Obesity treatment (not covered by NHI)

Obesity treatment (not covered by NHI)

Our clinic offers obesity treatment with Mounjaro (not covered by NHI) for those with a BMI of 25 or higher who have struggled to achieve weight loss through diet and exercise or who have limitations on physical activity due to pain in their limbs or trunk, or conditions affecting the heart or lungs.

We do not offer treatment for weight loss solely for cosmetic purposes. Therefore, treatment is generally not provided to individuals with a BMI below 25 at the start of treatment.

At the moment, we offer this treatment only to patients currently receiving treatment at our clinic for lifestyle-related diseases, rheumatic conditions, etc.

What is tirzepatide / Mounjaro / Zepbound ?

Tirzepatide (generic name) was originally developed as a treatment for type 2 diabetes (administered via a weekly subcutaneous injection). It was approved by the U.S. Food and Drug Administration (FDA) on May 13, 2022, and in Japan on September 26, 2022, and has been widely used by patients with diabetes. Due to its appetite-suppressing and weight-loss effects, tirzepatice has also gained attention as an obesity treatment. In the U.S., it was approved as an obesity treatment under the brand name Zepbound by the FDA on November 8, 2023, for individuals with a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related condition such as hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea, or cardiovascular disease.

Tirzepatide works by binding to and activating the receptors of two hormones, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), improving blood sugar control by stimulating insulin secretion in response to blood sugar levels. It also suppresses appetite and caloric intake, leading to weight loss. This effect is believed to be primarily due to its influence on brain regions that control hunger and satiety signals, reducing the feeling of hunger and slowing the movement of food from the stomach to the intestines, thereby prolonging the feeling of fullness. It is also believed that tirzepatide achieves weight loss via a slight but significant increase in energy expenditure (fat burning) (Mol Metab 2018;18:3–14).

The most common side effects of tirzepatide include gastrointestinal symptoms such as nausea, vomiting, diarrhea, and constipation, experienced by about 30% of patients, especially in the early stages of treatment. Additionally, as with other medications acting on GLP-1 receptors, there is a reported increase (1.3~1.5 times) in the risk of acute biliary diseases (cholecystitis, cholangitis). As tirzepatide is the first medication to act on both GLP-1 and GIP receptors, its long-term safety data are still being accumulated.

Not covered by NHI

Although Mounjaro is approved as an obesity treatment under the brand name Zepbound in the U.S., it has not yet been approved for obesity treatment in Japan, thus it is not covered by National Health Insurance (NHI) and falls under “self-pay services” in which all costs (100%) are borne by the patient.

As mentioned above, tirzepatide has already been approved in the United States as an anti-obesity medication under the brand name Zepbound. Following this, Japan also approved Zepbound as a treatment for obesity on December 27, 2024. In the coming months, its official drug price will be determined, and it will become available for NHI-covered treatment at approved medical institutions for eligible patients.

However, similar to semaglutide, which has already been approved in Japan both as a diabetes medication (Ozempic) and an anti-obesity drug (Wegovy), the prescription of Zepbound under NHI is expected to be limited to certain medical institutions that meet strict facility criteria. It is anticipated that only university hospitals and large general hospitals will be permitted to prescribe it under NHI.

Under the circumstance, with the strong passion to assist individuals with a BMI of 25 or higher who have struggled to achieve weight loss through diet and exercise or who have limitations on physical activity due to pain in their limbs or trunk, or conditions affecting the heart or lungs, our clinic currently offers tirzepatide (Mounjaro is the only available option for purchase at clinics) as a self-pay (non-insurance) treatment option.

At our clinic, we do not encourage or solicit patients to undergo self-pay services, including tirzepatide (Mounjaro). If you are interested in obesity treatment with tirzepatide, please feel free to contact us. Below are the details of Mounjaro-based obesity treatment at our clinic.

Obesity Treatment with Mounjaro at Our Clinic

Our goal is to assist individuals with a BMI of 25 or higher who have struggled to achieve weight loss through diet and exercise or who have limitations on physical activity due to pain in their limbs or trunk, or conditions affecting the heart or lungs. We do not offer treatment for weight loss solely for cosmetic purposes. Therefore, treatment is generally not provided to individuals with a BMI below 25 at the start of treatment.

Furthermore, if a patient’s BMI drops below 25 during treatment, prescriptions will be limited to what is necessary to maintain a healthy BMI. To avoid health issues caused by the treatment, blood tests and examinations are mandatory before starting treatment and regularly thereafter (after the first 4 treatments, then every 12 treatments). Results from tests conducted at other medical institutions within a certain period can be shared as a substitute.

Initial Visit Includes:

• Physical measurements (height, weight, waist circumference)
• Medical interview
• Physical examination
• Blood tests (CBC, HbA1c, blood sugar, liver function, kidney function, pancreatic enzymes)

The initial prescription is limited to 4 pens for safety reasons, and up to 8 pens for subsequent prescriptions if clinically appropriate.

After the first 4 treatments, and every 12 treatments thereafter if treatment continues, the same blood tests as before starting will be conducted. Results from recent tests at other medical institutions can substitute for the tests at our clinic.

The initial consultation is generally conducted in person, but follow-up consultations can be conducted online if no blood tests are required.

Fees:

• Initial consultation: 3,000 yen (including tax) for both in-person and online
• Follow-up consultation: 1,000 yen (including tax) for both in-person and online
• Test fees (blood tests, height, and weight measurement): 4,800 yen (including tax)
• Mounjaro 2.5 mg pen (each): 4,800 yen (including tax)
• Mounjaro 5 mg pen (each): 6,800 yen (including tax)
• Mounjaro 10 mg pen (each): 11,500 yen (including tax)
• Shipping fee (for online consultations): 2,000 yen (including tax)
• Communication fee (for online consultations): 1,000 yen (including tax)

Sample treatment flow

If 2.5 mg is sufficient for weight loss:

First Visit (in-person):
Initial consultation fee + test fee + 2 Mounjaro 2.5 mg pens
Total: 17,400 yen

Second Visit (2 weeks later, online):
Follow-up consultation fee + 2 Mounjaro 2.5 mg pens + shipping fee + communication fee
Total: 13,600 yen

Third Visit (2 weeks later, in-person):
Follow-up consultation fee + test fee + 4 Mounjaro 2.5 mg pens
Total: 25,000 yen

Fourth Visit (4 weeks later, online):
Follow-up consultation fee + 4 Mounjaro 2.5 mg pens + shipping fee + communication fee
Total: 23,200 yen

Fifth Visit (4 weeks later, online):
Follow-up consultation fee + 4 Mounjaro 2.5 mg pens + shipping fee + communication fee
Total: 23,200 yen

Sixth Visit (4 weeks later, in-person):
Follow-up consultation fee + test fee + 4 Mounjaro 2.5 mg pens
Total: 25,000 yen

If 2.5 mg is insufficient, and increased to 5 mg:

First Visit (in-person):
Initial consultation fee + test fee + 2 Mounjaro 2.5 mg pens
Total: 17,400 yen

Second Visit (2 weeks later, online):
Follow-up consultation fee + 2 Mounjaro 2.5 mg pens + shipping fee + communication fee
Total: 13,600 yen

Third Visit (2 weeks later, in-person):
Follow-up consultation fee + test fee + 4 Mounjaro 5 mg pens
Total: 33,000 yen

Fourth Visit (4 weeks later, online):
Follow-up consultation fee + 4 Mounjaro 5 mg pens + shipping fee + communication fee
Total: 31,200 yen

Fifth Visit (4 weeks later, online):
Follow-up consultation fee + 4 Mounjaro 5 mg pens + shipping fee + communication fee
Total: 31,200 yen

Sixth Visit (4 weeks later, in-person):
Follow-up consultation fee + test fee + 4 Mounjaro 5 mg pens
Total: 33,000 yen