FARGO, N.D. — Tara Morris felt she was too young to be so sick.
Once a fitness-loving police officer, the Fargo woman started gaining weight after she took a less-active job and hit her late 30s. She was on multiple medications for high blood pressure and high cholesterol. She had sleep apnea and felt tired all the time.
She had tried everything from weight-loss programs to hormone therapy, but found nothing was sustainable.
Then her provider referred her to see physician assistant Cody Baxter in 2021.
Baxter, then working for a local healthcare system, prescribed Metformin for Morris’s pre-diabetes as well as Wegovy, a version of Ozempic designed for weight loss. But he also helped her untangle the root cause of her overeating, which included “boredom eating,” or reaching for less-healthy foods after she’d had a drink or two.
Within a year, Morris dropped 75 pounds. She no longer needed blood pressure and cholesterol meds. Her sleep apnea disappeared. Her energy, confidence and lifelong love of physical fitness returned.
“I’m probably Cody’s biggest fan,” says Morris. Now 45, she has held steady at 135 pounds for 2 ½ years. “He really took me on a journey of self-discovery.”
Patients who find self-discovery and renewed health are what Baxter and co-founder/physician assistant, Stephanie Severson, hoped to see when they forged out on their own this summer. Their new practice,
Progress Weight Management,
began seeing clients in July at 3625 Lincoln St. S., Suite C, Fargo.
They offer all the services one might expect in a weight-management program: individualized nutrition and exercise plans, referrals to outside mental-health or sleep-disorder providers as needed, body scans to determine body composition and an in-depth look at a patient’s health and family history.
But they also assure their clients that obesity isn’t a moral failing, which could be eliminated simply by eating more kale and getting off the couch. It’s a chronic, complex disease, which sometimes must be treated with powerful new medications — just as medications are used for other metabolic conditions like diabetes.
“Healthy lifestyle should always be a goal, and we should emphasize and help educate patients in that regard,” Baxter says. “We also need to be realistic about factors outside our control that may make the disease severity to the point that additional interventions such as medicine or surgery are the level of support required to meet the needs of the patient.”
In fact, Severson and Baxter say one of their biggest challenges in treating patients isn’t ignorance about nutrition or exercise, but the shame that excess weight is a sign of their own weakness.
“We have to convince patients, ‘It’s not your fault,’” Baxter says. “Yes, there are always things we can improve on. But they’ll put so much of the blame on themselves with what we call internalized bias because they’ve just been hammered over the head with it. “
The providers like to show their patients
a chart from the Obesity Society
which illustrates just how complex the disease of obesity is: Research shows it is driven by a convoluted interplay of genetics, family influences, environmental factors, stress, aging, hormones and the Western world’s ready access to processed, calorie-dense convenience foods.
Left untreated, weight problems trigger so many costly and deadly health problems that the partners question why obesity treatment isn’t prioritized more often.
“So rather than waiting till someone develops high blood pressure, high cholesterol, diabetes, all these other things — and then treating them in silos — let’s treat weight first and we can reverse a lot of these chronic disease aspects,” Baxter says.
Although the American Medical Association issued a position statement in 2013 recognizing obesity as a chronic disease, Baxter says there’s still been “a tremendous amount of inertia” in the medical field to acknowledge that.
One issue, he says, is that the average provider within most healthcare systems is given just 15 to 30 minutes per patient, which isn’t enough time to unravel a complicated condition like obesity.
With their independent status, longer appointments and specialized obesity training, Baxter and Severson are better positioned to prescribe the newest and most successful
like Wegovy and Ozempic. Baxter became one of the first providers in the area to prescribe Ozempic off label when it hit the market six years ago.
Despite the expense of the drugs (some costing as much as $1,300 per month) and
shortages caused by TikTok influencers,
these GLP-1s have been game-changers for many.
Baxter believes the drugs level the playing field for patients who have numerous genetic and environmental factors stacked against them. Research shows that people who lose considerable weight purely by exercising more and eating less are “a statistical anomaly,” Baxter says. “For every one of them, there’s 20 others that are on that same hamster wheel of gaining some, losing some, getting frustrated or giving up.”
While preparing to open their practice, Severson and Baxter pursued the highest level of obesity training available for physician assistants. They completed a 60-credit-hour certification through the Obesity Medicine Association, which required completing the board-review course for the American Board of Obesity Medicine — the same exam which physicians are required to take to get board-certified in obesity, according to Baxter, who says he became interested in fitness, nutrition and health after struggling with weight as a teen.
Severson became interested in obesity issues while working in a large healthcare system. She had previously been a registered dietitian before becoming a physician assistant in gastroenterology with a specialized interest in
nonalcoholic fatty liver disease (NAFLD).
NAFLD is common in patients with obesity, Type 2 diabetes, high cholesterol and insulin resistance.
But Severson had grown frustrated with the advice she was expected to give NAFLD patients. “The training I got … was like, if a patient comes in, you diagnose them with fatty liver, tell them they should lose 5% of their body weight and send them on their way,” she says.“I wasn’t getting training like, this is how you help them, this is what you do.”
She reached out to Baxter, who was becoming known as an obesity specialist, to see if he could recommend more helpful treatment. He steered her toward the new medications.
Severson became even more convinced after seeing how the medications reduced liver damage. In several cases, her patients had stage 3 fibrosis (stage 4 is considered irreversible cirrhosis). After the patients had been on the GLP-1s for a year, Severson conducted scans of their livers and found liver damage had disappeared. Her colleagues were so skeptical that Severson ran a second scan. “It was still stage zero fibrosis,” she says.
The GLP-1 medication known as semaglutide (Ozempric) is now in late-stage trials to be approved specifically for fatty liver disease, which would make it the first FDA-approved medication for that condition, Baxter says.
As she and Baxter continued seeing how their medication and treatment philosophies aligned, they agreed to start a practice together.
GLP-1s, technically known as GLP-1 receptor agonists, are medications that mimic the action of a naturally occurring hormone in the gut called glucagon-like peptide 1.
But while the natural hormone lasts just minutes in the system, these drugs are engineered to last much longer. In the process, the drugs help regulate blood sugar, slow emptying of the stomach and make people feel “full” sooner.
Users say they also reduce “food noise,” or mental preoccupation with food, Severson says.
Examples of this class of drugs are
semaglutide (better known as Ozempric and Wegovy)
and liraglutide (Saxenda).
Related drugs like
have upped the ante by not only mimicking GLP-1, but also a second gastrointestinal hormone. Baxter says this Eli Lilly drug is reported to be even more effective at silencing “food noise.”
Studies found people using semaglutide and making lifestyle changes lost about 33.7 pounds vs. 5.7 pounds in those who made lifestyle changes alone, according to the Mayo Clinic.
But these medications aren’t for everyone.
Common side effects are nausea, vomiting and diarrhea, which typically lessen as the body adjusts to the drugs, Baxter says.
Low blood sugar levels can also be a danger with GLP-1s, especially for patients also taking drugs to lower blood sugar.
People with pancreatitis shouldn’t take them.
The drugs also contain a “black box warning” — the FDA’s most stringent warning — that they shouldn’t be used by anyone who has a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia, as lab studies have linked the medications to thyroid tumors in rats, according to Mayo Clinic.
And if people want to keep the weight off, they typically must keep taking the drugs, Baxter says.
The high price of losing weight
But the biggest barrier might be price. Without insurance coverage, the injectable drug can cost up to $1,300 a month.
Even so, Baxter says only one person in his current caseload pays full price for their medication. He says most major carriers, with the exception of one, will pay for obesity treatment if the person has a body mass index of 30 or higher, which meets the medical criteria for anti-obesity treatment.
If a person has a BMI of 27 to 29, they sometimes qualify if they also have a weight-related health condition such as diabetes or hypertension, he says.
As evidence of GLP-1 effectiveness mounts, drug manufacturers are lobbying to allow Medicare coverage.
A bipartisan group of lawmakers has introduced
the Treat and Reduce Obesity Act
, which would authorize Part D coverage of medications when used for the treatment of obesity or weight-loss in overweight individuals with related comorbidities, according to KFF, an independent source for health policy research.
A recent study estimated if 10% of Medicare beneficiaries with obesity use Wegovy, the annual cost to Medicare could be $13.6 billion to $26.8 billion, according to KFF.
But others argue that treating obesity effectively could save Medicare billions long-term. Researchers wrote in
a 2023 paper
that Medicare could save $176 billion in medical costs over 10 years, driven by fewer hospitalizations, surgeries and doctors’ visits, according to Business Insider.
Medication alone not the answer
The drugs seem to yield the best results when combined with personalized coaching, nutrition education and other tools, according to Calibrate, a weight-loss program which uses GLP-1s.
In fact, Baxter says they would love to add a mental-health professional to the team and to possibly even add gym facilities for people who are intimidated by working out publicly.
Severson says the importance of nutrition, physical activity and lifestyle can’t be overstated — but needs to be personalized for each person.
“We really pride ourselves that we don’t have a cookie-cutter approach because the same diet and the same plan is not going to fit the same person, right? I tell pretty much all my patients, ‘I do not want to put you on a diet. I want to give you nutrition advice that is sustainable and will help you make lifelong changes.’”
Even in cases where people aren’t ready to change behavior, Baxter believes they deserve help.
“We don’t withhold COPD meds or cancer treatments from people who smoke,” he says. “And oftentimes, the behaviors/habits improve once the medication addresses the underlying biological dysfunction that is contributing to the suboptimal behavior. Our job as medical providers is never to judge, but to advise and offer all appropriate treatments regardless of where the patient is at in their journey.”
Learn more by calling 701-532-2458 or at