Two years on GLP-1 drugs

#299: Life with the food noise turned down

Photo by Haberdoedas on Unsplash

As many of you know, I wrote a whole book about my lifelong struggle with my weight. That book came out in 2019. In 2021, the FDA approved the use of the first GLP-1 drug for weight loss. In 2024, I started taking one of those drugs. This week marks exactly two years since my first dose. I figured it was time to let y’all know how it’s been going.

In case you just want the numbers, here they are: At my heaviest, I weighed 460 pounds. As of Sunday, my most recent weigh-in, I’m at 328. That’s a loss of 132 pounds, or nearly 30 percent of my body weight. I had lost some of that before I started taking the drugs, but most of it since.

This little shot, once a week, has transformed my life. Let’s talk about all of it.

***

Before we get to the good things, let me point out two bad things.

The first is that Ozempic—the first GLP-1 I tried—gave me terrible stomach problems. This is a common side effect. I often had two or three days a week of constipation, followed by … the opposite of constipation. After a few months, and consulting my doctor, I switched to Zepbound (in pharmaceutical terms, from semaglutide to tirzepatide). I’ve lost weight at the same pace and Zepbound has been much easier on my system.

The second downside is that all these drugs are expensive as hell. Insurance usually doesn’t cover them for weight loss (although Medicare began a limited trial program last month). When I started on Ozempic, I bought it through my regular CVS and it cost more than $1,500 a month. Now I buy Zepbound direct from the manufacturer (Lilly). I get four doses at a time, 13 times a year, for $449 a shipment. That comes out to $486 a month. That’s like going from a house payment to a car payment, but it’s still an awful lot. At the beginning, especially, Alix and I had some long conversations about whether it would be worth the cost. It has turned out to be worth it for us. We are lucky to be able to afford it. A lot of people can’t.

I don’t get why insurance companies aren’t knocking one another down to make it easier for their customers to afford these drugs. It seems to me they will clearly reduce health-care costs (and the insurance companies’ costs) in the long run. But that’s a conversation for another day.

What I want to do now is tell you how GLP-1s have changed me for the good, in ways I’m still trying to understand.

***

It’s not clear who invented the term food noise, but let me tell you, few terms have ever been so accurate. At least for me.

If you’ve read THE ELEPHANT IN THE ROOM, you might remember I wrote a whole chapter about the concept of USUCK-FM. As I wrote in the book:

It’s that voice that tells you you’re not good enough, the voice that wonders why you ever believe in yourself, the one that leans in your ear when you’re facedown on the ground and tells you you’re a failure.

I battled that voice most of my life, and a big part of ELEPHANT is about my efforts to tame it. But when I started taking a GLP-1, I realized there was another voice in there. (To be clear: There are LOTS of voices in my head. Most of them are friendly. Lately one of them has been playing the first Boston album in my head when I wake up. It’s a good record!)

The food-noise voice was, in some ways, the opposite of USUCK-FM. It was a giddy voice and its purpose was to tell me about all the great things I would soon get to eat. At breakfast it would start talking about lunch. If I was reading a book, it would remind me about the Cheez-Its in the pantry. If we were going out somewhere it would prod me to look up the menu online and start strategizing about the meal that would fill me to the fullest. But because of the food voice, I was never really full. I was rarely hungry, not physically, but I was always craving. The food noise was a constant chatter in my head.

To sum up GLP-1 drugs, in the most simple way I know how: They shush the noise.

It’s still not entirely clear how the drugs work. They somehow connect to the pathways between the brain and the digestive system, both slowing down digestion and affecting parts of the brain connected to motivation and reward.

What that means for me is that I just don’t think about food like I used to. I’ll finish breakfast, and might not think about lunch until I look up and go Hmm, it’s time for lunch. When I do sit down to eat, I no longer want the biggest portion or the greasiest item on the menu. My brain has been rewired to eat less and want less. I can’t stress how different my mindset is every day.

This, for me, ended the debate about whether losing weight is simply a matter of willpower. I’ve heard that all my life from well-meaning (and not so well-meaning) doctors and family members and strangers on the internet. Just stop eating so much, they’d say. Or have a salad every once in a while*.

*To be fair, I’m not sure ANYBODY is pushing salads these days, given the recent Attack of the Killer Lettuce. I was in a buffet line recently, and like always, there were two big trays of salad at the front of the line. Everybody gave the trays such a wide berth it looked like we were sidestepping dog poop in the street.

I have obviously made some terrible decisions around food over the years, the same way other people make terrible decisions about alcohol or drugs or gambling. None of us old enough to make our own choices are ever innocent of all charges. But “just stop” is not just unhelpful—it’s actively harmful. It pushes all the chips of recovery to the wrong end of the table.

Last year I got a call out of the blue from Lee Kaplan, an obesity expert and a retired professor at Harvard Medical School. He had read ELEPHANT and wanted to talk about it. He spent much of his career convincing others in his field that obesity isn’t just a character flaw. I told him I was on a GLP-1 and it was really helping. We also talked about USUCK-FM and my own self-doubts.

Let me ask you something, he said (I’m paraphrasing here). Now that you see how much the drug has helped, is it fair to say that there is a profound chemical component to losing weight?

Of course, I said.

So, then, he said, doesn’t it make sense that there was also a profound chemical component to gaining all that weight in the first place?

Our lives are too complicated to reduce to just one thing. I ended up at 460 pounds for a lot of reasons: growing up in a Southern family where food equaled wealth; living in an American culture that constantly pushes processed foods in massive portions; existing in a time when food is one of the last acceptable vices; and, yes, terrible choices. But I keep coming back to that one phrase: a profound chemical component.

These drugs, for me, have changed my chemistry. And they have quieted the voice that was happily guiding me into the dark.

***

This is where I remind you of another crucial phrase: Your mileage may vary.

Now that millions of people have taken GLP-1s, you can find a multitude of reactions. Some people have had even more success than I have. Others found the side effects so crippling that they had to give up. Still others have found that the drugs just don’t do much for them. This is how medicine works. It never treats everybody the same.

Beyond that, there has been a backlash from some who believe that GLP-1s are a form of fat-shaming, and that people who like their bodies the way they are feel even more pressure to lose weight now that such effective drugs are available.

I understand all those reactions and empathize with everybody. All I will tell you is that I, personally, was living a deeply unhealthy life. And I felt like if I stayed at the weight I was, I wouldn’t be around much longer.

When I started writing ELEPHANT, I was just turning 50. Back then I thought a lot about a friend of ours, a fellow fat guy, who died at 50 of a heart attack. At the time I wrote:

Guys like us don’t make it to sixty.

This year I turned 62.

I’m not pretending that I’m in great shape—328 pounds is still overweight for anybody except a sumo wrestler or offensive lineman. My aging body will always have to deal with the aftereffects of my heaviest days. I had a knee replacement this January (going great!) and continuing lower back pain (not great, although better this week after a course of steroids).

There is also a tiny part of me that worries all this is some FLOWERS FOR ALGERNON situation where I’ll eventually end up back where I was. (The pandemic knocked me sideways and I gained back some of the weight I’d lost when I worked on ELEPHANT.)

I am a natural skeptic about losing weight, given my history. But GLP-1s have made me an optimist. On the whole, after dropping 132 pounds, I feel like I’m on the path to a longer and happier and more fulfilling life. Which is not just something I deserve for myself but owe to the people who love me.

There are some mysteries ahead.

The short-term mystery is that my weight loss (generally, a slow drip of one or two pounds a week) has stalled over the past month or so. It’s normal for people on GLP-1s to plateau. There’s evidence that they can only take you so far. We’re getting ready to increase my Zepbound dose and we’ll see how that goes. Either way, the current thinking goes that once you’re on a GLP-1, you have to take it for the rest of your life or risk backsliding. (There are new versions on their way soon, and it’s possible they might change the calculus.)

The long-term mystery is this: Nobody knows what will happen to people who take these drugs for years on end. Even though these drugs went through tests and trials, nobody predicted that so many of us would be taking them at once—not to mention that GLP-1s show promise in treating a whole host of other medical problems. Science is figuring this out on the fly. It’s not out of the question that there’s some disastrous side effect we don’t know about yet. Then again … life itself is full of side effects. I’m inclined to take the shots and have some faith.

I do know this: It feels great to have to buy new clothes because my old ones were falling off. It feels great to sit in a chair at a theater or restaurant without having to wedge myself in, or worry about whether it might collapse. It feels great to have one less voice buzzing around in my head.

At some point, every day, I look down at the veins on the backs of my hands. Take a second now and run your fingers across your own. Even with a light touch you can feel the ridges under your fingertips, part of the relief map of the normal human body. But when I weighed 460, the veins in my hands were almost invisible—blue shadows under a layer of fat.

Over these last two years, the fat has receded and the veins have emerged. They fascinate me way more than they should. I guess I’m just getting used to them. I look down and imagine a great river and all the creeks branching from it. Except it’s not water, it’s blood. And that blood flowing through my hands has a drug in it that is giving me life.

—TT

P.S.: I always ask you to share one of my posts if you’re so inclined, but I hope more than usual that you’ll consider sharing this one … especially if you know someone who needs to read it. There’s always a share button at the end of the post but I’ll add another here:

My books DOGLAND and THE ELEPHANT IN THE ROOM are available in all formats pretty much everywhere books are sold.