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.