Today I am going for my semi-annual doctor’s visit for a check-up. The general state of my health is good (I know its not “excellent” and I find myself debating if its just “good” or “very good” in the five level rating system the questionnaire asks). In fact, it’s much better than it was six months ago, which is before I lost twenty pounds, solved my edema problem and started wearing compression socks every day. I have more energy and am able to do more physically more comfortably, whether in the garden or walking the airport terminals. But here’s the thing, after my initial weight loss in June, I hit a set-point, something the body quite intentionally does to stabilize itself, and I have found it hard to get myself off that set point to lose more weight. I feel so much better being 20 pound lighter that I want to feel the improvement from another twenty and another twenty and maybe even another twenty after that. I have recently updated my ideal weight reference point and continue to conclude (as do most overweight people that enjoy varying degrees of denial) that my perfect weight is probably forty pounds greater than that of the insurance industry’s estimation. My goal is to get to the weight I attained one summer during college when I worked at the Cornell Plantations in 8-12 hour shifts of hard manual labor. It was then that I was wearing off-the-shelf XL shirts and wore jeans that were 4 inches smaller than my current pants (and those jeans didn’t have the elasticity that today’s pants have…so maybe it was really 6 inches smaller).
Having spent my adult life trying one weight loss program after another (Pritikin – twice, Duke for a month, clinical trial at Roosevelt Hospital, Weight-Watchers several times, Jenny Craig, and various online things like Noom for a nanosecond or two) I know how to calculate caloric consumption and expenditure. The most accurate method is the Mifflin-St. Jeor equation, which employes a combination of weight, height, age, and sex. For men, that formula is (10 × weight in kg) + (6.25 × height in cm) – (5 × age) + 5. In theory, even if I sit in a chair all day, my body mass requires over 2,400 calories to maintain itself. That could be as high as 3,200 if I’m very active. I regularly ear 450 calories at breakfast, about 600 calories for lunch and then maybe 1,000 for dinner. In other words, I’m pretty sure I am somewhere around 500 calories below what the math says I should eat to maintain my current weight. I understand that those needs reduce as my weight reduces, but why don’t I lose weight at that level of consumption? The answer is far too complex and the body is far too mysterious and bespoke to make that determination. I know I could eat a lot less and probably get off that set-point, but I also know that keeping that discipline going is near impossible without a prophylactic. The success I had with my lap-band, which is still very much in place regulating the amount I can comfortably eat is the ONLY permanent success I have ever had with weight loss (next year will be the 20th anniversary of my lap-band) and I am 140 pounds shy of the weight I achieved before that surgery.
What this tells me is that I have to either change my consumption dramatically through willpower (unlikely) or turn to the modern solution…a GLP-1 of some sort, like 12% of my fellow Americans (including Kim) are doing right now. Given that there are reportedly 40% of Americans that qualify as obese (BMI>30), that means there are almost 100 million of us who could qualify for some help in reducing our waistlines. I can’t do much about the other 99.999999 million, but I can address my need…again. I have been a GLP-1 skeptic because except for my Lap-Band, which feels very tangible and understandable (restricting how much food can get into your stomach…end of story), I have never met a pharmaceutical or behavioral solution to weight control that I cannot overcome due to whatever natural instincts the universe has imbedded in me. You have heard me say that I am blessed with good brain chemistry in that I seem to have an abundance of serotonin and dopamine in my system every morning. I guess the good Lord has given me my “Not so fast, Abernathy…” comeuppance in the form of an innate ability to override weight control medications and programs that don’t tie a noose around my system. So, this morning I told my primary care physician of six years that I wanted to try Zepbound.
Zepbound is the brand name for tirzepatide, which is prescribed for weight loss (as opposed to Diabetes, for which Mounjaro is prescribed). Zepbound is the first and only dual GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1) receptor agonist approved for obesity. It was just approved by the FDA in January, 2025… and is said to also help sleep apnea (which I may or may not have since I started using a CPAP before a formal diagnosis). A receptor agonist is pretty much what it sounds like, a substance that activates a receptor in your body to produce a biological response. Your cells have receptors, which act as locks on your cells that are proteins on the cell surfaces that receive chemical signals. When an agonist binds to a receptor, it triggers the same response as the body’s natural chemical would…things like releasing insulin, slowing down digestion and reducing appetite. It only took us 300,000 years to figure that out. Zepbound is a medication that mimics these natural hormones and binds to the same receptors and produces similar effects, even though it’s a synthetic drug rather than your body’s natural hormone…and they last a lot longer than the real thing and produce a stronger effect…thereby effectively suppressing appetite. So far that’s just like all the other GLP-1s out there. What makes Zepbound different is that GIP stuff. GIP plays a more significant role in how the body handles dietary fat by promoting fat storage in adipose (fat) tissue. It then influences how the body uses energy from fats. I know from my Roosevelt Hospital clinical trial a long time ago that I have lots of fats cells (Hyperplasia) rather than too few bigger fat cells (Hypoplasia). That means that its harder for my fat cells to naturally release content. That’s what a GIP should be able to encourage. Think of Zepbound as giving me a one-two punch at this weight management effort. Even the scientists can’t explain it better until they do more studies.
During clinical trials, study volunteers who used tirzepatide lost as much as 21% of their body weight. The average weight loss for study subjects without diabetes who used the largest dose (15 mg once weekly) was 18%. If that happened with me, it would put me down to my “fighting weight” from my college summer of manual labor. Like all GLP-1’s, Zepbound is an injectable medication given as 1 injection under the skin once a week. The reason my doctor suggested Zepbound had less to do with all these new added receptor agonist features, and more to do with the fact that its inventor, Eli Lilly, has seen the popular insurance problem light and offered it for direct payment (without the rigmarole of insurance…which I’m sure they would find a way to deny me since I have no diabetes and no formal sleep apnea diagnosis) at about a 60% discount from their usual exorbitant price point. They mitigate their costs a bit by not giving it to me in the convenient EpiPen format, but rather in single-dose vials which we then have to use with a fresh needle…no big deal. They will give me the gradual dosage increment program starting at 2.5 mg, then 5 mg, then 7.5 mg, then 10 mg, then 12.5 mg, and finally 15 mg (ratcheted up every month over 6 months) for the bargain autopay amount of $499/month. My math on that is that that equates to one fast food meal per day at current prices, so…what the hell. Between Prime, Netflix, Paramount, HBO Max, Hulu/Disney (no I did not cancel…shhhh…don’t tell Kim), what’s another auto-expense out of my monthly hide, right? Especially if it is literally causing my hide to get smaller.
Common side effects of Zepbound include nausea, diarrhea, and injection site reactions, so pretty much a non-event from what I can tell. Zepbound may cause thyroid tumors but I have no family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2, so that should not enter into the picture.
I’ve been watching GLP-1s since Ozempic got FDA approval seven years ago. I’ve watched family and friends rave about it. My doctor has already called in the prescription to LilyDirect, so I guess I’m finally in…..Big GLP Gulp!