I have lost a lot of weight. It's not by accident. It is because of medicine. The medicines prescribed by medical doctors? For me, particularly, they are “glucagon like peptide 1 inhibitors.” That meant Ozempic (semeglutide) and then Mounjaro (tirzepetide)…which adds a kicker (gastric inhibitory peptide)
It is a lot of complex pharmacology. The medically crucial detail is that I had a hemoglobin A1c in the diabetic range—7.4. This is what I look like, according to a screen capture of my TikTok account…that was all about a year ago.
I don't look well. I did not feel well. Being obese, having out of control blood sugar, having the inflammation that goes along with that, it's bad.
The next screenshot it was acquired by just scrolling up, the top line is today, the bottom line is about 8 months ago:
These are serious illnesses. They cause tremendous suffering. The makers of the medicine I take go to extraordinary lengths to claim it's not a weight loss drug:
It will make you lose a lot of weight— they are making the claim because they have a regulatory requirement to do so. I am reinforcing that statement, because I understand these to be doing something much more profound then “because I understand these to be doing something much more profound then "helping you lose weight.”
In my mind, it's a little bit like calling parachutes a treatment to help you fall more slowly from the sky. Reduce your rate of descent by over 80%! That number is impressive, but beside the point.
The risk, of course, is that people lose skeletal muscle mass, which isn't really good weight to lose. Fat is metabolically flimsy compared Skeletal muscle, which burns a lot more calories. Muscle is a calorie burning factory. Do not lose muscle! I have to do low slow weight bearing exercise to maintain my muscle mass. This is not a trivial problem. You can't just take the medicine and not lose muscle mass, you actually have to have that as part of the plan. It's a serious risk, because you end up with less skeletal muscle to burn less calories. This is wasting away, it's not healthy. It is potentially dangerous. I started out with actual diabetes, and so the process for me is probably different than the process for people in whom the drug was not studied.
I have gone from 246 pounds and visually sick to 176 pounds today, and visually a lot less sick.
These are not trivial interventions— they are profound.
We can remember that suffering is involved in “being overweight,” with metabolic syndrome. It is not about being “thin and attractive.” That's a different problem, if there isn't metabolic syndrome involved.
This is a call to contemplation. I hope we can spend time with our compassion, and recognition that these are serious medicines for extremely serious problems. They have serious consequences, both positive and negative. It is worth noting they're wildly expensive, and could account for $736,000,000,000 if we just treated half of people with obesity with the existing semeglutide at the existing market price.
I don't have anything funny or sarcastic to say.
—Owen Scott Muir, M.D.