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- Nurse practitioner Tim Nicaise reached a weight of 300 pounds before exploring anti-obesity medication.
- After years of unsuccessful weight loss attempts, his doctor recommended Contrave.
- One year after stopping the medication, Nicaise successfully maintained an 85-pound weight loss.
Tim Nicaise’s journey with weight began in gymnastics, where he typically maintained a healthy weight of about 140 pounds.
However, in his late 20s, socializing and dining out increased, and by his early 30s, becoming a father introduced stressors that led to an unhealthy relationship with food. Working as a nurse practitioner added to this pressure, particularly during the pandemic.
“When the pandemic began… my work shifted into crisis mode, seeing patients who were dying unexpectedly,” Nicaise shared with Healthline.
“My mental health declined significantly during that period, and food became a source of comfort. I did whatever I could to feel better and get through the day.”
By 2023, Nicaise had reached 300 pounds, was prediabetic, and suffered from sleep apnea, relying on three different blood pressure medications.
“I no longer recognized myself. I loathed looking in the mirror and detested everything about my situation,” he reflected.
For six years, he tried various wellness strategies, including multiple diets such as Weight Watchers and Keto, but none yielded lasting results.
“I had altered my body so significantly that I needed a total transformation—not just in diet, but also in exercise, mental health, and establishing boundaries with my family,” Nicaise noted.
In January 2023, facing the possibility of needing a fourth blood pressure medication, Nicaise’s doctor suggested anti-obesity medication. Initially, he hesitated due to the stigma surrounding these treatments.
“It felt like an easy way out, and I felt like I had failed. As a medical professional, I didn’t want to rely on a pill for every ailment,” he explained.
Due to insurance complications, Nicaise could not access GLP-1 medications like Zepbound or Wegovy. However, he obtained preauthorization for Contrave, a combination of bupropion and naltrexone.
“Bupropion, known for treating depression under the trade name Wellbutrin, is a dopamine/norepinephrine reuptake inhibitor that helps decrease appetite by acting on the hypothalamus,” explained Karl Nadolsky, DO, an endocrinologist and obesity specialist.
Naltrexone, an opioid antagonist used for alcohol misuse, enhances the effects of bupropion by blocking negative feedback from endorphins, as noted by Nadolsky.
“Contrave also engages mesolimbic brain areas, making it especially beneficial for those experiencing cravings or food addiction,” he added.
Contrave and GLP-1 receptor agonists, like Ozempic, Wegovy, and Zepbound, serve different roles in weight management.
The two components of Contrave affect mood, energy use, cravings, and pleasure sensations in the brain, according to Allison Rhodes, MD, an obesity medicine expert.
“GLP-1 receptor agonists mimic gut hormones, slowing gastric emptying and enhancing insulin release when glucose is present, among other effects,” Rhodes explained.
These medications also boost glucose uptake in muscles while suppressing hunger signals through various brain pathways.
“Together, these actions can significantly reduce food intake, enhance feelings of fullness, and improve glucose metabolism, promoting effective weight loss,” Rhodes stated.
While Contrave does not directly aid diabetes management, Nadolsky mentioned that GLP-1s can enhance insulin secretion and reduce liver glucose production.
The side effects of each medication can differ, as noted by Caroline Messer, MD, an endocrinologist.
“Contrave may lead to fatigue, anxiety, agitation, and a heightened risk of seizures, while GLP-1s primarily cause gastrointestinal issues,” Messer stated.
However, serious side effects are also possible.
Contrave is generally more affordable than GLP-1 medications, and discount coupons can help make it accessible, according to Messer.
Additionally, the administration methods differ; Contrave is taken as a pill twice a day, while GLP-1s are typically injected weekly.
“Naltrexone has a half-life of 5 hours, while extended-release bupropion lasts 21 hours; in contrast, GLP-1 injections have a half-life of about 7 days,” Rhodes elaborated.
“For those who notice early results, such as 5% weight loss within the first few months, average weight loss can be around 11%, which is clinically significant,” Nadolsky added.
After six months on Contrave, Nicaise shed 100 pounds. He combined the medication with a low-carb diet, intermittent fasting, and a daily walking goal of either 20,000 steps or 10 miles.
He also continued attending therapy sessions for added support throughout his weight loss journey.
“My therapist helped me find ways to improve my mental state, enabling me to become healthier both mentally and physically,” Nicaise shared.
He recognized that his weight loss was closely linked to his mental health and that Contrave offered psychological benefits as well.
Reflecting on his previous obsession with food and snacking, Nicaise acknowledged the need for change. He discovered that engaging in activities such as exercise and meditation allowed him to manage cravings and make healthier choices. “I found alternative outlets like exercise and meditation to replace moments when I would usually eat,” he revealed.
Although Nicaise regained some weight after stopping Contrave for a year, his overall health improved significantly. His cholesterol, blood sugar, and blood pressure levels decreased, and he no longer experiences sleep apnea. He maintains a healthy diet, has transitioned from walking to running, and continues regular therapy sessions for support.
Currently, Nicaise uses naltrexone for its mental health benefits and reflects on the profound impact of his weight loss journey. “My transformation has been a complete 180. I feel happier, less irritable, and have regained my self-esteem and confidence,” he expressed.
For individuals aiming to pursue a similar health journey through weight loss, Nicaise suggests avoiding shame about past weight struggles. Instead, he encourages seeking support from healthcare professionals. “Don’t hesitate to discuss your weight with your doctor. It affects many aspects of your health,” he advised. “Once you gain control over it, you’ll notice extraordinary changes in your daily life.”
Recognizing that obesity has unique contributing factors for each person, consulting a doctor to establish the best approach is crucial. “Obesity is a chronic, multifactorial condition that requires a personalized, comprehensive strategy,” Rhodes explained. By crafting a customized plan addressing nutrition, exercise, behavior, and potentially medication, individuals can achieve sustainable and healthy weight loss.
