• Tim Nicaise, a nurse practitioner, weighed 300 pounds before exploring anti-obesity medication.
• After years of unsuccessful weight loss attempts, his doctor suggested the medication Contrave.
• One year post-medication, Nicaise has successfully maintained an 85-pound weight loss.

Tim Nicaise spent his childhood competing in gymnastics, which helped him maintain a stable weight of around 140 pounds for much of his early life.

However, in his late 20s, a shift towards more social dining experiences began to influence his eating habits. By his early 30s, the stresses of fatherhood and a demanding career as a nurse practitioner made it increasingly difficult for him to maintain his health. The added pressures during the pandemic only exacerbated his unhealthy relationship with food.

“When the pandemic struck, my role shifted to crisis mode, dealing with patients who were unexpectedly dying,” Nicaise shared with Healthline. “It was heartbreaking to see once healthy individuals deteriorate so rapidly.”

“My mental health took a nosedive during that time, and food became my source of comfort. I did whatever I could to cope and get through each day,” he added.

By 2023, Nicaise found himself at 300 pounds, grappling with prediabetes and sleep apnea, as well as taking three different medications for high blood pressure.

“I didn’t recognize myself anymore. I dreaded looking in the mirror and was unhappy with every aspect of myself,” he recalled.

For six years prior, he had attempted to regain his health by reading wellness books and trying various diets, including Weight Watchers and Keto, but none proved effective.

“I had severely compromised my body, and I needed a complete transformation—not just in diet, but in exercise, mental health, and personal boundaries,” Nicaise explained.

In January 2023, facing the possibility of requiring a fourth blood pressure medication, Nicaise’s doctor proposed an anti-obesity medication. Initially, he was hesitant due to societal stigma surrounding such treatments.

“It felt like taking the easy way out, as though I had failed. As a medical professional, I didn’t want to rely on medication to address my issues,” he expressed.

Due to insurance limitations, Nicaise was unable to access GLP-1 medications like Zepbound or Wegovy, but he obtained preauthorization for Contrave, which combines bupropion and naltrexone.

“Bupropion, known by its brand Wellbutrin for treating depression, is a dopamine/norepinephrine reuptake inhibitor that enhances the levels of these neurotransmitters in the hypothalamus, helping to curb appetite,” explained Karl Nadolsky, DO, an endocrinologist and obesity specialist.

Naltrexone is an opioid antagonist used primarily for treating alcohol use disorder. According to Nadolsky, it helps block negative endorphin feedback, which amplifies the effects of bupropion.

“Contrave also impacts the brain’s mesolimbic system, showing greater efficacy for those who experience cravings or food addiction,” he added.

Contrave and GLP-1 medications such as Ozempic, Wegovy, and Zepbound differ significantly in their mechanisms.

Contrave’s ingredients target brain pathways related to mood, energy regulation, cravings, and pleasure, as noted by Allison Rhodes, MD, an obesity medicine specialist.

“GLP-1 receptor agonists mimic gut hormones, slowing gastric emptying, enhancing insulin release in response to glucose, and decreasing hunger through various brain pathways,” Rhodes elaborated.

“These combined actions lead to reduced food intake and improved glucose metabolism, ultimately resulting in significant weight loss,” she continued.

While Contrave does not directly benefit diabetes management, Nadolsky pointed out that GLP-1 medications can enhance insulin secretion from the pancreas.

Side effects also differ between the two types of medication, as noted by Caroline Messer, MD, an endocrinologist.

“Contrave may lead to fatigue, anxiety, and even an increased risk of seizures, while GLP-1 side effects are primarily gastrointestinal,” Messer stated.

However, there are more serious side effects associated with both medications.

Contrave is generally more affordable, with available coupons to help reduce costs, Messer highlighted.

The administration methods also differ: Contrave is a pill taken twice daily, whereas GLP-1 medications are typically administered as weekly subcutaneous injections.

“Naltrexone has a half-life of 5 hours, while the extended-release bupropion lasts 21 hours, in contrast to the 7-day half-life of weekly GLP-1 medications,” Rhodes explained.

“For those who see early results, such as a 5% weight loss within the initial months, the average weight loss can reach around 11%, which is clinically significant,” said Nadolsky.

After six months on Contrave, Nicaise lost 100 pounds. Alongside the medication, he adopted a low-carb diet and practiced intermittent fasting, ensuring he walked daily, targeting either 20,000 steps or 10 miles.

He continued seeing a therapist for guidance and emotional support throughout his weight loss journey.

“She helped me mentally prepare to lose weight and improve my overall well-being,” Nicaise said.

He noted that his weight loss success was closely tied to his mental health, with Contrave offering significant psychological benefits.