Obesity Medicine at Bespoke

Medical care for a chronic disease, built around your life

Our approach

Obesity is a common, chronic, and treatable disease. It is shaped by genetics, hormones, sleep, stress, medications, and the environment we live in, not by willpower alone. Like other chronic conditions, it often needs long-term care, and weight can return when treatment stops.

Our goal is to improve your health and quality of life. That might mean lower blood pressure or blood sugar, less joint pain, better sleep, more energy, or the ability to do the things you love. Weight reduction is one tool for getting there.

Who we care for

We care for adults with obesity, and for adults with overweight who also have a weight-related condition. Examples include prediabetes or type 2 diabetes, high blood pressure, high cholesterol, fatty liver disease, sleep apnea, joint pain, and PMOS (polyendocrine metabolic ovarian syndrome, previously known as PCOS).

BMI is where we start, not where we stop. We also look at waist size, body composition, your health history, and how weight affects your daily life.

Your first visit

• A full review of your health history, weight history, past treatments, and current medications, including any that can cause weight gain

• A look at sleep, stress, eating patterns, activity, and mood

• Lab testing if you have none from the past 3 months: comprehensive metabolic panel, CBC, lipids, A1c, and TSH

• A conversation about your goals and what matters most to you

Your treatment plan

Obesity care works best when it combines several approaches. We use the four pillars of obesity treatment:

1. Nutrition: Practical eating patterns that fit your life, culture, and budget. We focus on protein, fiber, and nutrient-dense foods to protect muscle and support your medication. No one-size-fits-all diets.

2. Physical activity: Goals that match your current fitness and preferences. We build toward 150 minutes of moderate activity each week, as you’re able, plus strength training at least twice a week to preserve muscle and bone.

3. Behavior: Support with sleep, stress, hunger cues, and the habits that make change last.

4. Medical treatment: FDA-approved anti-obesity medications when appropriate. We discuss benefits, side effects, and cost before starting, and adjust your dose step by step.

Anti-obesity medications we prescribe

• Semaglutide (a GLP-1 receptor agonist)

• Tirzepatide (a GIP/GLP-1 receptor agonist)

• Naltrexone/bupropion

• Phentermine/topiramate

• Metformin (used off-label, especially with prediabetes, insulin resistance, or PMOS, previously known as PCOS)

• Diethylpropion (a short-term appetite suppressant)

• Phendimetrazine (Bontril, a short-term appetite suppressant)

• Benzphetamine (a short-term appetite suppressant)

These medications act on the body’s hunger and fullness signals. They are not a shortcut. They treat the biology of obesity, the same way blood pressure medication treats hypertension. We show you how to take, store, and handle your medication, and we can give your first dose together in the office.

Follow-up visits

• We check your progress, side effects, and how you feel, not just your weight

• We manage common side effects, especially nausea, constipation, and other stomach symptoms

• We adjust your dose based on your response and how well you tolerate it

• We repeat labs as needed: lipids, metabolic panel, CBC, and A1c

• We plan for the long term, including what happens if you reach a plateau or want to change or stop medication

How we track your progress

Weight alone doesn’t tell the whole story. At your first visit and regular check-ins, we use an InBody body composition scan, a quick, non-invasive test that measures muscle, body fat, and body water, not just your weight. It helps us make sure you’re losing fat while protecting muscle, which matters for your metabolism, strength, and long-term health.

Your results sync to the InBody app, so you can see your progress between visits and we can review trends together.

Protecting muscle while you lose weight: Losing weight, especially with GLP-1 medications, can mean losing some muscle too. Alongside strength training and protein, we offer EMSCULPT NEO, a non-invasive treatment that builds muscle with thousands of strong contractions per session.

Safety

Tell us about every medication and supplement you take. Some anti-obesity medications are not safe during pregnancy or with certain health conditions, and we review these with you before starting. Your information is kept private and protected under HIPAA.