A Randomized Controlled Trial Comparing the Effectiveness of Different Treatment Options for Weight Management After Discontinuation of Semaglutide and Tirzepatide (GLP1 Transition Trial)

Eligibility Criteria

• * 18 years or older
• * Previous hx of BMI of \>30 or BMI of \>27 with one or more weight related medically qualifying condition (hypertension, dyslipidemia, sleep apnea, cardiovascular disease)
• * Currently taking Wegovy, Ozempic, Mounjaro or Zepbound and have been for at least 6 months
• * At least 15% body weight loss since taking Wegovy, Ozempic, Mounjaro, or Zepbound
• * Willing to stop taking their GLP-1 medication or is discontinuing due to circumstances such as access, cost, coverage, choice, or any other reason
• * Ability to provide informed consent prior to any trial-related activities
• * Able to read and write in English
• * BMI \<26 kg/m2
• * Diabetes
• * Previous surgical obesity treatment
• * Currently pregnant or intending to become pregnant during the study
• * Not using highly effective contraception during the study period and for 3 months after
• * Breastfeeding
• * History of seizures or epilepsy
• * Current opioid use or in acute opioid withdrawal
• * Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, antiepileptic drugs
• * History of glaucoma
• * Uncontrolled hypertension
• * Severe renal impairment and/or Chronic kidney disease stage III or GFR \<60
• * Acute hepatitis or liver failure
• * Acute or chronic metabolic acidosis, including diabetic ketoacidosis
• * Use of antipsychotic medications or opiod analgesics
• * Current or previous history of anorexia or bulimia nervosa
• * Engagement with vomiting or laxative use within the last 28 days with the aim of controlling their shape or weight
• * Current SSRI, SNRI, mood stabilizer, amphetamine, or corticosteroid use
• * Current diagnosis of hyper or hypothyroidism or current use of thyroid replacement medicine
• * Current use of beta blockers
• * Current use of depo shot (medroxyprogesterone acetate) for birth control
• * Current diagnosis of Cushing's disease or syndrome
• * Current use of Monoamine Oxidase Inhibitors (MAOIs)
• * Known hypersensitivity to bupropion, naltrexone, or metformin
• * Any other reason rendering a participant unsuitable for trial participation, as determined by a clinician or study investigator