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What happens when the medication that's finally helping you is no longer affordable?

If you've had success on Mounjaro or Zepbound but need to switch to a more affordable option like Ozempic for maintenance, you're probably wondering: will this actually work? 

And if semaglutide didn't help you before, the idea of going back can feel risky, especially when you're worried about regaining weight, increased food noise, or losing the progress you've worked so hard for.

In this post, I break down when switching medications for cost reasons can make sense, when it often backfires, and what to consider if semaglutide is your only affordable option. 

When affordability forces a medication switch

I recently got an email from someone in Canada who lost 90 pounds on Mounjaro. Their doctor suggested switching to Ozempic, or semaglutide, for maintenance because it’s expected to go generic soon, making it much more affordable long term.

This person had already tried Ozempic before starting Mounjaro, but they never made it to the highest dose because it just didn’t feel effective. It wasn’t giving them the appetite control or metabolic support they needed.

This is a scenario I’m hearing more and more, both from people in Canada and across the US. Rising costs are forcing tough medication decisions, and switching isn’t always as straightforward or as safe as it sounds. 

In an ideal world, we wouldn’t have to make medical decisions based on finances. This isn’t an aesthetic issue. Obesity is a complicated, multifactorial disease that deserves proper treatment.

The fact that we’re forced to treat it like something cosmetic and pay out of pocket is honestly a crime. But this is the reality many people in the US and Canada are facing, so let’s talk about how to navigate it wisely.

Why returning to semaglutide often fails for maintenance

If semaglutide didn’t work for you the first time, it’s unlikely to work for maintenance. People who struggled on Ozempic but finally saw results on tirzepatide often run into problems when they switch back. So if you never had a response in the first place, it’s almost pointless to come back to it to maintain. This is what I see clinically.

You worked hard to lose weight with a medication that actually worked for your body. Going back to something that didn’t help sets you up for struggle, weight regain, and the return of the food noise you finally got relief from.

When switching back can work

There is a different scenario where switching back may work.

If semaglutide was helping you lose weight and quiet food noise (even if not dramatically), and you only switched to tirzepatide to boost those results, then yes, going back to semaglutide for maintenance can work in some cases.

The key difference is response. Your body already showed it could work with semaglutide. Tirzepatide simply gave you more support to reach your goal. Once you’re there, the original medication may be enough to help you maintain.

When semaglutide is the only affordable option

Sometimes cost removes choice. If semaglutide is truly the only medication you can afford long term, don’t panic. There are ways to approach this strategically.

Clinically, I look at adding oral medications that target other pathways involved in weight regulation:

• Bupropion and naltrexone (generic Contrave): helps with urges, cravings, and dopamine signaling. Even if the GLP-1 alone wasn’t enough before, this combination can make maintenance more achievable.
  
  
• Metformin: can provide additional metabolic and insulin support when appropriate.

The goal is not to recreate tirzepatide exactly. It’s to layer enough support so you’re not white-knuckling maintenance.

What matters most is working with someone experienced in making these adjustments. This is not a situation where you switch medications and wait months to see if it works. There is nuance here, and intervention should happen quickly if things aren’t going well.

Does daily oral Wegovy create steadier results?

Some people wonder if oral Wegovy, the daily pill form of semaglutide, might solve the ups and downs that come with weekly injections.

With injections, many people feel supported for the first few days, then struggle toward the end of the week. It’s a peak and valley pattern. Daily dosing sounds like it should smooth that out.

In reality, what many patients report is a different version of the same issue. They feel supported shortly after taking the pill, but by evening, hunger and food noise return. Instead of a weekly struggle period, it becomes a daily one.

So daily does not automatically mean steadier.

Why no medication works perfectly forever

Something I want to normalize is that there is no medication that works perfectly all the time.

Some people experience periods where food noise is quiet and things feel easy. Others hit times where hunger increases or progress stalls. This doesn’t mean the medication has failed. Obesity is a chronic disease, and long-term management often requires adjustments.

What matters is having a clinician who understands the physiology and is willing to titrate, combine, and adapt treatment to you. This is not one-size-fits-all situation.

Why this matters beyond the number on the scale

I care deeply about this because I see what happens when people lose access to the metabolic support they need. They don’t just regain weight, their health risks increase.

There are at least 13 types of cancer associated with long-term elevated weight set point. I see conditions like renal cell carcinoma more often than I wish I did. This is about cardiac health, cancer risk reduction, and long-term disease prevention.

There is no organ in the body that is untouched by obesity. This has never been just about appearance.

If You're Facing This Decision

If cost is forcing a medication change, I do everything I can to avoid sending someone back to a medication that was ineffective. And if that switch has to happen, I want other supports in place quickly so no one spends months struggling and eventually giving up.

This is already hard enough, even with the right medication. Adding unnecessary struggle helps no one.

Work with someone who understands this space, who will advocate for you, and who is willing to get creative when needed. You deserve care that prioritizes your long-term health, not just the lowest-cost option.

listen to the full episode for more on navigating medication switches, combining treatments, and working with the right clinician to maintain your progress long-term.

P.S. Registration is now open for the September round of The 30/30 Program. When you join early, you get access to monthly live Q&A calls starting now, plus ongoing support all the way through the program. Learn more and save your spot here.

Special COUPON CODE for Orchard Pond Granola mentioned in this episode: WELLNESS2026. Limit one per customer. Offer valid until April 30, 2026.

TRANSCRIPT:

Disclaimer: The transcript below is provided for your convenience and may contain typos, errors, or grammatical inconsistencies, as it has not been professionally edited or proofread. Please enjoy it as-is and read at your own discretion.

Please note: The content shared in this podcast and blog post is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider for personalized medical guidance.   

 Welcome back to another episode of the podcast. How are you all doing? We're gonna talk shortly here real quick about, I've been getting a lot of messages, actually, both from US listeners and Canadian listeners, so I'll tell you why, people asking, Hey, I'm on tirzepatide, whether it be Mounjaro or Zep bound, same thing.

Just from a cost standpoint, it's unaffordable. So people are asking about switching to semaglutide. The reason it's popping up in Canada that people are asking me is because in Canada. Subcutaneous semaglutide is going generic this year. Everyone's thinking, okay, can I switch to that? Because it's more affordable, long-term to maintain.

We'll have some conversations about, I've gotten a few different questions in different ways and I'll see what I see clinically. But I wanna tell you just real quick. So I've been knee deep in planning these two retreats that I have coming up right of in person in Indianapolis, Indiana, and. Part of what I love about a retreat, so me, myself, over the past five years, I have attended so many different retreats, larger, smaller things like that.

I tend to like more the smaller retreats. 20 people or less. You just get to know people a lot more. You actually get something out of it. It's not only when I go to a retreat that I love the people, the connection, what I learn, all of that. It's that you also usually get to try different snacks and meals.

These are things that maybe, it's not normally what you would be doing. You're exposed to what someone else likes, what they think is valuable, things like that. Part of what I'm really enjoying about planning these retreats is really thinking through, okay, what? What snacks, what meals, what are we gonna do?

Because I only wanna bring what I think is the best of the best. So jump to the part where I'm thinking about the breakfast for people, right? So yes, there's the Greek yogurt and the fruit and da da da. Okay? But there's this granola guys that is out of this world, amazing.

I'm not even a granola girl. Okay. I'm not like, oh my gosh, this is an amazing granola. I've never bought a granola. This is like not a thing. There's new trail, which is a a, like a nut free granola, but I don't really consider that granola. It's like it's nuts that you're putting on something. This is not sponsored, by the way.

They have no idea who I am. But there's a, there's a farm. It's Orchard Pond, so Orchard pond.com. I'll make sure that we link it down below. And they have this old fashioned granola that guys, when I say this is amazing, I literally could eat the whole eight ounce bag at once. So the way that I got introduced to it months ago here, I went to Chicago and I was.

Staying with my sister and my family is part of this organic food co-op and so part of it, it's like it's very old school. You have to literally like drive into the bottles of the city of Chicago and you're waiting in line at this lady's house. It's so funny because all the other neighbors are like, what is happening?

'cause in Chicago people walk home and everyone's just looking over like, that's so weird where all these people lined up outside this lady's house. I felt honestly like we were getting into a rock concert. But anyway. So long story short, we get all this food, we're on the way home.

I'm ravenous, it's late on a Thursday or Friday night. I'm opening this bag of granola. I'm thinking, well, what the hell? I'm hungry. I'm just gonna have a few bites of something. Guys. It was the best thing I'd ever eaten. They do have two different kinds of granola. The one that I'm talking about is their old fashioned one. It's a green bag if you're looking online. They also have one that's a a, a nut free granola. That one looks amazing as well. That's in a purple bag. But anyway, the green bag, I wanna read you the ingredients here.

'cause it's so super simple. But when you have it, it has this amazing flavor of like, it's a little bit sticky together, but not overly. And it's nice and soft, but not too soft. And the sweetness is just perfect. Just everything really. Is perfection as far as different consistencies throughout the granola, all of it.

So everything is organic, so it's organic rolled oats, organic coconut flakes, banana chips, almonds, honey, olive oil, all that organic, and then a little bit of salt. So the flavor, I mean, the ingredients are so simple, but the flavors just amazing. So anyway, I just put in a massive order so that we can have it at my retreat.

So I got not only the bigger bags, but they also have, and I love when companies do this. They have one ounce bags, single serve as well. So I really love that from a, not only if you're taking on the road like a, like being able to travel with it standpoint, but also from a portion control standpoint. So I am someone, I'm sorry about the ECOS sustainability of all of this, but I am someone that.

Loves when something is already portion controlled for me, because then I don't need to think about it as much. And while I'm all about learning how to work with your body and listening to hunger signals and all that kind of stuff, I do think that honestly sometimes when a food is really just tasting amazing, I'm very grateful when someone, when, when it's already portioned.

So I was already kind of thinking about for the people at my retreat, uh. You know, if they're wanting a snack, if it's proportioned, if they're wanting it as part of something, it's kind of sometimes nice when it's already done for you. So anyway, just made the biggest purchase of my life for them, but I can't recommend them enough.

The flavor is just out of this world. So if you are someone, if you are a granola. Person out there. I think this is worth you trying. Alright, so let's talk about today's topic. I'm gonna read you roughly an email that I got just so you can kind of get a sense of why we're, uh, why we're talking about this.

So someone wrote in here, let me get the email up. Hold

on. Here we go.

All right, so here's the email that I got. This person's asking, and they're saying, I'm in Canada and I've lost 90 pounds on Manjaro. My doctor and I have been having the discussion of what to do for maintenance, and we believe the best thing for me to do is to stay on the medication, how I've been paying out of pocket and the cost of, of, of living and, and with the cost of living, looking for cheaper options and, okay, so this person.

Reframe. All right. I'm in Canada. I've lost 90 Pon Majaro. My doctor and I have been having the discussion of what to do for maintenance, and I'm just gonna recap here. They, the doctor says, look, I think the best thing to stay on the medication, but this person has been paying out of pocket, and they're looking at the cost of living going up, and they're looking for cheaper options.

So the doctors then saying, Hey, what about Ozempic slash wegovy? Because down the pipeline in Canada here coming up, it's going generic. So he's thinking, Hey, you can use that to maintain. And this person's asking, what's your experience been with switching someone over? Or have you heard anything about whether this is something that can possibly work?

They tried. Here's the thing that matters, and this is why I'm reading this part. They try, I tried ozempic before Majaro, but never got to the highest dose because I felt defeated. I, um, they like, it wasn't, it didn't feel effective for them. Uh, thanks in advance. Okay, so here's what I wanna talk about.

Let's talk about scenarios where it would make sense to switch to another option to maintain. There are realities to the world, okay? So in an ideal world, we would not have to make decisions based on finances. Things would be covered. We wouldn't have to do these mental gymnastics. So we're gonna say it once just so everybody.

If you're new here, you hear this, it's not right. The fact that we think of this as an aesthetic disease. It. It's not right that we think of this as aesthetic. This is a very complicated, multifactorial disease that deserves treatment, but unfortunately, the way that our world is right now, it's something where you have to prioritize your own health and pay cash for it potentially.

And it's again, that's just a crime all on its own. But let's ignore that for a second. Let's just talk realities of the world. So if you are someone that didn't ever respond to semaglutide to begin with, so that's Ozempic. You were taking it and you're like, I don't really feel much effect. It wasn't, maybe you didn't, maybe you couldn't even lose 5%, or you barely lost 5%.

You were on it just month after month after month, and you were thinking, this is just really, nothing's changed for me here how I'm feeling. And then you switch to Tirzepatide, which is manjaro, zep bound, and suddenly, boom, you start to get the results. You start to get the help. For those people. Let's take this scenario where you've lost 90 pounds.

I do not see it work out well. When that person tries to go back to Semaglutide to maintain that person, I don't, I don't think that it will work out well. Now if you or someone where. Because this was kind of my story where I started on Wegovy. So you started on Semaglutide and you were getting results.

You were getting help, but you were not responding as robustly as everyone else, or you didn't lose as much total as you needed to lose all those kind of things. And then you. So you switch to Tirzepatide in order to kind of get more of a boost, right? Like to get a higher fat loss percentage, to get more help, to get more help with food, noise, all those kind of things.

If you already responded to Semaglutide, but you went to the other one, you went to Tirzepatide, just to kind of get more help, quote unquote, those people potentially do fine to come back to Semaglutide to maintain. But if you never had a response to begin with, it's very, it, it, it's. It's almost pointless to come back to it to maintain.

Okay. So that's just what I've seen clinically. This is not hard and fast. Everybody is different, everybody responds differently, but that's just what I've seen. Now, let's say that coming back to semaglutide is your only option, you just can't afford any more. The other one, what I would do clinically for my patient if they were under my medical care, is that I would look, are there other.

Oral options that we can add on. So for example, like a generic contrave, which is Wellbutrin, which is Bupropion, and also Naltrexone. So can we help with another pathway that's being affected? So can we help more with urges and cravings with the Wellbutrin, naltrexone? And then you're getting some of the help from the GLP one.

When you were on it to begin with, maybe that GLP one wasn't enough, but maybe it was helping some. And now if we also help with the, those other pathways with urges and cravings and uh, dopamine and all the other signaling potentially that could be enough to help you with maintenance. Or does there need to be Metformin involved?

There's all these other medications that we have. So what I would look at is, even if you didn't respond to it, maybe it's that you need more of a combination when you come down. So the main thing is this. You need to be working with someone that's familiar with making these changes. And then it's not just like, oh, okay, you can't afford it.

We go to this other one. Oh well it's hard. Okay. Who cares? There are, there's a nuance to all of this that can be done. Right. So just to recap, if you never responded to to be, to begin with, with just semaglutide and you went to Tirzepatide, now you're trying to come back to that, probably life's gonna look pretty hard.

And the reason I bring this up is that this is already hard enough, even when you get on a medication and. And you get help from a standpoint of less food noise and you're getting help metabolically, right? That's the thing you are getting help on. That's the reason you're able to do this. It's just, it's hard enough to do all the lifestyle things and all the things that are required.

And even if you stay on the majaro that that tirzepatide, you still potentially. Six months, one year, 18 months, two years down the road are really gonna have a time of struggling again. So it's one of those scenarios where I really try everything in the world to not have to go back to something that was ineffective, or if we do, to really look at let's very quickly get other supports in place with either other medications or other interventions that we're gonna do really quickly and not have you sit there and struggle for three months to six months and give up on the whole process.

So that's the only thing I wanted to kind of go over today because I know a lot of people are saying. Uh, a, a common scenario that I see right now, people are on subcutaneous, zep bound, and then they're saying, well, can I go to Oral Wago v? Well, you can do anything you want. I mean, anything you can, you can always make a change and you can always go back, by the way.

Right. But it's, it's the, the efficacy is potentially lower. Um, again, what, what happened before you ever did the zep bound? Where did you already try the other medication before? So. These things need to be watched very closely. Everyone is very different and I love the fact that we're having so many options, but it's the switching over that's kind of where some of the art and the nuance lies.

Right. Um, something that's interesting that I'm hearing with the, with oral Wegovy that's taken daily. I was thinking, oh, would the, would the steady state be better? And what I mean by that is when you take a weekly injection, oftentimes people, maybe the first three, four days are helped, but then they struggle the second half of the week until they take the medication again.

So it's very sort of a peak in valley, right? So with Tirzepatide, sort of max effect is within 72 hours. So maybe within three days you sort of, within one, two days after the injection, you feel it get to a peak, you have help for a day or two, but then you struggle again. So different people. Are metabolizing this medication faster or not and, and struggling more or less than others.

And so I thought, okay, when it's, when it's a daily medication, would some of that be gone? But what I hear is, so within an hour of them taking it, supposedly it's max absorption and concentration, right? But that, that in the evening they struggle. So it's like, okay, great. Now we have daily, you're taking this, but you still have a struggle bus period.

So what I really wanna normalize is this. There is no medication that is perfect. Some of you will have perfect times. You'll have these bliss periods when the food noise is all down, or you're losing easily at all the things are happening. But remember, this is a chronic disease, and it's okay if there's times where you, again, need to figure things out or where you need to adjust things, or you need to get creative with things.

I really think that you need a physician on your side that is willing to get creative because when something is super complex that we're dealing with, it's really not a one size fits all for everyone. It's really not. So you wanna see someone that understands the physiology behind it and can really, I.

Titrate the things to specifically fit you. So if you're in Indiana or Illinois, I have the Renta metabolic clinic. You see me specifically, I work very closely with you. Uh, that would be you go to renta clinic.com and you click on telehealth. Um, but even for a lot of other states, there are amazing clinicians as well.

Sometimes people email me and they'll ask about, Hey, do you know someone in X, Y, z? Most states I know someone. It's very rare that that, I don't know a clinician that's good in, in certain states. Um, but get, get help from someone that that really knows what they're doing because it's going to make it such that you don't have times where, where the metabolic help is taken away and then you get sicker.

Remember, we're really trying to. Help with these things long term. Um, I was just talking to someone the other day. Well, not, you know, one, one of the, I don't think I've mentioned this in a while on the podcast. One of the reasons that we're doing all this is one of the things that I care about is cancer prevention in reduced risk of cancer in the future.

And so we know that there are 13 types of cancer where if your weight set point is up long term, you're at increased risk of getting them. And one that. I don't know why. I just see this a lot as renal cell carcinoma, and partly it's because my patients in the past might have been a smoker, so that contributes as well.

But not everybody's a smoker that has this. It's the weight that can contribute to it. And I bring this up because a lot of people. After having thyroid cancer, after having renal cell carcinoma, after these things will come to work with me because they understand the hormonal aspect of how it's playing into these cancer either occurring or recurring.

And so I bring this up because again, this is just not an aesthetic thing. This is really about your cardiac health. Uh, cancer reduction. I could go on and on. There's no organ. That is not affected by obesity. So I'm gonna just end here. Um.

Okay. All right. That is what I wanted to talk about today. Now, I wanted to bring up, I know this is way early to bring this up, but the only other time this year that I'm gonna be running 30, 30 is gonna be in September, and something that I wanted to bring up is that we open registration way ahead of time.

And one of the things being that a lot of people that have done the January round, they wanted to partake in the next one. But there's this period in between where, okay, so, so reframe. Okay, so one of the things I wanted to bring up real quick, I know this is way early, but we are, I am only running 30, 32 times.

Okay. Reframe, reframe, reframe, reframe. Alright, what? Okay. So that's all I have for, that's what I have for today. Hopefully that's helpful to some of you out there that are being. That are being forced into this scenario. The other thing I wanted to bring up real quick, if you're someone that wanted to do the September 30, 30 round, I know you're like Matea, that is like a hundred years away.

One thing I wanted to bring up is that we do have registration open already for it, and we're doing something unique, and I'll tell you why we're doing this. If you register however early you register. Monthly as a bonus, you'll have access leading up to it. So it could be potentially like six months here, monthly.

There's a q and A that you can come to, that you'll have access to. And the reason I'm doing this is that I have people that do every single 30, 30 round and they want support in between. And it's really hard to go from, you're getting all the support in the world during a 30, 30 round, and then there's nothing in between.

And so part of what I'm doing here is that, yes, you'll participate. And by the way, it's, it's 12 weeks this time, right? So it's gonna, it'll be that, you know, that last third of the year that we'll spend together. But if you want help over the spring, the summer, things like that, those monthly calls are really helpful because you can submit questions ahead of time and there's a really nice range of questions that happen on those calls.

And they're live, the replays go up, so you'll have access to that. So. If that's something that you're interested in, um, the, the registration will go up. Uh, there will also be replays. So let's say that you're not hearing this in, probably this is gonna go up in February, I don't know, end of January, February.

Let's say that you're hearing this March, April, the replays will be up. That occurred in February, in March, in April. So that you can still hear that as well. Reframe. So something that we're doing, reframe, reframe, reframe. Something that we're, something that I'm doing is that. So, all right. Okay. Reframe for the 900th time.

Yeah, yeah, yeah, yeah. Yes, yes, yes, yes, yes, yes, yes. I'm doing this as a marker so I can tell where to come back to. Alright. That is what I have for, that's what I have for today's episode. I just wanted to say something real quick, just that I didn't forget to mention it here. So we have registration. I have registration open for the September 30, 30 round.

Now, some of you might be hearing this, you're thinking, oh my Lord, that's a hundred years away. The reason I'm bring this up is that some people really want support between rounds and so let's say that you're doing the September round, but there's, as you know, six months in between when you did this previous round and the next one, things like that.

What I'm doing differently for this next round is that whenever you join, you'll start to get monthly access to a live q and a call that I do. So potentially if you join, let's say in February, March timeframe, things like that, you get a monthly call all the way up until September when we actually start the program.

So that's really a bonus. If you're someone that you want to continue to get support, this is a good opportunity If you're someone that you wanna ask. Me questions, you get to submit those ahead of time and so you can, um, I can answer your questions, kinda help you along the journey a little bit more. And then number two, what's nice is there's a really big variety of questions on that call.

So people ask about different supplements, they ask about different body composition things. There's a big range of what's happening. And so you could, you could have access to that leading up to it. So even before, alright, so that is available to you if that's something that you're looking for. Reframe.

All right, so reframe. Alright, I hope you guys have a great rest of the week. Let's all hold faith here that will soon have more light to the days 'cause I'm, I'm kind of over the winter at this point. Alright, we will talk. I'm, I reframe, reframe. All right. I hope that you all have a great rest of the week.

I'm really holding hope at this point that there's gonna be more sunlight during the days and that we're soon gonna be outta winter because I'm kind of, this is the time of year when I'm over it. So remember, if you're struggling a little bit, that's okay. Life will potentially get easier. Get back to the basics.

Get back to the things that support you, the water, the protein, the fiber, the movement. You can do this. All right. See you Friday.