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Metabolic care · Weight, appetite & body composition

Weight care. Your way forward.

Support for weight, appetite, body composition, and metabolic health, built around your schedule, your strength goals, and your life. Lili personalizes your plan and stays with you as it changes.

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What we help with

Your goals, taken seriously.

  • Weight that has been hard to manage

    You have tried the apps, the plans, and the willpower. Weight is regulated by hormones from the gut, pancreas, and brain, so a medical approach can help.

  • Persistent hunger, cravings, or food noise

    Constant thoughts about food are real and exhausting. Appetite is part of the plan, not a character flaw.

  • Midlife body-composition changes

    Shifts in where you carry weight, and in muscle versus fat, often show up in your 40s and 50s even when habits have not changed much.

  • Keeping muscle and strength while losing weight

    You want the scale to move without losing the strength you rely on. Protecting muscle is built into your plan from the start.

  • Metabolic risk factors

    Blood sugar, blood pressure, cholesterol, fatty liver, and sleep apnea risk are all part of the picture, not just the number on the scale.

  • Long-term maintenance

    The goal is a result you can keep. Planning for maintenance starts early, including what happens if you change or stop medication.

Medication options

Semaglutide and tirzepatide, side by side.

Both are weekly injections that can reduce appetite and help regulate blood sugar. The right choice, and the dose, depend on your goals, health history, and how you respond.

TopicSemaglutideTirzepatide
How it worksActs on one gut-hormone pathway (GLP-1) involved in appetite and blood-sugar regulation.Acts on two pathways (GIP and GLP-1) involved in appetite and blood-sugar regulation.
FDA-approved brands and usesWegovy (injection and tablets): chronic weight management, and cardiovascular risk reduction in adults with heart disease and obesity or overweight. Wegovy injection is also approved for MASH with moderate to advanced liver fibrosis. Ozempic: type 2 diabetes.Zepbound: chronic weight management, and moderate to severe obstructive sleep apnea in adults with obesity. Mounjaro: type 2 diabetes.
Key weight trialSTEP 1 (Wegovy): adults with obesity or overweight without diabetes, treated with semaglutide 2.4 mg weekly plus lifestyle support, lost 14.9% of body weight on average at 68 weeks, vs 2.4% with placebo.SURMOUNT-1 (Zepbound): adults with obesity or overweight without diabetes, treated with tirzepatide 15 mg weekly plus lifestyle support, lost 20.9% on average at 72 weeks, vs 3.1% with placebo.
Head to headSURMOUNT-5 (NEJM 2025): in 751 adults with obesity and without type 2 diabetes, average weight loss at 72 weeks was 20.2% with tirzepatide vs 13.7% with semaglutide, each at the highest tolerated dose.
Key safety informationNausea, diarrhea, vomiting, and constipation are most common, especially during dose increases. Both carry a boxed warning about thyroid C-cell tumors and are not used with a personal or family history of medullary thyroid carcinoma or MEN2. Other risks include pancreatitis, gallbladder problems, and low blood sugar when combined with certain diabetes medications. Tirzepatide can make oral birth control less effective after starting and after each dose increase.
Approved vs compoundedThe results above come from FDA-approved brand products. Viva’s memberships use compounded semaglutide or tirzepatide, prescribed for you and prepared by a licensed 503A compounding pharmacy. Compounded medications are not FDA-approved, and brand trial results cannot be assumed to apply to them.
At VivaMetabolic Essential, at any prescribed dose.Metabolic Essential (microdose) or Metabolic Core (standard dosing).

Optional: read the detailed comparison

Muscle preservation

Lose the fat. Protect the muscle.

Weight loss should support your health and strength. During weight loss, including treatment with GLP-1 medications, some of the weight lost can be lean tissue. We help you build a plan that prioritizes fat loss while supporting muscle through individualized nutrition, adequate protein, resistance training, and progress monitoring.

  • Nutrition and protein

    Individualized guidance on protein and overall nutrition, especially when appetite is lower.

  • Resistance training

    Appropriate strength training that fits your schedule, experience, and health history.

  • Regular reviews

    Follow-ups look at strength, intake, symptoms, and progress, not just weight.

  • Beyond the scale

    When appropriate, tracking body composition alongside weight.

Protecting lean muscle is a goal we plan for together, not a guarantee. Lean mass measured on a scan includes muscle as well as water and other non-fat tissue.

We can also help connect you with trusted local trainers and dietitians for additional support. See our partner directory

Partners are independent and separately priced; their services are not included in membership.

Hormones and peptides

An individualized approach to body composition.

Nutrition and strength training are the foundation. When clinically appropriate, we also evaluate whether hormone care or a specific peptide therapy belongs in your plan. Potential benefits depend on the treatment, your health history, and the evidence for that use.

For men with confirmed testosterone deficiency, treatment has been shown to increase lean mass and reduce fat mass. That evidence comes from men with low testosterone and cannot be assumed to apply to women. Neither hormones nor peptides have been shown to prevent muscle loss during GLP-1 treatment.

Hormone Care Peptide & Therapy Guide

How your plan comes together

More than a prescription.

  • Medical review

    Lili reviews your history, medications, recent labs, and metabolic risk factors, and orders appropriate labs when needed.

  • Individualized medication selection

    Semaglutide or tirzepatide, and the dose, are chosen for your goals, history, and how you respond.

  • Progress review

    Follow-ups look at weight, how you feel, side effects, strength, and energy, not just the scale.

  • Ongoing adjustments

    Doses and plans change as you progress, plateau, or reach maintenance, with direct messaging in between.

Included with every membership

Concierge care at your fingertips.

Your membership includes ongoing provider support, direct messaging with prompt responses, and one complimentary acute/sick visit per month for an appropriate minor illness, because life happens between follow-ups.

Medication or testing prescribed during that visit may cost extra. Not for emergencies.

See membership benefits

Memberships

Two metabolic memberships.

Both include medication management, follow-ups, supplies, home delivery, peptide management, and one complimentary acute/sick visit per month. Metabolic memberships don't include hormone management.

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  • Metabolic Essential

    $249per month

    Includes either semaglutide at any prescribed dose or microdose tirzepatide, as clinically appropriate.

  • Metabolic Core

    $349per month

    Metabolic Core includes tirzepatide at standard dosing, with individualized medication management, follow-ups, supplies, and home delivery. Membership is $349/month for doses up to and including 7.5 mg weekly. Doses above 7.5 mg weekly are $399/month. In the booking portal, the above-7.5 mg option is listed as Metabolic Advanced; it is the same option.

Compare all memberships and terms

Good to know

Metabolic medications, in context.

  • GLP-1 medications are not appropriate for everyone, including people who are pregnant or planning pregnancy. Your medical review covers your history before anything is prescribed.
  • Individual results vary.

Metabolic care questions

Your questions, answered.

Will I lose muscle on a GLP-1 medication?

Some of the weight lost with any significant weight loss is lean mass. In body-composition substudies, lean mass made up roughly a quarter (SURMOUNT-1, tirzepatide) to about two-fifths (STEP 1, semaglutide) of weight lost. A 2025 joint advisory from four nutrition and obesity medicine societies recommends adequate protein and regular resistance training alongside these medications to help preserve muscle. Your plan builds in both, and progress reviews look at how you feel and function, not just your weight.

How do follow-ups and adjustments work?

Your membership includes ongoing medication management, follow-ups, and direct messaging. Lili reviews your progress, side effects, and goals, and adjusts your dose or plan as needed. The schedule is set with you based on your plan.

What if I hit a plateau or have side effects?

Plateaus are common and do not mean the plan has failed. Lili looks at dose, nutrition, protein, training, sleep, and other medications before deciding on next steps. Nausea, constipation, diarrhea, and reflux are the most common side effects, usually during dose increases; message your provider so the plan can be adjusted. Severe or persistent abdominal pain, vomiting, or signs of dehydration need prompt medical attention.

What happens if I stop the medication?

Weight regain is common after stopping. In the STEP 1 extension, people regained about two-thirds of the weight they had lost within a year of stopping semaglutide. In SURMOUNT-4 (JAMA 2024), people switched from tirzepatide to placebo regained weight, while those who continued kept losing. That is why maintenance, strength, and habits are part of the plan from the start, and any change in medication is planned together.

Can I transfer my care from another provider?

Yes. Bring your medication history, current dose, and any recent lab results to your initial consultation. Lili reviews your history and decides on next steps with you; a prescription from another provider does not automatically carry over.

What do medication and labs cost?

Metabolic Essential ($249/month) and Metabolic Core ($349/month, or $399/month for doses above 7.5 mg weekly) include the listed medication, supplies, home delivery, and follow-ups. Labs are ordered during your initial consultation after a review of your history and goals, and are billed separately unless a membership lists them; insurance can be applied to labs. See Pricing for full terms.

Can I combine metabolic, hormone, and peptide care?

Yes. Hormone management requires an additional membership if you're enrolled in a metabolic program. Peptide management is included with all active memberships, with peptide therapy costs separate.

Keep exploring

Sources and further reading

General education. These sources do not replace individualized medical advice.