The Skinny Shot

The drug I’m shooting up doesn’t make me high. But it does make me feel good about myself. For the last six weeks, I have been injecting myself weekly with Mounjaro (chemical name, Tirzepatide) by Ely Lilly. Originally meant to treat type 2 diabetes, Mounjaro has been approved for weight loss since October 22, 2022. Unlike invasive procedures like bariatric surgery, you do not have to be 100 or more pounds overweight; you can be a little heavier than you ought to be. Even just 10 pounds and a doctor will grant you a prescription if you A) can afford it and B) find a pro-Mounjaro physician. And in LA and New York’s Upper East Side, those physicians’ waiting rooms are overflowing.  

Here’s how it works: Montjaro increases insulin production, but only when your blood sugar is rising—which means that you minimize the chances of sucking up all the sugar in your blood and making yourself woozy from hypoglycemia. It also decreases your liver’s production of sugar, and slows down the speed at which the stomach empties food into your intestine. Overall, this means the drug regulates blood sugar after eating, and leaves you feeling full longer.

After its introduction to the market in 2016 as a diabetes treatment, patients saw the pounds drop off—and so it began being prescribed ‘off label’ not only to the obese, but also to the merely chubby. The stampede to get it was followed by the inevitable backlash. A typical New York Times headline: The Doctor Prescribed an Obesity Drug. Her Insurer Called It ‘Vanity.’

If you’re not diabetic, there is not yet insurance reimbursement—despite the fact that obesity-related ailments are responsible for a vast number of insurance claims. Out-of-pocket costs will run you about $1,000 a month. Which of course means that, almost immediately, there was a black market. On a recent trip to Miami, I saw billboards advertising how to get your Tirzepatide for “as little as $200” a month.

I confess I was among the many who clamored for a drug that I didn’t, technically, need. I’m not overweight, but I am in my 40s and my metabolism is certainly beginning to slow down. After putting on a few pounds during the pandemic, I started exercising vigorously: weights in the gym, hiking on weekends, riding horses in the summer, and running regularly as well. The pounds would not budge. 

I cycled through a variety of diets. I tried Intermittent Fasting with ProLon, a five-day cleanse that comes complete with a giant container of hibiscus tea to sip on, decent chocolate cookies, and terrible soups. I made it exactly a day and half before eating all the cookies and throwing out all the soups. I tried Noom, the weight-loss app, but I was spending so much time taking quizzes, writing journal entries, and trying to get in touch with my feelings, I quickly gave up on that too.

I tried skipping  breakfast only to find that by 5:00 p.m., I was eating all of my children’s seaweed crackers and then gnawing on a three-week old parmesan cheese. 

I’d had it. 

When I started Mounjaro, I didn’t really expect it would work. Side effects can include nausea, constipation, diarrhea, headaches. I was a tiny bit nauseous the morning of the second day, but otherwise, had no discernible side effects. There has also been a flurry of press saying Mounjaro can cause the user to look gaunt—and worse—older. As I have a rounder face to begin with, I didn’t notice any difference (although I spent about an hour in the bathroom staring at every pore just in case). I thought I was eating as much as I usually do, though maybe I was a little less hungry for dinner. Normally, I’m ravenous during the kids’ bath/bedroom routine while waiting to have dinner with my husband. I’d have a glass of wine, which made the time fly, but would make me even hungrier. 

When I did have a glass with dinner, I felt ok. But the euphoric “all your problems have slipped away” feeling was lessened on Mounjaro. I felt… flat. On another day, I might have had a second glass to get in My Wine Zone. That day, I only had one.

I’m not alone. OneTwitter user, @AnneIsLosingIt, noted that after five months on Mounjaro and one week on the sister drug #Wegovy, the meds completely eliminated her desire for alcohol. As she put it, “One glass in 5 months vs 2 glasses a night before meds.” 

It worked the same with food. I was hungry enough to eat, but not to overeat. It was easy to resist the bread at lunch. I would eat a salad but find dessert less appealing. Beyond appetite, nothing seemed changed. Sleep still fine, exercise still satisfyingly endorphin-filled. But the dial on food and drink pleasure? That was turned way, way down. 

I thought the drug wasn’t working. In fact, three weeks in, I called the office to say I didn’t think it was effective. I waited another few weeks. After six weeks, with remarkably little effort and deprivation, I’d lost 10 pounds. 

I wasn’t aware of how different I looked until I saw a picture of me taken just before Christmas, in a pink satin suit which was no longer clinging to every lump as it once did. I look better this way—and frankly, I felt better. 

Ten pounds lighter really should not be the root of all happiness. And do I feel somehow guilty? I’m afraid I do. In our Puritanical culture, weight loss without exercising much discipline has got to be wrong. It’s very hard to remove the moral equation from weight loss, the sense of “I am good if I’m thinner, I am bad if I’m fatter—and I’m bad if I lose weight without suffering.”

But I was 10 pounds lighter before I had kids. I am happier 10 pounds lighter now. Removed from all of my overthinking,  that is the simple, irrefutable fact.  

I went off Mounjaro the week after Christmas. We were skiing, and I wanted a little break to enjoy my family…and raclette and cheese. But I still wasn’t ravenous. I didn’t put the weight back on. Whew.

When I headed back to my doctor’s office for a check-up, I was delighted to learn I’d lost 10 pounds. But unfortunately  I’d lost something else: Two pounds of muscle mass from my arms.  If I didn’t want to become Pigeon Wing Lady, Dr. Salas-Whalen told me I needed to consume at least 90 grams of protein a day, and continue to lift weights. 

Clinical research on this drug’s efficacy gives obesity experts reason for optimism. In a study conducted by Lily on about 2,500 participants, weight loss was correlated with dosage. At the lowest dose—5 mg—participants lost 15 percent of their body weight over 72 weeks. At higher doses—10 and 15 mg—participants lost about 20 percent of their body weight over 72 weeks.  (My dosage was 5 mg, very much on the lower end of the spectrum. The average participant in the study took about twice as much and weighed an average of 231 pounds.) These weight-loss figures are about equivalent to patients having bariatric surgery in the same time frame. So if it’s a question of having a weekly shot or having your intestines rearranged…which would you go for?

But here’s the problem: If you go off the drug, you are very likely to regain the weight. That’s the point. You are not meant to go off it. When the ideal weight is reached you go to a bi-weekly shot and that helps maintain weight for the long term. 

This medication is awfully expensive to consider taking it for the rest of my life. So I don’t know what I’ll do long term. And while there is some hope that insurers will approve its use within the next couple of years, you may well have to top a certain BMI in order for them to pick up the tab.

But for right now, I feel better than I have for a while, and don’t think I’ll be in any rush to stop it. The trade-off will be missing the intense rush of a sugar high or the initial feeling of pizza hitting your stomach when you’re really hungry. When you change your appetite, you change your brain—and I may always be wistful for that oh-my-God-give-me-a-chocolate-cookie NOW state of mind. But if I am lighter, both in pounds and in state-of-mind? Hard to put a price on that.