Hunger Trigger

Why I'm taking a medication designed for weight loss, and the reasons that conversations surrounding Ozempic and GLP-1 medications must shift.

This essay engages with the subjects of eating disorders, weight loss, and fatphobia. If you don’t feel good engaging with those subjects, consider reading carefully or not reading at all.

NOTE: The Interior Gaze is paused until after the election. I made this choice based on engagement metrics.

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No matter where you go on the internet, you can find people talking or writing about Ozempic.

Most of these conversations are judgmental, fatphobic, shaming, and toxic.

It’s because of the toxicity of this discourse that I feel compelled to share my own experiences with a GLP-1 medication.

I am not on Ozempic, aka Semaglitude, but I am currently taking Zepbound, whose active ingredient is Tirzepatide, a GLP-1 agonist that manages metabolism. Both medications are very similar.

Before you continue, I humbly ask you to consider the judgements that you may have regarding these medications and the people who take them. Consider your preconceived notions and, if possible, suspend them for the duration of this essay.

I don’t ask this of you because I am afraid of being judged (although, frankly, I am not not afraid of being judged), but because the dialogue regarding GLP-1 agonists is quite toxic and lacking in nuance. Fatness and weight loss are incredibly charged subjects for many people, myself included. But this essay is not about weight loss— at least it isn’t about my weight loss.

You can find so much information (and disinformation) about these medications online, both fatphobic and railing against fatphobia. I am in the latter camp: I have been fat for most of my life. Past the age of eleven, whenever I wasn’t fat, I was sick with an eating disorder (bulimia).

There are a few things I’d like to state clearly:

• Fatphobia and fat discrimination are toxic and destructive and not okay. Body size should not be conflated with health, because body size does not dictate health— physical or mental health. Fat people face a wide range of discrimination that is practically undetectable to people who are not and have never been fat. I wrote an essay about my experiences surrounding fat discrimination and thin privilege. You cannot judge someone’s health by looking at them, and health is a relative term. It is categorically ableist to think someone needs to be healthy in order to deserve love, care, and acceptance. And: it is guaranteed that everyone will be unhealthy at some point or another.

• The American food system is broken. We are constantly marketed ultra-processed foods with addictive qualities, the agricultural system has been overtaken by giant, money-hungry corporations, and we are deeply disconnected from nature and the land that produces food. Food is a commodity, and access to nourishing food is difficult for many people.

• Diet culture is totally fucked. There is a TON of fatphobic and frankly disgusting discourse surrounding weight loss. Many public figures who have lost weight, with or without these medications, denounce their formerly fat selves in ways that are destructive to the general public, further promoting the false idea that thin bodies are better than fat bodies. Diet culture promotes disordered eating. Period.

• Obesity is a deeply complex issue. Statistics and science are often distorted in ways that ignore demographic disparities and malign marginalized populations, such a those living in poverty and people of color. Many Americans live in food deserts and are unable to access fresh food. As a teacher of college writing composition, I have had several students choose obesity and fatness as subjects to examine in their papers, and through my teaching I’ve learned how deeply fat discrimination is embedded into our culture— and how mainstream media promotes the ideas that fat people lack control and that shaming and judging people’s bodies is okay.

• One does not have to exercise, eat “clean,” or follow any specific health regimen to be valuable and deserving of love. We are humans. Many of us are addicted to at least one thing. Americans are obsessed with self-improvement and self-betterment. Our country’s ideals spring from Puritan ideology, and the perfectionist ideology of white supremacy. We’re bad at accepting ourselves as we are, which means we’re terrible at accepting other people’s complexities. Every. Single. Person. Is. Deserving. Of. Love.

• Fatphobia is inherently entangled with racism, classism, and white supremacy. Fatphobia is part of the larger structure of white supremacy. I’ve done a lot of work to disentangle myself from body hatred, and learning this was part of my education. Sabrina Strings wrote an essential book about this, called Fearing the Black Body. I recommend this book to everyone.

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I am not taking Zepbound for weight loss, but it would be okay if I were.

You will never find me posting before and after photos of myself. I don’t have a goal weight. I am not dieting, because I know from experience and research that diets don’t work. I also can’t diet, because dieting, for me, has only led to disordered eating. The only person who weighs me is the doctor, and I request not to look at the scale and ask not to know my weight.

Although I am fat, my cholesterol and blood pressure have always been in the low range— this, despite what many assume about my body and health.

That said: it would be okay if I were trying to lose weight. And it would be okay if I had high cholesterol and high blood pressure. No one should be shamed for the choices they make concerning their body, or their health markers.

And although diets don’t work for weight loss, a person’s diet can have an effect on their health— positive and negative.

So, why am I taking a drug marketed for weight loss if I am actually okay with being fat?

I’m not going to deny that diet culture has an effect on me, even after over a decade of eating disorder recovery, but I didn’t seek out this medication for weight loss. It’s not that I love my body 24/7. I don’t. But I know that having a smaller body won’t change who I am. It won’t make me happier.

I also know that, in my experience, thin people are treated better than fat ones. That’s not only my experience— it’s a lot of people’s experiences. It’s fucked up but true. I don’t blame anyone for wanting to be thin.

When I asked my doctor about Zepbound, I foregrounded my weight, because I knew that weight loss was the only way she’d prescribe it to me. Having to do this was a side effect of the insidiousness of diet culture, fatphobia, and the medical establishment’s hyperfocus on body size, which can be detrimental to people of all sizes. Despite my relatively positive health markers (excepting my autoimmiune disorder, which I’ll get to soon), being categorized as “overweight” is a medical problem in itself, even if no actual medical problems are present. This is because most doctors rely on the BMI (Body Mass Index) to determine whether patients are “over” weight, despite BMI being totally bunk (and debunked many times over). One can have a low BMI while facing health problems (crazy that thin people can actually get sick, too!), and a high one while being totally healthy, but these basic facts are consistently sidelined.

I am lucky enough to have a doctor with whom I can be honest, so I did share that weight loss wasn’t a goal for me, and that focusing on weight could be detrimental to my mental and physical health.

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So why did I want to try Zepbound?

There are several reasons.

The first is that, despite having (mostly) recovered from my bulimia, I found myself at the mercy of food cravings. They were constant background (and foreground) noise. I craved food like a drug, and my addiction was ancient.

As a child I spent so much time alone. Sometimes days on end. Food was one of my only comforts— I used it like a drug: to dissociate. This might have been fine, but my mom checked the cabinets and refrigerator whenever she came home, and punished me if I ate too much. I learned to feel guilty simply for eating.

When I was twelve years-old I developed bulimia. For over three decades I binged and purged. During my recovery I went for lengths of time without purging, but I still binged, despite leaning into the Intuitive Eating philosophy. The binging ebbed and flowed. In my mid-thirties I began overexercising, to the point of injuring myself so badly that I needed to have knee surgery when I was 37.

After that, I developed a healthier relationship with exercise— first I stopped going to the gym altogether, then I began walking and practicing more embodied movement. I yearned for control over my addiction to ultra-processed foods. I was in therapy. I meditated. I took care of the parts of myself that needed healing (via Internal Family Systems). I accepted my large body, despite the discrimination I experienced as I gained weight. And despite gaining weight I didn’t diet, because I knew that dieting would lead to a bulimia relapse.

Despite all of this work and progress I eventually recognized a pattern of binging that I could not, no matter what I tried, interrupt. For the last couple years I’ve sobbed to my therapist many times, wished I could take food in pill form, and wished I could stop ordering Door Dash or buying and binging on foods that left me feeling absolutely terrible. This wasn’t every day, but it was at least once a week; often several nights a week.

Binging drenched me in deep shame, which led to more binging. I self-isolated. I kept telling myself I would figure it out. But I couldn’t figure it out. Occasionally my binges led to bulimia relapses, and over time my relapses became more frequent.

Unlike the other addictions I have struggled with (heroin, tobacco, alcohol, social media), I cannot cut food out of my life. A person has to eat.

I also want to repeat what I already said: it is okay to want to lose weight.

It is not a sin to want to lose weight, especially when our culture treats fat people so terribly. Early in my bulimia recovery (obviously been an ongoing process— one doesn’t easily recover from several decades of disordered eating), I immersed myself in anti-diet literature. I told myself it was okay to be fat. And for me, it was. I needed to be okay with being fat. But over time, and as I gained more weight, I felt less okay with what was essentially an addiction to food.

It wasn’t about my body anymore: it was about my addiction.

I freaked out when celebrities began losing weight using Ozempic.

I, like most folks who are fat positive and anti-diet, was repulsed by how these drugs and celebrity weight loss were increasing fatphobia in the wider zeitgeist. Celebrity weight loss became even more fraught with moralistic judgement. Did they do the work? Or take the easy way out? My repulsion turned to pity for anyone who lost weight— now there was a right and wrong way to do so. Maybe this is why celebrities have more recently treated their weight loss as a casual choice anyone can make, despite having clearly used GLP-1 medications.

Then I found a study outlining the relationship between GLP-1 drugs and addiction. I learned that they can reduce inflammation, eliciting a cascade of positive effects like increased heart and liver health and lowered risk of Alzheimer’s and Parkinson’s Disease. The addiction research intrigued me, but I was more interested in the possibility for lowered inflammation, because I have rheumatoid arthritis; an inflammatory autoimmune disease that attacks the protective synovial fluid surrounding joints. Could one of these drugs help decrease my inflammation? After nearly a year of consideration, I decided to ask my doctor. I told her that I didn’t want to focus on weight loss, but my being overweight (as judged by the BMI) qualified me for a prescription.

I began taking Zepbound this summer.

The medication is administered subcutaneously, by injection. this isn’t new to me— I inject Humira, an immunosuppressant, to manage my rheumatoid arthritis. I categorized the Zepbound in the same way, as a medication that could possibly improve my quality of life.

I told no one except my therapist. You are finding out that I am using a GLP-1 before I’ve told my closest friends. I wanted to see if Zepbound even did anything for me in the first place.

Zepbound, like all GLP-1 agonists, is taken on a titration schedule. A patient works up to the “therapeutic” dose. In summer I started at the lowest dose, and worked up to the next level in September. I am currently taking the second lowest dose (out of six possible potencies) of Zepbound instead of titrating up to the higher doses, with no plans to increase my dose.

This medication has changed my life.

I noticed a decrease in joint swelling within the first two weeks. The day before I began, I took a picture of my hand— my knuckles are always a little bit swollen despite my rheumatoid arthritis medication. When I compared my hand to the picture two weeks later, the swelling had decreased. By a lot.

My joints weren’t as stiff in the morning. My knees weren’t sore after long walks.

But the biggest change has been with my relationship to food.

I used to think about food all the time.

This isn’t because I was starving. I stopped dieting and restricting over a decade ago. But there is something amiss in my body’s technology— I craved comfort foods constantly, even when I wasn’t physically hungry. Binging was my secret life; as secret as my bulimia had been for so long.

In the week after I began taking a GLP-1, the cravings for sugar-laden, fried, and processed foods practically vanished. Their siren call was muted.

I didn’t crave food at all. When I felt hunger, I ate. I could stop when I was full. Before, my hunger had been bottomless for as long as I could remember— but it wasn’t physical hunger, because I rarely allowed myself to get hungry.

Hunger was what I’d been trying to escape.

Being raised in an environment where my mother restricted my access to food had taught me that hunger equaled danger. When I started gaining weight as a child (which is normal for children), my mom would send me to bed without dinner. I’d forgotten about those nights laying in bed, feeling my hunger gnaw at me, smelling the scent of my mom’s microwave meals and sneaking into the kitchen once she was asleep.

Physical hunger was a trigger. At any sign of hunger alarm bells clanged in my brain. Hunger became metaphysical. A trauma response. To avoid hunger, to avoid desire; to avoid needing anything at all, I kept myself full.

It’s been almost four months.

Today I opened my refrigerator and noticed it wasn’t stuffed with aspirational ingredients. I make one complex meal every four or five days (beef stew this week). Most nights I eat that for dinner. A protein shake every morning. Salads with protein for lunch. On some mornings, if I’m more hungry, I make toast, eggs, and spinach. There’s a cute little line of high-protein Chobani yogurt drinks that I get from Costco. Some refrigerated cookie dough for when I want to bake a cookie.

Today I opened my refrigerator and realized that I don’t feel conflicted each time I go into the kitchen. I don’t worry about eating and then wanting more. I just eat and go on with my day. I enjoy food. This is painfully ironic.

My therapist and I talk about neuroplasticity.

Who am I if I am not someone who hides from hunger? From desire?

What if I let myself want things and give myself what I want (and need)?

How can I take care of myself without using food to dissociate and self-soothe?

Here’s what’s changed for me:

• I only think of food when I am hungry. When I am hungry, I eat. When I am full, I stop eating. It sounds so simple, but I spent almost my entire life not being able to stop.

• I’ve become more intentional about exercise. Exercise helps me feel hungry, and feeling hungry is good— hunger is no longer a monster I must fight off by overeating. Moving my body is less painful. I’m not in pain after exercise (because exercise itself can trigger an inflammatory response). Moving my body has become pleasurable again.

• When I feel hunger, I don’t go to battle with myself over what to eat. I just eat. This medication has somehow made it possible for me to choose food that actually makes me feel better— not worse. More than possible, because that’s the food I now crave. I eat slowly, without distractions. I feel satiated by foods that never before left me feeling satisfied. I don’t know how this works on a scientific level, but I am so, so grateful for it.

• I have so much more mental energy. It’s like all that brain space that went to thinking about food is now freed up for other things.

• Spending time with people isn’t exhausting anymore. This was an entirely unexpected side effect. For most of my life my binging was a method of isolation and dissociation— an ancient way of existing I had long outgrown but didn’t know how to stop. Now I reach out to others, making and following through with plans. I am more open to friendships and relationships because I’m not holed up for entire afternoons and evenings dissociating. I don’t feel like I need to hide anything.

• I’m grateful. Grateful for this new ease of movement, grateful for mental peace. It’s not that I don’t get stressed or that my life is now perfect; it may actually be more difficult right now, because I am still trying to figure out how to live without using food like a drug. But I like it better this way.

• I’m processing my changing relationship with my body. I have lost weight. I don’t know how much— but I know that some of my clothes are now too big. That’s weird and triggering. It’s strange to feel shame about losing weight, but I do. Am I betraying the fat body I worked so hard to accept? Am I rejecting that fat child who felt so much shame about their size? I know that my body size is not a value judgement (although in the realm of our culture it really is). I’ll probably be working through this for a while.

• I have so much more compassion for myself. I understand why I overate. That it wasn’t only mental, but physiological. I have more compassion for all the folks who can’t stop eating. Thinking of our collective shame fills me with rage— even more than it used to. Because I am no longer blaming and shaming myself for what I truly could not control. I hate that I lived with that shame for so long, and that people are still being shamed.

One of the reasons I felt compelled to write about being on this medication is because I have lost weight. I don’t want to hide that from people, or pretend it isn’t happening. I don’t want to lie about it. I know that I have a right to my own privacy, and this isn’t me saying that everyone taking these medications needs to tell others about it. But for me, I need to.

I’m not sure how long I will stay on this medication. Some studies say I’ll need it forever— some studies show that this is untrue. My hope is that, with therapy and presence, I can work through my old trauma responses. My goal was never weight loss, and I am not worried about regaining weight. It’s about my relationship with myself, with my past, and with food and hunger. If this medication improves my quality of life and continues to helps with my rheumatoid arthritis, I will take it for as long as I can. I’m already taking one lifelong medication— that’s not a casual choice— it’s a necessity.

As far as the anti-inflammatory benefits; they are amazing. Part of me wonders if some of these benefits come from nourishing myself and showing up more in my whole life. Inflammation is mysterious. Rheumatoid arthritis is a lifelong disease, but my last round of blood work showed that my inflammatory markers have decreased substantially.

The biggest green flag? I haven’t relapsed once since I started taking this medication. I haven’t binged. I haven’t purged. Not once. I can count on one hand the times, since mid-summer, that I wanted to binge. Each of those times I chose something else to do. I painted. I wrote. I made a necklace. I went for a walk.

I know I’m walking a fine line; eating disorders are insidious. I’m letting myself hope. I’m doing my best.

My goals are internal. Not external.

There are negative aspects to this medication, particularly because our culture is obsessed with thinness.

I think these medications can be harmful if they are taken without the support of a therapist and solely for the purpose of becoming thin.

Many doctors are deeply uninformed and fatphobic. The same goes for dieticians.

GLP-1 medications can elicit strong appetite suppression, especially at higher doses, thus putting people at risk for disordered eating. Accelerated weight loss due to malnourishment inevitably leads to diminished muscle and a slower metabolism— these risks are similar to gastric bypass and gastric sleeve surgeries.

Taking this medication without the guidance of a knowledgeable and fat-accepting physician can reinforce shame and, again, lead to eating disorders. How many physicians are knowledgeable and fat-accepting? A small minority. Some physicians, physician’s assistants, and nurse practitioners barely know how these medications operate.

And: GLP-1s are already improving the lives of so many people.

Many folks who are diabetic, pre-diabetic, and folks who struggle with PCOS can have an excellent relationship with food but still struggle with weight gain in a way that adversely affects their health.

Why should they be shamed for taking a medication that improves their health?

Why should anyone?

Can we stop saying that Ozempic and other GLP-1 medications are evil? Because that rhetoric is harmful. The drugs aren’t evil. Yes, there are risks, but the conversation should be about diet culture and fatphobia and health and discrimination. Some of my favorite fat-positive educators have shamed folks for using GLP-1 medications. I can understand why. It’s scary to think that fatphobia could get worse now that a drug like this one exists. But that’s no excuse to shame or judge people when they lose (or gain) weight.

Is it possible for us to get to a place where one doesn’t have to fear judgement about their body and their personal choices? I don’t know. I have no control over what other people do or say or think. But I need to accept myself where I’m at, and I don’t want to waste time feeling ashamed about my personal choices— especially if those choices are positive ones.