-effects of Semaglutide, and its use in the weight loss arena. .**
**TIPS to diminish or avoid potential adverse reactions**
* Add some fiber supplement to avoid constipation and keep you regular with the diminished food intake. It is not uncommon to decrease the amount and/or frequency of your bowel movements. Your body’s natural gastrocolic reflex is diminished because of your decreased food intake. This is another reason to stay well hydrated.
* Spread out your fluid intake throughout the day (recommended intake 64 ounces). Also drink slowly, large gulps may result in fullness or reflux.
* Have over the counter (OTC) omeprazole on hand. It is an OTC reflux medication. Dissolving, under the tongue or pill form are available.
* If real nausea occurs, call the office and we can prescribe a stronger anti-nausea medication.
**VERY SAFE**
* This is a very safe medication. NO clinically relevant drug-drug interaction with *semaglutide* was observed. Therefore, NO dose adjustment of any medication is required. Also, NO apparent effect on the rate of gastric emptying was observed with *semaglutide* doses up to 2.4 mg weekly.
* However, I suggest caution and/or an alternative protection when taking oral contraception to ensure maximum pregnancy prevention.
**CONTRADICTIONS**
* A personal family history of medullary thyroid cancer. However, development of this cancer was only observed in mice.
* MEN syndrome
* Serious hypersensitivity reaction to *semaglutide*
**HOW TO USE**
* Follow package insert for directions for your weekly injection. Call or contact the office
  for support or any questions.
* Start with 10-12 units for the first week or two. Increasing the dose to achieve appetite suppression as needed to 25 units weekly is common. Some stay at 12 units a week. You may need 30, 40, or 50 units weekly. Others may need 100 units and still others may require the maximum dose of 2.4 mg weekly. Higher doses are typically needed with heavier patients.
* My recommendation is to go for the lowest effective dose, but don’t skimp out and compromise your results.
**CLOSING**
* I am intentionally NOT recommending ‘a diet’. A ‘no-diet diet’ has been found to be equally if not more effective than any specific restrictive diet plan. Everyone’s lifestyle and relationship with food is different and changes over time, You are all adults. I am not going to tell you what to eat or be the food police.
* You will find that you will become more efficient in your eating. You will likely spend less money on food and clean your refrigerator and freezer and lessen overall food waste. Take this time to observe and reflect and make small changes to your nutrition intake.
* Eating less is generally healthier and consistent with longevity. Particularly with supply chain issues, possible food source scarcity and inflation there are many reasons to incorporate a lifestyle less dependent on large amounts of food for satisfaction.
* If you need any suggestions on healthy food substitutes, nutritional education or tactical coaching on you eating habits, please contact  for a personalized evaluation and advice.
**LONG TERM MAINTENANCE**
* After your goal weight is attained–and this is done through commitment, time and dedication–maintenance is the next significant step which can be equally as hard, according to published research.
* I recommend you wean (slowly reduce) yourself off of *semaglutide*. Continue to weigh yourself daily. Keep good habits. Embrace and enjoy your ideal weight.
* If by chance you regain 5 pounds, I will recommend going back on the *semaglutide* to get you back on track to maintaining your ideal weight.
The majority of the weight loss literature is focused on medically obese (BMI > 30) or very medically overweight (BMI 27-30) patients.  These are people in a diseased state or an inflammatory state.  Generally, long term success for these groups of patients is not good.  But what was equally as interesting, is the lack of weight loss studies for normal weight people (BMI 18.5-25).  They are not perceived as ‘sick’ but generally are crippled by the defeat of not attaining success of their weight loss goal or ideal body weight.  I have seen this be quite devastating to people.  Please follow some simple math to illustrate the problem.
Take for example a woman who is 5’7”.  A low weight for her as an adult was 127 (BMI 20).  While that is thin, she reports bouncing around 5 pounds from 127 to 132 (BMI 20-20.7).  Over the years she drifted up to 140 (BMI 22), an increase of 13 pounds.  While still normal weight she can no longer fit into her clothes.  Then, a family member died and she drifted up to 153 (BMI 24), resulting in a total increase of 26 pounds.  She is still technically a normal weight but is nearly 3 clothing sizes bigger.  She is someone who is ignored by the traditional medical establishment because she is still with a normal BMI of 24, but is relatively overweight to her.
This is where science and the psyche come in.  She feels very defeated, motivated to lose weight, but has not been able to reach her goals despite multiple attempts.  The fact of the matter is it is really hard to stay on a restricted calorie diet for a sustained period of time and typically takes longer than one thinks–or desires.  Everyone wants a quick fix, but sorry,  slow and steady is the path to success here.
This is where semaglutide comes in.  It cuts the appetite resulting in less food intake and weight loss.  Healthy weight loss is a slow process.  People can expect ½ to 2 pounds a week loss.  Staying relatively deprived for 3-6 months is very difficult to do.  I could see that even normal weight people truly needed help.
My first weight reduction program was called “Fast track to Better health”, incorporating large volume liposuction into a successful weight loss program.  That still holds true today, but now I can additionally offer a non-surgical, natural tool to suppress appetite and help anyone achieve their goal.
***Patient Testimonial:**I began this elective weight loss journey with Dr. Sharon Giese because the biggest day of my life approaching. My husband and I have planned a magnificent wedding in Palm Beach Florida with 75 of our closest friends and family and it is quickly approaching. Due to COVID our wedding was pushed back and during that time I slowly put on about 15 lbs. As months passed and wedding planning commenced again, it was time to try on my custom made, one of a kind, wedding gown. When I tried to zip it up the unimaginable happened, it no longer fit. It is every persons dream to look their best on their wedding night and now the pressure was on. What was I going to do? I have been a patient with Dr. Sharon Giese in the past and when she told me about her new elective weight loss program that she was beginning I was invested. It is only a singular injection, once a week, virtually painless, and was showing very promising results. The purpose of the medication is to keep you fuller longer, so basically, I just began eating and drinking significantly less, every day. It has been about two months now and I have lost 13 pounds! Almost all the COVID weight is off and now I can’t wait to put on my gown again. Thanks to Dr. Giese’s Elective Weight Loss program I am going to have the wedding I have always dreamed of.*
Dr. Sharon Giese and her staff are happy to schedule a consultation with you about Elective Weight Loss. For more information on plastic surgery, testosterone therapy in NYC and Dr. Sharon Giese, please **email us at ** or call us at **212.421.3400**.
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Phone: 212-421-3400
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*\*Disclaimer: The information contained on this website is intended to be purely educational in nature and does not create a physician-patient relationship with Sharon Giese, M.D, her practice, or any agent, servant or employee thereof. By no means should the information contained in this website be considered as a substitute for consultation with a qualified physician and it does not constitute a second opinion. This website and its contents do not represent or claim to provide the information needed for a patient to give his or her informed consent to any surgical procedure or are a reflection of individual patient results, as they may vary patient to patient. Individual results will vary and no guaranteed result is stated or implied by any photo use or any statement, testimonial, or video on this website. The results depicted in “before” and “after” pictures and stated by any “patient testimonial” illustrate results you may or may not achieve if you choose to have a cosmetic surgery procedure. Individual results may vary by patient. Please see our Notice of Privacy Practices.*