Zepbound, Starting Month 5

As I’ve mentioned before, I started the weight loss drug Zepbound on January 7. As I’ve also mentioned, I’ve had some ups and downs, and also some things to say about Oprah. Now and about 20 weeks later, I’ve lost just over 20 pounds. Here are some thoughts on all that:

Zepbound (and this is true with similar products) is a medication where you step up on the dosage over time. So I started in January with 2.5 mg a week, and I have just started 15 mg, which is the maximum dose. It’s a once a week injection that’s delivered with a pen device– it is a barely noticeable little shot. I’m feeling lucky I was able to get this latest dose because there have been a lot of shortages and I was preparing to be off Zepbound for a while. But the pharmacy came through and I have the meds– for at least another month.

My overall weight loss goal is to get to a weight where, according to BMI, I would be still considered “overweight.” Roughly speaking, that’d be around 60 pounds from where I started. I’m a little disappointed that I’ve only been losing about a pound a week, though it’s probably healthier to lose at a somewhat slow rate. Anyway, I feel like I’ve gotten a good start and I also feel like I’ve got a long ways to go.

What does Zepbound do for me? I will occasionally read about different folks’ experiences on these drugs (like Wegovy, and to a lesser extent, Ozempic) on Reddit and Facebook, and it’s quite clear that there are some common experiences and side effects, along with a lot of individual differences. For me, the reason why this medication is working is not complicated: I’m not as hungry as I used to be, and when I do sit down to eat a meal, I don’t eat as much as I used to eat. That’s it.

The drug also has a psychological effect as well, and that’s much harder for me to explain. Some of what I’ve read talks about how these drugs help people deal with “food noise,” which is the “internal chatter” about food. Since food (cooking it, baking it, eating it, reading/writing about it) is still one of my main hobbies, I still have what I would describe as an internal food “dialog.”

But that internal food dialog/chatter has changed. I’m not following a “diet” like South Beach or Weight Watchers or whatever, but I do find myself eating less junky food and more “real” food. I still have cravings for doughnuts or steak or burgers, sure, and I’ll still eat those things sometimes. But instead of going through a McDonalds drive-through on a busy day and getting a quarter-pounder or a Big Mac, now I either skip it or I’ll get a regular-sized cheeseburger, which is now plenty for me. I’ve been cooking more vegetarian, and I’ve been eating a lot less bread without thinking about it much. I’ll still have an occasional dessert kind of treat too late at night, but not as often. I’ve met skinny people who tell me that sometimes, they’ll just forget to eat all day. I still cannot relate to that quite yet, but it is a lot easier to just say no, if that makes sense.

I think the thing about these drugs is that they work extremely well, but you do have to want to lose weight. It’s a drug that makes me feel less hungry, but as my family will often joke, “I’m not hungry, but I could eat.” The same is true with this stuff. Though one difference is if I did try to eat all of a full-on “Super Size” me kind of Big Mac meal, I’d probably puke (more on that in a moment).

Some people on these drugs also report giving up or reducing other “vices.” A lot of people talk about stopping drinking, for example, but there are also stories about people who started these meds for weight loss and they stopped gambling or binge shopping or some other bad behavior. For better or worse, my vices are about the same.

There are also some well-publicized downsides to Zepbound et. al. First off, it’s expensive as shit, and the only reason I am able to do this at all is my insurance covers most of it (I pay $25 a month). This is one of the major perks of working for the government: good benefits.

Second, there are the digestive system/GI tract side effects, which, for some people, can be severe. A not small percentage of people start one of these drugs but then stop because of vomiting or diarrhea, not to mention more rare but possible side effects. For me (possibly TMI), the side effects are unpleasant, especially the day after I inject a dose, but tolerable. I get a lot indigestion, nausea, and (oddly) burping, and not exactly constipation but things have “slowed down,” if that makes sense. I deal with all this with a lot more fiber and various antacid products. I also am much more thirsty and I find myself drinking a tremendous amount of water, which also cuts down on the tummy trouble.

But other than the side effects, I feel pretty good. After I lost about a dozen pounds, I started to realize how much easier it was for me to exercise than it was before losing the weight. Maybe that’s just obvious, but it never occurred to me that the fatter you are, the harder it is to exercise. I’ll be curious to see how that keeps changing as I (hopefully) keep losing. I don’t think anyone has noticed my weight loss yet (or maybe they just aren’t saying anything), but I can tell every time I put on clothes. The jeans I have that were kind of snug before I started losing weight are now kind of baggy, and there are a few things I had that were too small that now fit.

So as long as I can still get my prescription refilled…

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