How next-gen diet pills and cutting-edge hormones help the rich lose weight and live longer

When Fabiana Saba was a young model, the 5-foot, 10-inch, 100-pound stunner graced the covers of Elle and Marie Claire in her native Brazil, shared a magazine spread with Gisele Bündchen and walked the runways at fashion week in New York, Paris, Milan, Tokyo and St. Paolo with the likes of Alessandra Ambrosio — all before becoming a TV host. As she grew into adulthood, her weight rose to a still-slender 130 pounds.

But, after having two kids and enduring the first few months of the pandemic, Saba found herself in a body that no longer felt like her own. By the second half of 2020, she weighed 186 pounds and struggled with joint pain and breathing issues. 

“Like so many people, I started baking during the pandemic, and I wasn’t just eating one piece; I would eat the whole cake,” Saba, now 44 and living on New York’s Sutton Place, told The Post. The prospect of losing the weight on her own was daunting —  “I had tried many times in the past … and it never went well,” she said — so she turned to her uptown neighbor, Dr. Caroline Messer.

Messer diagnosed her with pre-diabetes and high cholesterol and prescribed her both an anti-anxiety medication and an appetite suppressant. The meds helped her drop down to 137 pounds in less than a year with relative ease. 

“Having a doctor changed everything,” gushed Saba, who remains on the medications.

The city’s rich and fabulous looking to lose weight aren’t slogging it with fad diets and Noom subscriptions. They’re spending thousands of dollars to work with Messer, a noted endocrinologist whose patients include Saudi royals, A-list stars, titans of industry, professional athletes and socialites looking to slim down and supercharge their health.

“There is definitely a trend toward seeing endocrinologists … because we have more treatments now that address hormonal imbalances that lead to weight gain,” said Messer. “A lot of people suspect they have easily measured hormonal imbalance, but it’s often something more subtle.”

The 44-year-old has had a traditional endocrinology practice on Fifth Avenue for years and she’s just opened a boutique clinic, Well By Messer, on East 60th Street that takes a holistic approach to managing metabolic issues. In addition to Messer and two other endocrinologists, it’s staffed by a psychologist, two fitness trainers and a dietician. A bariatric surgeon and pulmonologist are also available to patients.

Messer, who doesn’t take insurance but is sometimes covered as an out-of-network expense, offers an initial $900 diagnostic visit, which entails a full history and physical including a thyroid panel. She then crafts a plan with her team best suited for the patient. 

“I assess their level of activity and nutrient content, as well as whether they have a need for cognitive behavioral change,’’ said Messer, who charges $450 for follow-up appointments. Visits to other members of her team range from $80 to $600.

Often the Well by Messer plan includes medication. 

Among her popular treatments are GLP1 and GIP, replications of hormones secreted by the gut that trigger a feeling of satiety and slow digestion. The trendy new treatments — “Half the well-heeled women I see on the Upper East Side are on these hormones for weight loss, and they are working” said a Manhattan plastic surgeon — are notoriously costly. But, Messer orders them from a Canadian pharmacy, reducing the price from approximately $1,400 to $250 per month.  

Other meds in Messer’s arsenal include Contrave, an anti-depressant approved for weight loss, and methamphetamines, which have been used to shed pounds for years with mixed success.

“They have risks but are life saving for real binge-eating disorders,” Messer said. 

Marc Schwartz, the 57-year-old head of global marketing for a pharmaceutical company, turned to Messer to help avoid packing on the pandemic pounds. 

“I had a family history of diabetes, and I knew that people were sitting around and gaining weight, so I wanted to take the negativity going on around me and turn it positive,’’ the New Rochelle resident said. Messer put him on medication to lower his blood sugar, and she encouraged him to become an endurance runner.

“She really motivated me, so I had an incredible sense of joy and purpose,’’ said Schwartz, who lost 23 pounds with Messer’s help. “I went from being in danger of diabetes to normal range. Without her support I never could have done it.’’

In addition to weight loss health, Well by Messer offers luxe health extras, such as metabolic rate testing, and beauty treatments like Kybella injections to remove fat from under the chin. 

But, it’s the cutting-edge approach to trimming down that patients most often rave about. 

”I’m not walking any runways soon, but I am back to running with my kids in the park,” said Saba.   

Cutting-edge drugs endocrinologists prescribe for weight loss

Wegovy

This cutting-edge weight loss drug contains semaglutide, a hormone produced by the body to trigger feelings of fullness after eating. While it’s effective — it has been shown to reduce overall weight by 15% — it’s also expensive, costing up to $1,300 a month.

Contrave

A combination pill used to target food addiction, Contrave contains naltrexone — which has traditionally been prescribed for alcohol and drug dependence — and bupropion, an antidepressant often sold under the name Wellbutrin. It was FDA approved in 2014, but like all medications, it comes with potential side effects, including an increased risk of seizures.

Xenical

This controversial weight loss drug has also been sold under the name Alli. It works by blocking the body from absorbing some fats, but the lifestyle costs are steep: It can cause a range of nasty side effects, from flatulence to fecal incontinence.

Plenity

Think of it as a gastric bypass — in pill form. Twenty minutes before eating, dieters swallow three Plenity capsules along with 16 ounces of water. Once in the stomach, the pills release gel particles, which then expand and prevent users from eating too much by literally taking up space in the belly. It was cleared by the FDA in 2019 and costs $98 a month.

Phentermine

Remember Fen-Phen? While the former drug, fenfluramine, was taken off the market in 1997 for potentially causing heart damage, the appetite suppressant phentermine is still available. But that doesn’t mean it’s risk-free. This amphetamine-like pill can induce mania-like symptoms such as insomnia and heart palpitations.