Magic Diet Drugs

GLP-1s and the Advent of a Dieter's Utopia

“One day, they’ll cure me.”

We have arrived at what seems to be a cure for obesity. I know the side effects are too severe for some, and the overall efficacy isn’t guaranteed, but it seems pretty damn close to a medical cure to me.

And I really don’t know how to feel about it. I know how I do feel, I am simultaneously torn by jealousy, hope, and apprehension/fear.

“One day, they’ll cure me.”

This was my “Next year in Jerusalem,” “Amen. Come, Lord Jesus!” or “Insha’Allah.” It was the mantra that gave me hope.

But it was colored by the awareness of fantasy, make-believe.

I don’t think I’ve ever played the lottery with the sincere idea that I would actually win and it would change my life. I have played it though.

When I was five years old, the doctor told my mom that my weight needed to be brought under control. ‘The Doctor,’ because there was just the one. Nicotine stained fingers and teeth, a perfect early 80s shag haircut. He was an affable yet severe man who, to memory, mostly prescribed vitamin C.

His words landed. Sitting in that office in 1981, I saw myself as a massive blimp in a lonely field, workmen scurrying about, frantic because they’d somehow lost control of the hose pumping gas into it. Its skin now taut, and the only thing keeping it in contact with terra firma were rope tethers. My mother was the hose, and this cigarette scented Doctor, one of the men scurrying around the blimp. She’d lost all control and the blimp was fit to burst.

I could not connect the need to eat or action of eating with my weight. I understood abstractly that there was a connection, but it wasn’t sterile like mathematics. There was no simple computation that seemed to unlock me.

“Get yourself under control.” - Medical professionals, et al.

What swims around in the mind of a child? My children asked “why” so much when they were five, and while I think I did my best to answer them honestly, I made a lot up too. Once when asked where shampoo came from, I went with an elaborate tale about tiny creatures called ‘Shams’ and the hair cleansing power of their fecal matter, “sham-poo”. I cannot recall anyone taking the time to explain to me the exact mechanics of how my eating contributed to my weight, though I’m somehow sure they did.

My body was wrong, bad, shameful. The punishment for this wrongness was that my food was restricted. This began with portion control, no seconds, no helping myself to family style meals. Instead, I was given servings I found to be wholly inadequate. When no progress was achieved by these means, various food types became restricted. Red foods were out for a time, then white ones, sugar and processed foods soon followed. I was put on diets named after places like Cleveland and Beverly Hills. I did diets based around soups, Cabbage Soup and Sacred Heart Soup diets. Diets designed to solve internal problems like Candida and even one that involved drinking electrolyzed oxidized water.

From my 5th year on, dieting is the background of my childhood. Diets always felt like punishment. Until very recently, I had no understanding of the mechanics of food.

When I was very sick, the kindly yet austere doctor gave us antibiotics, and I got better. I had one fairly serious bout with strep throat as a child. There was immense parental concern, deliriousness, and finally an orange bottle that cured me quickly. With my sudden, but very real medical world experience, I longed for something in an orange bottle that would fix my weight.

Ma huang (ephedra) was nearly my savior. I’d done numerous rounds of vitamin supplementation. Experienced the wacky ways that the chiropractors my mother frequented, marketed these things through muscle testing (applied kinesiology), and had zero results. But after I’d swallowed the very first ma huang pill, I knew something radical was happening within me. I was electrified, I was changing!

Photo by Myriam Zilles on Unsplash

Four sleepless nights later, a ball of energy, the ma huang was discontinued. I didn’t understand the mechanics of it then: activation of the central nervous system which can suppress appetite, increased sympathetic nervous system activity which can increase energy expenditure etc. But unlike the vitamins and holistic supplements, something was perceptibly happening.

This propped up my faith that medicine would one day figure it out.

As a kid, diets were done to me. But I eventually did want weight loss enough to subject myself to them as an adult.

It took me nearly two decades of dieting autonomously, to finally find some equilibrium. Leading up to that I looked for and bought into the easiest, or most seemingly efficient diet schemes being marketed to a rapidly widening America.

“Just eat these things,” or “just don’t eat these things” were the most basic and usual premise. The comprehensive calories-in, calories-out model existed but structurally lacked any nuance that assisted me in discovering why I overate in the first place.

Food is a warm hug from a friend. Food provides the fullness I seek internally - this is a figurative statement. I wasn’t merely hungry.

Today, when I imagine a sensation of wholeness, not much about it is innate. It’s bound up in who I am intentionally, meaning I’ve had to spend time and effort figuring it out. Probably for many, there is no need to rationally discover this as a concept. They just are, and if asked, could easily elaborate on their identity with profound accuracy. I was nothing but emotional turmoil, a painful void.

I found that the emptiness within overwhelmed any sense of self to the point of collapse, and the solution was to consume.

Addressing none of this, and simply withholding calories left me an anxious, nervous wreck, and my ability to withhold would eventually fail.

For me, addressing my panicked need to escape mental discomfort was paramount. The need to satisfy distress immediately with no regard for the fact that the bandage on the bursting dyke was in fact a contributing factor to its structural insecurity. The interest I would pay on kicking my discomfort down the road felt insurmountable.

I overeat for a myriad reasons. Some of them: environmental, genetic, cultural, and convenience. I’ve given up the pursuit of changing those external factors and exactly how I’d like to see the world just to suit me. Internally is an entirely different landscape, internally I can work to effect change.

And so I go about trying to stay present, with detailed and thorough knowledge of self, aware of my own compulsions and proclivities. And I can manage. I’m far more satisfied with life than I was, and my discomforts, both physically and mentally have improved.

I’ve given up on the idea that there is a magic number on the scale that will solve the systems within me, given up on the idea of a finish line, and proceeded with an attempt at a balanced life.

A new dawn arises. We’ve reached the promised land. The era of the magic diet drugs is upon us. Medicine has swept in to save the day.

Had the effects on weight loss associated with the GLP-1 inhibitors been known six or seven years ago, I can say with utmost certainty that I would have leapt at the medical breakthrough.

For those who have tried and tried again to solve their conditions through will power and diet alone, and found themselves back at square one time after time, these drugs offer hope. What a miraculous time we are in.

I do have some skepticism though. For anyone like me, whose condition arose not simply through an overly stimulated genetic appetite, what cause will there be to address these other conditions? If eating food provides some sense of joy, and the lack of joy is the solution being sought, how will those people find succor? There is an emotional component within me that’s paramount, and I don’t see that being addressed with the GLP-1s.

At morbidly obese, I’m all for any intervention. I’m pretty much for any intervention an individual finds workable. But I can see a future where those trapped in hundreds of excess pounds have access to a real solution, and I want to celebrate that. I find that worth celebrating.

But I know many who don’t have massive weight to lose, who yet are trapped in the yo-yo cycle, and for them, I’m terrified.

All crash diets produce lean tissue (muscle) loss. My wife and her friends would routinely go onto these wildly low calorie diets and none of them have ever been even approaching morbidly obese. For them and those like them, I see these drugs, if cycled, offering only to make these terrible diets easier. And so, these few pounds, lost rapidly due to the efficiency of GLP-1s, will return immediately once the drugs are stopped, though the lost muscle will not come back. Over time, their weight will look relatively static, but actually, their body fat will be increasing.

That idea is frighteningly bleak. Not to mention the potential for heroin chic to come back into fashion. Watching a recent awards show, two of the more prominent attendees were dramatically thinner than the last time I’d seen them. Bizarrely they were seated next to each other, bony shoulder to bony shoulder. I can’t imagine the potential for misuse of these drugs by the thin who dream of translucence.

The five year old me sitting in that doctor’s office is really saddened that medicine took 40 years to provide real treatment. I wonder what my life would’ve or could’ve been had I been put on these medicines in my youth? Perhaps I’d have become a high school athlete, hell, I might’ve actually attended and completed high school. I can glimpse that elusive sense of normalcy that I chased for so long. Picture me walking through the hallways of education, head held high, attention outward, fitting in like a perfect cog in the machine. The dour memories recede and the potential bursts with vivid joyful splendor.

The burgeoning fantasy casts doubts on all that is by undoing all that has been.

Attempting to be entirely pragmatic, I wouldn’t have been a candidate for GLP-1s at 5 years old. Possibly I should’ve been encouraged to play a sport, or watch less television, but I didn’t qualify for this magical intervention then. And just like smoke, the fantasy dissipates into the ether, leaving only an acrid stench.

There is a calmness in me now that was missing for the majority of my life. It began when I examined where in my life I could improve, be of service to others, and determine who I really was. When my friends sat me down and voiced concern for me, it did little to produce change. When I determine how to be the best friend I can be and part of that is being as healthy as I can, a bit of inner tension evaporates and my drive to improve rises. If I’d not had to think about these things, would I have progressed in this way?

I celebrate anyone’s success at health. I champion self-improvement. I do not judge the tools that are employed in this pursuit.

My thorny path to today was entirely necessary. Many of those thorns grew out of a desire to escape— to avoid the present, to find anything that took the burden off me. My own courage has grown by facing the day with all its barbed terrors and idiosyncrasies. The cure for me it seems, has been in embracing that burden. That place once occupied with a desperate need to be solved is now filled with an acceptance of what is.

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