Zepbound and Down
I haven't talked much about my recent weight loss journey, online or off, until now. When I began last year I stayed silent out of a mixture of fear of failure and judgment. Failure because much of my adult life has been spent trying and failing to lose weight and keep it off. And judgment because we're currently in a moment where using medicine to treat weight loss is very much seen as "cheating". I'm more recently becoming comfortable with talking about it all not only because I feel like I've been successful and feel confident I can maintain that success, but also because hopefully by talking it out I can demystify it for some folks and remove that sense of personal shame that for awhile I had myself.
I grew up in a house where fad diets were the norm. My father struggled all his life with weight and I have plenty of memories of the various diets he would try. Weight Watchers, Atkins, Faith First (I think that was a church-based group). I was an overweight teenager so there were times that I would join in the fad diet du jour, foregoing all carbs or going to the church group and weighing in. In college and shortly after I would try some more extreme measures like fasting and the Sri Lanka diet where you drink olive oil as an appetite suppressant (no I'm not making this up). My wife and I had a lot of success with Weight Watchers, in fact, it was the lowest I have seen myself on the scale at 188lbs, but it was short-lived as I convinced myself I could finally eat whatever I wanted and live a little since I had met my goal and well.....back up I went.
In 2016 we joined a gym and started calorie counting, later committing to running a Spartan race. I ended up getting hooked on them and ran several more along with taking up running as a hobby and doing several half-marathons. I think my weight was in the 190s at this time but I was also feeling strong. But I also discovered craft beer around this time and had a hard time finding balance. Slowly but surely the weight found its way back. I had hoped pushing myself to run a Spartan race last year would also be motivation for me to drop the weight but in reality, I just pushed through despite not being super fit or on any structured food program so that race was pretty brutal for me.
I first heard about GLP-1 medications in the Fall of 2022. I don't remember which article I read at the time but it was talking about this new wave of medications that showed so much promise some people were heralding it as "the end of obesity as we know it." I had also read they were super expensive and not likely to be covered by insurance. Sure enough, I put in a request for Wegovy and was denied by my insurance at the time since I didn't have diabetes and I believe the out-of-pocket cost was going to be $2,200/month. Gotta love healthcare in America. So I gave up on the idea almost as soon as I had it.
Meanwhile, around late Spring of 2024 my wife, who is a type 2 diabetic, was recommended to go on Mounjaro by her doctor. She asked me about it as it was apparently one of these GLP-1 antagonist drugs. Here's a short description of what GLP-1 is and what a GLP-1 antagonist does:
Glucagon-like peptide-1 (GLP-1) is a hormone released when food is eaten to slow gastric emptying, the process by which food leaves the stomach, so that the body can absorb nutrients from food. It also increases insulin release from the pancreas and controls the feeling of satiety after eating.
GLP-1 receptor agonists activate the GLP-1 receptors located in the hypothalamus in the brain, which regulates food intake. By activating these receptors, GLP-1 receptor agonists decrease the feeling of hunger and causes the patient to eat less. GLP-1 receptor agonists also bind to the GLP-1 receptors on certain neurons in the brain to decrease hunger and increase satiety. They have been shown to slow gastric emptying within the first hour of eating, resulting in the feeling of being full. Patients who use GLP-1 receptor agonists experience reduced appetite and hunger, lower preference for high calorie foods, decrease in food cravings, and better overall control of their eating habits.
https://www.endocrinologyadvisor.com/features/mechanism-of-action-glp-1-agonist/
I told my wife that I thought she should give it a shot (ha!) and she started around late May/early June. Very soon after she began taking the medicine you could tell there was a drastic change in her diet. All of a sudden she was eating much smaller portions, snacking was gone, and the only requests for fast food were coming from me and my daughter. She found that she was able to control her blood sugar with way more ease because she wasn't working against herself with what she ate. And she had begun to lose weight of course.
As happy as I was for her, I have to admit I was also really bummed out because it felt like this could be something I would have success with too, but I remembered all too well that insurance wouldn't cover it because unlike my wife I was not diabetic and I couldn't afford it without coverage. However, my wife reminded me that she had taken a new job in 2023 and we were on a different insurance plan. Although many companies were still denying GLP-1 drugs for weight loss, what harm could it do to try? Mounjaro is the pharmaceutical name for the drug tirzepatide and while it's only prescribed for diabetes, tirzepatide is sold under the name Zepbound for weight loss. While most people associate the term "Ozempic" with all the various brands I had read that studies were showing even greater results with Zepbound so I went for that. To my surprise, I was approved and got my first dose in July!
I began at a weight of 235 pounds (I think my highest recorded weigh-in was in 2022 at 249lbs, the cover image of this blog post is from around that time frame). The easiest way to describe what it was like once I started taking this medicine was the concept I had read from others of "food noise". For people who struggle with their weight, being hungry is like regular noise in your head as you consider what your next meal or snack might be. Sometimes it's completely mindless as you sit with a beer and a bag of chips and you're not even really truly hungry but just on autopilot. Within several days of starting on Zepbound, it was like all of that noise was suddenly gone, and it has never returned in the 6 months since.
I don't think anyone noticed I was losing weight until I was down about 25 pounds which took about 2 months. Even then I would only occasionally hear someone mention that they noticed I was losing weight. It wasn't until I dropped below 200 that the comments really started to ramp up. I feel like these days you can never know what people are going through and it's a bit more of a faux paux for some to mention weight loss. In fact, some would cautiously say things like "Is it for good reasons? Oh great! Well, congratulations!" If people asked me what I was doing I would truthfully say "Trying to eat less and watching what I eat, still going to the gym regularly" and leave it at that.
That has changed in the past month as I have started to settle into a maintenance routine. I'm at 171 pounds now and I don't feel like I need to lose any more weight, rather I'm working on building more muscle. The scale I use tracks body fat % and that number matters much more to me these days than total pounds. Unlike all previous attempts at losing weight, reaching this goal has not felt like an excuse to finally go crazy and start eating whatever I want. I'm still on the medicine and still doing what I've always been doing. Now when people ask me how I've lost the weight I'll honestly tell them it was a combination of medicine with a lifestyle change, but that I couldn't have done one without the other.
A natural question I get when I talk about the medicine is "Will you ever go off of it or are you going to be on it for life?" I honestly don't know the answer to that right now. Studies typically show people who go off the medicine have a higher rate of gaining the weight back, so I'm not in any rush as long as my insurance continues to cover it. If taking medicine to regulate the hormones in my body is something I have to do for the rest of my life that's a very small price to pay. I think it's unfortunate that these drugs have such a stigma around them right now. Obesity is a tricky disease because so many people believe you should just be able to work your way out of it. It's like telling someone who suffers from depression to just smile more and get out. Fatphobia is very strong around the world and if you're someone who is attempting to lose weight there's always a contingent of folks that want to tell you how you're doing it wrong. I hope as time goes on that changes. I hope the price of the drugs comes down along with the negative stigma around them. For myself personally, this medicine changed my life. It changed my wife's life dramatically too, she no longer takes Metformin or insulin shots and her A1C is at normal levels. She and I have never felt more healthy in our entire lives together and it's a real joy to experience.
