It’s important to avoid companies that offer medications without a prescription,” explains Amin. Not all companies are reputable, and it’s important to ensure that you won’t simply be given medication and not followed up with by a doctor, and if possible, a registered dietitian. I’m qualified to research and write about GLP-1 medications because I understand the type of care required for people taking these medications. Once you sign up for a membership, with or without the optional meal delivery service, you’ll get ongoing support from a weight loss physician, one-on-one dietitian coaching, and daily nutrition education in the app. When you join Form Health, it will ship a scale to your home so you can keep track of your weight loss. Patients lose an average of 5–10% of body weight on this extended-release combination medication. Some patients may lose an average of 5–10% of body weight. Adults with migraines and obesity are good candidates for this weight-loss medication. Average weight loss on phentermine is 5 to 10% of body weight. Phentermine is the oldest and most widely used weight loss medication. Genetic variations can influence how patients metabolize and respond to medications, with certain genetic variants predisposing individuals to obesity and affecting their response to weight loss therapies. At 18 months, 27 patients had extractable body weight data from the obesity clinic within 45 days of the 18‐month window and maintained their weight, with an average BMI of 29.0 ± 0.8 kg/m2. All patients in the study were part of a “medical weight loss bundle” (MWLB), an 18‐month program (12 months of treatment plus 6 months to transition care) designed by our institution . These findings therefore highlight the added value of combining pharmacologic treatments (i.e. GLP-1 agonist at standard diabetes dosages) with structured weight loss interventions (e.g. 500kcal deficit and increased physical activity and monthly follow-up contact), which patients in our cohort did not receive. For example, one cohort study used United Kingdom claims data to examine body weight changes among 589 patients with T2D initiating a GLP-1 agonist.22 In that sample, 33% achieved weight loss ≥5% at 12 months. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Most side effects of GLP-1 drugs are not serious. Gastrointestinal symptoms — nausea, vomiting, diarrhea, and constipation — are by far the most common side effects of GLP-1 drugs. The STEP-TEENS study is a noteworthy example of research on weight loss in obese teenagers. Maintenance of weight loss over time was examined in the STEP-4 trial, which demonstrated that semaglutide leads to continuous weight loss . The STEP-3 trial investigated the effects of semaglutide as a supplement to intensive behavioral therapy in overweight or obese individuals. Membership plans include up to four consultations with a board-certified medical provider specializing in weight loss in the first month and up to two consultations per month in the following months.GoodRx displays everything transparently – consultation fees, medication costs, and even estimated insurance coverage.Physicians and patients should be aware of the unique aspects of existing treatment options, the impacts of off-label prescribing, and the effects of these medications.This open-label, parallel-group study was conducted in 122 sites across 13 countries between 1 April and 15 November 2019, with 1947 participants assessed for eligibility and 1444 randomized to treatment .+ Follow Blog Description Weight loss section of our blog covers recipes, success stories, diet tips, and exercise.A total of 484 patients were randomized, with 323 patients receiving Lixisenatide and 161 receiving a placebo. FatBurner Journal Finally, we provide the first population-level estimates of side effects experienced by those who have taken GLP-1 agonists. Members of the panel are drawn using probability sampling methods, and the data are weighted to reflect the demographic diversity of the U.S. population. Given the recency of FDA approval and the rapid speed at which these drugs are penetrating the market, research on their use and their side effects at the population level is in its infancy. If appropriate, they’ll prescribe GLP-1 medications and send prescriptions to your preferred pharmacy. During your video consultation, discuss your weight loss goals with a board-certified physician. The consumer-focused approach might feel too casual for patients preferring traditional medical relationships. Limited to brand-name medications means potential supply issues and higher costs even with insurance. It can be easy to overlook first-generation OMs, but these may be appropriate for some patients, especially when cost is a factor.The new obesity treatments act on the various hormonal and metabolic drivers of obesity.Combined with the convenience of telehealth platforms, these treatments provide personalized care, expert guidance, and the flexibility of home delivery—all designed to help you succeed.Access to GLP-1s is only available to people with a BMI of 30 or higher, or 27 and higher with a weight-related health condition like high blood pressure, high cholesterol, or type 2 diabetes.Some medications are administered orally, and others are given as subcutaneous injections.If you’re a healthy person with no underlying health conditions, you’re probably OK to take a GLP-1 supplement.He recommends 1.2 to 1.5 grams of protein per kilogram of body weight per day, or about 30 to 35 grams of protein per meal.We like GoodRx because users can shop around to compare prices of medications at different nearby pharmacies. “In October (2024), we introduced compounded semaglutide into its offering, broadening eligible members’ access to clinical weight management interventions. WeightWatchers Clinic starts with a five-minute quiz to discuss your health history and to see if you’re a candidate to begin a weight loss journey with medication. Woman’s World spoke to a representative of the telehealth provider about how the company is combining over 60 years of weight loss experience with effective GLP-1 medication to create comprehensive weight health support. This service provides certain GLP-1 weight loss medications for those who qualify, in addition to the benefits of the standard WeightWatchers membership. Clinic Secret represents a telehealth platform structured around access facilitation, clinical review coordination, and prescription logistics rather than direct treatment delivery or outcome-based claims. Since structured weight loss programs are not typically covered by commercial or government health plans, findings that combine pharmacologic treatments with structured weight loss interventions may not reflect real world weight loss. However, there were only 3 patients and we censored all weight data following bariatric procedures for the 5 patients who underwent a bariatric procedure during the 72 weeks of follow-up. Additionally, we did not examine changes in body weight among the subset of patients with high medication adherence. For patients who underwent a bariatric procedure during the 72-week follow-up period, we censored all body weight and BMI measurements that occurred following the bariatric procedure. Baseline demographic and clinical variables were measured during the 52 weeks prior to the first GLP1-a dispense date and extracted from the electronic health record portion of the dataset. WeightWise Blog This progression can be slowed to help alleviate side effects, which include gastrointestinal symptoms, headache, dizziness, and fatigue. Wegovy is a brand name for semaglutide, a GLP-1 receptor agonist. It can be easy to overlook first-generation OMs, but these may be appropriate for some patients, especially when cost is a factor. The answer is complicated, newer is not always better, and not everyone needs the most potent medication choice. (Many more take them for other indications.) According to the Kaiser Family Foundation, public awareness has ramped up, with 32% of adults now saying they have heard “a lot” about these drugs. The figure on the right illustrates the model-predicted typical values of weight reduction for Liraglutide (A) and Semaglutide (B) at various age levels. The box plot on the left displays the observed weight reduction values for Liraglutide (A) and Semaglutide (B) across different age groups. The shaded gray area represents the range of treatment duration in the included studies, while the orange points indicate the effect values at 26 weeks and 52 weeks. Values exceeding 80 % suggest that the treatment duration has approached or reached its efficacy plateau. Points on the right indicate the typical values of the pure effect of 52-week weight reduction for each drug, with error bars denoting 95 % CIs of the estimates. PHD Weight Loss Blog Approximately half of participants were female (53%), 88% were White, 92% had type 2 diabetes and 86% had obesity. A linear mixed model was used to estimate percent weight change, with follow-up time as a discrete fixed effect (i.e., 8-week intervals from baseline to 72 weeks). Mixed models were also used to test for linear and quadratic trends in weight loss and proportion with at least 5% weight loss over time. We used descriptive statistics to summarize the percent weight change from baseline and percent of participants who lost at least 5% of baseline body weight in each 8-week time window. It feels more like having a concierge medical service than using a typical telehealth platform. Ro’s physicians analyze your complete health picture, creating personalized treatment protocols. If approved, medications ship directly from verified pharmacies. This flexibility, combined with their bold weight loss guarantee, sets them apart. Evaluable patients who switched from once-weekly sitagliptin to exenatide showed substantial improvements in HbA1c (−0.3 ± 0.1%), fasting blood glucose (−0.7 ± 0.2 mmol/L), and weight (−1.1 ± 0.3 kg). Of 295 patients in the intent-to-treat population, 122 (41%) completed seven years of treatment. Patients were initially randomized to receive exenatide 2 mg or exenatide twice daily for 30 weeks, followed by open-label treatment with exenatide 2 mg for up to seven years. Informatics identified a total of 105 patients who achieved BMI 2 after 12 months on treatment with AOMs during the MWLB.Others, like collagen, may support weight management more indirectly by promoting satiety and reducing appetite.Yes, the medications prescribed by Clinic Secret, such as semaglutide and tirzepatide, are FDA-approved and have undergone rigorous clinical testing.More common side effects often improve after taking the medicine for a while.+ Follow Blog Description Discover expert dietitian tips, evidence-based nutrition advice, and real-life health stories.Not only does Noom currently offer brand name GLP-1 drugs, it also offers a psychology-based weight-management program. You begin the program after analyzing your insurance coverage to find the right cost-effective weight loss medication. Coaching and effective weight loss medication sets members up for long term success Always consult a qualified healthcare professional before beginning any new supplement, especially if you have a medical condition or are taking prescription medication. The STEP-5 trial evaluated the effects of semaglutide in overweight or obese adults over a two-year period and found that semaglutide treatment led to significant and long-lasting weight loss . The STEP-1 trial demonstrated that Semaglutide 2.4 mg once weekly, when used as a supplement to lifestyle modifications, led to a clinically significant reduction in body weight in overweight or obese patients . A study published in May 2021 focused on maintaining healthy weight loss with exercise, liraglutide, or both. Patients who completed at least two visits in 12 months were considered “completers” of the program, and those who participated in only one were “noncompleters” for this study. This study was exempt as determined by the institution's institutional review board (November 2020; renewal November 2023). Primary outcomes included percentage changes in weight and BMI at intervals of 6 months up to 2 years. In addition to AOM coverage, the bundle includes all consultations and related services at our multidisciplinary academic tertiary care obesity center (Vanderbilt University Medical Center, Nashville, Tennessee), which accommodates over 10,000 new patient visits annually. Briefly, we created a direct‐to‐employer bundled payment program that incentivizes high‐quality care while minimizing unnecessary medical expenditures. Common adverse events of GLP-1RAs, reported in the literature include nausea, vomiting, diarrhea, and constipation, with a significantly higher incidence of nausea than that of placebo.This suggests that the combination of these therapies can be effective for long‐term weight management and sustained weight loss.Among those side effects is "Ozempic face," where skin on the face sags and wrinkles.Of the 415 patients who completed the 26-week course, 390 (194 EQW patients and 196 IG patients) enrolled in the extension trial.It is intended for use with a reduced-calorie diet and is also indicated to reduce the risk of weight regain.In current clinical trials, the maximum administered doses of these drugs are 0.6 mg, 200 mg, 10 mg, 12 mg, 45 mg, and 2.4 mg, corresponding to 70.8 %, 66.4 %, 65.8 %, 60.7 %, 75.2 %, and 77.3 % of their respective Emax values.While PD1 antagonist drugs currently reign as the top selling drug class, this status quo is poised for a shift. Dozens of new obesity drugs are coming: these are the ones to watch However, upon transition to primary care, for weight maintenance, phentermine was avoided due to its controlled substance designation. Of these 69 patients, 40 patients were transitioned to generic second‐generation AOMs after the MWLB ended (Table 3). As shown in Table 3, 69 of 105 patients received GLP‐1 RA therapy specifically during the MWLB for 12 months. These patients were placed on oral metformin, topiramate, bupropion, naltrexone monotherapy, or combination; phentermine was avoided in many cases due to its controlled substance designation upon transition to primary care. A total of 69 patients finished 12 months of GLP‐1 RA therapy and the 6‐month transition period. + Follow Blog Description Read informative articles on weight loss on the Scottsdale Weight Loss Center blog. True You Weight Loss is the nation's first and only physician-founded medical practice exclusively focused on providing non-surgical, state-of-the-art weight loss procedures and support.MORE Facebook 3.6KInstagram 9K Domain Authority Get Email Contact Read Now + Follow Blog Description Discover our blog, updated regularly with useful weight loss tips. In conclusion, this study demonstrated that exenatide QWS-AI reduced HbA1c more than sitagliptin or placebo and was well-tolerated 142,143,144. Exenatide QWS-AI and sitagliptin reduced fasting plasma glucose from baseline to 28 weeks (−21.3 and −11.3 mg/dL) compared to placebo (+9.6 mg/dL), without any significant differences between the two active treatments. This was an open-label, multicenter study involving 365 patients with T2DM who had suboptimal glycemic control on metformin monotherapy. Patients who continued on exenatide QWS-AI therapy for 52 weeks maintained their A1C levels and weight loss without any additional safety or tolerability issues . As with many medications, some weight loss drugs have been on the market longer, have generic alternatives, and tend to be more affordable. Studies have also evaluated drugs that target metabolic tissues—such as adipose tissue or muscle—to promote weight loss; however, to date, nothing has carried on into clinical practice.” Numerous studies have shown that stopping obesity medications after weight loss results in weight regain. All consultations are confidential, and your personal information is protected under medical privacy regulations. However, it’s essential to consult with a healthcare provider to ensure they suit you, especially if you have underlying health conditions. The prescribed medication will be shipped directly to your door for discreet use. After completing a health assessment on the Clinic Secret website, you will have a virtual consultation with a licensed physician. To help provide clarity around weight loss supplements, we asked three registered dietitians to share the ones they recommend to their clients. The data used to support the findings of this study are cited within the study and available from the corresponding author upon reasonable request. Future research should explore the differential impacts of GLP-1 agonists in different populations, in individuals with different lifestyle habits, and long-term efficacy data to develop precision medicine recommendations. There are many diagnostic tools and management options that may be used in conjunction with GLP-1 agonists, and the efficacy of different combinations of drugs and lifestyle changes should also be further explored. This rise in popularity can be attributed to successes demonstrated by clinical trials and the prevalence of discussions regarding this on social media. The following sections outline Clinic Secret's structure, treatment approach, and performance-focused design, without reference to consumer preferences or competitive positioning. Clinic Secret positions itself within this evolving landscape by offering a centralized digital pathway that connects eligible individuals with licensed providers, clinical assessment workflows, and prescription fulfillment coordination. Compounded medications are not approved or evaluated for safety, effectiveness, or quality by the FDA. The safety and efficacy of these medications should be discussed with a knowledgeable health professional before taking them, especially if you have underlying health conditions. Some OTC supplements promoted for weight loss have serious potential side effects. Currently, Medicare does not cover obesity medications. There is a wide range of obesity medications under investigation with different physiologic targets. The weight maintenance trial was estimated to start this month and be completed in early 2026. Results from a midstage study on that drug are expected this year, according to BMO’s research. Results from a later-stage study are expected in the first half of next year, according to Evan Seigerman, a research analyst with financial firm BMO Capital Markets. The most advanced of these pills include a form of semaglutide, the active ingredient in Ozempic and Wegovy, being developed by Novo Nordisk. But she and other doctors also warn about the potential for misuse, a problem that could become more pervasive with daily pills instead of weekly injections; they could make it easier to take more than recommended or to share medication inappropriately. In 2025, semaglutide became the first oral GLP-1 receptor agonist to be approved for obesity treatment. In addition, Wegovy injectable and pill have an indication to reduce cardiovascular risk in patients with known CVD and overweight/obesity. This surpasses the weight loss seen with semaglutide (Wegovy), which showed 14.9% average loss in the pivotal STEP 1 trialover a similar timeframe. The amount of weight a person loses depends on the medication they take, their overall health, and other individual factors. With more obesity medication options available along with indications for treatment of obesity-related diseases, doctors will be increasingly able to personalize treatments. The error margin for data extraction from the graphs was kept below 2 %; if it exceeded this threshold, the data were re-extracted. If the data in the publications were presented in graphical form, Engauge Digitizer (version 11.3) was used for data extraction. A literature search was conducted in the PubMed and Embase databases, covering the period from their inception to January 20, 2024. In obesity pharmacological research, glucagon-like peptide-1 (GLP-1) promotes insulin secretion, inhibits glucagon release, slows gastric emptying, reduces appetite, and decreases food intake 11,12. Key strategies for managing obesity include improving diet and increasing physical activity . Unlock the best weight loss tips and techniques with our top articles. + Follow Blog Description Weight Loss Teachers offer vital information & knowledge to accelerate your weight loss journey. + Follow Blog Description At Pure Gold Health & Wellness, we specialize in helping people overcome weight loss challenges with compassion and science. 5. GLP-1 Agonists and Lifestyle Intervention Patients successfully treated with GLP‐1 RAs can maintain their weight loss using generic older‐generation AOMs, suggesting potential cost savings for insurers and implications for policy regarding AOM coverage. At 18 months, they maintained the weight loss, with a mean BMI of 27.9 kg/m2. At 12 months, this cohort lost an average of 18.3%, 95% CI 13.0%, 23.6% body weight from baseline, with a mean BMI of 27.9 kg/m2. First, our findings may have limited generalizability since they were derived from patients who predominately identify as white and are receiving care at a single large regional healthcare system. Another limitation of this study is that it did not capture lifestyle modifications, including the patients' nutritional intake, exercise, sleep quality, emotional state, or stress level experienced in the weight maintenance phase, which could have also confounded the results. Incorporating genetic information into obesity management can significantly enhance treatment plans and improve long‐term outcomes for patients transitioning from GLP‐1 RA to AOM therapy. As a result, a patient who is now in the overweight category is more likely to respond to these older‐generation AOMs, as there is less inflammation and insulin resistance, even though (on average) these generic medications are weaker in efficacy compared to GLP‐1 RAs. This is particularly true for drugs with few reported efficacy data points, making it challenging to accurately estimate their ET50 values. However, owing to the limited sample sizes of clinical trials, the low incidence of these severe adverse reactions makes them difficult to detect in small-scale studies. Thus, dropout rates can reflect the safety and efficacy of medications to some extent. Therefore, the final approved dosages or titration schedules for these medications may be subject to changes, which requires a cautious interpretation of the current findings. Third, this study's comparison of the efficacy and safety of various GLP-1RA was not based on direct head-to-head trials, and some GLP-1RA drugs are still under development. Second, the data used in this study were derived from literature summaries rather than individual patient data, limiting our ability to access complete patient information and thus affecting the accuracy of our analysis of the factors influencing efficacy. When heterogeneity was obvious (I2 ≥ 50 %), a random-effects model was used to summarize the RRs; otherwise, a fixed-effect model was applied. The relative risk (RR) of the drug relative to the placebo along with its 95 % CIs were calculated. This process was repeated 10,000 times to estimate the median and 95 % confidence interval (CIs) of the drug effects at each time point for each subgroup. Finally, parameters from the distribution of pharmacodynamic parameters in each subgroup were randomly selected, and drug effects at different time points were calculated. Next, data synthesis was performed using a meta-analysis for single-arm trials, categorized by subgroup, to determine the overall mean and 95 % CIs for each subgroup. Consequently, the findings may not fully represent the diverse population affected by obesity. Specifically, obesity has been shown to involve high rates of plasma fatty acid mobilization and uptake, which play a central role in development of insulin resistance . Furthermore, it can alter the gut microbiome and can induce expression and secretion of growth‐differentiating factor 15, which reduces food intake, body mass, fasting insulin, and glucose intolerance 11, 12. Although some weight regain was observed by 24 months, the difference in weight reduction between 18 months and 24 months was not statistically significant. Approximately 76% of people lost more than 5% of their weight with liraglutide 3.0 mg than with placebo (30%) or orlistat (44%). Those who received liraglutide lost significantly more weight than those who received a placebo or orlistat. This has prompted studies evaluating the effect of liraglutide on body weight and tolerability in obese people without T2DM. In the LEAD-4 study, liraglutide was administered in combination with metformin and thiazolidinedione in 533 T2DM patients for 26 weeks. The LEAD-3 study investigated the safety and efficacy of liraglutide as monotherapy in 746 patients with early-stage T2DM. When it comes to GLP-1 options, here are the best weight loss meds providers of 2025. “If you qualify for the actual medications, that would be the best route.” And if you’re taking any medications, there’s always a risk that any supplement could interact with it. Eli Lilly, for example, recently announced that they would be selling vials of Zepbound and Mounjaro directly to consumers, which will half the cost of the medications. Metformin has been shown to helpful in weight loss by improving insulin resistance and promoting appetite suppression through increased secretion of GLP‐1 and peptide YY and increased hypothalamic leptin sensitivity 9, 10. The most common medications prescribed were metformin, topiramate, bupropion, and phentermine. The slight increase in weight and BMI at the 24‐month mark (though not found to be statistically significant) suggests a potential challenge in maintaining weight loss over the long term, indicating the need for ongoing support and possibly additional interventions for weight regain. For patients serious about sustainable fat loss, improved energy, and body recomposition, peptide therapy offers a safe, effective, and scientifically supported solution.Hers/Hims offers brand-name GLP-1s, as well as generic liraglutide, which is much more affordable and was approved by the FDA for weight loss in 2025.Readers should keep in mind that the data presented here are self-reported; therefore, they may not comport with other possible estimates based on diagnoses from health care professionals or on prescription data.There is a wide range of obesity medications under investigation with different physiologic targets.In the same trial, 49.1% of participants treated with subcutaneous semaglutide experienced gastrointestinal events, compared to 26.1% of those receiving placebo; a similar proportion of patients discontinued treatment due to adverse events in both groups (2.4% for semaglutide vs. 2.2% for placebo) .+ Follow Blog Description Weight loss blog by Sarah Graca that features tricks, tips, and helpful information to help you lose weight and keep it off long-term.Although the magnitude of weight loss reported in our observational study is not as impressive as what is described in the weight-loss specific GLP-1 agonist trials (e.g. 9.6% for semaglutide 2.4mg in STEP 2), our results are similar in magnitude to the results seen among participants of diabetes trials testing GLP-1 agonist at standard dosages for HbA1c reduction.Therefore, ExQW was found to result in superior glycemic control with less nausea than ExBID in patients with type 2 diabetes. + Follow Blog Description Health Total by Anjali Mukerjee provides natural & nutritional remedies for weight loss and lifestyle health issues acidity, Cholesterol, PCOD, and more. + Follow Blog Description A nutrition-forward meal‑prep brand's blog featuring evidence‑based content on weight‑management, gut health, workouts, and diet tips to complement its customizable healthy meal serviceMORE Twitter 8.5KInstagram 53.9K Get Email Contact Read Now + Follow Blog Description Blog covers healthy eating, healthy recipes, weight loss, diet tips and more.Coach Mindy is a weight loss coach, and loves helping people lose weight and maintain their weight loss. + Follow Blog Description Sean Anderson author of the blog shares his weight loss journey, on how he lost weight from 505 pounds to 230 pounds. + Follow Blog Description Blog covers articles on diet, body fat loss, tips for losing weight, best ways to get 6 pack abs, building muscles for your healthy and happy lifestyle.Hitch Fit is a customised Online Personal Training system. Following registration, users complete a comprehensive digital health intake. These materials are informational in nature and are not intended to replace medical advice, reinforcing the platform's compliance-oriented approach. This backend structure supports accountability and auditability, two critical components in telehealth service delivery. The intake framework is designed to reduce ambiguity by ensuring consistent data formatting and completeness prior to provider review. Through virtual consultations with licensed healthcare professionals, patients can access the medications they need to begin their weight loss journey. However, Clinic Secret has emerged as a potential game-changer in weight loss by offering a clinically proven, accessible solution that leverages the power of GLP-1 medications. These medications are regulated prescription treatments that require medical evaluation, monitoring, and adherence to established clinical guidelines. The platform does not produce medications directly; instead, it coordinates provider-led evaluations to determine whether GLP-1 treatments may be clinically appropriate based on individual health profiles. Thus, the addition of Lixisenatide to insulin glargine improved overall and post-prandial hyperglycemia and is worth considering as an alternative to prandial insulin for patients who do not achieve HbA1c goals with newly initiated basal insulin . It was found that the addition of Lixisenatide reduced HbA1c by 0.71% versus 0.40% with a placebo. Lixisenatide reduced HbA1c by an average of 0.7% over 24 weeks, significantly greater than the average reduction of 0.4% achieved in the placebo group . Second, claims data have inherent limitations such as incomplete or missing data, inaccurate data, and lack of specificity of some billing codes. These results are nearly identical to ours despite the fact that the study took place in the United Kingdom. Figure 2 (and Table S3) shows the observed and modeled percent weight change in each 8-week window through 72 weeks. Notably, there was a reduction in BMI from 36.5 to 27.2 over the study period, and weight loss of 20.6% was maintained over 24 months. Furthermore, this subgroup of patients who transitioned from GLP‐1 RA therapy to generic AOMs experienced significant weight loss (Table 5), with an average reduction from 219.5 lb to 163.5 lb over approximately 593 days. Since these older‐generation AOMs also target appetite, insulin resistance, cravings, and satiety, they are suitable and cost‐effective alternatives for the treatment of obesity and overweight at the appropriate doses. These generic medications can offset the weight regain expected with GLP‐1 RA discontinuation. This demonstrates that alternative and inexpensive medications can be used for weight maintenance if GLP‐1 RA therapy cannot be continued. Obesity is a chronic disease that has become a major concern in recent years, as it can have negative impacts on health, leading to increased morbidity and mortality. This all-in-one model makes it easy to balance medication, lifestyle changes, and support. MEDVi pairs GLP-1 meds with medical review and coaching in one subscription, so you won’t feel like you’re on your own. These and other gastrointestinal disturbances, such as vomiting, decreased appetite, indigestion, and constipation, are usually dose-related and generally occur within the first few weeks of treatment. The LEADER trial published in 2016 assessed the impact of liraglutide on cardiovascular outcomes in 9340 participants with advanced T2DM and high baseline cardiovascular risk. Liraglutide’s pharmacokinetic properties allow for 24 h glycemic management with a single dose, owing to metabolic stabilization and reduced renal filtration that slow down release from the injection site and eliminate the medication more slowly . After 30 years, the cardiovascular death rates for liraglutide 1.2 mg, 1.8 mg, and rosiglitazone were 69.7%, 68.4%, and 72.5%, respectively. Several studies have investigated the effectiveness of glimepiride in combination with either liraglutide or rosiglitazone for treating T2DM. She says social media is full of posts by people claiming to use obesity meds short term, as a kickstart to a diet saying, "'Oh, I'm just going to take these for a short time and then stop.'" "It would make sense that once we stop the therapy for those biological problems, that we would have relapse," says Dr. Eduardo Grunvald, director of the weight-management program at the University of California San Diego. Now, he can't find Zepbound anywhere, and says friends, family, and people he follows on social media are all in the same boat. This open-label, parallel-group study was conducted in 122 sites across 13 countries between 1 April and 15 November 2019, with 1947 participants assessed for eligibility and 1444 randomized to treatment . The second study, SURPASS-2, compared the efficacy and safety of once-weekly tirzepatide to semaglutide, a selective GLP-1 RA. The study evaluated the efficacy, safety, and tolerability of tirzepatide, a double-dependent insulinotropic polypeptide of glucose and the GLP-1 receptor agonist, as a monotherapy compared to placebo in people with T2DM who had inadequate control with diet and exercise . The first study, SURPASS-1, was conducted from 3 June 2019 to October 2020 across 52 medical research centers and hospitals in India, Japan, Mexico, and the USA. Serious adverse events were reported in 15 out of 133 participants (11%) in the semaglutide group and 6 out of 67 participants (9%) in the placebo group . Providers assess eligibility through medical history review and determine appropriate treatment parameters. The platform itself does not claim therapeutic outcomes or replace clinical judgment. This end-to-end process is designed to support medical oversight, regulatory compliance, and logistical efficiency within a digital healthcare environment. Clinic Secret follows a structured, multi-stage process designed to align with telehealth best practices and prescription compliance requirements. Overall, Clinic Secret's feature philosophy centers on facilitating structured medical workflows rather than promoting outcomes or lifestyle narratives, reflecting its positioning as a healthcare access platform. Our more-recent survey data allow us to examine whether GLP-1 use rates have changed since 2023. The survey was fielded in April and May 2025, approximately two years after the KFF study. In our brief report, we update this estimate using data from a survey fielded to a nationally representative sample of 8,793 adults from the RAND American Life Panel. Since 2020, the number of prescriptions made for these drugs has more than tripled (Jain, 2023). These drugs work by imitating glucagon-like peptide-1 (GLP-1), a growth hormone that triggers insulin release, reduces blood sugar levels, slows the progress of food along the intestinal track, and stimulates parts of the brain that control craving and satiety. Taking injectable Semaglutide (1.0 mg) as an example, the weight reduction effects at 52 weeks for subjects aged 45, 55, and 60 were 9.88 kg, 7.27 kg, and 6.24 kg, respectively, with the latter being 3.64 kg lower than the former (Fig. 6). Covariate analysis identified age as a significant factor affecting the weight reduction efficacy of GLP-1RA drugs. For example, with injectable Semaglutide, at doses of 0.05 mg, 1.0 mg, and 2.4 mg, the weight reduction effects at 52 weeks were1.21 kg, 7.6 kg, and 9.05 kg, respectively (Fig. 4). Additional access options: The FDA has approved glucagon-like peptide-1 (GLP-1) receptor agonists such as Liraglutide, Semaglutide, and the GLP-1/gastric inhibitory polypeptide (GIP) dual agonist Tirzepatide for the treatment of obesity. Clinicians should account for these surgical effects when evaluating treatment outcomes. Clinicians should discuss the benefits, risks, and cost‐effectiveness of transitioning from expensive GLP‐1 RA medications to oral generics. The findings suggest that, after significant weight reduction, the body's decreased inflammation and insulin resistance may enhance its responsiveness to therapies such as metformin, topiramate, phentermine/topiramate, or bupropion. Lean on the support offered by your telehealth platform’s providers, or involve family and friends in your journey. Platforms like Noom Med and Ro offer apps and dashboards to monitor your weight, eating habits, and overall progress. Medications are an effective tool, but combining them with healthy lifestyle changes is key. Next came a dual GLP-1/GIP receptor agonist, tirzepatide, marketed under the brand name Zepbound, which was approved for obesity in 2023. This section collects any data citations, data availability statements, or supplementary materials included in this article. Haoyang Guo and Juan Yang wrote the manuscript; Qingshan Zheng and Lujin Li designed the research; Haoyang Guo, Jihan Huang, Ling Xu and Yinghua Lv performed the research; Haoyang Guo, Yexuan Wang, Jiyuan Ren and Yulin Feng analyzed the data. Finally, as the study included only English-language publications, there may have been a publication bias. Particularly, the safety profiles of GLP-1RA drugs that are still under development require further investigation with larger samples. The study included patients with obesity and knee osteoarthritis with trial endpoints examining weight loss and reduction in knee pain. With fervent consumer demand for weight loss medications, combined with rising obesity rates, more medications are bound for the market in the coming years. With a growing selection of weight loss medications available, patients may ask what the strongest or most effective weight loss prescription medication is, and which one is best for them. This prompted Medicare to limit coverage of semaglutide 2.4 mg to patients with known heart disease or stroke history plus the presence of obesity, but it excluded those patients with obesity without these particular complications. With the advent of novel therapeutics, namely glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs), more patients are now able to achieve body mass index (BMI) of less than 30 kg/m2. As several studies have shown, lifestyle changes alone are not sufficient to sustain long‐term weight loss when severe obesity is present; often there is weight regain due to an increase in appetite and a decrease in energy expenditure and satiety. Subsequent follow‐up visits (average 1.5 months later) without GLP‐1 RAs showed further reduction, resulting in a total average weight loss of 25.5%, 95% CI 23.1%, 27.9% compared to the initial visit. Don’t wait to achieve the health and confidence you deserve. Their ability to reduce appetite, enhance insulin sensitivity, and promote long-term weight management has made them top choices for individuals seeking real, lasting results. He promotes wellness through lifestyle changes, emphasizing exercise, healthy eating, and supportive relationships in addition to traditional metric goals. Abdullah Bin Ahmed I. A Comprehensive Review on Weight Gain following Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists for Obesity. In the spring of 2025, both tirzepatide and semaglutide came off the drug shortage list ending the legitimate use of compounded agents in the absence of specific exceptions. Sarah is dedicated to simplifying complex health information so people can make informed decisions regarding their health. Her goal as a writer is to convey complex health information in an easy-to-understand and engaging way. Sarah is a registered dietitian and accomplished health and nutrition writer known for her expertise in crafting engaging content. Instant Loss was founded in April 2017 after I was encouraged by a group of 200,000 total strangers on the internet to start a blog.MORE Facebook 107KTwitter 953Instagram 224.5K Domain Authority Get Email Contact Read Now I help people just like you to lose weight, grow in faith, and be all God designed you to be.MORE Facebook 26.4KTwitter 1.3K Domain Authority Get Email Contact Read Now Through her platform, Megan shares low-calorie recipes and weight-loss tips tailored for women over 35, drawing from her transformative journey of shedding 80 pounds. + Follow Blog Description Covers Running Plans, Recipes, Half Marathon Training and Meal Plans for Runners.Run Eat Repeat is a Running, Weight loss, Lifestyle and Food blog by Monica. My goal is to help you create a life of balance between body, being, and mind. Liraglutide + Follow Blog Description A weight loss and wellness blog that offers diet reviews plus exclusive coupons and deals for popular diet and weight loss programs like WW. + Follow Blog Description Covers articles on recipes, weight loss motivation, news, healthy diet, stress management, weight loss tips and more. + Follow Blog Description The Zotrim blog is all you need, to learn about natural, effective weight loss. Medical Weight Loss Clinic is the largest established medically supervised weight loss program in the Midwest. + Follow Blog Description Explore our blog for tips and advice on weight loss, diet tips and more! Variations in weight measurement may arise because follow‐up weights were recorded at different provider offices using different scales. Furthermore, the 24‐month follow‐up data are incomplete, which affects the reliability of the results. Further research is needed to explicate the role of obesity pharmacogenomics during the weight maintenance phase. However, a study of the effects of liraglutide on gallbladder emptying in overweight or obese adults showed no effect on maximal postprandial gallbladder ejection fraction (GBEFmax), although time to GBEFmax appeared to be prolonged . After a median follow-up of 3.8 years, patients randomized to liraglutide experienced a substantial decline in the primary composite outcome compared to placebo, with a significant decrease in overall mortality and mortality from cardiovascular causes. However, patients who received liraglutide showed lower hypoglycemic events, bolus and total insulin doses, body weight, and increased heart rate . Exercise and liraglutide therapy together promoted healthy weight loss maintenance more than either therapy alone . Like the GLP-1 enzyme, GLP-1 receptor agonists can suppress appetite, delay gastric emptying, reduce plasma glucose levels, and enhance insulin secretion, thereby controlling glucose levels in the body .Get the latest in health news delivered to your inbox!Furthermore, cardiometabolic risk variables and participant-reported physical functioning improved significantly more in semaglutide-treated participants compared to placebo-treated participants .This is especially beneficial for individuals with conditions like prediabetes or type 2 diabetes, where managing blood sugar is crucial for overall health.Patients who have undergone bariatric surgery (e.g. gastric sleeve or Roux‐en‐Y gastric bypass) may experience metabolic changes affecting weight maintenance.Some common side effects include nausea, vomiting, and gastrointestinal discomfort. Robard Corporation Blog However, due to gastrointestinal issues, a higher number of study participants in the semaglutide group (59 4.5% vs. 5 0.8%) withdrew from the study. Multiple studies indicate that these drugs are able to promote the resolution of steatohepatitis in a significant proportion of patients with NASH and to reduce the progression of hepatic fibrosis 115,116. In contrast, therapy with these medications is linked to a higher incidence of cholelithiasis, which warrants more research . However, those meta-analyses did not include recently published cardiovascular outcome studies (CVOT) with GLP1- RAs, which give a large additional body of data. Furthermore, cardiometabolic risk variables and participant-reported physical functioning improved significantly more in semaglutide-treated participants compared to placebo-treated participants . For Kristian Cook, every pizza box he opened was another door closed on the path to overcoming obesity. + Follow Blog Description Explore the dynamic world of Fatgirlskinn, a vibrant food blog brimming with healthy recipes and Slimming World insights. If you're completely new to Slimming World, it's a sneak peek into a world of weight loss support and success. + Follow Blog Description The Slimming World blog is your space to discover, share and enjoy a taste of the nation's favorite way to lose weight. Mixed models were also used to test for linear and quadratic trends in weight loss and proportion with at least 5% weight loss over time.Drugs like Ozempic work by mimicking a hormone in the body also called GLP-1 (short for glucagon-like peptide 1), which the body naturally produces to regulate blood sugar, hunger, and metabolism.All consultations are confidential, and your personal information is protected under medical privacy regulations.Key strategies for managing obesity include improving diet and increasing physical activity .Semaglutide works by mimicking a protein in your body called glucagon-like peptide 1, a.k.a. GLP-1, says Kunal Shah, MD, an assistant professor in the division of endocrinology at the Rutgers Robert Wood Johnson Medical Center.In the semaglutide treatment groups, the mean decrease in body weight from baseline to week 68 was significantly higher compared to the placebo group.Metabolic Research Center's personalized approach to weight loss offers what YOU need to be successful, feel confident, and achieve your goals quickly and safely.MORE Facebook 34.8KTwitter 71Instagram 6.1K Domain Authority Get Email Contact Read NowFurthermore, 50% and 57% of participants in the 10 mg and 15 mg groups, respectively, had a reduction in body weight of 20% or more, compared to only 3% in the placebo group . While many weight loss supplements are safe to use, some — particularly those that contain caffeine — can have risky side effects involving blood pressure, heart rate, and heart function. Supplements alone are not a comprehensive approach to healthy weight loss, but they may help enhance weight loss due to other lifestyle changes, such as improved eating and exercise habits. Others have called to question the utilization of these drugs off-label for individuals that are not in the categories of a BMI above 30 or above a BMI of 27 with another weight-related condition threatening their health. GLP-1 agonists, used to treat type 2 diabetes, have been shown to be effective in promoting weight loss in preclinical and clinical studies. + Follow Blog Description A medically reviewed hub packed with science-backed articles, tools, and support spanning nutrition, fitness, mental health, medications (like GLP‑1), and digital apps to guide sustainable weight loss and healthy livingMORE Facebook 826.2KTwitter 67.8KInstagram 1.5M Domain Authority Get Email Contact Read Now These medications are commonly used in patients with type 2 diabetes to control blood sugar, but research has shown that they also have significant benefits for weight loss. The European Region has the second-highest prevalence of adult obesity among all WHO regions, after the Americas Region.Otherwise, the best way to ensure that the weight loss supplements you choose are as safe as possible is to look for third-party testing or certifications.In clinical trials, common adverse reactions to GLP-1 class drugs include gastrointestinal symptoms such as nausea, vomiting, diarrhea, and constipation 30,31.This surpasses the weight loss seen with semaglutide (Wegovy), which showed 14.9% average loss in the pivotal STEP 1 trialover a similar timeframe.Personalized care plans incorporate nutrition, physical activity, mindset work, and GLP-1 medication (cost not covered by the membership fee).The entire process, from consultation to medication delivery, is handled discreetly and confidentially.Extremely low-calorie diets and overexercising may help you lose weight rapidly, but these weight loss strategies aren’t safe or sustainable.Mazdutide has been approved for use in China where it showed a 14.8% weight loss, decrease in waist circumference and reduction in liver fat in that population.And all the chatter about the use of them on social media and in popular culture can confuse patients, says Dr. Rekha Kumar, an endocrinologist and former medical director of the American Board of Obesity Medicine. The 503B outsourcing facilities produce compounded drugs in bulk and are registered with the FDA. For about two years, traditional 503A compounding pharmacies and 503B outsourcing facilities were permitted by the FDA to make compounded semaglutide and tirzepatide under the exceptions for drug shortages. In April 2025, they banned the sale of “counterfeit” semaglutide and tirzepatide. Some online healthcare providers claim to sell Ozempic, Wegovy, or Zepbound at reduced prices. These programs apply only to self-pay patientsand are not covered by insurance. In the LEAD-2 trial, the effectiveness of adding metformin to T2DM patients who had previously received oral antidiabetic medication was assessed by adding a placebo or glimepiride. The LEAD series, which commenced in 2006 and involved 1041 adults from 21 countries, investigated the efficacy and safety of liraglutide, a human GLP-1 analog, in the treatment of type 2 diabetes mellitus (T2DM). Recently, a daily oral semaglutide formulation that showed clinical efficacy comparable to the once-weekly subcutaneous preparation was approved 61,62. GLP-1 RAs are currently used in treating patients with T2D and consistently result in weight loss, in addition to lowering blood glucose levels. Welcome to healthaccess.com, your partner in fitness, nutrition, and sexual wellness. Without insurance options, long-term costs might exceed other providers for some patients. Their proprietary compounds often include B-vitamins and other supplements to minimize side effects. PlushCare offers traditional medical care through modern technology – no apps, programs, or coaching required. Obesity was defined as an ICD-9-CM or ICD-10-CM diagnostic code of obesity or a calculated BMI ≥30 kg/m2. When there was more than one weight measurement in a given 8-week interval, we randomly selected a weight measurement for that window. Peptide therapy isn’t just for bodybuilders or elite athletes. Also suitable for older individuals seeking improved body composition. FDA-approved obesity medications (OMs) are safe, evidence-based therapies that target specific physiology to improve the disease and are most effective when used as part of a comprehensive treatment plan. In a 46-week obesity treatment trial, mean weight loss was 14.9% at the highest dose. Obesity medications targeting glucagon and GLP-1 represent another dual agonist target that benefit both weight and cardiometabolic health. More detailed information about each of the above weight loss medications can be found in the latest edition of Obesity Medicine Association’s Obesity Algorithm®. Some patients may lose 5–10% of body weight, especially with the higher dose of liraglutide. Trials of all doses of liraglutide concluded that the 3.0 mg dose had the most significant weight loss results . Nine randomized controlled trials were included, and from all doses of liraglutide for weight management in obese and non-diabetic subjects, the largest proportion of participants achieved approximately 5–10% weight loss. Nausea and vomiting occurred more frequently in patients treated with liraglutide than in those treated with placebo. “If you want to lose weight, start by speaking to a primary care physician,” Dr. Ali says.In this demographic, obesity is defined as a BMI at or above the 95th percentile, while overweight is defined as a BMI in the 85th to 94th percentile.This complex chronic condition results from a variety of influences, including genetic variants, endocrine abnormalities, poor dietary choices, sedentary behavior, increased stress, inadequate sleep, medications, and disruptions in circadian rhythms.The safety and efficacy of these medications should be discussed with a knowledgeable health professional before taking them, especially if you have underlying health conditions.Once you’ve received your prescription, you can reach out to your health coach at any time via the mobile app.She also advises that users get recommendations about stress management, healthy sleep, fluid intake, and food intake. Combining the two drugs provides a synergistic improvement in efficacy. Side effects include headache, overstimulation, high blood pressure, insomnia, rapid or irregular heart rate, and tremor. It is contraindicated in patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. Liraglutide is also approved for type 2 diabetes, under the brand name Victoza. This information is reviewed by a licensed provider, who determines whether treatment may be prescribed or whether further evaluation is required. The platform's structure emphasizes standardized screening, data-driven assessment, and documentation consistency. All medical decisions are made by licensed practitioners operating within their scope of practice and in accordance with applicable regulations. At its core, Clinic Secret functions as a healthcare services intermediary rather than a pharmaceutical manufacturer. However, some potential additional effects beyond weight loss could hypothetically contribute to some clinical outcomes, but evidence from human studies is lacking. Current clinical data has demonstrated that tirzepatide is superior to placebo in improving hemoglobin A1C levels in T2DM patients. In the STEP-5 clinical program, after a two-year follow-up, gastrointestinal adverse events were more frequently reported with semaglutide than with placebo (82.2% vs. 53.9%) . Moreover, particular attention should be paid to the way in which prescribing doctors apply the recommendations of international guidelines in order to avoid as much as possible clinical inertia, to improve cardio–reno metabolic efficiency and safety in obese patients with or without diabetes. The main outcomes and side effects observed in clinical trials of GLP1-RA against obesity are summarized in Table 5. The final study in the presented series was the DURATION-NEO-2 study, which demonstrated the efficacy and safety of a once-weekly self-injected exenatide suspension compared to sitagliptin or metformin placebo in patients with type 2 diabetes mellitus (T2DM). The DURATION-5 trial investigated the effects of once-weekly (ExQW) versus twice-daily (ExBID) glucagon-like peptide-1 receptor agonism for the treatment of patients with type 2 diabetes. Overweight and obesity cause more than 1.3 million deaths globally each year, with even these figures possibly underestimated. Although the prevalence decreases temporarily in those aged 10–19 years, there have been consistent increases in the prevalence of overweight and obesity in the WHO European Region, and no Member State is on track to reach the target of halting the rise in obesity by 2025. In this demographic, obesity is defined as a BMI at or above the 95th percentile, while overweight is defined as a BMI in the 85th to 94th percentile. The World Health Organization (WHO) defines BMI as a simple weight-for-height index used to classify underweight, normal weight, overweight, and obesity in adults. These revolutionary treatments, known for their effectiveness in aiding weight loss and improving overall health, have redefined how we approach obesity and metabolic health. Find an obesity medicine specialist near you who can assist in finding the best weight loss medications for you. Insurance coverage varies and will affect many patients’ choices about going on weight loss medications. In 2021, attention to obesity medications exploded in popularity and media attention with the approval of semaglutide for obesity treatment under the brand name Wegovy. These data can assist clinicians in selecting appropriate medications based on specific adverse reaction profiles of patients. Additionally, age should be considered as a crucial factor for randomization and balance in the design of clinical trials for weight reduction medications. This study compared the efficacy and safety profiles of different GLP-1 receptor agonists (GLP-1RAs) for weight reduction and explored the related influencing factors, providing quantitative information for the development of GLP-1RAs and their clinical use. Given the current challenges of medication scarcity and insurance barriers, transitioning patients to economical AOMs emerges as a prudent alternative for long‐term weight management in addition to maintaining a healthy lifestyle. The platform outlines what it does and does not provide, clarifying that medical determinations, prescribing authority, and ongoing treatment decisions rest exclusively with licensed professionals. This includes structured intake questionnaires, health disclosures, and documentation tools that allow providers to evaluate eligibility for GLP-1 therapies without reliance on informal or fragmented data sources. Its operational model reflects established telemedicine principles that emphasize licensed medical oversight, standardized data collection, and regulatory alignment across all stages of care coordination. Clinic Secret is positioned within the digital healthcare landscape as a structured telehealth facilitation platform rather than a consumer wellness product or direct treatment provider. This ensures compliance with telehealth regulations and data security standards. These medications are not made or packaged by the original manufacturers. However, the FDA warns against buying medications from any source other than a state-licensed pharmacy. The guidelines for pharmacotherapy for obesity treatment recommendations are based on BMI. Bupropion (Wellbutrin), an aminoketone, is considered weight-negative and is prescribed both to assist in weight loss and to treat depression. Desipramine, nortriptyline, and protriptyline have variable effects on weight. + Follow Blog Description Covers articles on Diet plans, tips, recipes and workouts.Through his blog, Anubhav Kumar, an entrepreneur and IT graduate, shares his weight loss journey's experience, tips and motivation. + Follow Blog Description Discover insightful Almased weight loss blogs that enhance your nutritional knowledge. + Follow Blog Description Read different blogs about weight loss and weight loss food. + Follow Blog Description Blog covers articles on fitness, exercises, diet, nutrition, motivation, inspiration and more.Granite Fitness Blog is committed to helping you lose weight and get in shape naturally with healthy diet plans and effective workouts for full body fitness.MORE Facebook 439Twitter 1.2K Domain Authority 9 Get Email Contact Read Now At least a dozen similar experimental weight-loss drugs designed to be taken as pills are working their way through clinical trials, with the most advanced now in the third and final stage of testing. With our expertise in GLP-1 medications like Ozempicand Mounjaro, along with our comprehensive weight loss strategies, you’re in trusted hands. Our program blends these medications with expert guidance, nutritional support, and continuous monitoring to help you achieve and maintain your weight loss goals. With the high demand for these high potency obesity medications, there has been an explosion of illicit sources of compounded semaglutide and tirzepatide. The 503A pharmacies are state-licensed facilities that follow USP guidelines to prepare customized medications for specific patients. And all the chatter about the use of them on social media and in popular culture can confuse patients, says Dr. Rekha Kumar, an endocrinologist and former medical director of the American Board of Obesity Medicine. He notes only the exceptional one or two of his patients have stopped the injections and not seen appetite and weight return. The new obesity treatments act on the various hormonal and metabolic drivers of obesity. New analysis showed 17% of people able to maintain 80% of their weight loss after stopping. Researchers continue to study hormones that play a role in appetite and for other ways to target obesity and obesity-related diseases with medication. Setmelanotide is a melanocortin-4 receptor agonist indicated for chronic weight management in adult and pediatric patients six years and older, with obesity due to certain rare genetic disorders. Some patients may lose about 5% of their body weight. Another significant observation was that liraglutide reduced blood pressure at all doses and reduced the prevalence of prediabetes (84–96% reduction) at 1.8–3.0 mg per day. The prevalence of obesity has dramatically increased in recent years, and few safe and effective drugs are currently available to treat it. Liraglutide was found to significantly reduce glycosylated hemoglobin compared to glargine and placebo and provided better glycemic control and weight outcomes . The study revealed that liraglutide, metformin, and thiazolidinedione constituted a well-tolerated combination therapy for T2DM that significantly improved glycemic control .