A Year on the Fat Shot

It’s officially been a year since I started taking Zepbound (aka Mounjaro aka Tirzepatide aka the ‘fat shot’) to lose weight and treat my obesity. I’ll cut to the part everyone wants to know, how much weight I’ve lost – I’m down 45 pounds.

Is that good? Well, it’s certainly better than gaining, any amount of pounds, really. And I cannot think of a time since the 90’s that I lost weight and wasn’t either diagnosed with a chronic condition or kept it off for more than 5 minutes. According to the trials, on average, participants lost 50lbs over 18 months (or about 20% of their starting weight). At 45lbs and 17% lost over 12 months, I’m pretty much on track or maybe even a teeny bit better than average. That said, it’s honestly felt a little slow at times. I’m grateful I am not a “non-responder,” the unlucky few who lost no weight in the trials, but I’m also not a “super responder” who dropped huge amounts in a short time. That comes with it’s own set of problems, but I’m not going to lie, there was a part of me that had hoped I might be more “super” in my response. I am where I’m supposed to be and ultimately I’m fine with that.

Has it been hard to lose the weight? No. Not even a little. I simply eat less than I did before. Attempting to lose weight “the old fashioned way” before going on this medication was impossibly hard. I was miserable, hungry, and frustrated all.of.the.time and I failed to lose (or maintain any losses I did have). I guess this lack of struggle is why people like to say the shot is cheating, but that suggests that losing weight is matter of laziness or lack of discipline. I’ve gained weight training to run marathons, an activity that requires both discipline and a marked absence of laziness. Maybe I need to better manage my diet. Sort of like when I cut out dairy, processed meat, and raw vegetables to manage my Crohn’s Disease, or when I stopped drinking all caffeine, any carbonated soda, and largely quit consuming alcohol (Manhattans on your birthday or anniversary don’t count). How can I be so active and change my eating habits so drastically and not lose any weight? It’s like obesity is a disease or something… To be clear, the journey hasn’t been perfect. I have had brief stalls and some minor gains along the way, but the overall trend has been in the losing direction. To anyone who thinks I just didn’t try hard enough without these cheater drugs; first, who cares what you think and, second, 57 years seemed like long enough of failing at the ‘real’ way to try a new approach.

I have been pretty lucky in regards to side effects on Zepbound. I went from being hot all the time to being cold all the time, but hoodies and sweaters keep that manageable. Around the 2nd day after the injection, I often get vasomotor rhinitis (a runny nose), but that is more of a minor nuisance and is transient. Periodically, I will sit down to a meal and the timing is such that I can only eat a bite or two and have to stop. That does not happen often and was more of an issue in the early months than it is now. I still have an appetite. I still enjoy eating and all the other joys of life. I do not journal my food or count calories or macros. Those strike me as the actions of someone on a diet and I refuse to diet. I might lose more or faster if I treated this like a diet, but we all know what happens when the diet ends. My focus is on being as healthy as I can and also still being a normal human. I do try to be mindful of eating protein and fiber, and did bump up my weekly resistance training to 2 classes a week, but honestly those are things any sensible middle-aged menopausal woman should be doing anyway.

Wow, that sounds effortless and without any challenges or problems. Ha. My challenges are all in my head. I spent a long time coming to terms with my size and learning to love myself, regardless of that size. Now, I am back in a place where I am very aware of my weight and am paying closer attention to the number on the scale. I wonder if people notice that I’ve lost weight. Some folks comment, others say nothing and I am not sure if they are being respectful by not commenting on my body or if they simply don’t notice. Probably both are true. While the weight I’ve lost is significant, when you need to lose another 90-100 pounds to get to a healthy range, the current loss is not as impactful in pictures as you might think. It’s also more than a little sobering to lose 45 pounds and still be clinically obese. I do try to look at other non-scale factors. I take measurements monthly and those have changed a little, but also not as much as one might imagine. My current clothes are quite loose, which is fun, but I recently bought a few items in the next size down and they just barely fit, if not are a little snug. I’m in the twilight zone between sizes. It also makes me realize that I was wearing my old clothes FAR beyond their appropriate level of fit. When I look at before and after pictures, I have to confess I am more shocked by how large I look in the old pictures than amazed by how I look now. There is also the annoying reality that I am on the borderline of the maximum amount of weight I can expect to lose on this drug. All of this has messed with my perceptions of my own size. I continue to practice self-compassion in this and all things, but it’s an ongoing process. Some days I am better at it than others.

I had high hopes for my recent annual wellness exam in May. After all, the ultimate point of starting this journey was to stay alive and well as long as possible. I have tried to cut back my blood pressure meds since starting the shot, but every time I do, my blood pressure jumps back up and I have to return to the previous dosage. More than one provider has assured me my blood pressure will go down as my weight does. Maybe after the next 45 pounds… My A1C did drop to the healthy range, which is awesome, but it was only a little above normal before and my PCP was only mildly to not impressed by that change. My cholesterol did drop quite a bit, but is still in the way too high range. We also added the ApoB and Lp(a) lab tests this time around which sealed the deal on my starting a statin. Instead of dropping meds, I added a new one. Sigh. My GERD is markedly improved, but trying to wean off that med has also proven unsuccessful. So, I still take an annoyingly high number (to me anyway) of prescription medications. However, I was reminded that sometimes not getting worse is actually an improvement. Without the Zepbound and the weight loss, who knows what my health stats would have been. It would not take a crystal ball to predict they easily could have been worse. Plus, the real take-away from all of this medical mumbo-jumbo is that I am taking care of my health. I am getting monitored and taking steps to address any issues. Steps that are just as important for skinny folks as they are for those of us in larger bodies (not to mention aging ones).

All of that said, am I glad I took the leap and started taking a GLP-1? So far, the positives have far outweighed the challenges. Do I think this class of drugs is a magic panacea for all weight-related woes? Sorry folks, there is no such unicorn drug. Just like bariatric surgery is great for some people, but was not the right choice for me, these powerful drugs may be a miracle for some and a nightmare for others. They are a tool in a hopefully expanding toolbox for treating obesity. I am grateful they have proven effective for me, and that I have the means to afford them. I do wish they were not so cost prohibitive to those who could benefit but don’t have the means to shill out a car payment sized monthly amount, but I hope that limitation will improve as new drugs come on the market and existing ones start to get generics. A year in, I am better off than before I started and you can’t ask for much more than that.