Oh-Oh-Oh, Oprah! (and Zepbound, Month 2)

Before I get to Oprah (and I intended that headline be sung to the tune of “Oh-oh-oh, Ozempic!”): my second month on Zepbound has been disappointing. In the first month, I lost a little over seven pounds on the “starter” dose of 2.5 mg weekly. Like all the other similar weight loss injectables on the market, the dose increases (with Zepbound, every month) until you reach the maximum dose (in this case 15 mg). So given that I lost about seven pounds with the lowest dose of this stuff, I assumed I’d continue to lose at about the same rate.

Well, not so much; instead, I stalled. My weight jumped around a bit so that at one point this past month, I was down another two pounds (for a total of nine), then I ended up gaining a pound or two, then losing again, etc. A month later, I’m where I was after month one. This is a bummer, especially since there are are lots of people in Reddit forums and the like posting about losing 20 pounds in the first month or two. Of course, besides the fact that the anonymous posts in discussion boards aren’t exactly peer reviewed, it seems like a lot of the people claiming these huge losses also have a lot more weight to lose.

But there is some good news. For one thing, I’ve got a long ways to go to get to the maximum dose– or whatever dose I land on as being the right dose. In the discussions, a lot of people talk about staying on a lower dose than longer, and that’s especially true for folks who have had a hard time with the side effects. Plus I’ve stalled but not bounced back up to where I started, which was what usually happens when I try to just “diet and exercise.” So I’m looking forward to see what happens when I ramp up from 5 mg to 7.5 mg.

Anyway, about Oprah:

As was reported in numerous sources the other day, O and Weight Watchers have decided to part ways. The New York Times (like this story) and similar outlets reported this was an “amicable” split. “‘Her decision was not the result of any disagreement with the company on any matter relating to the company’s operations, policies or practices,’ WeightWatchers said in the filing.” Also, she’s not profiting from selling her stock: “The company said in the statement that Ms. Winfrey would donate the value of her holdings in WeightWatchers to the National Museum of African American History and Culture in Washington in part to ‘eliminate any perceived conflict of interest around her taking weight loss medications.'” In other words, the story that both Oprah and Weight Watchers want to tell is this is just one of those things, we’re all happy about this, let’s let bygones be bygones, etc.

This could all very well be true. But it doesn’t take much picking at this to make me think this isn’t the whole story.

I have some personal experience with Weight Watchers, believe it or not. I can’t remember exactly when this was (maybe the late 2000s? the early 2010s?), but for about three or four years, I was a dues-paying member. I joined up with Annette, who, maybe 35 years ago and before we met, was on Weight Watchers and successfully reached her goal weight– which is to say it did work for her, at least at one point. The whole premise and purpose of Weight Watchers back then was quite straight-forward: eat less and maybe kinda/sorta exercise. The support meetings were mostly people talking about the challenges of dieting, along with celebrating the successes that some folks had, and perhaps a little shaming for the folks who weren’t as successful. For me, it didn’t work because success on Weight Watchers (at least back then) hinged on fastidiously keeping track of everything you ate with a system of points, and I’m just too lazy to do that. I’m pretty sure that when I stopped going to meetings, I was at the same weight as when I started.

Like I said, I don’t remember exactly when this was, but I do know it was before 2015. That’s when Oprah bought a 10% stake in what was already becoming a less profitable company. Her investment got her a seat on the board, and she became the primary public face/spokesperson for the company. That’s also when Weight Watchers started to rebrand itself as the more abstract WW. Instead of being all in on limiting calories, WW tried to pivot become a more “body positivity/acceptance” and healthy lifestyle kind of enterprise. They focused a lot more on exercise, a new line of WW cook books and new recipes (remember cauliflower crust pizza?) and food products, and more emphasis on apps for tracking food and online discussions, and a lot less emphasis on f2f meetings. For a while, this seemed to help the company. According to this May 2018 article in Money, Oprah’s $43.5 million investment ballooned quickly to more than $400 million. Sometime in 2018, she sold $110 million worth of her stock, and she also donated to her charitable foundation another $22.6 million from stock.

There’s nothing wrong with someone making a lot of money from what turned out to be a smart investment, so kudos to Oprah, at least back in 2018. But after reaching a high price mark of $101 a share in June 2018, the stock fell to $17.70 a share in April 2019. WW shares bounced up and down like a yo-yo dieter for a few years until falling even further by 2022. The day after Oprah announced she and WW were parting ways, the stock was $3.30 a share. In other words, that donation to eliminate any “perceived conflict of interest around her taking weight loss medications” is just a tax write-off.

Oprah has also significantly changed her story about weight loss medications. Back in September 2023, Oprah hosted a panel discussion for Oprah Daily (which is a subscription-based website of all things O) called “The Life You Want Class: The State of Weight.” It featured Oprah and a panel of experts on obesity and weight loss, and for the most part, the emphasis was on characterizing obesity as a disease, not about “willpower” per say, and also on body acceptance. But as People reported back then, when the discussion turned to Ozempic and similar drugs, Oprah was resistant:

“Shouldn’t we all just be more accepting of whatever body you choose to be in? That should be your choice,” Winfrey said during the panel. “Even when I first started hearing about the weight loss drugs, at the same time I was going through knee surgery, and I felt, ‘I’ve got to do this on my own.’ Because if I take the drug, that’s the easy way out.'”

In the same discussion, Oprah went on to explain that when she had surgery on both of her knees, she specifically decided against using any weight loss drugs, instead sticking to diet and a lot of hiking as exercise. It’s worth noting that as soon as Oprah said the drugs were the “easy way out,” the other panel members jumped in to emphasize that we need to think of obesity as a disease, it’s not about willpower, and so forth.

Still, the “mixed messages” from Oprah was problematic, particularly in terms of Weight Watchers’ (oops, I mean WW’s) efforts to get into the semaglutide and tirzepatide business themselves. As this little video snippet from Yahoo! finance makes clear, the only positive moment in Weight Watcher’s stock price in the previous year was the announcement that they were going to start offering these meds along with diet, exercise, and lifestyle. So for the company’s most famous stake holder, board member, spokesperson, and (for many WW customers) most inspirational persona to be skeptical of these new drugs was not the company line.

The other thing is Oprah was pretty explicit at this event that she had not herself taken Ozempic or similar drugs. As recent as early November, the “secret” to Oprah’s latest weight loss was being reported as being about following the WW diet and exercise. But by December, Oprah admitted she had been using these meds, but she still has not said what drug she’s been taking and when she started taking these drugs, and she describes the meds as weight “management” (rather than a weight loss) tool.

I have no doubt that Oprah did lose a lot of weight with the dieting and exercise she did after her knee surgeries a couple years ago. But I also have to think that she started whatever drug she’s on earlier than November– maybe even while she was claiming that taking a drug was the easy way out. In the stories back in December— when she first revealed she had been taking meds– she spoke about how she had “released the shame about it.” I suppose that means the shame of being overweight in the first place, but I also wonder if she was “releasing shame” about lying about being on these drugs.

I suppose Oprah had to bail on WW in part because of the story of her own weight gains and losses– an aspect of her celebrity image she’s cultivated for decades. After resisting them, Oprah seems to now recognize that these drugs do make a difference that simply cannot be matched by diet and exercise alone. That’s a pretty big shift from the story she’s been selling with WW as the weight loss plan where you can eat what you want and not being on a diet, including eating lots of bread.

But ultimately, business is business. Oprah cashed out of WW a long time ago, and at this stage, she’s leaving a sinking ship.

Zepbound, Month 1

A while  back, a Facebook “friend” (which is to say not so much a friend friend, but someone I know well enough from the academic world that I’ll talk with when I see him in person at a conference or something every few years) posted that he needed to lose 40 pounds and he was looking for suggestions. A lot of folks posted a lot of ideas, some of whom were also “friends” from academia who are very fit and athletic, competing in marathons and the like. All the advice boiled down to diet and exercise.

“Wait, in order to lose weight, I should eat less and exercise!?! Why, I never thought of that!” said every fat person in the world in their most sarcastic “this is just the way I talk” voice.

I wrote “Here’s what will be an unpopular suggestion: try drugs.” Which is what I’m currently doing.

Let me back up a bit:

I’m fat. I am not so fat that I need the seat belt expander on an airplane or I need to go to a special store to buy clothes, but I’m right on the edge of that level of fat. I should lose more than 40 pounds. To the extent that a Body Mass Index number matters, mine is in the high 30s. This puts me in the category of not just “obese” but on the edge of “morbidly obese.” It’s been like this for a long time.

I have of course tried many different diets and approaches, including Weight Watchers for a few years, but nothing has worked for long. For quite a while now, I’ve been completely locked into the same weight, plus or minus about 5 pounds: I’ll try something new and lose a bit, then plateau, and then gain it back. This has happened again and again and again.

So I gave up, and instead I try my best to be the healthiest fat person I can be. I go to the gym a few times a week, I try to eat mostly healthy foods (though I often fail), I stay on top of my various numbers with regular doctor visits, and I live with it. And for the most part, I’m at peace with that: I’ve been at least “overweight” since I was a kid so it’s not that big of a deal.

Still, I know I need to lose weight. After all, it is called morbid obesity.

About this time last year, I started hearing and reading things about Ozemspic, Wegovy, and similar drugs. The piece that peaked my interest most was Jia Tolentino’s New Yorker March 2023 article “Will the Ozemspic Era Change Howe We Thing About Being Fat and Being Thin?” Specifically, it was this paragraph:

The drugs mimic a hormone called glucagon-like peptide-1, which stimulates insulin production and suppresses the production of glucagon, which raises blood sugar. The body naturally releases GLP-1 after a meal, and the hormone travels to the brain, triggering the feeling of fullness. GLP-1 drugs effectively inject that sense of satiety, and also slow the rate at which food empties out of the stomach; patients generally report a freedom from cravings and an inability to overeat without becoming ill. “I’m convinced that this basically replaced a signal my body has been missing my whole life,” a commenter in a Reddit group for people using semaglutide wrote recently. “All I can say,” a member of an online group called Lose the Fat wrote, “is that it is no wonder that skinny people think heavy people have no willpower. Their brains actually do tell them to stop eating. I had no idea.”

This really really hit home for me. I remember talking about constantly feeling hungry in Weight Watcher meetings, but the only solution offered was willpower. For me, that works for a day or two, tops– thus my being stuck at my current weight for over a decade.

So when I went to see my doctor for a check-up and routine tests last spring, I said I’d like to give one of these Ozemspic-like drugs a try. Here I need to acknowledge the privilege and good luck I have in this situation. First, my doctor, who had never brought up weight loss in previous visits, said that she thought I’d be a good candidate for one of these drugs. When you look at the discussion forums about weight loss drugs, it’s easy to find someone talking about having a doctor who refused to prescribe anything. Second, I have very good health insurance through my employer that covers these drugs, with a $25 a month co-pay. There’s no way I’d pay out of pocket for this stuff because it costs around $1000 a month.

She put me on Saxenda, which is less effective than Wegovy and some of the other drugs out last year, but she said it was more available at pharmacies. Ozemspic was not an option because I’m not diabetic and she wasn’t willing to do that kind of off-label prescription– plus Ozemspic was (and I believe still is) in short supply. So after a couple of months of unfortunate events and delays (it’s a long story), I started Saxenda in late July. I was on it for about five weeks and I lost about six pounds– and then the supply dried up.

I went back to my doctor who was apologetic about the shortages, which are largely the result of the drug companies not being prepared for the enormous demand. She said that I must be disappointed, but actually, not really. Oh sure, I wish I could have continued on the meds because it was clearly working. I lost weight because I wasn’t hungry all the time, and thus I did not need to eat as much to feel full.

So for me, that experience on Saxenda was proof of concept. This shit might work for me– eventually, once the supply came back.

All through the fall and into December, I kept trying to find either Saxenda or Wegovy with no luck. Meanwhile in the fall/early winter, another one of these medications was approved by the FDA for weight loss, Zepbound. This one, which (IMO) has the best name, is similar to Eli Lilly’s diabetes drug Mounjaro, and the research I’ve seen so far suggests it’s the most effective weight loss drug like this on the market so far. On average, people on this stuff lose around 22% of their body weight within 16 months. Do the math on your weight– that’s a lot.  This perhaps explains why Zepbound is being projected to be the best selling prescription drug of all time.

Anyway, I happened to be in Costco in early January and I asked at the pharmacy if they had Wegovy or Zepbound in stock. I didn’t think they would (and they didn’t have Wegovy), but it turned out they were having no problems getting Zepbound. So I started it on January 7, and, without going into all of the details (maybe I’ll get into that in the future), so far, so good. I’m at the end of week 4 and I’ve lost about seven and a half pounds– not bad for about 30 days. I just do not feel hungry and I also don’t need to eat as much to feel full.  Plus I have now already secured another two months supply, which means I have enough to (hopefully) see some significant results.

One of the folks on that Facebook post I mentioned responded to my comment about “try drugs” by saying something like “Sure, but then you have to stay on those drugs the rest of your life.” First off, check back with me in a year or two on that. The likelihood of regaining weight is somewhat debatable, and there are maintenance levels of these drugs as well. Second, we’re just at the beginning of these medications. There are a dozen similar meds being developed, and that’s going to eventually bring down the costs and make them easier to take (potentially not as an injectable, for example). And third, the same is also true with the meds I take (along with zillions of other people, of course) for cholesterol and blood pressure– or meds for diabetes, which I am trying to avoid. The first thing my doctors told me before I started meds for blood pressure and cholesterol was “diet and exercise,” but they still prescribed drugs. And of course taking Zepbound might mean that I’ll eventually be able to get off of the other meds.

So we’ll see what happens.