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Share on Pinterest Nurse practitioner Tim Nicaise tried everything to lose weight without success. Then his doctor prescribed the drug Contrave and his life changed. Image Provided by Tim NicaiseNurse practitioner Tim Nicaise reached 300 pounds before turning to anti-obesity medication.After years of trying to lose weight and improve his health, his doctor recommended Contrave.A year after stopping the medication, Nicaise has maintained an 85-pound weight loss.

Tim Nicaise grew up competing in gymnastics, which helped him maintain a weight of about 140 pounds for most of his life.

However, in his late 20s, he began socializing and eating out more, and in his early 30s, after becoming a dad, life stressors began to push him toward an unhealthy relationship with food. As a nurse practitioner, the pressure of caring for people also played a part, especially during the pandemic.

Once the pandemic hitmy job really pivoted to crisis mode where I was seeing patients who were dying that shouldnt be dying, so patients who one week or two weeks prior were walking and healthy, Nicaise told Healthline.

My mental health was just depleted at that time, and food became even more of a comfort for me. you had to do whatever you could do to feel better at that point and get yourself through the day.

In 2023, Nicaise reached 300 pounds, was prediabetic, and had sleep apnea. He was also taking three blood pressure medications.

I didnt even look like the same person. I hated looking in the mirror. I hated everything about myself at that point, he said.

For the previous six years, he tried to get healthy by reading wellness books and following different diets like Weight Watchers and Keto. However, nothing worked.

I had really damaged and altered my body so much that I needed a complete overhaul of who I was; not just diet, but exercise, mental health, setting boundaries with family, said Nicaise. Turning to medication

In January 2023, Nicaises doctor suggested he consider taking an anti-obesity medication because he was on the brink of needing a fourth blood pressure medication. At first, he was apprehensive about taking an anti-obesity medication due to stigma.

It almost seemed like it was an easy way out, and I had failed. I am a medical professional and am not a person [who goes to] a pill for every ill situation, he said.

Due to insurance coverage issues, Nicaise was not eligible to take a GLP-1 drug like Zepbound or Wegovy. However, he did get preauthorization from his insurance to cover Contrave, an oral combination of bupropion and naltrexone.

Bupropion, famous by trade-name Wellbutrin for depression, is a dopamine/norepinephrine reuptake inhibitor, which increases those brain hormones in the areas of the hypothalamus which send signals to reduce appetite, Karl Nadolsky, DO, a clinical endocrinologist and obesity specialist at Holland Hospital and clinical assistant professor of medicine at Michigan State University, told Healthline.

Naltrexone is an opioid antagonist approved for alcohol misuse disorder. Nadolsky said it blocks the negative endorphin feedback, and this blocking helps to amplify the benefits of bupropion.

Contrave also works on the mesolimbic areas of the brain and seems to have more benefits in those who describe cravings or food addiction, Nadolsky said. Differences between Contrave and GLP-1 drugs like Ozempic

There are several differences between Contrave and GLP-1 receptor agonist medications like Ozempic, Wegovy, and Zepbound.

First, the two medicines in Contrave target the pathways known to regulate mood, energy expenditure, cravings, and pleasure sensation in the brain, said Allison Rhodes, MD, dual-certified obesity medicine and internal medicine physician at The Ohio State University Wexner Medical Center.

GLP-1 receptor agonists are incretin mimetics, a.k.a. similar copies of our own gut hormones. GLP-1 slows gastric emptying, increases release of insulin when sugar (glucose) is present, suppresses glucagon secretion and therefore liver glucose output, stimulates glucose uptake into cells, and increases proliferation of the cells in the pancreas that make insulin, Rhodes told Healthline.

GLP-1s also increase glucose uptake and storage in muscles and decrease hunger through multiple pathways in the brain.

Overall, these collective effects reduce food intake, increase satiety, and improve glucose metabolism, which can lead to robust weight loss, said Rhodes.

While Contrave has no direct benefits for diabetes, Nadolsky said GLP-1s can improve pancreatic insulin secretion and glucagon inhibition of the liver.

Side effects from each may vary too, said Caroline Messer, MD, an endocrinologist at Northwell Lenox Hill Hospital.

Contrave may cause some fatigue, anxiety, agitation, and increased risk of seizures. The side effects from GLP1s are almost exclusively gastrointestinal in nature, she told Healthline.

However, more serious side effects have also been reported.

Contrave is typically much cheaper, and there are coupons that can make the medication affordable, Messer noted.

The way the medications are taken also varies. While Contrave is a pill that is taken twice daily, the most common forms of GLP-1s used for weight loss are subcutaneous injections given once a week.

Naltrexone has a half-life of 5 hours, and extended-release bupropion has a half-life of 21 hours, whereas weekly dosed GLP-1 receptor agonist medications have a half-life of 7 days, Rhodes said. Weight loss differences between Contrave and GLP-1s like Ozempic

The average weight loss with Contrave is more modest than semaglutide or tirzepatide.

But for those who respond early, as assessed by 5% weight loss in the first few months, average around 11% weight loss, which is very clinically meaningful, said Nadolsky.

After six months of taking Contrave, Nicaise lost 100 pounds. In addition to taking the medication, he ate a low-carb diet and practiced intermittent fasting. He also walked every day, ensuring he reached either 20,000 steps or 10 miles.

He also continued to see a therapist he had been going to for years for additional support in his weight loss journey.

[She helped me on how] I can mentally get myself in a better place to lose the weight and become physically more well, along with mentally more well, said Nicaise.

He said the process of losing weight was largely connected to his mental well-being and that Contrave provided a psychological benefit.

I would say it calmed my desire to comfort myself with food. I used to think about food all the time and snacking was a huge thing for me and it dampens that desire to reach out to food and it allowed me to find other avenues like exercise and meditation.I was replacing times that I didnt need to eat with other activities, he said.

Nicaise has been off Contrave for a year and has gained back 15 pounds. He has lower cholesterol, blood sugar, and blood pressure and no longer has sleep apnea. He continues to follow the same diet, and his daily walks have turned into daily runs. He also continues to see his therapist regularly.

He now takes naltrexone alone for its mental health benefits.

My weight loss journey has changed my life like a complete 180, he said. Im happier. Im not as irritableI feel better, and the most unexpected of the weight loss journey is honestly getting my self-esteem back and self-confidence. Encouraging others to begin their weight loss journey

For others who want to improve their health through weight loss, Nicaises biggest advice is to reject being embarrassed about how they reached their current weight and instead look forward.

Dont be embarrassed to talk to your doctor about it. If your doctor doesnt want to talk to you about it, find a new doctor, he said. Your weight plays such a role in so many aspects of your health and once you can get that thing under control, the changes you notice in your day-to-day life are just extraordinary.

Because every person has unique risk factors that contribute to the development of overweight and obesity, your doctor ca determine which type of medication is best for you.

Obesity is a chronic, multifactorial disease that requires a multifaceted, individualized approach to create a sustainable, adaptive plan that manages nutrition, physical activity, behavior, and selection of pharmacotherapy to optimize healthy weight loss, said Rhodes.

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Vladimir Putin sends grave warning to Ukraine’s allies over Western troop deployment

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Vladimir Putin sends grave warning to Ukraine's allies over Western troop deployment

Russian President Vladimir Putin has said any foreign troops operating as part of a peacekeeping force in Ukraine would be considered a “legitimate target” by Moscow.

It comes a day after French President Emmanuel Macron said 26 of Ukraine’s allies had formally committed to deploying troops “by land, sea or air” to help guarantee Kyiv’s security the day after any ceasefire or peace is achieved.

Mr Macron stressed any troops would be deployed to prevent “any new major aggression” and not at the frontline, adding the force does “not have the will or the objective of waging war against Russia”.

Mr Putin quickly poured cold water on the proposals when speaking at an economic forum in Russia’s eastern Vladivostok region on Friday.

Directly responding to Mr Macron’s comments, he said: “If any troops appear there, especially now, during military operations, we proceed from the fact that these will be legitimate targets for their destruction.

“And if decisions are reached that lead to peace, to long-term peace, then I simply do not see any sense in their presence on the territory of Ukraine, full stop.”

Russia has long argued that one of its reasons for going to war in Ukraine was to prevent NATO from admitting Kyiv as a member and placing its forces in Ukraine.

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Speaking today, Ukrainian President Volodymyr Zelenskyy said it was important that security guarantees “start working now, during the war, and not only after it ends”.

On Thursday, NATO chief Mark Rutte said Russia had no veto on Western troops being deployed to Ukraine: “Why are we interested in what Russia thinks about troops in Ukraine? It’s a sovereign country. It’s not for them to decide.”

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Our Moscow correspondent Ivor Bennett reveals the that three things Vladimir Putin’s warning to foreign peacekeeping troops in Ukraine reveals.

‘Please come to Moscow’

Mr Putin also addressed the chances of a direct meeting between himself and Mr Zelesnkyy aimed at ending the war.

Such a proposal looked positive after the Russian met Donald Trump in Alaska last month, but Mr Putin said on Friday he did not see much point in such a meeting because “it will be practically impossible to reach an agreement with the Ukrainian side on key issues”.

However, he reiterated an offer he made earlier this week to host Mr Zelenskyy for talks in Moscow, which Ukraine’s defence minister previously declared as “knowingly unacceptable”.

“I said: ‘I’m ready, please, come, we will definitely provide working conditions and security, a 100% guarantee’,” Mr Putin said.

Russian President Vladimir Putin visits an interactive exhibition in Vladivostok. Pic: Sputnik/Reuters
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Russian President Vladimir Putin visits an interactive exhibition in Vladivostok. Pic: Sputnik/Reuters

“But if they tell us: ‘we want to meet with you, but you have to go somewhere else for this meeting’, it seems to me that these are simply excessive requests on us.”

Speaking at a news conference in Paris on Thursday, Mr Zelenskyy said US mediators informed him about Mr Putin’s invitation.

“Our American partners told us that Putin invited me to Moscow, and I believe that if you want to avoid a meeting, you should invite me to Moscow,” he said.

However, he said the fact that the issue of organising a meeting arose was “not bad”.

Drone strikes continue

While talks to end the war continue at a diplomatic level, more heavy drone strikes were recorded across Ukraine.

Kyiv’s air force said Moscow attacked Ukraine overnight with 157 strike and decoy drones, as well as seven missiles of various types.

Air defences shot down or jammed 121 of the drones, it said, but 35 drones and seven missiles still struck 10 locations.

Russian drone attack damages houses in Dnipro. Pic: Reuters
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Russian drone attack damages houses in Dnipro. Pic: Reuters

Russian drone attack damages houses in Dnipro. Pic: Reuters
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Russian drone attack damages houses in Dnipro. Pic: Reuters

Elsewhere, Russian troops destroyed 92 Ukrainian drones overnight, according to its defence ministry.

Local social media channels in the city of Ryazan, approximately 200 kilometres (125 miles) southeast of Moscow, reported that the city’s Rosneft oil refinery had been targeted. Ryazan’s regional governor said that drone debris had fallen on an “industrial enterprise” but did not give further details.

Ukraine has stepped up attacks on Russian oil infrastructure that it says fuels Moscow’s war effort in recent months.

Military analyst Professor Michael Clarke said Ukraine’s campaign on Russia’s oil refineries has been a successful one so far, but doubts it will hurt Moscow’s war machine too much.

“Will that directly affect the war? Probably not. Because the Russian military runs on diesel,” he said.

“It filters through to the war in the sense that it inconveniences and bothers the Russians and reminds the Russian population that this war has a cost to them as well.”

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Two hostages shown in Hamas video – as Israel strikes high-rise building in Gaza City

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Two hostages shown in Hamas video - as Israel strikes high-rise building in Gaza City

Hamas has released a video showing two Israeli hostages, one of whom says he is being held in Gaza City, where the IDF has launched a major offensive.

Guy Gilboa-Dalal and Alon Ohel were kidnapped during the October 2023 massacre and are two of 48 captives still believed to be held by Hamas, with 20 thought to still be alive.

Israel’s Prime Minister Benjamin Netanyahu has ordered his military to occupy the whole of Gaza, with troops and armour currently assaulting Gaza City, where around a million people lived before the war broke out.

On Friday, the IDF bombed a high-rise building in the city’s west that – without providing evidence – it said was being used by Hamas. The military claimed that civilians were warned beforehand.

Pictures from Gaza City show Palestinians running for safety as the building collapses.

Guy Gilboa-Dalal (right) and Alon Ohel. Pics: Bring Them Home Now
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Guy Gilboa-Dalal (right) and Alon Ohel. Pics: Bring Them Home Now

Hostages appear in video released by Hamas

The video was edited and featured an exhausted-looking Mr Gilboa-Dalal speaking for around three-and-a-half minutes.

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He appears in a car for some of the video and says that he is being held in Gaza City along with other hostages.

He says that he is afraid of being killed by Israel’s latest assault.

The video is dated 28 August. Sky News could not independently determine the date of recording.

Palestinians inspect the site of an Israeli strike on a tent, outside al Shifa Hospital, in Gaza City. Pic: Reuters
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Palestinians inspect the site of an Israeli strike on a tent, outside al Shifa Hospital, in Gaza City. Pic: Reuters

Mr Gilboa-Dalal appears to be in the backseat of a car that is being driven around. At one point, he identifies a passing building as one belonging to the Red Cross.

Hamas has refused to allow the Red Cross to see the hostages.

At one point, Mr Ohel, 24, is also seen.

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Israeli strike hits Gaza displacement camp

Family mark ‘sign of life’

In a statement, Mr Gilboa-Dalal’s family said: “We have received a sign of life from our Guy after six months since the previous video in which he was seen with Evyatar David watching their friends being released.

“Guy, Alon, and other hostages were transferred to Gaza, and we are deeply concerned for their lives. They must be brought home.”

But talks between Israel and Hamas via mediators – aimed at stopping the fighting and freeing the hostages – collapsed in July.

After the release of the video, Israeli opposition leader Yair Lapid urged Israeli negotiators to resume talks on a deal to free the hostages.

Read more:
Anger over Israeli president’s visit to UK

A diary of daily life in Gaza

Smoke rises as a building hit by an Israeli air strike collapses in Gaza City. Pic: Reuters
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Smoke rises as a building hit by an Israeli air strike collapses in Gaza City. Pic: Reuters

Strike on high-rise building

The release of the hostage video comes as the Israeli military continues its attack on Gaza City, where residents say it bombed a high-rise tower on Friday.

The building’s management said it was being used for displaced people and denied it had been used for anything other than civilian purposes.

Footage of the strike showed the building collapsing and sending thick clouds of smoke billowing over nearby tent camps.

Father-of-two Ismail, from the city’s Sheikh Radwan neighbourhood, told Reuters that his family feared they would not be able to return if they fled.

“We pray for a ceasefire,” he said.

More than 64,000 Palestinians have been killed in the Gaza Strip since the war began, Gaza health authorities say.

The war was sparked by Hamas’ attack on Israel, when militants killed 1,200 people and took around 250 hostages.

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Lammy, Cooper and Mahmood get new jobs in major reshuffle after Rayner’s resignation

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Lammy, Cooper and Mahmood get new jobs in major reshuffle after Rayner's resignation

David Lammy has been stripped of his role as foreign secretary, and given the job of justice secretary, along with the role of deputy PM.

Mr Lammy‘s move was one of the most momentous of Sir Keir Starmer‘s ministerial reshuffle on Friday afternoon, which saw a whole host of roles change hands, and two departments partially combined.

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The PM moved him away from one of the great offices of state, despite his apparently burgeoning ‘bromance’ with US vice president JD Vance. But Mr Lammy benefited from Angela Rayner‘s departure.

David Lammy arrives in Downing Street following his appointment as deputy PM. Pic: PA
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David Lammy arrives in Downing Street following his appointment as deputy PM. Pic: PA

The deputy prime minister and housing secretary resigned from government on Friday morning, after it was found she had breached the ministerial code over her tax affairs. Sir Keir regretfully accepted her resignation, leaving her roles vacant.

Thus began the ministerial reshuffle, brought forward by several weeks as a result of Ms Rayner’s departure.

Mr Lammy has been given the role of deputy prime minister, and appeared cheery on Friday afternoon – strolling up Downing Street in the sunshine with a big smile on his face.

More on Angela Rayner

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David Lammy appointed deputy PM

His move from the Foreign Office to the Ministry of Justice then allowed Yvette Cooper, the home secretary, to take on Mr Lammy’s previous job. She has never served in any role involving foreign affairs before, bar a three-month stint as shadow foreign secretary in 2010.

Her pivot to foreign affairs then allowed the biggest promotion of them all, with then justice secretary and key Starmer ally, Shabana Mahmood, being appointed as home secretary.

This means that for the first time in British history, all three great offices of state, after the prime minister, are held by women.

Shabana Mahmood arrives at Downing Street after being appointed home secretary. Pic: PA
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Shabana Mahmood arrives at Downing Street after being appointed home secretary. Pic: PA

With those roles rejigged, and Number 10 insisting from the start that Rachel Reeves was safe as chancellor, it was time to tinker with the rest of the cabinet.

It appears that while the reshuffle was carried out unexpectedly early, a lot of thought had gone into it.

Sir Keir began by creating a new ‘super ministry’, combining the skills remit of the Department for Education with the Department for Work and Pensions.

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Cooper appointed foreign secretary

Pat McFadden, on Friday morning the chancellor of the Duchy of Lancaster (the highest ranking Cabinet Office minister), has been given responsibility for this new ministerial empire. It also means that Bridget Phillipson, who was and remains the education secretary, has had her responsibilities slimmed down.

Officially, Mr McFadden has become the work and pensions secretary. This meant the current occupant of that role, Liz Kendall, also needed to be reshuffled.

She has now been appointed as the science, innovation and technology secretary. Her predecessor in that role, Peter Kyle, in turn received a promotion to lead the Department of Business and Trade.

Peter Kyle has been promoted to business secretary
Pic: PA
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Peter Kyle has been promoted to business secretary
Pic: PA

Mr Kyle made incorporating and using AI a key part of his first year in office, and had been seen to be doing well in the job. His promotion, though, has led to the current business secretary, Jonathan Reynolds, being left without a department.

While he remains in the cabinet, his appointment to the job of chief whip is unlikely to be viewed as a promotion.

The reshuffle brought better news for Darren Jones, who was only promoted on Monday to the newly created role of chief secretary to the prime minister.

He got to keep his role, but was gifted Mr McFadden’s old job – chancellor of the Duchy of Lancaster – to add to his growing political portfolio.

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Starmer’s effort to reset govt

Read more:
Cabinet reshuffle: Who’s in and who’s out
What a moment for Shabana Mahmood
Cooper picking up the reins at a challenging time

Steve Reed, another long-time Starmer ally, benefitted alongside Mr Lammy from Ms Rayner’s departure. He has been given her former role of housing secretary, leaving behind the Department for Environment, Food and Rural Affairs.

Also ending in a better position than they started off on Friday morning are Emma Reynolds, a Treasury minister who has now received Mr Reed’s old job, and trade minister Douglas Alexander, who has now become the Scotland secretary. Sir Alan Campbell, previously chief whip, has now become leader of the House of Commons.

On the other side of the spectrum, former leader of the Commons Lucy Powell, and ex-Scotland secretary Ian Murray, joined Ms Rayner in leaving the government. Both were sacked, and both made clear their desire not to lose their roles.

Sacked ministers Lucy Powell and Ian Murray.
Pic: PA
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Sacked ministers Lucy Powell and Ian Murray.
Pic: PA

Ms Powell said it had been “an honour” to serve but warned that “the future of our democracy looks uncertain”, citing rising levels of “abuse, misrepresentation…. and the call for easy answers”.

Mr Murray also echoed this sentiment, stating that politics in the UK “is at a dangerous crossroads”. He called on MPs to bring “prosperity, hope and our communities together, rather than furthering division and despair”, and said he would support Sir Keir’s government from the backbenches.

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