![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
the post about GLP-1
Mar. 7th, 2026 02:10 pmi. background
I have been obese for most of my adult life. I managed not to be a fat kid, but as soon as I was in charge of feeding myself and got a car, I started gaining. Went from overweight in my 20's to obese in my 30s and have gotten as high as 278 pounds, way too much for my 5'8" frame. I've been able to maintain it at the same spot, between 250-260 for probably a decade at this point. I've tried to get it off with little success. It's possible to blame this on genetics, stress, or the fact that I'm an emotional eater who also self-medicates with cannabis, which don't go well together, and also increasing insulin resistance means I'm constantly in an uphill struggle. Whatever the reason, here we are.
When I was discussing this with a friend recently, he said "I thought you were pretty happy with your body, and these proposed changes make it seem like you aren't." So, while I try hard to love my body, visceral fat is fucking with my health, probably pretty badly. Being fat may have been a contributor to the cancer. My mom died of a combination of breast cancer and complications from diabetes, and that was hard to watch; it wasn't fast. My knees are wearing out sooner than I'd like because I'm fat. Clothing options are limited; I had thought losing my breasts was going to make that easier but it has not. Clothes cut for women assume someone my size has big breasts, and clothes cut for men assume that someone with my chest size doesn't have a big ass. Being fat probably is why I have sleep apnea and am fucked if I have to sleep somewhere that doesn't have electricity, so I can't go camping anymore. There are workarounds to some of these, but the health is not one of them, and all other things being equal my life would be a lot easier and probably longer and more comfortable if I was not this fat.
Awhile back, I researched and even started paying for gastric sleeve surgery, but abandoned that plan when I looked at what it changes and why people fail on it, and figured I was too high a risk for failure to alter my body in such a drastic way. It felt like it was trying to brute-force a solution in the gut without addressing the brain, and I realized that if I can't get my brain onboard this won't work, because I believe that's where it's starting and the rest (insulin resistance, etc.) is just side-effects that came later. I've been going to OA and that's been pretty helpful, actually, though more as a social environment that gives me some structured space to look at my brain stuff related to eating than because I'm any kind of fan of the Twelve Step program. I've actually been very, very slowly losing but then this miracle shot showed up on the scene.
ii. data-gathering
Brö has been overweight all his life and diabetic for years, and his doctor put him on Ozempic and he lost like all of his excess weight over a couple of years. It sounded like it came with some pretty severe GI symptoms but I also think he has severe unmanaged anxiety that sits in his GI tract in addition to pretty bad eating habits. Most of my overweight and obese friends have gone on some sort of GLP-1 shot and I've been watching how they do with that. Videos from science-based sources have presented more data.
My doctors are pretty good about not shaming me for being fat, but they're also always up my ass to lose weight. One of them mentioned GLP-1s to me a couple of years ago, but not since, opting to push the usual plant-based but low-carb diet and daily exercise route since insurance wasn't going to cover it and it was really expensive. After some years we talked again. She said I had some factors and behaviors that are in my favor, which gives me more confidence that this has a better chance to be a sustainable fix (that's the test gastric sleeve surgery failed). The last thing that was stopping me was the idea of having to be on it for the rest of my life (which is not guaranteed, but from the research and knowing myself is possible, if not likely) but I am on so many medications now that I assume I will have to be on for the rest of my life, I'm not sure why that thought even bothers me. Maybe just the idea of giving myself a shot versus swallowing a big handful of pills? Who knows. Moving on. Oh- and a pill form just came out, so hey what's one more pill, but it's so fussy about how and when and with what you take it, they only recommend it for super consistent people who wake up at the same time every day and also have a deathly fear of needles. Neither of those things is me.
iii. acquisition
The reason I didn't go with this idea when the doctor brought it up initially was lack of data and cost. I've heard rumors that the landscape around cost had changed, and had some hope we could get insurance on board with this. I heard someone with the same insurance I had got his covered for sleep apnea! I have that! Optimism! We tried through the insurance portal right there at my doctor appointment, and they said "NO MOTHERFUCKER!" but there was a "maybe" in there that allowed us to try again in some other arcane way that involved sending it to the pharmacist and then seeing if we could get it in that way. Fast-forward a few days and after jumping through the expected hoops we got another "NO MOTHERFUCKER" from Blue Cross Blue Shield.
If I may briefly digress, I know my insurance company wants me to lose weight but evidently it's not worth it to them unless I am also diabetic (or had some other serious co-morbidity; sleep apnea, crumbling joints, and maybe multiple bouts of breast cancer apparently don't count) and since I have seen how badly diabetes just fucks with everything, I have been terrified of becoming diabetic and been doing my best to avoid it. My glucose has been creeping up, and if we kept up at our current rate I might get there eventually. I don't know exactly what I said to my doctor, but she relayed a story about another patient who said "So what you're telling me is that if I seriously trash my diet for three months and get my blood levels bad enough I can get insurance to pay for the shot?" and she had to explain how as a doctor she absolutely could not sign off on such a plan, but, well, yeah, that would work. Like, this is upfront a terrible, very bad, no-good plan but it'll work. My takeaway from this is that we seriously need to decouple profit from health care. It's not the most egregious way that this country sucks, but it's the one relevant to this journal entry.
Anyway! Insurance not covering things means we have to take a less conventional route. Until literally a few weeks ago it was cool to get your meds mixed up by compounding pharmacies, but that came to an end- however many pharmacies still do this by either mixing the compound at a different strength (like, the standard first dose from a pen injector is .25 so they make it .33, or something along those lines) or else they mix something else up with it. Thankfully my PCP has enough patients going this route that they've been able to gather some data about a few different compounding pharmacies, and for a number of reasons we decided to go with one in San Antonio that has many reports of great customer service and free shipping. Their deal is that they mix it with B12; some studies say people on GLP1s don't tend to get enough B12, and it can help with the low energy symptoms that bother some people.
Technical shit it's okay to skip- Ozempic and Wegovy are both semaglutide and that was the first one out, so there's more long-range data on those. Zepbound is tirzepatide, and while it hasn't been out as long it seems to work better, on a couple of different peptides instead of just the one semaglutide does, and the side effects seem to be less. But I don't know what my therapeutic dose will be. By this I mean the dose that I will stay on as my maintenance dose once my body figures out how to work with this drug. It might be the maximum dose they sell, but it might not. Since it's hard on your GI tract no one starts high, they start on a tiny dose and slowly ramp up. If I were getting the name-brand pens I'd have 4 doses to chose from, with the first step up doubling the dose. Since I'm getting it compounded, I get a vial and a prescribed amount to draw up, with the unspoken option of altering that if I wish- for instance creeping up my dose for a couple of weeks before I officially jump to a higher dose. This pharmacy sells semaglutide at nine different dosing levels, which range from $75 a month up to $125 a month for the highest dose. I could afford it at the highest dose. They sell tirzepatide at eight different dose levels ranging from $80 to $400 a month. There's no way I can afford $400, and if I'm gonna go through the laborious ramp-up only to find out that I can no longer afford the dose I need and have to switch- apparently people do this, but it sounds like a pain in the ass, and I have reasons to be optimistic that I can make the semaglutide work so that's what I'm going with.
Once we decided to go with a compounding pharmacy things happened really quickly. They sent me a UPS code that sat on "waiting for package" until after the package actually showed up. I got a vial that's sitting in the refrigerator, and a bunch of alcohol wipes and syringes with 31 gauge needles. I'd thought about starting right away but then I remembered- JoCo cruise is coming up in two weeks. JD and I are planning to drive across the country for 2-3 days, then get on a boat for another If everything goes perfectly, I have no symptoms and no problems keeping the drug chilled for the entire trip the way it needs. But I have no guarantees of any of that being true and Erica made a pretty good case for me having my last vacation of indulgence on the boat and then get back home and start up without throwing all the other variables in, which include possibly going GI-tract-rainbird out of one or both ends while on the road in the middle of Arizona or something. Who needs that?
iv. summary
My understanding is that these drugs all work on both the gut and the brain, and one of the things that made me seriously start considering this was folks describing how this quiets the "food noise", which has become the standard term that describes how the brains of some people are constantly going "food food food food food" every waking moment. I know this has been the case for me for as long as I can remember, and I am working on what to do with my brain once that isn't there. Evidently the things that trip people up are not working hard enough to maintain muscle (I've been doing weights at Planet Fitness), not eating enough protein and fiber (been slowly increasing those) and not drinking enough water, and I looooooove drinking water all the time. A lot of the symptoms sound like they might be a result of or at least worsened by bad eating habits that I'm pretty sure I can manage if the food noise is not there. I plan to go slowly. I walk or swim almost every day. I feel like a lot of what trips people up will not be as much of a problem for me, because I've been slowly whittling away at the bad brain things and poor diet for years now. If this works the way I've seen it work for a lot of people, I have a good chance of wearing normal clothes someday. Maybe I won't need my cpap. Maybe I won't need my knees replaced. Maybe I'll stop sweating all the time. Maybe I will fit in airplane seats again. Maybe I won't dread dying like my mom and can look forward to living forever like my dad appears to be doing- or at least not dying of something I could've done something about.
I have a good feeling about this.
I have been obese for most of my adult life. I managed not to be a fat kid, but as soon as I was in charge of feeding myself and got a car, I started gaining. Went from overweight in my 20's to obese in my 30s and have gotten as high as 278 pounds, way too much for my 5'8" frame. I've been able to maintain it at the same spot, between 250-260 for probably a decade at this point. I've tried to get it off with little success. It's possible to blame this on genetics, stress, or the fact that I'm an emotional eater who also self-medicates with cannabis, which don't go well together, and also increasing insulin resistance means I'm constantly in an uphill struggle. Whatever the reason, here we are.
When I was discussing this with a friend recently, he said "I thought you were pretty happy with your body, and these proposed changes make it seem like you aren't." So, while I try hard to love my body, visceral fat is fucking with my health, probably pretty badly. Being fat may have been a contributor to the cancer. My mom died of a combination of breast cancer and complications from diabetes, and that was hard to watch; it wasn't fast. My knees are wearing out sooner than I'd like because I'm fat. Clothing options are limited; I had thought losing my breasts was going to make that easier but it has not. Clothes cut for women assume someone my size has big breasts, and clothes cut for men assume that someone with my chest size doesn't have a big ass. Being fat probably is why I have sleep apnea and am fucked if I have to sleep somewhere that doesn't have electricity, so I can't go camping anymore. There are workarounds to some of these, but the health is not one of them, and all other things being equal my life would be a lot easier and probably longer and more comfortable if I was not this fat.
Awhile back, I researched and even started paying for gastric sleeve surgery, but abandoned that plan when I looked at what it changes and why people fail on it, and figured I was too high a risk for failure to alter my body in such a drastic way. It felt like it was trying to brute-force a solution in the gut without addressing the brain, and I realized that if I can't get my brain onboard this won't work, because I believe that's where it's starting and the rest (insulin resistance, etc.) is just side-effects that came later. I've been going to OA and that's been pretty helpful, actually, though more as a social environment that gives me some structured space to look at my brain stuff related to eating than because I'm any kind of fan of the Twelve Step program. I've actually been very, very slowly losing but then this miracle shot showed up on the scene.
ii. data-gathering
Brö has been overweight all his life and diabetic for years, and his doctor put him on Ozempic and he lost like all of his excess weight over a couple of years. It sounded like it came with some pretty severe GI symptoms but I also think he has severe unmanaged anxiety that sits in his GI tract in addition to pretty bad eating habits. Most of my overweight and obese friends have gone on some sort of GLP-1 shot and I've been watching how they do with that. Videos from science-based sources have presented more data.
My doctors are pretty good about not shaming me for being fat, but they're also always up my ass to lose weight. One of them mentioned GLP-1s to me a couple of years ago, but not since, opting to push the usual plant-based but low-carb diet and daily exercise route since insurance wasn't going to cover it and it was really expensive. After some years we talked again. She said I had some factors and behaviors that are in my favor, which gives me more confidence that this has a better chance to be a sustainable fix (that's the test gastric sleeve surgery failed). The last thing that was stopping me was the idea of having to be on it for the rest of my life (which is not guaranteed, but from the research and knowing myself is possible, if not likely) but I am on so many medications now that I assume I will have to be on for the rest of my life, I'm not sure why that thought even bothers me. Maybe just the idea of giving myself a shot versus swallowing a big handful of pills? Who knows. Moving on. Oh- and a pill form just came out, so hey what's one more pill, but it's so fussy about how and when and with what you take it, they only recommend it for super consistent people who wake up at the same time every day and also have a deathly fear of needles. Neither of those things is me.
iii. acquisition
The reason I didn't go with this idea when the doctor brought it up initially was lack of data and cost. I've heard rumors that the landscape around cost had changed, and had some hope we could get insurance on board with this. I heard someone with the same insurance I had got his covered for sleep apnea! I have that! Optimism! We tried through the insurance portal right there at my doctor appointment, and they said "NO MOTHERFUCKER!" but there was a "maybe" in there that allowed us to try again in some other arcane way that involved sending it to the pharmacist and then seeing if we could get it in that way. Fast-forward a few days and after jumping through the expected hoops we got another "NO MOTHERFUCKER" from Blue Cross Blue Shield.
If I may briefly digress, I know my insurance company wants me to lose weight but evidently it's not worth it to them unless I am also diabetic (or had some other serious co-morbidity; sleep apnea, crumbling joints, and maybe multiple bouts of breast cancer apparently don't count) and since I have seen how badly diabetes just fucks with everything, I have been terrified of becoming diabetic and been doing my best to avoid it. My glucose has been creeping up, and if we kept up at our current rate I might get there eventually. I don't know exactly what I said to my doctor, but she relayed a story about another patient who said "So what you're telling me is that if I seriously trash my diet for three months and get my blood levels bad enough I can get insurance to pay for the shot?" and she had to explain how as a doctor she absolutely could not sign off on such a plan, but, well, yeah, that would work. Like, this is upfront a terrible, very bad, no-good plan but it'll work. My takeaway from this is that we seriously need to decouple profit from health care. It's not the most egregious way that this country sucks, but it's the one relevant to this journal entry.
Anyway! Insurance not covering things means we have to take a less conventional route. Until literally a few weeks ago it was cool to get your meds mixed up by compounding pharmacies, but that came to an end- however many pharmacies still do this by either mixing the compound at a different strength (like, the standard first dose from a pen injector is .25 so they make it .33, or something along those lines) or else they mix something else up with it. Thankfully my PCP has enough patients going this route that they've been able to gather some data about a few different compounding pharmacies, and for a number of reasons we decided to go with one in San Antonio that has many reports of great customer service and free shipping. Their deal is that they mix it with B12; some studies say people on GLP1s don't tend to get enough B12, and it can help with the low energy symptoms that bother some people.
Technical shit it's okay to skip- Ozempic and Wegovy are both semaglutide and that was the first one out, so there's more long-range data on those. Zepbound is tirzepatide, and while it hasn't been out as long it seems to work better, on a couple of different peptides instead of just the one semaglutide does, and the side effects seem to be less. But I don't know what my therapeutic dose will be. By this I mean the dose that I will stay on as my maintenance dose once my body figures out how to work with this drug. It might be the maximum dose they sell, but it might not. Since it's hard on your GI tract no one starts high, they start on a tiny dose and slowly ramp up. If I were getting the name-brand pens I'd have 4 doses to chose from, with the first step up doubling the dose. Since I'm getting it compounded, I get a vial and a prescribed amount to draw up, with the unspoken option of altering that if I wish- for instance creeping up my dose for a couple of weeks before I officially jump to a higher dose. This pharmacy sells semaglutide at nine different dosing levels, which range from $75 a month up to $125 a month for the highest dose. I could afford it at the highest dose. They sell tirzepatide at eight different dose levels ranging from $80 to $400 a month. There's no way I can afford $400, and if I'm gonna go through the laborious ramp-up only to find out that I can no longer afford the dose I need and have to switch- apparently people do this, but it sounds like a pain in the ass, and I have reasons to be optimistic that I can make the semaglutide work so that's what I'm going with.
Once we decided to go with a compounding pharmacy things happened really quickly. They sent me a UPS code that sat on "waiting for package" until after the package actually showed up. I got a vial that's sitting in the refrigerator, and a bunch of alcohol wipes and syringes with 31 gauge needles. I'd thought about starting right away but then I remembered- JoCo cruise is coming up in two weeks. JD and I are planning to drive across the country for 2-3 days, then get on a boat for another If everything goes perfectly, I have no symptoms and no problems keeping the drug chilled for the entire trip the way it needs. But I have no guarantees of any of that being true and Erica made a pretty good case for me having my last vacation of indulgence on the boat and then get back home and start up without throwing all the other variables in, which include possibly going GI-tract-rainbird out of one or both ends while on the road in the middle of Arizona or something. Who needs that?
iv. summary
My understanding is that these drugs all work on both the gut and the brain, and one of the things that made me seriously start considering this was folks describing how this quiets the "food noise", which has become the standard term that describes how the brains of some people are constantly going "food food food food food" every waking moment. I know this has been the case for me for as long as I can remember, and I am working on what to do with my brain once that isn't there. Evidently the things that trip people up are not working hard enough to maintain muscle (I've been doing weights at Planet Fitness), not eating enough protein and fiber (been slowly increasing those) and not drinking enough water, and I looooooove drinking water all the time. A lot of the symptoms sound like they might be a result of or at least worsened by bad eating habits that I'm pretty sure I can manage if the food noise is not there. I plan to go slowly. I walk or swim almost every day. I feel like a lot of what trips people up will not be as much of a problem for me, because I've been slowly whittling away at the bad brain things and poor diet for years now. If this works the way I've seen it work for a lot of people, I have a good chance of wearing normal clothes someday. Maybe I won't need my cpap. Maybe I won't need my knees replaced. Maybe I'll stop sweating all the time. Maybe I will fit in airplane seats again. Maybe I won't dread dying like my mom and can look forward to living forever like my dad appears to be doing- or at least not dying of something I could've done something about.
I have a good feeling about this.
