This document (“Informed Consent”) summarizes information about the Semaglutide/Tirzepatide (with B12 and/or BPC-157 peptide) weight loss program, including the Treatment (as defined below) that I have requested from Champion Health and Wellness Clinics and its medical providers, and gives my informed consent to proceed with Treatment (as defined herein). I have read and understood the following:

A. Purpose/Background:  

Semaglutide/Tirzepatide are injectable or sublingual medications that, when used in combination with a low-calorie diet and exercise, help with chronic weight management in adult patients. They can also be used for individuals with an increased risk for Cardiometabolic diseases such as heart attack, stroke, and Type 2 diabetes. Semaglutide/Tirzepatide belong to a class of medications called glucagon-like peptide-1 (GLP-1) agonists, which mimic the hormone GLP-1 in your body. This hormone slows down how fast your stomach empties food (called gastric emptying), stimulates your pancreas to release insulin (lowering blood sugar levels), it blocks a hormone that causes your liver to release sugar (glucagon). Together, these functions can help you feel less hungry, causing you to eat less food and lose weight. Like other prescription weight-loss drugs, Semaglutide/Tirzepatide are intended to be used as part of an overall weight-loss plan. It is indicated for people who are obese or overweight, and who have failed to lose enough weight with diet and exercise alone — not for people who want to lose just a few pounds.

Semaglutide/Tirzepatide, are prescription medications that can help adults with obesity or overweight lose weight and maintain it.

The FDA has approved Semaglutide/Tirzepatide for adults with a body mass index (BMI) of 30 or higher, or 27 or higher with at least one weight-related condition. Weight-related conditions include type 2 diabetes, high blood pressure, or high cholesterol.

The FDA also says that weight loss medications may be considered for people who have not lost at least 5% of their body weight in three to six months with lifestyle changes alone.

B. Possible Benefits:  

Possible benefits of Semaglutide/Tirzepatide include fat loss, weight loss, improved self-image, improved self-esteem, and improved cardiometabolic risk factors. 

C. Alternatives to Treatment 

Alternatives to Semaglutide/Tirzepatide treatment include diet and exercise alone, other weight loss prescription medications, or procedure-based weight loss methods including gastric banding or bypass.

D. Potential Risks and Contra-indications:

Semaglutide/Tirzepatide are considered safe and effective when used as indicated. But safe doesn’t mean that there aren’t risks. Semaglutide/TIrzeaptide carry a boxed warning about thyroid C-cell tumors occurring in rodents and Multiple Endocrine Neoplasia Type 2, and it shouldn’t be used if you or your family have a history of certain thyroid cancers or Multiple Endocrine Neoplasia Type 2. Semaglutide/Tirzepatide should not be used in people with Type-1 diabetes or a history of pancreatitis. Semaglutide/TIrzepatide should be used cautiously for people on other blood- sugar-lowering medications. Patients may experience significant drops in blood sugars when using Semaglutide/Tirzepatide.

Although side effects are minimal for most people who follow the Treatment protocol, common potential side effects of Semaglutide/Tirzepatide include nausea, diarrhea, vomiting, constipation, stomach (abdomen) pain, headache, tiredness (fatigue), upset stomach, dizziness, feeling bloated, belching, gas, and heartburn. Rare, but potential side effects include acute pancreatitis, acute gallbladder disease, hypoglycemia, acute kidney injury, diabetic retinopathy, heart rate increase, suicidal behavior, and ideation. Semaglutide/Tirzepatide usage has also been associated with gastroparesis which is where the stomach stops its normal movement (peristalsis) and causes the patient to vomit uncontrollably. Rare cases can lead to hospitalization from dehydration and esophageal bleeding.

Semaglutide/Tirzeaptide may cause fetal harm. When pregnancy is recognized, discontinue Semaglutide/Tirzepatide immediately. Discontinue Semaglutide/Tirzepatide at least 2 months before a planned pregnancy because of the long half-life of the medication.

By signing below, I have read, acknowledge and agree as follows: My clinical team at Champion Health and Wellness Clinics will not monitor the blood sugars of a non-diabetic patient. I will take the medication only as directed by the medical provider according to the treatment guidelines established. I understand the risks associated with Treatment, and that not complying with the dosage recommendations and dietary restrictions could increase risks and alter the results. Product information is available upon request. Champion Health and Wellness Clinics works in conjunction with, but cannot replace, my primary care physicians, such as general practitioners or other specialists in Family Medicine or Internal Medicine.