I have been a registered dietitian for nearly 20 years. I became a registered dietitian because I wanted to figure out the secret to sustained weight loss and I also wanted to help others lose weight. My first job was in bariatrics, working with patients getting ready to undergo surgery. I loved seeing the transformations and there were many. I have helped dozens of patients lose hundreds and hundreds of pounds in my career.
But despite my best efforts, consultations with all of my “weight loss specialist” colleagues, a regular exercise routine, and what I would consider a healthy diet, the weight loss never happened for me. At one point I was able to lose about 15 pounds with the help of Phentramine, but once the effects of that medication wore off (which it does after a few weeks), the weight came right back on.
Granted, I was never extremely overweight. My pre-kids BMI probably hovered around 28. But once I had kids I moved squarely into the “obese” category. I was able to lose about 10-15 pounds of baby weight with dedication at the gym and a keto diet, but a low-carb diet was not sustainable long-term. I am a foodie at heart.
My weight was stuck squarely at about 20-30 pounds more than I wanted and more than was “healthy” on the BMI scale. (I am aware of the issues and concerns around BMI, but regardless I still believe that it is a good way to gauge where you are with your weight and health).
I felt defeated that even with all my knowledge (and other “experts” at my fingertips), I still couldn’t figure this out. It really impacted my confidence and ability to engage with others or put myself out there as a nutrition expert.
The First Step
In 2022, I was feeling frustrated about my weight and the lack of change. I had heard about this trending weight loss medication called Ozempic, that it was effective for weight loss. Somehow through the magic of the internet, I came across a telehealth company that was prescribing these medications for weight loss specifically.
Surprisingly, with just a review of information that I entered about my weight and health conditions and without even ever speaking to an MD, I was given a prescription for Mounjaro and a coupon for $500 off.
I gleefully took the prescription to the pharmacy and was able to get it filled for about $600, as my insurance didn’t cover it. And the first month on the medication was incredible. I effortlessly lost 5 pounds, despite traveling and the holiday season. I didn’t change anything I was doing, the weight just fell off.
Not Approved for Weight Loss
After the first month, things got complicated. Several pharmacies around town were either out of the medication or straight up said they wouldn’t fill it for weight loss purposes. Granted, this was before Mounjaro/Zepbound was approved for weight loss.
I had to scramble to various pharmacies, hoping that someone would fill it. Eventually, I was able to find somewhere that would fill it, but it was a lot of work and quite expensive at $600 a month.
I loved being on the medication, the weight kept falling off. In three months on the medication, I was about 20 pounds down and back to my pre-marriage weight. I was thrilled.
During those three months, I went up on my dose twice. At the highest dose I took (7.5mg) I did not feel well. I could barely eat at all. I did not enjoy not being able to eat, since I love a good meal. But the doctor I was “seeing” seemed to just want to keep upping the dose each month based on how quickly I was losing. I felt like I was losing at a good pace of around 4 pounds a month, I guess he wanted it to go faster? I can’t say because we never talked.
After 3 months on the medication, the coupon ran out. The medication was now over $1000 a month IF I could find somewhere to fill it. I decided to quit taking it because I was happy with my weight and it was just too expensive to justify.
Weight Regain
I got off the medication and thought, “I got this”. Then I proceeded to have a very fun summer, which involved many cocktails, parties, trips, and more. The weight came back on very quickly.
By September, I was frustrated that I had gained back almost all the weight I lost. We were between insurance providers at the time, so rather than trying to get the medication prescribed again, I decided to take the compounded version of semaglutide from a local med spa.
I stayed on the medication through the holidays that year. I lost the weight I had regained and got back to a weight where I was comfortable.
But once again, the cost became an issue. Even the compounded version was running about $300-$400/month. And I thought I had learned lessons from gaining the weight back before.
Acceptance
Once again, I got off the GLP-1 and the weight started to creep back on. I met with a colleague who has experience in helping people maintain their weight after losing large amounts. She said that after these medications, people need to exercise at least 1 hour or more per day and have to eat a high protein, lower carb diet or the weight will just come back on.
While there aren’t a huge number of long-term studies on what happens when people get off these meds, it seems that most people gain about 2/3 of the weight back. So I am not alone in my experience.
After speaking to my colleague, I realized that a life of worrying about food and my weight ALL THE TIME was a life I did not want to go back to. Always dieting, always exercising, always worrying. When I was on the GLP-1, I could still enjoy exercise (and I do!), and I could choose healthy foods, but I didn’t have to worry about every single bite.
I gave it some thought and decided that I was just going to accept that using a GLP-1 medication was going to be part of my life for the foreseeable future. Menopause is creeping up on me quickly and that’s when weight management will become even more challenging. Why not have a tool handy to try to prevent some of the menopause pounds from creeping in?
Luckily, at the moment, my primary care doctor is able to prescribe Zepbound now that it is approved for weight loss and my health insurance covers it. It only costs me $25 a month, which is manageable long-term.
Final Thoughts
Everyone always asks if I have had side effects from the GLP-1 medications, but I have not experienced anything significant. I have thrown up a few times, but there were other circumstances involved that may have caused that. I have no significant digestive issues. I am able to eat and enjoy enough food. I have the energy to exercise three to four days a week.
My main piece of advice is not to be in a hurry to increase your dose or lose a lot of weight quickly. Talk to your provider about staying on a low dose until you stop losing for several months.
I know it can be tempting when the weight starts to fall off to see how far you can push it. But, the higher the dose, the more likely you are to have negative side effects. Losing two to four pounds a month means you are doing incredibly.
Finally, you need to eat. Sometimes the medication allows you not to eat. But that will eventually backfire. You will start to lose muscle. You will get weak. If you ever decide to get off the medication, you will put the weight back on incredibly quickly because your metabolism is now significantly slower.
These medications have changed my life so much that I started a whole new business around them. They have given me freedom and the ability to not be consumed by what I am eating all the time. But they are one tool in your toolbox. They should be accompanied by other healthy habits and a balanced diet. The goal is not to be as thin as possible but to be as healthy as possible and these medications can help you achieve that goal.
