12 May 15-21, 2025 dallasobserver.com DALLAS OBSERVER Classified | MusiC | dish | Culture | unfair Park | Contents health and wellness platforms like Hims and Hers that market “100% online” GLP-1 pro- grams. “These medicines need oversight,” Voafit’s Ellis says. “They’re like a loaded gun, or if you point in the wrong direction, you could really get hurt.” On March 19, the U.S. Food and Drug Ad- ministration restricted the use of com- pounded tirzepatide. Unlike FDA-approved GLP-1s, compounded versions mix in addi- tional ingredients and purportedly sidestep patent protections for GLP-1 drugs. Accord- ing to a March 17 FDA release, the adminis- tration has received more than 775 adverse events related to compounded semaglutide and tirzepatide. Some may be linked to over- dosing. WW filed for Chapter 11 bankruptcy on May 6. BBC reports the weight-loss program had a net loss of $346 million, with subscrip- tion revenue down 9.3%. However, its clini- cal program revenue was up more than 57%. “These meds are not magic pills,” Carter- Williams says. “They can be life-changing for some, but you need to know that they’re right for your unique health profile.” The Skinny-Fat Era E llis, an emergency room physician, says his lifelong battle with “the ap- petite problem” fueled his creation of Voafit. At 14, Ellis vowed to overcome genera- tional obesity. As he grew older, he became obsessed with chiseling his body into a real- life version of Michelangelo’s David through dance, bodybuilding, extreme calorie defi- cits, bingeing and grueling workouts. In adulthood, Ellis found that marriage, home, medical school and life’s endless de- mands replaced the gym and meticulous food prep. He graduated from his residency 60 pounds heavier in 2016. In 2023, a colleague handed him the cure to his lifelong struggle: an Ozempic prescrip- tion. The drug was a paradigm shift in medi- cine — a new class of drugs simultaneously affecting obesity, diabetes and cardiovascular health that rapidly melted off Ellis’ weight. “If you turn it up to 11 and take too much, you literally will just stop eating and you’ll have an aversion to food,” he notes. “Of course, you’ll lose weight because you’re lit- erally starving yourself, but you’re not even feeling it. That’s what’s weird about these medicines, is they drive you to that.” Appetite suppression isn’t permanent, ei- ther. “Usually you’re not wanting to eat be- cause you’re too nauseous or your stomach is already upset or uneasy, and so it doesn’t do anything with the true hunger producing hormone, so the moment that you get off, I’ve heard from a lot of patients, their hun- ger and their cravings come back with a ven- geance,” Sadler says. Ellis was assured there’d be no side ef- fects. The drugs are “wonderful,” his pro- vider said. Unknowingly, he traded his muscle mass and energy for an idealized number on the scale, only to experience life- interrupting gastrointestinal issues he mis- took for a persistent stomach bug. Though his body mass index was normal, he was “skinny-fat,” low in muscle mass and high in body fat. “There’s no point in having an entire population of skinny, fat people who are emaciated and sick all the time,” he says. The emergence of GLP-1s as an obesity treatment is so new that long-term data isn’t available. Still, doctors are heavily recom- mending the drug’s use. More than 70 percent of U.S. adults are overweight or obese, UT Southwestern Medical Center internal medicine Dr. Jaime Almandoz said in a 2023 blog. “However, anti-obesity medications are prescribed to only about 4% of eligible people due to con- cerns about safety or effectiveness, lack of health care provider training in weight man- agement, excessive costs due to insurance companies refusing coverage, and a toxic stigma that portrays obesity as a lack of will- power. Advising a patient with obesity to simply ‘eat less and exercise more’ is like telling a patient with depression to ‘cheer up.’ It’s ineffective and often quite hurtful.” The blog stated that the UTSW Weight Wellness Program is “the only academic medical center in North Texas with a dedi- cated multidisciplinary weight management team of obesity medicine physicians, ad- vanced practice providers, dietitians and mental health professionals.” UT South- western declined to comment. The oversimplification of GLP-1s on so- cial media has transformed medicine into a fad, leaving users unprepared for the side ef- fects and enchanted by the allure of adver- tising. “This is the only country where pharma- ceutical companies actually have to adver- tise medicine,” Barceló says. “It doesn’t happen in Europe or in Canada, and so this creates a very uncomfortable situation for physicians because you have to fight the so- cial media and let people understand what the truth is about this.” Ellis estimates 99% of his GLP-1-pre- scribed emergency room patients arrive with gastrointestinal complaints such as ex- treme abdominal pain, diarrhea, nausea and constipation. “I’ve had two [patients] come in that are ready for surgery recently that have experi- enced GI bleeding,” Sadler says. “I’ve had a lot that just can’t handle the nausea and vomiting, the constipation, the bloating, the heartburn, reflux. Those kinds of symptoms are very typical.” Ellis’ attributes his issues to overdosing. Like many of his Voafit patients, he was pre- scribed the standard incremental dosage that begins at 0.25 milligrams and increases to 2.4 milligrams. “Nobody’s doing this right,” he says. “Ev- eryone’s overdosing. No one’s getting infor- mation on how this changes your physiology and slows your gastric emptying and how to avoid these side effects.” Going Nuclear D allas father and husband Greg Pinn was unpersuaded by GLP-1’s glam- our. Nine months ago, after de- cades of yo-yo dieting, he chose the “nuclear option,” gastric bypass. “Your body will fight you, tooth and nail to maintain what it has decided is your set weight, and for a lot of people, that set weight is unhealthy, and it’s insidious,” Pinn says. His comorbidities included diabetes, high blood pressure, high cholesterol and non-alcoholic fatty liver. His doctor warned against GLP-1s because of their effects on muscle loss. Terms like “Ozempic face” and “Ozempic butt” describe facial and body volume loss caused by rapid weight and muscle loss. Us- ers often show signs of hollowing and accel- erated aging. “Your face has its shape not because of fat. It’s because of muscle tissue, ideally, but if all you have is a skeleton and layer of skin over top of it, it’s not gonna look great,” Ellis says. The decision for Pinn was simple math. The gastric bypass cost $13,000, just two and a half years’ worth of medication costs and significantly less than lifelong GLP-1 usage. “The risk of weight loss surgery nation- wide, it’s about 3%. With our complication rate, it’s less than 1%,” Sadler says. “If people were more aware that surgery is really not that scary, and you could only have two inci- sions, then maybe they would be more apt for looking into it, since it’s more long-term and more cost-effective.” A 2024 study by the American Society for Metabolic and Bariatric Surgery found that bariatric surgery patients lost an average of 31.9% of their body weight after one year and maintained a 25% loss for up to a de- cade. In comparison, GLP-1 users lost 10.6% to 21.1%, but regained about half within a year. Total Wellness and Bariatrics special- izes in the patented Mini Sleeve, a mini- mally invasive gastric sleeve developed by the late Dr. Todd McCarty. The 30-minute outpatient surgery requires two to three in- cisions. Patients from as far as Dubai and the United Kingdom have traveled to Dallas for the approximately $10,500 surgery. (Gastric bypasses and sleeves are surgical methods that essentially reduce the size of the stomach.) Gastric sleeve recipient Courtney Paige says that, in hindsight, neither surgery nor GLP-1s are worth it. Kathy Tran Dr. Ian Justl Ellis founded Voafit, a medical concierge service overseeing GLP-1 use for hundreds of North Texans. Tipping the Scales from p10
