• Tim Nicaise, a nurse practitioner, hit 300 pounds before turning to anti-obesity medication.
• After years of unsuccessful weight loss attempts, his doctor recommended Contrave.
• A year after discontinuing the medication, Nicaise has successfully maintained an 85-pound weight loss.

Growing up, Tim Nicaise was an avid gymnast, which helped him maintain a weight of around 140 pounds for most of his life.

However, in his late 20s, increased social activities and dining out began to affect his weight. By his early 30s, as he became a father, life stressors contributed to an unhealthy relationship with food. The pressure of caring for patients as a nurse practitioner, especially during the pandemic, added to this struggle.

“When the pandemic struck, my job shifted into crisis mode, dealing with patients who were dying unexpectedly,” Nicaise shared with Healthline. “It was heartbreaking to see individuals who were healthy just weeks before.”

“During that time, my mental well-being took a nosedive, and food became a source of comfort for me. I felt like I had to find ways to cope and get through each day,” he added.

By 2023, Nicaise had reached 300 pounds, was prediabetic, suffered from sleep apnea, and was on three different blood pressure medications.

“I didn’t recognize myself; I dreaded looking in the mirror. I was unhappy with every aspect of my life at that moment,” he admitted.

For six years, he tried various wellness strategies, including reading self-help books and engaging with different diets like Weight Watchers and Keto, but none yielded lasting results.

“I had altered my body so significantly that I realized I needed a total transformation—not just in diet but also in exercise, mental health, and establishing boundaries with my family,” Nicaise reflected.

In January 2023, after discussions with his doctor, Nicaise was advised to consider anti-obesity medication as he faced the prospect of needing a fourth blood pressure medication. Initially, he was hesitant due to the stigma surrounding such treatments.

“It felt like taking the easy way out, and I felt like I had failed. As a medical professional, I’ve always believed in finding solutions beyond medication,” he expressed.

Due to insurance limitations, Nicaise was unable to access GLP-1 medications like Zepbound or Wegovy. However, he received authorization for Contrave, an oral medication combining bupropion and naltrexone.

“Bupropion, commonly known as Wellbutrin for depression, is a dopamine/norepinephrine reuptake inhibitor that enhances those brain chemicals in the hypothalamus, which signals reduced appetite,” explained Karl Nadolsky, DO, a clinical endocrinologist and obesity specialist.

Naltrexone, an opioid antagonist used in alcohol misuse treatment, amplifies the effects of bupropion by blocking negative endorphin feedback, Nadolsky added.

“Contrave also influences brain areas associated with cravings and food addiction,” he noted.

Contrave differs from GLP-1 receptor agonist medications like Ozempic, Wegovy, and Zepbound in several ways.

According to Allison Rhodes, MD, a dual-certified obesity medicine and internal medicine physician, the two components in Contrave target pathways in the brain that regulate mood, energy balance, cravings, and pleasure sensations.

“GLP-1 receptor agonists mimic our gut hormones, aiding in various metabolic processes including slowing gastric emptying, enhancing insulin release when glucose is present, and reducing hunger by acting on multiple brain pathways,” Rhodes explained.

“Together, these effects can lead to significant weight loss by reducing food intake and increasing feelings of fullness,” she added.

While Contrave doesn’t directly address diabetes, Nadolsky noted that GLP-1s can enhance insulin secretion in the pancreas and inhibit liver glucose output.

Side effects vary between the two medication classes, according to Caroline Messer, MD, an endocrinologist.

“Contrave may result in fatigue, anxiety, agitation, and increased seizure risk, while GLP-1s primarily cause gastrointestinal side effects,” she stated.

More severe adverse effects have also been reported.

Contrave is typically more affordable, and discounts can further reduce costs, Messer noted.

Medication administration varies as well; Contrave is taken as a pill twice daily, whereas GLP-1 medications are usually injected weekly.

“Naltrexone has a half-life of five hours, while extended-release bupropion lasts 21 hours. In contrast, GLP-1 receptor agonists maintain a half-life of seven days,” Rhodes explained.

“For individuals 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,” Nadolsky added.

After six months on Contrave, Nicaise achieved a 100-pound weight loss. Alongside the medication, he adopted a low-carb diet, practiced intermittent fasting, and ensured he walked daily, aiming for either 20,000 steps or 10 miles.

He also continued therapy, which he had been attending for years, to support his weight loss efforts.

“My therapist helped me find ways to improve my mental state, which was crucial for my physical health,” Nicaise said.

The connection between weight loss and mental well-being was evident for him, and he found that Contrave had a positive psychological impact.