The Magic of Ozempic

Weight loss injections and me

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First things first: I know this content won’t be for everyone. Maybe you don’t want to read about intentional weight loss! Maybe you don’t want to read about injections! Maybe you’re only here for the money diaries!

All of those reasons are absolutely fair and valid, and you can avoid any and all mention of Ozempic (or, more accurately, compounded semaglutide, more on which shortly) by heading to rosemarymaccabe.substack.com (on browser only, I’m afraid this won’t work in the Substack App) and hitting the three lines on the top right of the screen.

You’ll see a drop down menu, and you’ll click on “Manage subscription”, which will show you a list of “notifications” options (see above!). You can toggle between any sections you are or aren’t interested in, including “Ozempic etc”, which you just need to switch to “off” to ensure you won’t get any updates about it. (You can also do this for any other sections or categories you don’t want to read about!)

But if you are interested – please, read on, and download the Substack app if you’d like to get involved in the Ozempic chat, where I’ll be answering questions and hopefully other people will share their experiences too!

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Let’s start at the start…

I have been overweight pretty much all of my adult life, cycling through diets like, well, like so many of us who have tried various ways of losing weight, mostly with success, until I’d inevitably fall off the wagon and gain the weight back (usually with the addition of a few extra pounds).

This is definitely an abridged history, but I think it’s one that will be familiar to a lot of you. The Cliff’s Notes version is this: I’ve been dieting for as long as I’ve been fat, and it’s never “worked”, just as science tells us it won’t.

So, a couple of months ago, almost two years after the emergence of weight loss injectables like semaglutide (marketed as Ozempic, for diabetes, and Wegovy, for weight loss) and tirzepatide (Mounjaro), I asked my doctor if I would be a good candidate to try one of these injectable weight loss medications.

Why?

I was a little over two years postpartum, and though I gained a minimal amount of weight when pregnant (10lbs, give or take), I’d been gaining weight, slowly but steadily, ever since, due to, I’m sure, my feeling hungrier than ever before in the months and years after his birth.

And I was really, really unhappy about it.

I’ve tried, for years, to be more “body positive”. I follow fat influencers and I’ve read books on being fat and books dispelling myths around fatness and books about the best ways to talk to children about fatness and I’ve tried to buy clothes I find comfy and remind myself how kind and funny and loving I am, and that those things are more important than what I look like.

But it really hasn’t ever sunk in, and I’ve grappled with what seems like a straight-up binary choice: accept the body I’m in and try as hard as I possibly can, every minute of every day, not to be affected by beauty standards and anti-fat bias and the disgust I feel when I look at myself in the mirror or see a photo of myself, or change my body.

So I’ve decided to try (again) to change my body – this time with science on my side, or at least more on my side than ever before.

How?

My doctor wasn’t against this choice for me, saying she’s had many patients who’ve had great results from semaglutide and tirzepatide injections. But she also suggested that I use the medication as a springboard to make healthier choices around both food and activity.

The medication, as I understood her, should be a crutch, rather than a prosthetic limb.

So she prescribed me first Mounjaro (it was my number one preference, as I had a friend who’d seen dramatic results with it) and then Wegovy, but of course, this being America, my health insurance – for which we pay $600 or so each month – wouldn’t cover it.

Despite my being pre-diabetic, and Wegovy being FDA-approved for weight loss, my insurance will only cover these weight loss medications for those with a diabetes diagnosis, and I wasn’t quite there (just on my way). Without insurance chipping in, the medications were going to cost more than $1,000 each month.

My initial reaction to that number was, that’s way too much, although I did go back and forth in discussions with my husband about whether or not we could afford it. As it is, we’re spending $200 a week on groceries, and probably $100 a week on takeout.

While we’d still need to buy food, I could at least imagine that taking weight loss injections would result in a serious decrease in takeaway orders… but it was still too much money.

So I forgot about it for a few months. I tried to eat healthily; I joined the YMCA; I pledged, every day, that I would work out tomorrow. But I was so hungry all the time, and it was too cold to go for walks, and I felt too nervous to go to the YMCA (due, in part, to my feelings about my body, honestly), and numerous other excuses that are excuses but feel, too, like reasons (as excuses often do).

Then, the week before last, I saw a video of Kelly Clarkson performing on her TV show, having lost 70lbs, she says, by walking and eating more protein. That is in italics to denote that it is a lie.

I immediately messaged my doctor: “I’ve just seen a video of Kelly Clarkson and I’m wondering if anything has changed in terms of what weight loss injections my insurance will or won’t cover.”

The answer came swiftly: nothing has changed. My insurance company still won’t cover injectable semaglutide for weight loss. (There’s a whole rabbit-hole here I could go down wondering why, exactly, when medical experts seem to think obesity is responsible for every single malady known to mankind, insurance won’t help people take the pre-emptive step of losing weight before they get to the “seriously ill” point – caveating this by saying that a lot of the alleged “links” between obesity and illness are correlative, rather than causative, and scientists are still very unsure about how much anti-fat bias in medicine, to use one example, contributes to bad health outcomes for fat people.)

However, she continued, there is a compounding pharmacy in Michigan that makes up generic semaglutide and will post it out to patients – and, while my insurance won’t cover that either, getting the medication that way costs between $200 and $300 a month, a fraction of what it costs to get from Novo Nordisk, the Danish healthcare company that owns Ozempic and Wegovy. Would I like to try that route?

Yes, I said. Yes I would. So the wheels were set in motion, the prescription was sent through. A few days later, I received an email invoice from the pharmacy, along with details of what to do once the medication arrives (refrigerate it immediately) and how to self-inject correctly.

So… I guess I was doing it.

When?

It all arrived on Tuesday morning in insulated packaging – six syringes and a tiny little bottle of the medication itself – and I pretty much spent the entire day worrying about when I would start.

I looked online for some support groups to see what people recommended and, let me tell you, there were no facts there. Some people said they took theirs during the week, others said they preferred the weekend. Some said they injected at night, while others favoured first thing.

There were horror stories of side effects: “I’ve been vomiting non-stop since I took mine!” said one. “I have the worst reflux, I have to sleep sitting up,” said another, then added, depressingly, “But it’s worth it!”

“Would it be ‘worth it’, I wondered, if I lost weight but ended up vomiting all the time, and sleeping in a recliner instead of a bed?!”

The short answer is no, but I couldn’t say for sure that I wouldn’t put up with some terrible side effects if I was no longer hungry, 24/7, and could fit into all of my nice clothes.

I took my first injection on Tuesday night, right after dinner – a large helping of beef tacos, which may have been a mistake – and, despite some panic when I cleaned the injection site with an alcohol prep pad and promptly forgot which area I’d cleaned, it was very straightforward. I didn’t even feel the needle, which is absolutely teeny tiny, more like an acupuncture needle than anything else (although honestly I feel acupuncture needles more than I felt this; I had to double check I’d inserted it).

Immediately, I felt slightly queasy, which I’m putting down to the apprehension leading up to injecting myself (I’d never done that before, which added to the stress of it all), but by the time I went to bed, I felt totally normal.

That night, I slept terribly, waking up several times with really bad heartburn and reflux, more than once startling myself awake, thinking I was about to vomit. Was this the semaglutide or the tacos? I honestly could not say – heartburn and reflux aren’t new, and have increased in frequency and ferocity in tandem with my weight.

The next day

The following morning, I felt totally normal, except for the fact that I was weirdly un-hungry. It was as if I’d just had a small meal – I wasn’t stuffed, but I wasn’t exactly hungry either (and honestly, as someone who eats big meals and is always either stuffed or starving, this was a new experience for me).

I cooked myself a small (again, for me) breakfast: two eggs, scrambled, with a single slice of toast with Kerrygold butter, and waited to feel incredibly nauseated after the third mouthful. Readers, I ate it all.

The rest of the day continued in the same vein. I felt… less hungry than usual, but not exactly full, and it was not difficult for me to eat (even if I abandoned my lunch of salad and pita roughly halfway through, as I started to feel slightly nauseated). I should also say, at this point, that I am on the lowest possible dose of semaglutide – 0.125mg – and will be on this same dose for six weeks, before going to .25mg for four weeks, then .5mg… etc.

I couldn’t swear that the reduced hunger I’m feeling is a result of the semaglutide, rather than simply being due to the placebo effect of being told (and believing!) that my appetite is going to decrease, and that my feelings of fullness are going to increase (semaglutide does two main things, in weight loss terms: it slows digestion, meaning you feel fuller for longer, and it reduces appetite).

Simply knowing that I’m taking this expensive drug is definitely – so far – inducing me to make healthier food choices than I usually would, and while it hasn’t eliminated the “food noise” entirely (I think about food a lot), I definitely feel a decrease in urgency when mealtimes come around.

But like I said, it’s very early days… so only time will tell what effects are in store for me, and how my body will respond to this so-called “wonder drug”.

I spoke about this on Instagram Stories yesterday, and I got a lot of questions, and while I don’t want to bombard my Instagram followers – who may not be particularly interested in the semaglutide chatter – I thought I would answer the most frequently asked questions here.

As always, please feel free to leave a comment, or send me a message (simply reply to this email, if you receive your newsletters via email, rather than using the Substack app, or use the button below to DM me) with whatever questions or comments you might have.

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Once you get to a weight you’re happy with, do you come off it?

This – in so many words – was by far the most asked question about this whole thing, and honestly? I don’t really know yet. One person I saw on Instagram started to wean off semaglutide once she reached her “goal” weight, but the evidence so far seems to suggest that, once you stop taking it, your appetite will come back, and very few people will have enough willpower to ignore their body’s natural food cravings for the rest of their lives.

As a general rule, I am not against medication: I currently take a mood stabiliser for my depression and anxiety (as recommended by a psychiatrist who suggested that might work better for me than straight-up anti-depressants), and each night I take a muscle relaxant to help with my intense teeth-grinding. I will happily take these for the rest of my life if needs be, and I feel the same about semaglutide.

If the side effects are not severe, my health improves – blood sugars, blood pressure – and I manage to lose weight, I could easily see myself staying on it. But I’m also open to weaning off, if that’s something my doctor recommends, and if I can keep up the (hopefully!) healthier habits I adopt while taking the injections.

How did you get the prescription?

I spoke to my doctor about it. From the feedback I got over on Instagram, it seems like a lot of GPs are reluctant to prescribe these injections for weight loss, instead suggesting that patients reduce their calorie intake and increase their exercise, which is hardly a new or groundbreaking recommendation, and something that everyone who is overweight has tried at least once in their lives.

The fact of the matter is: some people have much bigger appetites than other people, and cannot simply “eat less” and ignore their body’s hunger cues for their entire lives. I feel as though I’m one of those people, to be honest, and I’m really grateful that my doctor is as understanding and empathetic as she is.

Weight loss injections – Wegovy and Saxenda, I don’t think Mounjaro is available in Europe yet – are also available to be prescribed by doctors in the UK and Ireland, and according to people in my DMs, they are helping a lot of people.

If your GP refuses to entertain the idea of weight loss injections and you feel this is a route you’d like to explore for yourself, I would, honestly, suggest finding another doctor. (“Eat less and exercise” is to being fat as “go for a walk” is to being depressed, in my opinion, and any doctor who uses one of the former suggestions simply does not understand the people they’re treating.)

Do you not feel bad about the shortages?

So: there are shortages, in the US and, as far as I know, in Europe, in the supplies of Ozempic and Wegovy, because Novo Nordisk can’t produce them fast enough (this is also apparently due to the time it takes to make the Ozempic branded pens).

I got my semaglutide from a compounding pharmacy which makes medications from the raw materials, which are not in short supply.

Think about it this way: Levi’s Wedgie jeans are on backorder, because they’re out of the product. It doesn’t mean the world has run out of denim, simply that Levi’s is behind on its production of those jeans. In this example, Levi’s is Novo Nordisk and the wedgie jeans are Ozempic and/or Wegovy. Generic semaglutide is a different pair of jeans entirely, made of the same denim and a similar design, but in a different factory. One does not affect the other.

What about breastfeeding? Are you done?

I’ve been breastfeeding Atlas for two and a half years now, and I think I am – finally – ready to be done. Ask him and he might have a different answer (but luckily he can’t talk yet!).

There is no official green light for taking semaglutide while breastfeeding because, as you can imagine, testing on mothers and babies is ethically murky, at best. But the science seems to suggest that semaglutide will transfer to milk in miniscule amounts, and is absorbed orally in even lower amounts.

Because Atlas is eating so much food now, we are nursing twice a day at most – and as I’m on such a low dose of semaglutide, I’m not worried about it affecting him right now. But I am planning on weaning him off in the next few weeks so that as I increase my dosage, there’s no worry that it’s transferring to him via breastmilk.

Are you worried about long-term side effects?

Yes and no. As it’s such a new medication, there aren’t many long-term studies on its side effects, although initial results suggest that risk factors are quite low, unless you have a pre-existing condition or family history (of, say, thyroid cancer, which is contraindicated).

Even if I do end up staying on it long-term, I think the ideal scenario would be tapering down to a low dose for maintenance purposes, and obviously as the science advances and more and more studies are done, we’ll all know more about it and be able to make better, more informed decisions.

That being said, if you buy into the rhetoric in many healthcare settings about obesity, the long-term side effects of that are dire: type 2 diabetes, high blood pressure, increased risk of cardiac events, mobility issues… I could go on. So it’s interesting to me that, in a lot of cases, the people who’ve been telling fat people that they’re “eating themselves into an early grave” are the same people who will admonish them for taking a weight loss drug when it may carry a risk, rather than a guarantee, of adverse health conditions. You literally cannot win.

What did your family and friends say when you told them you were going on it?

In many ways, I am brave – look at me here, talking about this in public, on the internet – but in other ways, I am a coward, so when I spoke about this on Instagram, I had told exactly three people: my sister, my husband and a good friend of mine. I decided the others could find out with the rest of the world, and that way I wouldn’t be expecting a response or reaction from them right away.

What is interesting is that, when I spoke about it on Instagram, I got dozens of messages from people who told me that they were taking either Ozempic or Saxenda, but that they had told no one in their lives. NO ONE.

There is, for some reason, such massive shame around weight loss injections, as if it’s tantamount to taking “the easy option”, when this is not a decision that anyone comes to easily. Plus, it’s not easy! It’s expensive, you’ve to inject yourself, for God’s sake and you may end up experiencing nausea, constipation, headaches, cramping, fatigue…

Honestly, if I thought I could just eat less and move more, I would much rather take that option. But I know that I can only do that for a limited amount of time, and I am, honestly, more concerned about the negative health outcomes related to drastic weight fluctuations than I am about the potential negative outcomes of long-term semaglutide use.

In other words: I don’t want to put my body through drastic weight loss again (for probably the third time) if I’m just going to fall off the proverbial wagon and put it all back on. I really, really need this to be the last time I lose weight. Quite aside from anything else, I’ve dedicated way too much time and energy to dieting, and I’m ready to use that headspace for something more fun.

How long will it take you to get to your goal weight?

I’ve gone back and forth over talking actual numbers, because I know that can be triggering for some people, but I’m hoping those people stopped reading in the first few paragraphs, so here goes: right now, I weigh around 250lbs (over 250lbs a few days ago, 248lbs today), or 114kg, and I really think it would make a world of difference to me if I could get to 200lbs or so (89kg).

I don’t particularly want to be “thin”, whatever that means, because I don’t think my body is designed to be thin. I have broad shoulders and a very solid frame, and I just feel as though I’d have to be eating very little to get to, and stay at, that weight. (And I don’t want that! I love food!)

I suppose I wouldn’t be upset if I got down to 170lbs or so, which is the weight I was at during my Weight Watchers phase in my early twenties, but for now I’m aiming for 200lbs. If I lose 1.5lbs a week (literature suggests people lose between 1 and 2lbs weekly on semaglutide), that makes it roughly 33 weeks before I’d reach my goal, so around Thanksgiving of this year.

But really, who knows if I’ll even stick it out? I can’t guarantee that I’ll keep taking this if it means puking constantly, or being entirely unable to enjoy any food. That just doesn’t sound like a great way to live.

Would it not be cheaper and easier to hire a personal trainer who would do a food and workout plan?

No. LOL.