Zepbound, Starting Month 9
I am beginning my ninth month on Zepbound, and so far, I’ve lost around 35 pounds, which averages out to about a pound a week. When I started Zepbound in January, I had a BMI that was just on the edge of “morbidly obese;” now I’m solidly “obese.” I can now run for a mile on the track at the gym without stopping (well, my “run” is more like a jog that isn’t walking, and I am often passed by taller people who are fast-walking), a goal I’ve been trying to reach for a long time. I went to my doctor for a physical in June, and learned my cholesterol (which has been under control for a while with a statin) was even lower, and, more importantly, my AIC numbers went from pre-diabetic to normal. A couple of weeks ago, I went through my closet and drawers. I set aside almost all of my pants and jeans and went shopping for things that actually fit.
So, so far, so good. As I described in a bit more detail in my previous Zepbound post, I still have nausea and other tummy-trouble side effects for a day or two after I inject, and it has changed in subtle and not subtle ways the way I think about food. I’m also feeling like after nine months, I need to be a more conscious participant in the process. As I said before, Zepbound works for me because I’m not always hungry, and when I do sit down to eat a meal, I cannot physically eat as much as I used to be able to eat. That is still true. But if I want to get to my goal of being considered merely overweight, I’m going to need to lose at least another 25 pounds. That’s going to take a more conscious effort cut out even more snacks, late night treats, booze, etc.
Meanwhile, I finished listening to Johann Hari’s book Magic Pill, which is about these new drugs, and based on his research and own experiences on the meds— in his case, Ozempic. Hari is a Scottish writer/journalist whose fast-rising career in British media almost ended in 2011 when he was caught plagiarizing and fabricating huge elements of his stories. He made a comeback a few years later with a couple of books about addiction and depression, and also a couple of very well received Ted Talks.
I became familiar with Hari from his previous book, Stolen Focus: Why You Can’t Pay Attention. As the title suggests, it’s about the loss of attention and focus I think most of us sense in our day-to-day lives. Hari mostly blames cell phones and the intentionally addicting properties of social media, and also a host of other environmental and cultural factors. He presents the book as a literal journey: it starts with him traveling America with his nephew, and then Hari recounts his a solo trip to Provincetown, Massachusetts where he was on a social media detox and offline for several weeks. The rest of the book has him traveling the world, talking to various experts. All along the way and as a direct result of the previous plagiarism/fabrication scandals, he cites his work in detail, both in the notes in the book and on his website about the book.
For the most part, I agree with the arguments that Hari makes, though not everything— I think Hari goes too far with some of his claims about the dangers of social media and the causes of ADHD. But those disagreements were part of what made that book interesting. I assigned it in my first year composition and rhetoric classes last year, but that’s a different story. In short, Stolen Focus is a good and informative read. I’d recommend it.
Magic Pill is not.
Several reviews— notably this detailed take-down by Daniel Engber in The Atlantic— point out that in Magic Pill, Hari is slipping back into the sloppy journalism that got him in trouble before. He recycles many bits of past columns and books (I recognized a couple of these passages from Stolen Focus, complete with his nephew), and he significantly altered some of those stories to make them fit into this new book. He mixies up dates and places and people, and some of these errors are glaring. For example, Hari claims that a well-known British restaurant critic named Jay Rayner lost his love of food after being on Ozempic. Rayner posted on Twitter that that was “complete and utter bollocks.” The Telegraph did a deeper fact-checking dive into the book, and there are a lot of problems. In the end, as Marion Winik wrote in The Washington Post, Hari is constantly trying to create “ah-ha” moments out of things that anyone who has tried to lose weight— or merely eaten— already knows, like you eat less when you feel full.
Hari spends a lot of time mulling over the upsides of dramatic weight loss versus the downsides of yet still undetermined harms and the potential of needing to stay on these expensive medications for life. But in the closing chapter, I think he sums up what should be the decision making process for just about everyone with these medications in a couple sentences. To paraphrase: if you have a BMI higher than the low 30s (aka “obese”), you probably should consider trying these drugs. If you have a BMI lower than about 27 (which is the lower-end of “overweight”), you probably shouldn’t take these drugs.
What I did find interesting in listening to Magic Pill was his recounting of his experiences on Ozempic compared to mine on Zepbound. We’ve had similarly mild but persistent side-effects, and I too was surprised at how quickly it lowered my ability or desire to eat something like a Big Mac— though in his case, it’s fried chicken.
I also agree with the way Hari talks about BMI and when he gently critiques the concept of “health at every size.” Body Mass Index is far from an ideal system because of its lack of diversity and also its inability to distinguish between mass from muscles versus mass from fat, and because of its definition of “healthy” weight. I mean, for my height, BMI thinks I should weigh around 150 pounds, which is not a weight I’ve seen since middle school. At the same time, it’s kind of the best measure we’ve got. I of course agree that fat people should not be stigmatized or shamed or seen as failures because of their weight. But no one who is in the morbidly obese weight range should believe that there’s no correlation between weight and health, nor that the health problems of being too fat can be negated by only embracing body positivity.
But mostly, it’s about the differences. I began taking these drugs after years of being stuck at the same morbidly obese weight and because I did not want to develop type 2 diabetes and other health problems. Hari started taking Ozempic because he wanted to look better. As a side effect, I suppose, I’ve been pleased how Zepbound has also improved my appearance. Hari’s side effect was it improved his health.
Also, and I am surprised he never discusses this and it doesn’t come up in the reviews, Ozempic is a type 2 diabetes medication. Prescribing it “off-label” for weight loss has been common, but it also created shortages that made it a lot harder for people who actually need it for diabetes.
Hari describes a chaotic childhood where his Swiss father (who was also a chef at one point) angrily tried to force him to eat nutritious food and his mother and grandmother smuggled him junk food. He talks about how (before Ozempic, of course) he used to eat an entire bucket of Kentucky Fried Chicken by himself, how he used to go on these eating binges with a friend of his who was enormously fat and who died young several years before. Hari is in his early forties, and he says he has never cooked himself anything ever, and in one scene, he describes how a friend tried to teach him how to make some simple and healthy meals and how inept he was at it. And to hear him tell it, the food industry in the UK and the US are so hopelessly hell-bent on making all of us addicted to crappy food that he literally had to go to Japan to study how the richest nation with the lowest average BMI eats real food.
How much of this is exaggerated to fit the story is unclear, but as Engber wrote in that Atlantic piece, all of Hari’s “comeback” writings and books have been obsessed with “self-control and self-destruction,” which Hari argues has been brought about by his upbringing and other social factors. In other words, Hari blames this trauma, his eating disorders, and the complete lack of available health food choices for his weight. And by implication, Hari seems to think that this is how all fat people got that way.
I don’t think this is true for me. In my teens and early twenties, I was overweight. Most people in my extended family are overweight or more. But I think there were three things that really pushed me into that “morbidly obese” range: I quit smoking over 30 years ago (still the smartest thing I’ve done for my overall health, but I almost immediately gained 20 pounds); I did not take very good care of myself in graduate school; and I got older (it’s a whole lot harder to lose a few pounds in your 50s than it is in your 30s). What I’m saying is my weight gain has been slow and steady, and it wasn’t caused by trauma or an eating disorder. I think that’s how most people get fat.
Very much like Stolen Focus, Hari calls for larger societal changes to solve the problem— in this case, changes to the food industry and also in promoting (regulating?) healthier and more nutritious diets. I agree there are some things governments can do easily (calorie and ingredient information on packages and also at the fast food counter, taxes on sugary foods, etc.), and there are some things that governments might be able to do not so easily. There is a clear correspondence between obesity and income levels in the US, so doing more to get people out of poverty would help with that.
But here’s the thing: it’s not that hard to buy food from a grocery store or a restaurant that is healthy, and it is much easier to do this now than it was just a few years ago. Detroit (and other cities like it) definitely still have food desert neighborhoods, but they also have a lot of urban farming, mobile farmers markets, and, as development has come to parts of the city like midtown, so has Whole Foods and some other chains. And yes, it’s cheaper and easier to buy and prepare processed foods and junk food, but it’s not that much cheaper and easier than buying and preparing simple meals with vegetables, fish, and (less often) meat. We don’t have to go to Japan to eat like this and none of this is new information. As Michael Pollan discovered and advised us in 2008, it’s simple: eat food (by which he means not the overly processed things), not to much, mostly plants.
Here’s the other thing that Hari never talks about, nor does anyone else trying to convince us to eat healthier: besides the undeniable convenience of fast food and processed food, these manufactured and engineered and packaged “food” products are fucking delicious. I don’t know about you, but I don’t think I eat things that are bad for me just because I have “Daddy Issues” or depression or stress, or because there are few other options. I eat chocolate and doughnuts and ice cream and bacon and other clearly not good for me foods because they still give me pleasure.
The difference is with Zepbound, I just don’t eat that stuff as often.