I’m 46 years old and I have been on a diet since I was 11.
For as long as I can remember, eating has given me comfort. As a kid, I lied to my friends’ parents so I could eat a second dinner at their house. I’ve never wanted just one cookie – I’d eat 12 and only stop when I felt physically ill, and sometimes not even then. In nearly every photo of me as a teenager I’m wincing, sucking in my stomach, trying to pose.
I never really enjoyed the taste of these foods, nor was I happy with myself after eating them. They came with a side of guilt: you don’t deserve this. This relentless food noise trapped me in a cycle of wanting to eat, then shaming myself for doing it. I spent inordinate energy hating my too tall, too big body. I always felt simultaneously like not enough and too much.
Now, GLP-1 drugs like Ozempic, Wegovy and Mounjaro are being hyped as an easy fix to obesity. Their manufacturers have experienced significant revenue growth credited to the drugs’ popularity; for instance, Eli Lilly recently announced 38% yearly growth, credited in part to sales of Zepbound and Mounjaro. Media headlines tout the changes in weight and appetite for those who take them.
But what if the “miracle” doesn’t work for you?
***
Being diagnosed with diabetes at age 27 threw me deeper into a shame spiral. At the time, my doctor clinically defined me as obese. That, along with the prognosis of a deficient pancreas, felt like punishment for decades of failing to control my overeating.
Given my family history of diabetes – my grandpa had it – the doctor diagnosed me as type 2 and recommended dramatic lifestyle adjustments, including carb counting and daily exercise. She also did an A1C test, which measures average blood sugar levels for three months. A non-diabetic’s result would be under 5.7%. Mine was 7.7%.
This diagnosis felt like being sentenced to lifelong obsession. Food already controlled me, and now it had even more power.
Over the next five years, I worked with a nutritionist and psychotherapist. I trained for a 200-mile relay race with friends. I did Weight Watchers, went to Overeaters Anonymous, worked the 12-step program, and used apps like Noom and My Fitness Pal. I lost 50lb. Still, I remained overweight according to the BMI chart, and my A1C didn’t budge, which confounded my primary care doctor.
She referred me to an endocrinologist who specialized in metabolic health. Six months later, when my appointment finally arrived, my A1C had shot up to 9.1%. That should not have happened while I shed pounds. She declared I was misdiagnosed: type 2 diabetics’ bodies make insulin, which helps regulate blood sugar, but don’t use it effectively. But I was actually type 1, an autoimmune condition where the body stops producing insulin.
I would be dependent on insulin injections from that point forward.
Living with diabetes was taxing. I had to order a continuous glucose monitor (CGM), pen needles, insulin vials and other items – but via a specialty supplier rather than a standard pharmacy, for insurance purposes. I had to procure pre-authorization forms for medication and attend required half-day training sessions every time I wanted to try a different insulin pump or when my insurance changed.
But in 2018, after five years of effort, my A1C settled in at 5.9% – a happy result for me and my doctor. But to get to a weight my doctor would approve, I still had to lose 30lb. She started me on a new drug called Ozempic. Like most people at that point, I’d never heard of it. She said it was only technically approved for type 2 patients – but some who were overweight with type 1, like me, were taking it to help with weight loss.
Over the next four years, my doctor and I gradually increased my Ozempic dosage and eventually were pleased with the results: when I woke in the morning my fasting blood sugar reading was finally within the recommended range of 80-120 on my CGM. I was able to reduce my regular insulin usage.
But my weight didn’t change. I continued my healthier eating habits and exercised regularly with cycling, yoga and running. Still, the scale didn’t move.
***
In 2022, when Ozempic was becoming a household name, I suddenly had two problems. First, my doctor confirmed I was already on the highest available dose, so taking more wouldn’t help me lose weight. Second, because the drugs were now approved for general weight loss, I might have trouble filling my prescription. A global shortage followed, and I went four months without, eventually switching to Mounjaro because it was available.
My already-thin friends started taking GLP-1s, and I couldn’t avoid chatter about the “skinny shot”. “I’m not even hungry! I don’t even think about food!” they’d say. But I didn’t experience this quieting of the voices in my head telling me I was hungry all the time, and I wondered why.
I was furious. As my friends celebrated their new bodies, I wondered, again, what was wrong with mine. My diabetes was under control, but I was also existing at the margins of a miracle.
An estimated 15% of all GLP-1 users are so-called “non-responders” to the weight loss effect, according to Atlanta-based physician Dr Cristina Del Toro Badessa. Lucas Veritas, a GLP-1 user from Montreal and author of The GLP-1 Effect newsletter, highlighted clinical trials showing that approximately 13% of people taking semaglutide (the active ingredient in Ozempic and Wegovy) and about 9% of those taking tirzepatide (found in Mounjaro and Zepbound) did not lose more than 5% of their body weight.
“The meds are highly effective for a majority of patients but there is still a percentage who don’t lose a clinically significant percentage of body weight. Everyone’s physiology is a little different,” said Veronica Johnson MD, an obesity medicine specialist in Chicago. Recent research has identified a gene that may help predict who will successfully lose weight with GLP-1 medications.
Additionally, according to a recent study comparing GLP-1 medications to bariatric surgery, “real world” cohorts lost less weight than what drug companies reported in their trials: about 5% of their body weight, compared with the 15% reported for semaglutide and the 20–25% for tirzepatide in pharma-funded studies.
Nicoletta LaMarca-Sacco, 56, a former Ozempic user in New York, also didn’t lose weight after a year of use. “I’ve always been a squishy mom and will continue to be,” she said. “It just didn’t work for me.” She expected the drug would quiet more of the internal chatter telling her she needed to snack. “It did help, but only to a small degree,” she said.
“When we consider these drugs, they need to be combined with other markers of good health like diet, exercise, even stress management,” said Dr Raj Dasgupta, an ABIM Quadruple board-certified physician in Los Angeles. He said his patients sometimes had unrealistic expectations about how quickly and dramatically they will drop extra pounds. He explained that for someone who is overweight, shedding even a small amount of weight can improve heart and kidney function, adding: “The bar has been set too high for weight loss.”
“What’s dangerous,” Badessa said, “is the dominant societal narrative that these are ‘magic shots’ for weight loss.” Veritas agreed: “Expectations are sky-high. People see all the before/after photos and expect an easy ride.”
“It feels similar to any other time the diet industry has thrown marketing momentum behind one particular ‘fix’,” Virginia Sole-Smith, author of Fat Talk, told me about the current hype. “There’s excitement that we’ve found a ‘silver bullet’, then it silences any other narratives and experiences about it.”
I had definitely been looking for an elixir to rid me of body mass. Then I discovered that diabetes itself might be the reason I wasn’t losing weight. Andrew Koutnik, a metabolic research scientist, said that GLP-1s typically lead to significant weight loss for people with obesity (15-25% of their body weight). However, people with diabetes generally lost less weight, proportionally: for type 2, an average of 8-11%; for type 1, about 8-12%.
“While we don’t know why this is occurring, prior data suggests the drug’s metabolic effects may be tied to how well the body manages glucose,” Koutnik said. GLP-1s are designed to coax the body into making and using insulin more efficiently, he explained. But for someone with type 1 diabetes, meaning their pancreas cannot make insulin, that’s like installing a turbocharger on a car with no engine – there’s nothing to boost.
That said, he clarified, these drugs aren’t entirely useless for people with type 1. GLP-1s slow digestion and suppress appetite, which can lead to fewer snacks and less carb-heavy meals. That might nudge blood sugar in the right direction, but it’s more of a side-effect. “The actual impact on blood sugar control is minimal: less than a 1% drop in A1C,” Koutnik explained.
***
The psychological fallout of being a non-responder can be devastating. It was more fodder for my destructive inner dialogue: Why won’t my body just comply?
Alyson Curtis, a therapist based in New York, works with patients who feel isolated as they see others losing weight and don’t have the same result. I told her how unfair it felt and she agreed the loss of agency can be a lot to process. “I hear the ‘thin fantasy’ constantly from patients – it’s a dream to fit into societal norms,” Curtis added, “but what they’re really saying is they want to be accepted, cherished, adored.” She helps patients reframe success to focus on healthy outcomes beyond weight loss – like how the Health at Every Size (HAES) movement centers on overall wellbeing.
Still, these drugs are here to stay. Johnson pointed to recent innovations like CagriSema, a compound drug bringing together an amylin agonist and a GLP-1. In trials, CagriSema helped reduce blood sugar spikes after meals and can also contribute to weight loss. “The hormone called amylin is normally released by the same cells that make insulin – which type 1 diabetics lack,” Koutnik said. He added that amylin helps slow digestion and also lowers levels of glucagon, which could help better manage blood sugar.
Society seems to have rewritten ideas about health, worth and willpower through the lens of these astonishing drugs. I figured I could, too. I’ve tried to quiet the inner voice that’s shaming me into thinking I’m a failure for not losing more weight.
Forging self-acceptance from deep frustration, I am realizing there is nothing inherently “wrong” with my body – I am simply among those for whom the current medications produce a partial benefit. Learning that I’m not alone has helped curb my body shame.
I am grateful that GLP-1s have helped me with blood sugar control, minimizing my risk of complications from diabetes. “When we focus on the miracle weight loss narrative, we ignore their real value in helping people with diabetes, adding to the discourse of body shaming, which is never health-promoting,” said Sole-Smith.
I’ve been trying to shift my focus from weight loss to improving my relationship with food. For me, that’s learning to eat with more intention and maybe even a little joy. Hopefully, I can come to appreciate my right to the occasional indulgence without self-recrimination. And on my next birthday, I want to celebrate with the most delicious symbol of self-acceptance: a guilt-free piece of cake.
