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- Nurse practitioner Tim Nicaise reached a weight of 300 pounds before exploring anti-obesity medication options.
- After years of unsuccessful weight loss attempts, his doctor recommended the drug Contrave.
- One year after discontinuing the medication, he successfully maintained an 85-pound weight loss.
Tim Nicaise was once a competitive gymnast, which allowed him to maintain a healthy weight around 140 pounds for a significant part of his life.
However, as he entered his late 20s and began to socialize more, his weight crept up. By his early 30s, fatherhood and various life stressors contributed to an unhealthy relationship with food. The demands of his job as a nurse practitioner, particularly during the pandemic, exacerbated the situation.
“When the pandemic struck, my role shifted into crisis mode. I was witnessing patients die who shouldn’t have, individuals who were just fine weeks earlier,” Nicaise shared with Healthline.
“At that time, my mental health deteriorated, and I turned to food for comfort. It felt like I had to do whatever it took to get through each day.”
By 2023, Nicaise found himself at 300 pounds, facing prediabetes, sleep apnea, and reliant on three blood pressure medications.
“I hardly recognized myself. Looking in the mirror was painful, and I despised everything about my situation,” he recalled.
Over the past six years, he had attempted to reclaim his health by reading wellness literature and trying various diets, including Weight Watchers and Keto. Unfortunately, none yielded lasting results.
“I had altered my body to such a degree that I needed a comprehensive transformation—not just in diet, but also in exercise, mental health, and setting personal boundaries,” Nicaise explained.
In January 2023, his doctor suggested he look into anti-obesity medication, as he teetered on the edge of needing a fourth blood pressure medication. Initially, he was hesitant due to the stigma surrounding such treatments.
“It felt like a cop-out, and I felt like a failure. As a healthcare professional, relying on a pill for every ailment wasn’t something I was comfortable with,” he confessed.
Due to insurance limitations, he wasn’t cleared to use GLP-1 drugs like Zepbound or Wegovy. However, he obtained authorization for Contrave, an oral medication that combines bupropion and naltrexone.
Bupropion, widely known as Wellbutrin for treating depression, functions as a dopamine/norepinephrine reuptake inhibitor, enhancing these brain hormones in areas that signal reduced appetite, according to Dr. Karl Nadolsky, an endocrinologist and obesity specialist.
Naltrexone, an opioid antagonist typically used for alcohol dependency, amplifies the effects of bupropion by blocking negative endorphin feedback, Nadolsky elaborated.
“Contrave also influences areas of the brain linked to cravings and food addiction,” he noted.
Contrave and GLP-1 receptor agonists, such as Ozempic, Wegovy, and Zepbound, differ significantly in their mechanisms.
The two components of Contrave target brain pathways involved in mood, energy, cravings, and pleasure sensations, explained Dr. Allison Rhodes, an obesity medicine and internal medicine expert.
“GLP-1 receptor agonists mimic gut hormones, slowing gastric emptying, enhancing insulin release when glucose is present, and suppressing glucagon secretion, among other effects,” Rhodes added.
These GLP-1s enhance glucose uptake in muscles while also reducing hunger through various brain pathways.
“Collectively, these actions lead to decreased food intake, increased satiety, and improved glucose metabolism, which can promote significant weight loss,” she stated.
While Contrave doesn’t directly aid in diabetes management, Nadolsky mentioned that GLP-1s can enhance pancreatic insulin production and reduce liver glucose output.
Each medication also has distinct side effects, as noted by Dr. Caroline Messer, an endocrinologist.
“Contrave can lead to fatigue, anxiety, agitation, and a heightened risk of seizures, whereas GLP-1s typically cause gastrointestinal side effects,” she explained.
More severe side effects have also been reported with both medications.
Contrave is often more affordable, and coupons can further reduce the cost, Messer pointed out.
Another key difference lies in administration; Contrave is taken as a pill twice daily, while popular GLP-1 medications are usually injected weekly.
“Naltrexone has a five-hour half-life, while extended-release bupropion lasts about 21 hours. In contrast, GLP-1 receptor agonists have a half-life of around seven days,” Rhodes noted.
“For those who see results early, like losing 5% of their weight in the first few months, the average weight loss can reach around 11%, which is quite significant,” Nadolsky added.
After six months on Contrave, Nicaise shed 100 pounds. In addition to the medication, he adopted a low-carb diet and practiced intermittent fasting, walking daily to achieve either 20,000 steps or 10 miles.
He maintained regular therapy sessions for additional support throughout his weight loss journey.
“My therapist guided me in improving my mental state, which was crucial for both my physical and emotional well-being,” Nicaise reflected.
He emphasized that his weight loss journey was closely tied to his mental health, noting that Contrave also provided psychological benefits.
Reflecting on his previous obsession with food and frequent snacking, Nicaise recognized the necessity for change. He found that by replacing unhealthy eating habits with exercise and meditation, he could manage cravings and prioritize healthier choices. “I discovered alternative outlets like exercise and meditation, which helped me replace unnecessary eating with more constructive activities,” he shared.
After a year off Contrave, Nicaise experienced slight weight gain, but his overall health significantly improved. His cholesterol, blood sugar, and blood pressure levels all decreased, and he no longer suffers from sleep apnea. He continues to follow a nutritious diet, has transitioned his daily walks into runs, and maintains regular therapy sessions for ongoing support.
Currently, Nicaise uses naltrexone mainly for its mental health advantages, reflecting on how his weight loss journey has vastly transformed his life. “This journey has completely changed my life. I feel happier, less irritable, and have regained my self-esteem and confidence,” he stated.
For individuals pursuing a similar path to improved health through weight loss, Nicaise suggests not to feel ashamed of their current weight. Instead, he encourages them to focus on the future and seek assistance from healthcare professionals. “Don’t hesitate to discuss your weight with your doctor. It significantly impacts many aspects of your health,” he advised. “Once you regain control over it, the improvements you’ll notice in your daily life are remarkable.”
Given the unique risk factors that contribute to obesity, consulting with a healthcare provider to determine the optimal approach is essential. “Obesity is a chronic, multifaceted condition that necessitates a personalized strategy,” Rhodes explained. By crafting a customized plan that addresses nutrition, physical activity, behavioral changes, and potentially medication, individuals can achieve sustainable and healthy weight loss.
