Before injectable medications are prescribed, Kaiser Permanente requires patients to complete two separate 3-month courses of oral medications.

Oral Medications include:

• Phentermine: Boosts energy and suppresses appetite. Not for those over 65 or with heart disease. May raise blood pressure.
• Topiramate: Reduces appetite and improves sleep. Common side effects: drowsiness, tingling, metallic taste. Avoid if you have glaucoma or kidney stones.
• Naltrexone/Wellbutrin: Targets cravings and mood. Not for those using narcotics or with seizure history.
• Metformin: Curbs sugar cravings and regulates blood sugar. May cause gas, diarrhea, or stomach discomfort.
• Orlistat (Available on Amazon, ~$60/month): Blocks fat absorption. Side effects: oily stools, gas-related leakage.
• Vyvanse: Approved for binge eating disorder. Not for those over 65 or with heart disease.

For a deeper dive into oral medications, watch the video above.

These reduce appetite, slow digestion, support blood sugar regulation, and reduce food noise/cravings. They may also reduce risk of heart attack and stroke.

Common Side Effects:

· GI discomfort – Nausea, vomiting, constipation, diarrhea

· Skin reactions at injection site

Rare Side Effects Needing Immediate Attention:

· Vision changes (seek emergency care for sudden vision loss)

· Permanent gastroparesis (chronic constipation or obstruction)

· Increased risk of thyroid cancer (check neck for nodules)

Not recommended for individuals with personal or family history of:

· Medullary Thyroid Cancer

· Multiple Endocrine Neoplasia (MEN)

Injectable medication outcomes:

1. Semaglutide (Ozempic/Wegovy: This is a GLP-1 medication. In general, people can expect about 10–15% weight loss over a 1 year period.

2. Tirzepatide (Zepbound/Mounjaro) This is a GLP-1/GIP medication. In general, people can expect about 15–25% weight loss over a 1-4 year period.

Your physician will help you decide if these types of medications are a good fit for you.

Discontinuation of the medication often leads to weight regain. Up to 40% of weight loss may come from muscle if you are not strength training. Prioritize strength training and protein intake.

Medication prescriptions are part of a comprehensive decision-making process with your physician. Although you may be prescribed a medication, coverage for medications depends on your individual benefits coverage. Everyone who is eligible may not be covered, you may have out of pocket costs for medication.

For information regarding coverage, contact Member Services at 1-800-464-4000 or visit kp.org/supportcenter.

In general, Kaiser Permanente covers weight loss injectables ONLY if you have a BMI > 40 OR  BMI > 30 with one of the following: 

• A history of a heart attack or stroke 
• Moderate to severe sleep apnea (AHI> 15) 
• Type 2 Diabetes 
• Severe peripheral vascular disease 

Your employer may have additional coverage, please refer to your benefits package for your coverage.

Please note that injectable weight loss medications are not covered by Medicare for obesity alone. To qualify, you must also have one or more of the following: 

• A history of a heart attack or stroke 
• Moderate to severe sleep apnea (AHI> 15) 
• Type 2 Diabetes 
• Severe peripheral vascular disease 
• Liver fibrosis (level 2 or 3)

 Other eligibility considerations: 

• Pregnancy & Breastfeeding: You must not be pregnant, breastfeeding, or planning pregnancy within the next 3 months. Weight loss medications can cause irreversible harm to a fetus.  
• You may need an EKG, urine drug screen (UDS), and pregnancy test (if applicable) within 3 months. 

Refill requirements include:

• Ongoing monitoring and labs
• Weight and blood pressure checks
• Class completion 

As part of our monitoring process, you will need to have labs drawn every 3–6 months so we can make sure the medication is working well and not causing any problems. Depending on your needs, you might have some or all of the following: liver and kidney function tests, electrocardiogram, urine drug screening, a pregnancy test, sodium and potassium levels, and vitamin B12.  

To continue receiving your medications, you must complete a weight and blood pressure check every month at an approved clinic. To make sure the medication is working safely and effectively, we anticipate at least 5% weight loss within the first 3 months, whether it’s an injectable or oral treatment. If that goal isn’t met, we’ll stop the medication and explore other options that may work better for you. Our Healthy Balance program and other classes are designed to support you in achieving the best possible outcomes. 

Before and during medication use:

• Stay upright for at least 2 hours after eating—no lying down right away
• Eat slowly: chew each bite well or sip water between bites
• Avoid skipping meals or going long hours without eating
• Drink at least 64 oz of water daily before adding more protein or fiber
• Start a fiber supplement 1 week before your medication (aim for 10g/day using options like Benefiber, Metamucil, keto bread, flax or chia seeds)
• If you feel constipated, try 2 tablespoons of magnesium citrate daily while increasing fiber
• Focus on a high-protein diet and include resistance exercises like weight training

If you’re using injectable weight loss medications:

• Let your provider know if you notice any changes in your vision
• Check your neck regularly for any lumps or nodules
• Wear sunscreen every day to protect your skin
• Use reliable birth control—oral pills may not work as well during treatment

Your provider may recommend taking additional vitamins and minerals while using weight loss medications. These may include:

• Multivitamin: Any brand is fine—just a good way to cover your bases.
• Vitamin D (2000 units daily): Many people have low levels, which can slow down weight loss. Taking this daily can help.
• Vitamin B Complex: Hair thinning during weight loss is common. This vitamin can help reduce that effect.

1. Stay well hydrated. Stay well hydrated. Aim for at least 64 ounces daily. This can include herbal teas, sparkling waters (if you have had bariatric surgery, avoid carbonation), plain water, and sugar-free drinks.
2. Follow the Healthy Plate Method:  You’ll learn this method in Healthy Balance. Include meals three times a day with two snacks using the food combinations demonstrated on the plate. Each day, aim for 25-35 grams of fiber and 80-100 grams of protein from mostly whole, unprocessed foods.
3. Move Daily: Start with 10 minutes of exercise per day, building up to 150 minutes per week.
4. Sleep Well: Prioritize restful, consistent sleep to support recovery and hormone balance.
5. Stress Reset: Practice 10 minutes of daily meditation to reduce stress and improve focus.

Why Fiber Matters

· Prevents Constipation

· Feeds beneficial gut bacteria

· Reduces inflammation

· Cleanses the colon

· Helps you feel full with fewer calories

Tips For Adding More Fiber

· Start your day strong: Choose steel-cut oats, whole grain bread, or cereal with at least 5g fiber per serving

· Lean on legumes: Add beans, lentils, and peas to soups and salads

· Switch to whole grains: Try brown rice, barley, bulgur, or whole-wheat pasta

· Eat the rainbow: Fruits and veggies are fiber-rich and nutrient-packed

If food sources are not enough, consider adding supplements:

· Benefiber

· Metamucil

· Psyllium husk

· Flax or chia seeds (soaked overnight)

Start slow:

1. Increase fiber gradually to avoid bloating or cramping

2. Drink extra fluids as fiber absorbs water. Without enough fluids, you can become bloated and constipated.

3. Prioritize fiber from whole foods—overuse of powders/pills may block nutrient absorption

4. If you are already constipated, adding in more fiber may make it worse.

Plant-Based Protein Sources

Whole food plants can be excellent sources of high-quality protein. Try to include 1 cup or enough to reach ~20g per meal.

Tofu ½ cup; 10g

Tempeh (organic) ½ cup; 15g

Edamame ½ cup; 9g

Chia Seeds 2 Tablespoons; 5 g

Garbanzo beans ½ cup; 10g

Lentils (cooked) ½ cup; 12g

Lentils (raw) ½ cup; 20g

Beans (various) ½ cup; 8g

Green peas ½ cup; 4g

Hemp seeds ½ cup; 25g

Seitan ½ cup; 21g

Quinoa ½ cup; 4g

Animal-Based Protein Sources

The Birds and the Fishes without shells

Chicken (lean) 4 oz; 26g

Ground turkey (lean) 4 oz; 26g

Tuna 4 oz; 23g

Salmon 4 oz; 21g

Egg 1; 6g

Dairy-Based Protein

Limit cheese to once per day.

A tasty and healthy alternative to cheese is nutritional yeast—it has a cheesy flavor and adds a boost of nutrients without the extra fat or dairy. Try sprinkling it on veggies, popcorn, or pasta for a flavorful twist!

Babybel Cheese 1 piece; 6g

Ricotta (light) ¼ cup; 7g

Cottage Cheese (low-fat) ½ cup; 13g

Goat Cheese ¼ cup; 5g

Feta Cheese ¼ cup; 5g

String Mozzarella 1 piece; 7g

Cheddar (low-fat) 1 oz; 7g

Gouda 1 oz; 8g

Yogurt & Milk

Yoplait 100 1 container; 14–15g

Oikos Triple Zero (Greek) 1 container; 15g

Fage (Greek) 1 container; 18g

Dannon Light & Fit 1 container; 12–14g

Cow’s Milk (1% or skim) 1 cup; 8g

Soy Milk 1 cup; 8g

Fairlife Milk 1 cup; 13g

Lactaid 1 cup; 8g

High-Protein Almond Milk 1 cup; 5–10g

Protein Powders

Look for options with <200 kcal, >20g protein, <5g sugar.

Bariatric Fusion 2 scoops; 27g

Premier 1 scoop; 30g

Pure Protein 1 scoop; 23g

Iso 100 Dymatize 1 scoop; 25g

Orgain (plant-based) 2 scoops; 21g

Unjury (unflavored) 1 scoop; 21g

Seeq / Isopure (clear whey) 1 scoop; 21g

Outlier (plant-based clear) 1 scoop; 21g

Naked Pea 1 scoop; 20g

Pre-Mixed Protein Shakes

Same criteria: <200 kcal, >20g protein, <5g sugar

Premier Protein 1 bottle; 30g

Muscle Milk 1 bottle; 25–40g

Wheybolic 1 bottle; 40g

Pure Protein 1 bottle; 35g

Orgain (plant-based) 1 bottle; 20g

Fairlife 1 bottle; 30g

OWYN (plant-based) 1 bottle; 32g

Protein Bars

Look for <200 kcal, >13g protein, <8g sugar

Bariatric Fusion 1 bar; 17g

Quest 1 bar; 20–21g

Pure Protein 1 bar; 20–21g

Barbells 1 bar; 20g

Great Side Dishes to Pair with Protein

Leafy Greens (2–3 cups per meal)

• Baby spinach, kale, arugula, Swiss chard, cabbage, lettuce, spring mix, Brussels sprouts, parsley, cilantro
• Other great options: cauliflower, zucchini, carrots, beets, pumpkin

Non-Starchy Veggies (unlimited)

• Artichoke hearts, asparagus, bell peppers, broccoli, carrots, cauliflower, cucumber, mushrooms, onions, snap peas, squash

Smart Carbs (½ cup per meal)

• Quinoa, brown/wild rice, farro, barley, potatoes, yams, winter squash, corn, peas
• Fruit options: mango, apples, berries, citrus, pomegranate seeds

Fiber-Rich Foods Chart

Fruits

Apple (w/ skin) 1 medium; 3.7g

Raspberries 1 cup; 8.4g

Pear 1 medium; 4.0g

Prunes (dried) 10 pieces; 6.0g

Blueberries 1 cup; 4.0g

Orange 1 medium; 3.0g

Strawberry 1 cup; 3.4g

Others (grapefruit, cherries, grapes, etc.); 1–2.5g

Vegetables

Baked beans 1 cup; 14.0g

Pinto beans 1 cup; 14.7g

Lima beans 1 cup; 13.2g

Artichoke 1 medium; 6.2g

Pumpkin (canned) ½ cup; 5.0g

Potato (baked w/ skin) 1 medium; 5.0g

Spinach (boiled) ½ cup; 2.2g

Broccoli ½ cup; 2.3g

Peas ½ cup; 4.0g

Grains & Seeds

Chia/Flax Seeds 3 tbsp; 10g

Quinoa 1 cup; 5g

Brown Rice 1 cup; 3.5g

Whole Wheat Bread 1 slice; 2.0g

Keto Bread 1 slice; 10g

· Aim for 7 -9 hours of sleep per night.

Improve sleep quality with these habits:

· Avoid screens, liquids, and exercise 2 hours before bed

· Use your bed only for sleep—not work or entertainment

· Wind down with calming activities

· Consider melatonin (available over-the-counter)

· Join our sleep class: Sleep Well, Live Well – Positive Choice

Strength Training

We recommend starting a strength training routine.

If you are new to strength training, start with finding a class, either in person or online. Go to that class 2-3x per week, with 1 day rest in between.

Online class suggestions:

Building Strength  Playlist

Positive Choice Fitness Videos

Get started with Strength Training

Center for Healthy Living Videos

Strength Training Tips:

• Start light with weights.
• Increase weight as the exercises become easier.
• Fatigue is the goal. Use enough weight/resistance where your last repetition feels challenging.
• If you want a specific strength training program to meet your goals or work with injuries or pain, call us to set up a one-on-one appointment with one of our fitness professionals. (858) 616-5514

Activity Goals

Aim for 150 minutes of activity per week. Start with 10 minutes/day of exercise that works for you. Choose exercises that make conversation difficult—this means you’re working hard enough! When that activity starts to feel easy, increase the time or the intensity. Kaiser members get gym discounts: Explore fitness offerings

Understanding your stress triggers and how you respond is key to emotional wellness.

Mindfulness Practices

· Try 10 minutes of meditation in the morning and evening

· Use imagery: visualize thoughts floating away in a stream or balloon

· Apps like CALM or Headspace

· If emotional eating is a concern, consider joining Making Peace with Food

· Try BioFeedback. You can get a referral from your Primary Care Provider.

Free Mental Health Apps for Kaiser Members

· Calm – #1 app for sleep and meditation

· Headspace (formerly Ginger) – 24/7 emotional support with trained coaches

· Rootd – Personalized tools for anxiety and stress

· Explore digital mental health tools 

If you and your physician decided that weight loss medications aren’t the right fit for you, consider one of our other programs. Those who qualify can consider our bariatric surgery program, starting with an information session. We also offer a medically-supervised meal replacement program. You can view all of our one on one and group services by browsing our menu at the top of this page.