Lapinha’s sustainable weight-loss program combines intensive lifestyle intervention, dedicated medical supervision, and, when clinically indicated, the judicious use of novel antiobesity medications.

The so-called “weight-loss pens (injections)” have profoundly transformed obesity management. Semaglutide and tirzepatide can yield weight reductions that, until recently, were rarely achievable through pharmacotherapy alone. In the SURMOUNT-1 trial, for instance, tirzepatide produced an average body weight reduction of up to 20.9% over 72 weeks; in the STEP 1 trial, semaglutide 2.4 mg combined with lifestyle intervention led to a mean weight reduction approaching 15% over 68 weeks (Jastreboff et al., 2022; Wilding et al., 2021).

At Lapinha, however, we do not view these medications as competitors to our weight-loss program. We see them as allies. Why?

The assumption that these new pharmacotherapies would diminish demand for the “Emagreça e Continue Magro” (Lose Weight and Stay Lean) program has not materialized. First, there is a simple reason: Lapinha offers far more than weight loss. Programs such as Stress Reduction, Restorative Sleep (Bem Dormir), Sport and Performance, Senior Health, Mayr Prevent, Detox, Personalized Health, and Smoking Cessation, among others, maintain distinct therapeutic goals and continue to attract individuals whose primary pursuit is enhanced health and overall quality of life.

Second, there is a deeper reason: Lapinha has never focused solely on weight loss. Our mission is to teach individuals how to live in a way that allows sustained weight management over the long term.

 

Medication Can Open the Window; the Patient Must Step Through It

Obesity is far from a simple issue of willpower. Appetite regulation, sleep architecture, chronic stress, the surrounding food environment, sedentary behaviors, circadian rhythms, behavioral patterns, and underlying metabolic signaling all contribute to its persistence.

For this reason, our program incorporates Intensive Lifestyle Intervention (ILI), built on core Lifestyle Medicine Interventions (LMIs):

• Tailored, nutrient-dense nutrition;
• Physical exercise aligned with individual clinical capacity and preferences;
• Restorative, adequate sleep;
• Respect for circadian biology and meal timing;
• Structured stress management;
• And, crucially, a cognitive shift in mindset.

 

Injections Can Suppress Hunger, but They Do Not Teach How to Live Well

This is where one of the greatest opportunities of incretin-based therapies lies: by reducing appetite and facilitating initial weight loss, they create a critical window of opportunity for new, sustainable habits to be learned, practiced, and integrated into daily life.

 

How the “Emagreça e Continue Magro” (Lose Weight and Stay Slim) Program Works

Our model is deliberately distinct from pharmacological-only strategies:

• Phase 1 — Lifestyle Foundation:

The patient begins a structured Intensive Lifestyle Intervention (ILI) supported by continuous monitoring and Lifestyle Medicine Interventions (LMIs). The primary objective is not merely weight loss, but altering the underlying physiological and behavioral drivers of weight gain. This phase may extend over at least one year.

• Phase 2 — Targeted Pharmacological Support (When Indicated):

If, despite an optimal lifestyle intervention, the patient experiences unmanageable appetite dysregulation, poor dietary adherence, or fails to achieve clinically meaningful weight loss, pharmacotherapy can be integrated. Medications do not replace lifestyle interventions; they are added to them. Typically, this support is maintained for six to twelve months under close medical supervision, monitoring efficacy, tolerability, and clinical safety.

• Phase 3 — Sustained Autonomy:

Where clinically feasible, reliance on medication is gradually tapered while reinforcing lifestyle habits. If the patient can maintain their progress independently, they transition off medication. If maintenance requires continued pharmacotherapy, it can be extended or reintroduced on an individualized, evidence-based basis.

The goal is never to maximize pharmaceutical dosage, but to maximize clinical benefit using the minimum effective intervention.

 

What About the Next Generation of Medications?

Currently, several incretin mimetics are approved for type 2 diabetes and/or obesity management, including liraglutide, semaglutide, and tirzepatide, alongside other GLP-1 receptor agonists utilized primarily in diabetes management.

Next-generation agents are on the horizon. Emerging molecules include retatrutide (a triple GIP/GLP-1/glucagon receptor agonist), CagriSema (cagrilintide + semaglutide), survodutide, and other innovative compounds. Retatrutide demonstrated substantial weight reductions exceeding 20% in Phase 3 clinical data reported in 2026 across diverse cohorts; however, it remains investigational and should not be confused with routinely available clinical treatments. Non-injectable oral options, such as the small-molecule oral GLP-1 receptor agonist orforglipron, have also presented Phase 3 data.

 

Losing Weight Without Compromising Health

Weight reduction is not inherently synonymous with fat loss.

A portion of weight lost via incretin mimetics can stem from lean body mass. In the body composition substudy of SURMOUNT-1, approximately 75% of weight lost with tirzepatide was fat mass and 25% was lean mass. While this does not indicate that tirzepatide causes abnormal muscle wasting—the ratio remained comparable to the placebo group—it highlights why preserving lean muscle mass is essential in any comprehensive weight-loss program (Lundgren et al., 2025).

At Lapinha, clinical monitoring extends beyond the scale. We comprehensively assess body composition, dietary quality, physical activity, and prioritize resistance training paired with adequate protein intake.

Adverse effect profiles require diligent oversight. Nausea, vomiting, constipation, and other gastrointestinal symptoms are common, particularly during dose titration. Furthermore, hepatobiliary safety warrants attention: a large meta-analysis of 76 randomized clinical trials identified an increased risk of gallbladder and biliary diseases associated with GLP-1 receptor agonists, particularly at higher dosages and in weight-loss indications (He et al., 2022).

Efficacy does not equate to absence of risk. Indications, dosing regimens, treatment duration, diagnostic workups, and ongoing follow-up must remain strictly individualized.

 

The Lapinha Philosophy

Incretin-based therapies represent a major advance in the treatment of obesity. We do not oppose them; we oppose their unguided and uncoordinated use.

Our goal is not simply to produce a lower number on the scale. We aim for individuals to lose weight while preserving functional muscle mass, optimizing cardiometabolic markers, improving sleep quality, moving more, eating mindfully, and acquiring long-term autonomy over their health.

Incretin therapies can serve as valuable allies within the “Emagreça e Continue Magro” framework rather than adversaries:

• Losing weight without compromising health.
• Utilizing pharmacotherapy when clinically necessary—and avoiding it when unneeded.
• Converting the therapeutic window of appetite reduction into permanent, transformative lifestyle changes.

Ultimately, the true achievement is not merely losing weight; it is living with greater vitality, improved metabolic health, and more years of high-quality life.

 

References

• GARVEY, W. T. et al. Coadministered cagrilintide and semaglutide in adults with overweight or obesity. New England Journal of Medicine, v. 393, p. 635–647, 2025. DOI: 10.1056/NEJMoa2502081.
• HE, L. et al. Association of glucagon-like peptide-1 receptor agonist use with risk of gallbladder and biliary diseases: a systematic review and meta-analysis of randomized clinical trials. JAMA Internal Medicine, v. 182, n. 5, p. 513–519, 2022. DOI: 10.1001/jamainternmed.2022.0338.
• JASTREBOFF, A. M. et al. Tirzepatide once weekly for the treatment of obesity. New England Journal of Medicine, v. 387, p. 205–216, 2022. DOI: 10.1056/NEJMoa2206038.
• JASTREBOFF, A. M. et al. Triple-hormone-receptor agonist retatrutide for obesity: a phase 2 trial. New England Journal of Medicine, v. 389, p. 514–526, 2023. DOI: 10.1056/NEJMoa2301972.
• LUNDGREN, J. R. et al. Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight. Diabetes, Obesity and Metabolism, 2025. DOI: 10.1111/dom.16275.
• WILDING, J. P. H. et al. Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, v. 384, p. 989–1002, 2021. DOI: 10.1056/NEJMoa2032183.