What it’s like to take GLP-1 Drugs

I started writing this some time ago but never really felt happy enough with it to hit that publish button. But I’ve been revising it over time, and I think it’s ready. Some more recent updates are sprinkled throughout in [].

I still love to eat all of the same things I used to eat, just less of them.

— — — — — — — — — — — —

I’m in my late 40s [ahem], and I’ve been somewhat (“somewhat”) overweight for my entire adult life. I love everything about food. This obviously isn’t medical advice, I’m sharing my personal story. I seem to be pretty sensitive to these drugs, and of course you may not get the same results. But this experience has completely changed the way I think about weight loss and willpower, and I think that’s worth discussing.

I’ve tried (“tried”) to lose weight over the years (“decades”), with varying levels of success from none at all to kinda sorta moderately “I can drop 5–10 pounds with a tremendous amout of sacrifice and willpower and I’ll put it back on again in a few weeks to months when I get frustrated with feeling deprived and the cravings set in”.

“Craving” isn’t a strong enough word for it, it’s not even like I want to eat this stuff, I just do. It’s on auto-pilot, putting food in my mouth hole until my body says “no, you have to stop that already”. Not all the time, but apparently enough of the time. [Since I first wrote this a few years ago, “food noise” has entered the popular lexicon, and that’s a good way to describe it.]

I eat more or less heathily most of the time. Relatively few processed foods. Lots of fruits and vegetables. Sometimes simple starches, but mostly whole grains. As little added sugar as possible. Basically no soda except some homemade ginger beer every once few months. And too often, dessert.

i.e.: dinner was a few hours ago, but now I’m still a bit peckish. Maybe a piece of fruit. That plum was great, but pretty small, How about two more? How about a small bowl of yogurt, with some granola, with some blueberries, with some raisins, now it needs some honey on top won’t that be delightful. Maybe a cookie or two. I don’t really want it, I’m just grazing, and it snowballs. It’s not really eating out of boredom, though I’m told that’s a thing. Sometimes this involves junk food, but usually it’s just… more food, and more food, until my body says no. It doesn’t even feel like I have a choice in the matter, it’s just a thing that happens. I’ve tried making better choices, substituting healthier food, and when the cravings hit, that usually means eating the healthier food first, not being satisfied, and then moving onto eating something else. It’s not like all I’m doing is eating, and it’s not all the time, but it’s enough over time to make me a little fat and keep me that way.

Increasing my exercise didn’t put a dent in any of that. I practice karate usually 3 times a week (and have recently earned my black belt). I take a 30–45 minute bike ride 2–3 times a week. On days that I don’t do either of those, I walk at least 30+ minutes, or do 30 minutes of Fitness Boxing with hand weights. I completed The Ring Fit Adventure main storyline on the hardest difficulty. My fitness level has gotten a lot better — strength, agility, balance have all improved, but none of this made any appreciable difference to my weight. On the contrary — exercising made me more hungry. But let me say, all of these things are a LOT easier when I’m carrying around 10 or 15 or 25 pounds less.

So Enter semaglutide. I took Wegovy for a month on an initial ramp-up dose of .25mg/week. It was difficult to get, there’s a national shortage. Even at the lowest dose, the effects were marked and noticeable. Again, I gather that not everyone has the same experience or sensitivity to these drugs, but they seem to work remarkably well for me. I lost about 8 pounds over the course of a month. My cravings… simply disappeared. I experienced a bit of nausea, and some wicked diarrhea usually two days after the weekly injection (though I read later that this is much more likely to happen as a result of injecting into your abdomen, which the helpful insert does not tell you).

But then, when the initial supply was exhausted, I found when I wanted to move up to the next higher ramp-up dose of .5mg, there wasn’t any available, there’s a national shortage. So I stopped. Over the course of the next two weeks, I put all of the weight I’d lost back on. The rebound effect is real. I didn’t feel ravenously hungry, but I went right back to my old patterns — being hungry what in retrospect feels like most of the time, and eating more because it didn’t feel like I shouldn’t. Hopefully that distinction makes sense. It feels like eating doesn’t do enough to satisfy my hunger, like my hunger isn’t an accurate gauge of how much I should be eating. It feels weird to not trust this basic biological process, because the messages it’s communicating to my body are very compelling. Of course there are a ton of people selling books who want to tell you how our food system is broken, and that’s compelling too, but I’m still stymied by how it isn’t all evenly distributed. There are plenty of thin people, and a lot of them eat the same or worse things I do. I make a conscious choice to eat more or less well and exercise daily, but this isn’t enough.

After a bunch of searching and going back and forth with my endocrinologist, I determined that I could take Saxenda instead. It’s a daily subcutaneous injection instead of weekly, but I’ve found that I really don’t mind all that much — the needle is tiny and it barely registers as a pinprick. It’s much more flexible because you can set the dosage for each injection — I’ve been able to manage my own ramp-up, and I stopped at 1.8mg/day because I’ve had a comfortable level of weight loss at that dosage. I initially started doing the injections at night (recommended to reduce nausea), but then switched to the morning to get the most effect during the day — I found that it was wearing off a bit and I was still getting hungry again late at night, and switching to morning injections fixed that.

It feels like Saxenda doesn’t have as strong effects as Wegovy (notably, no GI issues for me), but that’s fine — I really just mostly need a nudge in the right direction. I’ve been on it for 6 weeks now, and I’ve lost another 15 pounds — a fantastic and sustainable level of weight loss.

The primary effects for me are:

1. My snack cravings are gone. They’re just… gone.
2. The amount of food I eat at meals is reduced. I’ve hit a wall in the middle of meals sometimes. I’ve had the experience where a meal I could comfortably eat before, I needed to stop eating. When that happens, it’s like a door closes in my throat, and I just don’t want to put any more food in. I’m starting to adjust my food orders to much smaller portions, because I know that if I order more, I won’t be able to finish it and it will go to waste anyway.
3. I get hungry less often, and it’s a bit difficult to regulate sometimes. When I’m exercising a lot, I have to push myself a bit to eat more, earlier, which is tough because I don’t want to eat more. This is a weird balancing act for me to get used to.
4. I’ve lost none of the enjoyment of my food, it’s just… less. I’ll still eat dessert occasionally, but now a single cookie or a small piece of chocolate is enough, and when I’m done I don’t want more.

This has been a transformative experience for me. I used to think that overeating was about willpower. Was I weak because I couldn’t control this? I’m coming around to the realization that the answer may be no. Biology has very strong effects. Why couldn’t I simply decide to not listen, to not eat more, to follow strict portion control, to eat less? I don’t know how to answer that except that it still doesn’t feel like a thing I have any natural control over. I recently had someone say “hey, congratulations on losing weight, you look great”, and I was taken a little bit shaken by that. I haven’t done anything, certainly not anything to warrant congratulations. I’ve expended no effort of willpower or discipline, I’ve conquered nothing. This is the most important thing — I just took the drugs, they did what they’re supposed to do.

Will I have to stay on these drugs longterm in order to keep this weight off? Maybe. There may be a maintenance dose that’s even lower. A pill form is coming, which would be nicer than having to manage injections.

Since I started writing this piece, I’m now at the point where I’m almost out of the initial Saxenda round, and… of course there’s a shortage of that now and it’s unclear if I’ll be able to get more. I’m not looking forward to what happens when I have to go off of this again. I’ve lowered the dose somewhat to stretch out my last remaining supply, and I’m *trying* to maintain the same level of eating less, but I can already feel the hunger creeping in at the edges again. I’ve had a moderate amount of success in maintaining the eating habits I had while fully on the drug, but there’s a world of difference between eating half a sandwich because I don’t want the other half, and eating half a sandwich because I know that’s what I want/need to do despite still being hungry and being hungry again a half an hour later. I don’t love it.

[Update from 2025: I did get more Saxenda, and eventually transitioned back to Wegovy when that became more widely available. I’m now down roughly 40 pounds from my top weight. This is a point I’d never even imagined being able to achieve when I started, but now that I’m here, it doesn’t feel like enough and I want to keep going. The GI issues have been mostly gone for months. I still sometimes get snack cravings again, but they are manageable, and I can just stop eating naturally after one or two. No more grazing. Often I will only eat half a normal portion of whatever I ordered and save the rest for late. Having hit a plateau on Wegovy, I am about to switch to Zepbound. I remain extremely optimistic that the next generations of these drugs will continue to be even more effective for a while to the point where everyone who wants to can lose as much weight as they want, and the research seems to show that they are also beneficial across a wide range of other health concerns.]