Why Zepound?

My frustration with relying on just diet and exercise to lose weight led me to try medication for obesity management. It worked.

As 2023 drew to a close, I embarked on a life-changing weight loss journey with GLP1/GIP medications, specifically Zepbound (tirzepatide, developed by Eli Lilly).

Despite my insurance not covering it, I was determined to lose weight, having reached my peak heaviness of 236 pounds in March 2023. I was tired of feeling exhausted, uncomfortable in my own skin, taking two different medications for high blood pressure, and feeling generally defeated after gaining weight despite numerous attempts with various weight loss methods like Noom, Weight Watchers, seemingly useless gym routines, intermittent fasting, supplements, and fad diets.

The buzz around new weight loss medications in the media and Hollywood caught my attention earlier in the year, though I was initially concerned about potential side effects. A friend with Type 2 diabetes shared his positive experience with Ozempic (or semaglutide, a medicine for blood sugar control developed by Novo Nordisk), which piqued my interest, and he had minimal side effects. However, as a non-diabetic, I needed an alternative solution since Ozempic wasn't an option.

Thankfully, the FDA had cleared tirzepatide (Zepbound) in November 2023 and I was a candidate. I started watching YouTube videos about the various chronic obesity management medications and the stories people shared about their lives and how they changed for the better but was still on the fence about whether I really needed medication. I waffled back and forth for a few, including considering going to a (sketchy) "weight loss clinic” near my house.

My breakthrough came when I received an email from WW (the rebrand of Weight Watchers) about their new online service for medication-assisted weight loss. I joined Sequence, completed the necessary steps (that is for another blog), and was prescribed Zepbound for weight loss. At $550 a month out of pocket with the Eli Lilly "discount" card, I took my first 2.5mg injection.

The result was transformative. Literally.

For the first time in my life, I experienced a lack of appetite and got full quickly. My brain changed almost immediately. Food no longer dominated my thoughts, and interestingly, I lost my cravings for alcohol as well (my COVID martinis had become a daily habit even after the pandemic which I think added a few pounds a month for sure). Mealtimes became a conscious experience rather than a mindless act of overeating. The constant "food noise" in my head quieted, allowing me to develop a healthier relationship with eating.

Eating the things my body needed to be at its best became my mantra not just stuffing my face with what I thought tasted good. I tracked my good intake daily and tried to stick to my total calorie goal for the day as best I could (see another blog on calories needs). I started back at the gym with some basic exercise because I was worried about muscle loss that I read about by some taking these drugs. I went to my local Planet Fitness gym and did some very basic weight training twice a week based on a routine that the trainer with Sequence shared on YouTube. I felt like I finally might be able to lose some weight, and that was amazing. This must be how most people feel about food, I thought. And it was nice to finally be one of them.

Diet and exercise, with medication and intentional eating, worked. Big time.

Of course, there were side effects, particularly in the first few weeks. I experienced increased thirst and some nausea, though I never actually got sick. Over-the-counter medications and probiotics helped manage these issues (yet another blog), and I began tracking my protein not just calories using an updated WW app specifically for members on GLP-1 programs. I bought a scale that synced with the app and weighed myself daily (I know this is controversial; that is indeed fodder for another blog). Unlike some people that I watched on YouTube who had to stop due to side effects, I was able to manage them and they resolved over time with some probiotic supplements and avoiding some foods that I know would trigger stomach upset (yep, another blog).

After four weeks on 2.5mg and doing okay with side effects, my provider at Sequence and I decided to up my dose to 5mg. Weight loss continued at a good clip of 3 to 5 pounds a week, and the side effects were manageable. At this point, I changed jobs and started with a new physician who suggested that he manage the GLP-1 medication along with my other medications. We stuck to the 5mg dose, and I continued to lose weight. I canceled Sequence but kept using the WW app and tracking my protein and activity. I had lost 20 pounds in two months. I was feeling great about my progress and my commitment. My doctor was happy, I was happy. Happiness abounded.

Then the shortage hit. And my panic.

Manufacturers could not keep up with the popularity of these medications. It wasn't the actual drug that was the problem, it was the injector pens: there just were not enough pens available to produce the shots. It became harder to get the 5mg dose and my refills were no longer easy to fill. I would have to call multiple pharmacies to find Zepbound, and fewer and fewer had any. To make matters worse, my new insurance company started denying my coverage and requiring multiple prior authorizations to get the medication. I had to spend hours on hold trying to speak to someone about my coverage and why I was being billed full price.

I had been losing at a good clip and was feeling great. I did not want to stop my progress. But getting the medication and having it covered by insurance so I did not have to pay $1050 a month was starting to take hours a week that I didn’t have.

I started to worry excessively about getting the medication. I knew I couldn't continue to make progress with just diet and exercise, having tried and failed for decades. I started to get seriously scared I would gain all the weight back if I did not find a way to track down the medicine and then have to pay for it full price because insurance was making it so difficult.

One of the GLP1/GIP influencers I watch on YouTube suggested using a weight management telehealth provider as a resource for compound tirzepatide to get around the endless phone calls to pharmacies. It piqued my interest and seemed easier than dealing with insurance during the shortage. So, I signed up for that provider and did their intake process. They prescribed me compound tirzepatide at my current dose and I was able to keep on the medication and continue to lose weight. While the compound involved using an actual syringe instead of an autoinjector, I learned how to administer the shots after watching some YouTube videos and quickly got used to it. It worked just fine, and I noticed no major differences between the compound and the brand name (again, another blog with a few more details).

Seven months and fifty pounds later, I have hit my goal weight using both Zepbound and compound tirzepatide. I never had to go above the 5mg dose, though my appetite suppression certainly has decreased over time. I placate it with increasing my protein and eating smaller meals and snacks more frequently (yes, another blog on these strategies for sure). In short, it worked. I am now at 185 pounds from 236 and have a new relationship with food, how I think about it, and how I treat my body.

I am inspired to continue to maintain my weight with these medications. While my primary care doctor wants to step me down to 2.5mg and then stop the medicine and see what happens, I am not there yet. I think I know what will happen: I will gain it all back. We are continuing to discuss it. At this point, I firmly believe that I may be on medicine for the rest of my life and I am okay with that. If I was diabetic, I would take insulin. If I had a hormonal imbalance, I would take a hormone medicine to supplement it. With chronic obesity, and perhaps a GLP1 deficiency, I will keep taking these GLP1/GIP agonists that have helped me immensely. There is a lot we need to learn about maintenance using GLP-1/GIP medications and the next generation of these medicines. I am excited.

If you are considering medication, and you are a candidate for it, and then think you are able to tolerate and afford it, I would say try it. It was the tool I needed to be successful. Of course, it was not just medicine but a set of things that came along with it including lots of other supports from several healthcare providers, many friends, some great people on social communities, and a whole spiritual mindset shift and how I think about myself. Remember that weight loss is a journey, not just a destination, and by taking advantage of all that we know today and potentially in the next few years, you will be successful too!