Category: Zepbound

I’ve now been on Zepbound for 70 weeks, and I was just looking over my notes on my progress over that time.¹ For the first 35 weeks, I was losing about a pound a week and without thinking about it much. I didn’t exercise or diet more than usual (though I did and still do exercise and watch what I eat); I just wasn’t as hungry and so I didn’t eat as much.

Since week 35 (which was September 2024), I’ve lost just shy of eight more pounds– about 3 more pounds since the last time I wrote here about this— for a total of around 42-43 pounds. So on the one hand, I haven’t completely plateaued in my weight loss progress, and at least I am still heading in the right direction. Plus even with the stall, I’m still a lot less fat (and more healthy) than I was before I lost the weight– and at least I haven’t gained it back (yet). On the other hand, I ain’t going to get to my goal, which means losing about another 17-20 pounds, with Zepbound alone.

Obviously, that means I need to start doing something closer to acutally dieting and exercising more– or at least I need to shake up the routine/rut, and I’ll be doing that for the next month. Annette and I are going on a month long trip through Europe starting next week as part of a celebration of our 31st wedding anniversary, a trip that was delayed by a year because we decided to buy a new house. I won’t be dieting, and because it will not be easy to refrigerate Zepbound as we go from place to place, I’ll have to skip a week of dosing at the end of the trip.² Still, I’m not worried because on trips like this that involve a lot of walking around, I almost never gain weight.

But enough about me (or just me). There’s been some interesting Zepbound news in the last couple of months. A few highlights:

• Access to Zepbound and similar weight loss drugs remains a significant problem. There was an article about this in The New York Times back in December, and how several other state’s biggest insurers have cut back on coverage. My insurance still covers it, but they have added additional hoops I need to jump through for me to get the drugs.
• One of the other ways that access has been reduced is new restrictions of compound pharmacy and other “knock-off” versions of these drugs. Basically, because these drugs are no longer in short supply from manufacturers, companies that make their own version of Zepbound (and there are a lot of companies like this) can no longer sell their own versions. The drug manufacturers and companies like Ro have been making deals to make the drugs a little less expensive, but they’re still expensive. I’m just happy that I don’t have to decide if it would be worth the $700 or so it would cost me a month out of pocket (and honestly, it might be).
• Still, there’s a lot of optimism about the near future of these drugs. Eli Lilly Chief Scientific Officer Dan Skovronsky gave an interview on CNBC where he talked about a daily pill as effective as a weekly injection will be available soon (maybe by the end of the year), stronger versions of these drugs, and also using these drugs for lots of stuff besides weight loss specifically: heart disease, sleep apnea, and maybe other things like addiction. Sure, this guy is trying to sell Eli Lilly drugs, but there are a lot of articles out there reporting similar things.
• Just a few days ago, there was this article in The New York Times, “Group Dining on Ozempic? It’s Complicated,” which is about the social etiquette of being on a GLP-1 drug and out to eat with others where you don’t eat that much. I am obviously not shy about the fact that I’m taking Zepbound, so when I’m eating with others at a restaurant or at a dinner party, I just tell people it’s the drugs. Annette and I went to a breakfast diner place in Detroit in April, and I ordered what turned out to be an enormous skillet of eggs, hash browns, sausage, and peppers and onions. It was delicious, but I could barely eat half. When the waitress came away to clear our plates, she seemed concerned that I might not have liked it. “No, it’s great– it’s just I’m taking one of those weight loss drugs and I can’t eat more.” “Oh yeah?” she said. “How’s it going? I have a cousin of mine who is on one of those things and has last 50 pounds.” So at least she understood.
• And then there was the recent news that Weight Watchers (aka WW International) was going bankrupt largely as a result of people shifting to drug alternatives instead. I saw this op-ed in The New York Times on the mixed messages of Weight Watchers, “Weight Watchers Got One Thing Very Right” by Jennifer Weiner. On the one hand, Weiner points out a lot of the dieting culture promoted by Weight Watchers was harmful. A lot of mothers took their slightly overweight but still growing/developing daughters to Weight Watchers too early, and a lot of their customers never succeeded and yet kept coming back, “stuck in a cycle of loss, regain and shame that didn’t ultimately leave them any thinner, even as it fattened Weight Watchers’ coffers.” On the other hand, Weiner says Weight Watchers provided its customers– especially women– a sense of community at what were (pre-Covid, of course) regular meetings. They were safe “third spaces,” a gathering that was one of the “all-too-rare places in America where conservatives and progressives found themselves sitting side by side, commiserating about the same plateaus or the same frustrations or the same annoyance that the power that be had changed the point value of avocados, again.”

I’ve written about this before, but I actually was Weight Watchers member and attended meetings (with my wife) for about three years in I believe the early 2010s. The regular meeting we attended was similar to what Weiner describes. It was at a WW storefront center in a strip mall located right next to a Chinese restaurant. Whenever I went, I always peed right before weighing in, anxious to cut every possible ounce. Then there’d be a meeting that lasted anywhere from 30 to 45 minutes where people “shared,” and where the leader (in our case, a gay man named Robert) led us through some lesson, mostly built upon stories of his own weight loss he’d repeat over and over. I was not the only man to attend these meetings, but yes, mostly women. Annette and I attended regularly enough to know most of the other “regulars,” and to also spot folks who would show up once or twice and never again. I do not remember any discussions about exercise, or really any other weight loss advice that went beyond “eat less.” In those three years, my weight did not change, and I never felt the sense of belonging to a community. It felt pretty hopeless by the end. So yeah, I don’t feel too badly about the demise of WW.

1. As part of my journaling practices, I write down my weight for the morning and I also have a part where I track my weight on the days where I take Zepbound. ↩︎
2. Zepbound needs to be stored in the fridge, but it can be kept at room temperature for up to 21 days. So I’ll have to skip one dose in the last week we’re gone and then I’ll be able to return to normal when we get back. That’s a good thing because if I miss two weeks, I need to start over on Zepbound with the lowest dose, and as far as I can tell from my limited internet research, people who restart with Zepbound often don’t have the same level of success the second time around. ↩︎

My one year of Zepbound anniversary passed a couple of weeks ago without any real notice or celebration on my part. I started the drug on January 7, 2024. I‘ve blogged about my experiences on Zepbound a few times before in the last year, and so far, so good. Mostly.

The good news is I’ve lost about 40 pounds so far. My goal is to lose another 20 pounds, which, according to the problematic BMI scale, would just barely move me into the category of “overweight” from where I am now, which is “obese.” I know, I know, it probably doesn’t matter a whole lot if I manage to get my BMI from a 31 to a 29, but still, it’s a goal.

Anyway, I’m feeling pretty good. The last time I had blood work done as part of my yearly check-up was back in June and after I’d lost about 25 pounds. My various numbers had improved (I moved out of the “pre-diabetic” category, for example), so I’m assuming that all of that would be even better now. The main side effect I have from Zepbound are all “tummy issue” related, and I still do have a bit of that, especially for a day or two after I inject myself. But it’s still not a big deal. And the stuff I wrote about before is still true: it’s easier to exercise (though I haven’t been “running” as much lately, now that I think about it), I find myself eating healthier (I mean besides just eating less), I’m enjoying the fact that I have had to once again buy some new clothes that fit better, and so forth.

The bad news is I’ve only lost about 6 pounds since the beginning of October. I think there are two reasons for this. First, I think it’s fair to say my main remaining food weakness is sweet things. My cravings for fatty things like a Big Mac are way down, but I still like candy. So fall and winter were rough with all the leftover Halloween candy (especially since we literally only had 3 very small kids with their parents knocking on our door out here in the new house!), with pies and just excesses at Thanksgiving, cookies and cakes and stuff at Christmas, etc.

Second, I think I’ve reached the limits of the drug’s effectiveness alone. As I wrote about back in May (after I had lost about 20 pounds), the reason why Zepbound was working for me was I just wasn’t as hungry, so I didn’t eat much between meals and when I did sit down for dinner or lunch, I ate less. So it didn’t feel like I was trying at all.

But at this point, if I’m going to lose another 20 pounds, I am going to need to try. For me, “trying” means being more in an “I’m on a diet” mindset in the sense cutting back even more on calories, eating even better, doing more at the gym, all that kind of stuff. I think the Zepbound helps with that too. Besides quieting the so-called “food noise,” it also helps me to better recognize when I’m eating just to eat, versus eating when I’m actually hungry. One of the ways it does this is if I do find myself hungry nowadays, it’s almost certainly because I actually do need to eat something.

But enough about only me. What else is in the news about GLP- 1 drugs and Zepbound and the like? Here’s a few articles that struck me as interesting in recent months.

• From something called The List comes “Elon Musk’s Holiday X Post Surely Got Under RFK Jr.s Skin (& Caused Trouble for Trump.)” Apparently, Elon has lost a bunch of weight from these drugs too. Among other things, Musk posted on X “Nothing would do more to improve the health, lifespan and quality of life for Americans than making GLP inhibitors super low cost to the public. Nothing else is even close.”
  
  RFK Jr. is no fan of these drugs at all, and he’s quoted in this article (from other sources) saying “If we just gave good food, three meals a day, to every man, woman and child in our country, we could solve the obesity and diabetes epidemic overnight.”
  
  Funny enough, I think both of these fascist meatbags full of shit are correct. As I’ll get to next, these drugs have all kinds of benefits, including a lot of things well beyond weight loss. The two main barriers for making them more available are the injectable format and the high costs. Also no question that Kennedy is right too: good food isn’t going to solve these problems “overnight,” but I get his point. But for me (and I’d bet 99% of GLP-1 users), it’s not an either/or thing– the drugs help me eat better.
• There were several MSM articles about a study that was published in Nature Medicine called “Mapping the effectiveness and risks of GLP-1 receptor agonists.” That link to Nature Medicine only works at all if I access it through the EMU library, so your results will vary. Anyway, the study used the US Department of Veterans Affairs database to study hundreds of thousands of patients who had used these drugs, primarily for diabetes. As Time summed it up, patients taking “GLP-1 medications had a lower risk of a number of health conditions, including Alzheimer’s disease and dementia, addiction, seizures, blood-clotting problems, heart conditions, and infectious diseases, compared to people taking the other types of diabetes treatments. The people taking the GLP-1 drugs also had increased GI-related issues, low blood pressure, and arthritis, as well as certain kidney conditions and pancreatitis—most of which are already known side effects of the medications.”
• I have a news alert for Zepbound, and I see a lot of articles like this one: “The Best Obesity Drugs Aren’t Even Here Yet,” from Gizmodo. Take that with a smaller piece of cake (if you will), but the success of Ozempic and other drugs like this have fueled a bit of a gold rush in research. Soon there are going to be versions of these drugs that are more effective, and, with any luck once they are available in pill form, versions that will be a lot cheaper.
• And last, I guess Oprah got into a bit of trouble the other day. From Page Six, “Oprah Winfrey faces backlash for making bold claim about ‘thin people’ after taking weight-loss drug.” Read the whole thing, but I guess you can see the “bold claim” in this snippet on Instagram:

I mean, I am not in the business of defending Oprah, especially since she originally denied that she was taking these drugs to lose weight. And I’ve never been a skinny person, and of course people end up being skinny (or fat) for all kinds of different reasons. But I have had conversations similar to this with skinny (or not overweight at least) people, and I think what Oprah is saying here is right– at least for about half of the thinner/very in shape people I know well. One very skinny guy I know told me one time he has to remind himself to eat some days, and I assure that has never been a problem for me.

But I will say there is one other category of skinny/very fit people I have known over the years: the person who got a serious medical wake-up call. I’m talking about having a doctor say if you don’t make some seriously big changes in diet and exercise, you’re gonna die a lot sooner than you should. I think this category is much smaller than the category of “I never feel that hungry,” but I can see why these people might not like Oprah implying they don’t have will power or “work” at it.

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.