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sirfrogsworth · 11 months ago

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Mounjaro's Revenge: The Inevitable Adventures of Froggie, Chapter Unknown

I keep saying I can't leave the house without having some kind of adventure. And I really thought I was going to have a quick, uneventful doctor's visit with my monthly checkup this past Wednesday. I'd go in, they'd check the box Medicare requires every month, and I'd come straight home.

But adventure seeks me out. I can't seem to escape its grasp. And, yes, sometimes I like having adventures. They give me something to write about. And sometimes they are fun memories. But sometimes adventures just make me tired. And not all adventures are positive.

For the past 3 weeks I have been on the second dosage amount of Mounjaro. Unlike the Ozempic, I have had a few issues with side effects. Roughly 48 hours after my injection, I get sick to my stomach and feel pukey. It lasts for about two hours. I either vomit and lose the urge or I hold it in and it fades. I am then compelled to take a nap.

Considering the weight loss and glucose control, getting sick for an hour or two per week isn't a huge deal. There is a good chance I will get used to the medication as time goes on, but even if I don't, I am okay with this consequence.

My injection day was Tuesday, and based on past experience, I figured I'd have until Thursday morning before I got sick. The past 2 episodes happened at almost identical times, so I figured Wednesday wouldn't be a problem.

But right before my doctor's appointment I started feeling extremely... rough.

Optimistic for no good reason, I was hopeful I could get through the appointment before the urge to vomit arrived.

I get to the office and there are 3 patients ahead of me. This was not a good sign. My doctor tends to overbook and I was probably going to have a bit of a wait. I arrived in the middle of a lively conversation about where to get a good steak in St. Louis. I'm used to waiting rooms being full of quiet and bored people staring at their phones so when I opened the door it felt like the conversation smacked me in the face.

The cast of characters were as follows...

There was an older black man who had the spirit of a kindly grandpa. He seemed nice and wise and was enjoying the steak conversation. Let's call him, Old Guy.

There was an older white fellow who was anxious about the wait time due to having another appointment soon. He was on hold with the other doctor's office trying to delay his appointment time. He was only mildly interested in steak due to that distraction. I already used Old Guy, so... Anxious Guy.

And then there was the steak expert who was leading the conversation. Actually, leading is not strong enough. He was *dominating* the conversation. As I sat down and his visage entered my field of view, I was a bit taken aback.

Do you know how in Star Trek everyone has a mirror universe doppelganger who may look the same, but they usually have personality traits that are reversed?

They are often identified by arch overacting or a change in facial hair.

The steak expert was my mirror universe counterpart. He was of similar age, height, and weight. Same color hair and eyes. He even wore similar clothing.

But he had a goatee instead of a beard. *gasp*

And he wore... sandals. *double gasp*

He had clearly been in a recent transporter mishap.

I mean, I could *never* wear sandals. The world is not ready to handle my nude foot and I find very few sandals have the load-bearing capacity necessary for people my size. You are asking for foot pain if you are over 300 pounds and wearing sandals.

Mirror Froggie was very outgoing and personable, but he had trouble filtering what he said and was often obliviously rude. He clearly thought himself to be hilarious but struggled to make even kindly Old Guy chuckle.

Old Guy said, "I think Longhorn makes a decent steak for the money."

And then Mirror Me's unfiltered response... "Longhorn is shit. You shouldn't eat there. You are wasting your money on shit steak."

"I don't know, I've always enjoyed..."

"I'm telling you, friend, it is shit steak. End of story."

You could tell that made Old Guy feel bad for suggesting what he liked. But he brushed it off and asked for a better suggestion. Mirror Froggie confidently told him of a restaurant called "Sam's" that had "the best steak in town."

Old Guy proceeded to ask Siri to look up Sam's and it took a few tries. He reminded me of my dad fighting with the iPhone and repeating things over and over with increasing volume. I think Old Guy wasn't specific enough as he got the wholesale club on the first few attempts. Finally he said, "SAMMM'S STEAKHOUSSSSE" and found success. Old Guy saw the reviews and some of them were... not great.

But Mirror Froggie was like, "You can't read reviews. They're all liars." And I was questioning why people would take the time to lie about a small St. Louis steakhouse, but whatever. He then said it was because the restaurant was in disrepair and needed new plumbing, but that's why they could sell such amazing steak at reasonable prices.

Theories are less logical in the Mirror Universe. ¯\_(ツ)_/¯

Anxious Guy got off his phone call and cursed into the void. He missed his other appointment. He interjected with, "Is that Sam's place expensive?" And that sent Mirror Froggie into a long diatribe about the price of meat at different places and his annoyance at steak-related inflation. Soon after, Anxious Guy finally got in to see the doctor. Old Guy was keeping Mirror Froggie busy with conversation, so I just closed my eyes and rested as they discussed the price of oversized shrimp "as big as your fist". I guess they ran out of things to say about steak.

As they were talking I started to get a spidey-sense about Mirror Froggie.

He *needed* conversation.

He *needed* distraction.

His boredom abhors a vacuum.

Whenever there was a lull or silent moment, I could see him getting very antsy. And if Old Guy got called in before Mirror Froggie... I was going to have a problem.

I was feeling sicker by the moment and did not have the bandwidth to help some stranger with his inability to accept boredom.

And... Old Guy was next.

Because, of course he was.

I feel like sitting there with my eyes closed and also not having said a word the entire time was a pretty decent social cue that I was not interested in talking. But Mirror Me decided to poke that notion with a stick in order to find a way in.

He speaks barely above a whisper, "I wish I could sleep in a public waiting room. Not sure how you do that."

"Yeah, I'm not feeling well. Nothing contagious, just very tired."

"Well, if you're sick, I guess you're in the right place, am I right? *long pause* Cuz we're next to a hospital. *short pause* Right?"

Oh great, he's a joke explainer.

Mirror Froggie did not care about my desire to sit in peace while I waited. His foot was anxiously a-tappin' and he was vibrating with energy that needed someplace to go. He tried standing up and walking in circles. And I guess because my eyes were shut he decided to narrate his walking and stretching to keep me informed. That satisfied him for roughly 20 seconds. He sat back down and was clearly struggling to be alone with his own thoughts.

"Hey, friend."

I open my eyes slowly.

"Do you see that magazine next to you? Would you mind handing that to me?"

I thought, "This is good. He's seeking out an alternate source of stimulation. He can read the magazine and I can rest until my turn."

Seriously, brain... where is this optimism coming from? I've been a cynical misanthrope for like 4 years now.

He flips through a few pages. "Look at this. It's got Oprah on the cover. It's got to be good, right? They don't put Oprah on the cover unless it is good, ya know? Though she doesn't look right after losing all that weight. You know what I mean, friend?"

Well, shit.

I didn't give him a distraction, I gave him a conversation starter. Still, I kept my eyes closed in the hopes he would give up.

"Hey, friend."

Crap.

"You want to hear a joke?"

I open my eyes. I'm not getting out of this.

"Sure." as unenthusiastically as I can manage.

He proceeds to tell three jokes all strung together. All of them terrible and none of them coherent enough for me to remember. I gave him complimentary singular chuckles even though two of the punchlines didn't make sense. I think one was about accidentally eating cat food.

"Hey, friend... how'd you like my jokes?"

I jokingly replied back, "Well, you said *a* joke and that was *three* jokes. That wasn't what I agreed to."

He chuckles and I close my eyes again.

"Hey, friend."

Jesus Christ, would someone jingle their keys for this dude?

"Do you want to hear a 'locker room' joke?"

Oh fuck me.

"I... guess?"

There was no way out of this aside from unpleasant confrontation and my energy calculation of that was much higher than just suffering through a dirty joke.

Here it is, as best as I can remember...

"So there is a pirate ship. And the captain has a beautiful daughter who has come aboard. He tells her that the crew hasn't seen a woman in a long time and they aren't safe to be around, so she should keep a razor blade 'down there.' After the voyage he assembles all of his men and instructs them to pull down their pants. Every one of them has had their dick cut off... except for one. The captain goes up to the only one with their dick intact and says, 'Thank you for not deflowering my only daughter. You should be commended for your restraint. And as a reward, I will make you my first mate.'"

I literally cannot type the punchline because it was an unintelligible noise. Basically, Mirror Froggie imitated someone without a tongue trying to speak.

Yeah. That happened.

I could not hide my disdain for this joke and I was feeling too awful to muster up any kind of response. He seemed confused by the absence of laughter from his wonderful rapey body mutilation joke.

"You get it, friend? He lost his tongue because he ate her pussy."

Yes, explaining the joke always helps... friend.

In whatever the opposite of the nick of time is, moments after this stranger said "ate her pussy"... the nurse calls Mirror Froggie in for his appointment.

I would feel relieved, but the Mounjaro side effects were getting worse and the urge to lose the remaining nutritional value from last night's dinner was increasing by the moment. I was next in line, so I was hoping Mirror Froggie didn't take up too much of the doctor's time with horrible "locker room" jokes and dubious steakhouse suggestions.

Roughly 5 minutes later the nurse calls me in to get my vitals. She weighs me and I am down another 3 pounds. That reminded me of why I was suffering this tummy tantrum. My blood pressure was perfect but my pulse was quite high. I was very anxious holding in my stomach contents and I tried to explain, but she asked me to try and relax to lower my heart rate. We compromised when I got it down to 107.

The nurse keeps forgetting that I don't really have a family anymore. And I know she has a lot of patients in and out and they probably all blend together. But she always ends up asking me questions that require me to remind her my parents are dead.

"Did your mom put up the Christmas tree yet?"

I went with, "No tree this year. Too much work."

"Aw, that's too bad. I actually got mine up early this year. You gotta put up a tree for Christmas."

Thankfully her job was done at this point and she abruptly ended the conversation.

Next up, the pee guy.

He has never actually told me what his name is so that is just what I call him in my head.

Every month I have to sacrifice my urine to the gods of Medicare so they know I am taking my meds and not selling them on the mean streets of Spanish Lake. And the pee guy always comes in to collect my sample. The little cup is kept in a white paper bag for discretion. He used to just give you a clear ziplock, and that was a little embarrassing, as everyone in the waiting room could see your pee. I definitely prefer the new white paper bag system.

It could be my lunch or some cookies or a bunch of peanuts.

Who is to know?

The pee guy is a bit of a talker as well. But the nice thing about his conversational style is that you can't get in a word edgewise. If he asks you a question, he'll even answer it for you. This requires very little effort on my part.

"Hey there, Mr. Benjermin!"

(I have noticed Ben-jer-min is a common pronunciation among Black folks in the area. Not sure if that is just a St. Louis thing or not. Perhaps I have a dialectologist follower who knows.)

I wave hello.

"How's it going, Mr. Benjermin!? Good? Good. Just gotta get your sample. Still taking the same meds? (I nod yes.) Okay, just need you to sign here. New Year's is coming up. Gotta be careful not to party too hard. You'll be regretting that. Though you don't look like a drinker to me. (I nod no.) Yeah, you're a good one. You keep it clean. Okay then, Mr. Benjermin. You're all set. Here is your new sample cup for next time."

He replaces my white paper bag with a new white paper bag and leaves the room without me saying a word. And I'm just realizing he asks me if I am a drinker quite a lot. He must sense my teetotaler spirit or something because he always assumes (correctly) that I don't drink. He's just really concerned about me partying too hard.

Finally the doctor comes in.

My doctor is kind, compassionate, and competent. The almost 3 Cs. But he's got a touch of what I call "Boomer-itis." He's on the progressive side of most things but there are a few ingrained sensibilities from that generation he didn't escape. It's mostly harmless. Though he said something sexist in front of a nurse practitioner student during my last visit that made her roll her eyes behind him.

He greets me and I tell him I'm not feeling well from the Mounjaro and that I am still recovering from my trip to Florida. He tells me that a lot of people can get sick for days from these new drugs, so getting sick for an hour or two isn't so bad. I agree, though I really wish I had not gotten sick at the exact time of this appointment. I keep eyeballing the trash can in the corner just in case things go sideways in my tummy.

He asks about my trip to Florida and I predicted that—as I already had photos ready to go on my phone. I scroll through them, showing off amazing cityscapes and mountainous clouds and an orange sunset over a lake—hoping to impress him with my photography skills to no avail. And then he sees Katrina. Now, I am not blind to her attractiveness, but I do sometimes forget how people respond when they see her next to me.

"Oh, wow. She's beautiful!" he exclaims.

I almost felt flattered on her behalf. But then his Boomer-itis starts to kick in. And he repeats, "Yeah, she's *really* beautiful. Just a friend, you said?" His facial expression and tone of voice are like, "You poor thing, you have been friendzone'd." And probably a touch of, "She's out of your league, buddy." I don't know exactly how to describe it, but it is this familiar look of pity and worry. This is usually followed up with a probing question trying to figure out what our "deal" is. Why is it so odd to that generation that a man and woman can earnestly be just friends and perfectly content with that arrangement?

It would be the easiest thing in the world to just say, "She's gay" and that she isn't "out of my league" as she plays an entirely different sport. (Competitive Subaru Ownership?) But my friendship with Katrina is not some consolation prize due to her queerness. I shouldn't have to explain or justify why I'm "just friends" or why I'm not "being led on."

In a worried tone, "So, umm, how'd you two meet?"

There it is.

"She is an artist. I posted some of her work on my website and it was very popular and helped people find her work. She messaged me to say thank you and we were instant friends. 10 years later she's my best friend and very much like family."

Thankfully his pity face evaporated and he finally saw how long-lasting and meaningful this friendship was. But it is a weirdly common obstacle I have noticed whenever people see a fat guy has a conventionally attractive friend.

Friends are great. Friends have been more supportive and beneficial to me than any romantic entanglement I've ever had.

All of my friends are hot and queer and that's awesome.

Note to self: Put that on a t-shirt.

Knowing how difficult it was, he congratulated me on surviving the trip and we wrapped up our appointment quickly. All I have left to do is check in with his assistant, get my prescriptions sent in, and make my next appointment. I can see the finish line, but my tummy is rumbling and I am making contingency plans for the Great Upchuck of 2023™. I'm clocking trashcans with plastic liners. I'm trying to remember where the nearest restroom is. And then I look down at the little white paper bag containing my urine sample cup and think, "Last resort."

Trinica (the competence ninja and my favorite person in the office) is processing my meds and searching the calendar for next month's visit. Shelly is keeping quiet and working on her computer. I start pacing back and forth. I'm not sure what I think that will do, but I think desperation is taking over at this point.

Shelly sees me and asks, "How's that whole disability situation going for you?" She is acting like my best friend now after cursing at me on the phone. I have a feeling she had an unpleasant conversation with my doctor after that episode because she isn't this sweet and nice to anyone.

I give her the update, "Everything is submitted. My lawyer is happy with all of the records we were able to find. It's just a waiting game now. It could be a couple of months but if I have to see a judge it could be over a year."

She commiserates with me about how slow the process can be.

Then, out of fucking nowhere, Mirror Froggie reappears in the little sliding reception window like a jumpscare in a horror movie.

Are you fucking kidding me with this guy?

"Hey Trinica, do you have a business card for the doctor? I want to recommend him to Doug."

Who the fuck is Doug? Are we supposed to know Doug? Is Doug the tongueless pussy-eating pirate who needs medical attention?

Trinica looks in her desk and is unable to find a spare card. So she stops processing my stuff and starts hunting around the office. She has a bad leg so she is slowly limping while searching every desk. I have never wanted to strangle anyone before, but my doppeldouche was really pushing his luck.

At this point I am just staring at the little trash can in the blood-draw room. I can feel the scrambled eggs reversing course through my digestive system.

Trinica finds a fucking card for fucking Doug and fucking Mirror Froggie finally fucks off to bother people that are not me.

Trinica gets me all sorted, I wish everyone a Merry Christmas, and make to the car.

I sit in the driver's seat, and with that unearned optimism, say to myself, "I made it."

For all of you who are squeamish about bodily fluids, you can just pretend this is where the story ends. Everything was fine. I made it home and was happy and comfortable and nothing gross happened. The nausea faded away and I lived happily ever after.

The End.

Thank you for reading this and have a lovely day.

Just scroll on by to the next post!

Okay, so you all probably thought I was foreshadowing a monumental barf.

But foreshadowing is typically subtle. You don't want to give away the ending. Of course this was going to end in barf. The barfing was inevitable. The barf was not what I was *actually* foreshadowing at all.

Did anyone catch what it was?

You know that discrete white paper bag?

The one that could be for peanuts or maybe a sammich and definitely not my urine sample cup?

The last resort?

Look, it's all I had.

I was not going to make it home. I was not going to make it back into the bathroom. No trash bins on the horizon. Nothing in my car.

At first it was just an itty bitty baby barf. A perfect amount to be contained in a flimsy paper bag. I felt a relief wash over me.

"That's all?" still being stupidly optimistic.

But then I made that noise.

That... pre-retch noise.

That one where your head kinda juts forward and your lips make a giant O shape and you make a very specific grunting sound. That sound where if another person hears it, they involuntarily make the same specific grunting sound.

This was when I had one of those movie moments when a character knows they are about to die and they can't do anything about it. And I made this exact face as I waited for the impending doom of a vomitous explosion.

The Great Upchuck of 2023™ commenced.

And it was... intense.

Everything inside my stomach transferred rapidly, furiously, projectile-ly into the bag of foreshadowing.

I mean, I'm pretty much convinced my stomach is a TARDIS because I do not remember ingesting that much food. This sheer volume of barf had to be coming from another dimensional plane.

I could see it staining the sides of the bag as it was clearly not meant for this. When I finished it was barely intact—soggy, if you will. When I was absolutely sure I had ralph'd to completion, my only option was to gently place it on the passenger's side floor (sans floor mats). All I needed was for it to last 5 more minutes on the trip home and then I could dispose of it and pretend this never happened.

Physically I felt such a relief. Sometimes there is this post-puke euphoria where you just feel, well... lighter. Unburdened with no longer having that feeling. Happy it is over with.

I place the key in the ignition and head for home. As I'm driving I can't help but stare at the bag. I can see it mocking me as it changes colors. The exterior was getting... damp. If this were someone else's vomit, I would have been vomiting because of it. Just... so gross.

I get home and park the car. I walk around to the passenger side to begin the extraction process. I pull the trash can close and I have to psych myself up to deal with this horrible hurling happenstance.

And this next part, well... it would be hilarious if it weren't so damned disgusting.

I stare at the bag.

The bag stares back at me.

I take a deep breath and approach the bag.

The bag grins at me.

I gingerly grasp the very tippy-top in an effort to not touch any of the offending material.

I slowly lift up the bag.

And the very instant it reaches just enough height to do the most damage...

The bottom falls out.

If the bag had broken just as I was picking it up, the carnage would have been minimal. Only a small area to clean up. But clearly this bag read the Wikipedia page on air burst nuclear weapons. It knew you get a much more devastating blast radius if you detonate from an elevated position.

A TARDIS worth of partially digested scrambled eggs just pour and splatter and spray onto the floor of my car. It looked like the bag was puking out my puke.

The bag is now dead but I can feel its ghost laughing at me.

I stand there frozen holding the top of this evil deceased white paper bag trying and failing to process what just happened.

I realize I have no idea what to do with this situation. This is something that would usually be followed with, "MOoooOOOoooommmmm! How do I clean up vomit?"

And she would say, "You'll never do it right. I'll clean it up."

And I'd pretend to be like, "Oh no, it's my mess. I could never let you do that for me."

And she'd insist and break out her endless supply of very specific cleaning potions and magics and soon it would be as if the vomit didn't even exist.

So, I guess my question is... do I have to get my car detailed now?

The Actual End.

#long post #the inevitable adventures of froggie #trigger warning #vomit mention #rape mention

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mariacallous · 2 years ago

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A revolution in weight loss is apparently underway. It started in 2021, when the FDA approved the diabetes drug semaglutide for weight loss. The weekly injectable—sold under the brand name Wegovy—can help users lose 5 to 10 percent of their body weight, leading commentators to describe the drug as both a “medical breakthrough” and a “silver bullet” for obesity. Elon Musk says he’s taking it, Kim Kardashian is rumored to be using it, and everyone from Hollywood to the Hamptons reportedly wants a prescription.

Soon, there will be a new weight loss medication on the block—and it’s even more potent than its peers. Last fall, the FDA fast-tracked the review process for using tirzepatide as a weight loss drug after a clinical trial showed that people with BMIs labeled “overweight” or “obese” lost a staggering 22.5 percent of their body weight on the highest dose. If all goes according to plan, that will make Mounjaro the latest in a fast-growing biomedical sector—spanning everything from bariatric surgery to deep brain stimulation for binge-eating—that aims to combat, if not cure, the problem of “excess” weight.

For pharmaceutical companies, the race to market is financially motivated: Wegovy and Mounjaro cost more than $1,000 a month. Weight loss drugs are rarely covered by insurance, but people who can afford them have proven they’re willing to pay. And the market seems effectively limitless: Despite an ongoing “war on obesity,” more than 1.9 billion adults globally are considered overweight or obese, and the number of prospective users is growing every year. Now doctors—desperate to treat what is widely seen as an “obesity epidemic”—are coming on board. In January, the American Academy of Pediatrics recommended such medications for kids as young as 12.

The victorious narratives gilding drugs like Mounjaro are already being positioned as a direct challenge to fat activism. For decades, the movement has pushed for social and economic opportunity for people of all sizes through civil rights, fat pride and liberation, and biomedical evidence itself. Thanks to prominent voices like Audrey Gordon and Michael Hobbes, many people now know that “lifestyle changes” like calorie restriction and exercise fail to produce sustained weight loss for 97 percent of people and that many dieters end up gaining back more weight than they lost. But what happens to the strength of these arguments when a weight loss drug seems to work?

Like other purported weight loss solutions, Mounjaro promises “to fix weight stigma by making you thinner, instead of removing the stigma,” says Susanne Johnson, a fat activist and family nurse practitioner in Pennsylvania. In so doing, these drugs and surgeries further exacerbate anti-fat discrimination. Instead of criticizing people in larger bodies for their perceived lack of willpower—that old “calories in, calories out” adage—people can now blame those in bigger bodies for something more akin to a techno-pessimist, or even anti-science, stance: “Just take the miracle cure!”

The history of the weight loss industry is more akin to prospecting for gold or investing in crypto than transplanting organs and developing antibiotics; less a story of scientific progress than an endless cycle of wild speculation, where boom inevitably gives way to bust. Fen-Phen was a miracle until it was linked to heart valve damage. Intermittent fasting was going to fix what caloric restriction couldn’t until researchers showed the two produce exactly the same results. And then there’s the complicated case of bariatric surgery.

From their inception in the 1950s, operations like gastric bypass (which reroutes food away from the stomach, inducing malabsorption) and gastric sleeve (which involves partially amputating the stomach so it holds less food and produces fewer hunger hormones) have been sold as a potential panacea, says Lisa Du Breuil, a clinical social worker at Massachusetts General Hospital. While fewer than 1 percent of people who qualify actually undergo bariatric surgery, those who do can lose up to 70 percent of their “excess” weight (or the weight above a BMI of 24.9).

But Du Breuil, who specializes in eating disorders and substance abuse disorders, has seen some of the worst of bariatric’s side effects. People can develop dumping syndrome—wherein sugar-rich meals leave the stomach too quickly, causing sweating, dizziness, rapid heart rate, and vomiting. Gastric bypass in particular raises the risk of postoperative alcohol abuse. Rates of suicide and self-harming behaviors also rise in the years after bariatric surgery. And even when people follow strict post-operative diets, malnutrition, tooth loss, gout, and new or resurging eating disorders are possible. “It can be really challenging to get a full picture,” Du Breuil says. She learns about new side effects all the time.

Semaglutide and tirzepatide—both part of a larger family of GLP-1 receptor agonists—were developed for diabetes management at lower doses. When pharmaceutical companies noticed their trial participants were also losing weight, they realized “if we can turn the volume up to 11, we can really enhance this side effect,” says Johnson, the nurse. “That means you’re also turning up the other side effects.”

The primary complaints from users of Ozempic, Wegovy, and Mounjaro sound like the kind of thing you can fix with a bottle (or three) of Pepto Bismol: nausea, upset stomach, diarrhea, and what one patient called “power vomiting.” But these might be less like classic “side effects” of a drug than a mechanism of weight loss itself, as The Guardian recently reported. By making the feeling of eating (and, in some cases, even hydrating) actively disgusting to the user, the drug curbs their consumption—similar to the experience of bariatric patients, who can only fit a few ounces of food in their stomachs at a time.

The list of complications doesn’t end there. For example, both GLP-1 receptor agonists may increase the risk of thyroid cancer—one of the many BMI-linked diseases that supposedly makes weight loss absolutely imperative for people in larger bodies. And there’s good reason to believe that other side effects will reveal themselves in years to come, as the number of long-term users grows.

The biggest surprise for many prospective patients is that long-term weight loss isn’t guaranteed—a reflection, perhaps, of the faulty assumption that people are obese because they overeat. Current estimates suggest that the average bariatric surgery patient regains 30 percent of the weight they lost in the 10 years after surgery. One in four regain all of their weight in that time. And 20 percent of people don’t respond to surgery in the first place.

The same is true for GLP-1 receptor agonists: If you stop injecting, the weight returns.

In case it wasn’t clear by now, biomedical weight loss interventions often mimic the deadly logic of anorexia, bulimia, or other forms of disordered eating, says Erin Harrop, a clinical social worker and researcher. Harrop would know. At the height of their own eating disorder, Harrop wished they could fill their stomach with air instead of food, or cut their stomach out, or wire their jaw shut. Later, they learned these things exist—in the form of gastric balloons, gastric sleeves, and even a magnetic jaw trap.

It’s no surprise, then, that some people who undergo bariatric surgery experience a resurgence of a preexisting eating disorder, or develop a new one. Frequent vomiting, never knowing what foods will upset your stomach, and feeling pressure to maintain a post-surgical weight—“you can create an eating disorder that way,” Du Briel says.

But semaglutide and tirzepatide promise to fulfill an even stranger fantasy: eliminating appetite itself. While a drug like Mounjaro works on numerous fronts—including preventing the body from storing fat and “browning” existing adipose tissue—it’s the feeling of being untethered from desire that seems to fascinate patients and physicians alike. People for whom the drug works often say, “I forget to eat,” says Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital’s Weight Center.

If doctors really believe that obesity is the greater of any two evils, then this approach makes sense. When it comes to bariatric surgery, for example, a review of the medical literature suggests it is, on balance, associated with a reduction in all-cause mortality—or death of any cause*—*compared to patients with high BMIs who don’t go under the knife (though such studies are profoundly limited, as they often do not control for social factors, like income or education). Many hope that semaglutide and tirzepatide will one day prove just as vitalizing.

But eating disorders kill too. In many contexts, sustained hunger is considered a travesty. And desire—for food, or anything else—is a great way to know you’re alive. “It’s wild to me that we see no appetite as a positive thing,” says Shira Rosenbluth, an eating disorder therapist who works with people of all sizes. Anna Toonk agrees: “I realized that there are worse things than being fat,” she told The Cut last fall. “The worst thing you can be is wanting to barf all the time.”

Ultimately, the proliferation of drugs like Mounjaro means medicine is not only in the business of dictating “normal” weights (a thing it still hasn’t quite figured out), but “normal” appetites. What was once an intuitive process, in which your body tells you what it needs, became a dictate under diet culture: You tell your body what it can have. Now medicine promises a radical reset: With the right drug, your body will hunger for nothing at all.

Weight loss technology can’t be stopped entirely—nor should it be. Everyone has the right to choose what they want to do with their bodies. But informed consent is built on information, and we may not have enough. Mounjaro was fast-tracked by the FDA based on studies designed to observe weight loss over just 72 weeks, a small fraction of the time real patients will be on the drug. At the very least, patients should be informed that in the first years after a drug hits the market, they are participants in an ongoing experiment.

As biomedicine’s war on obesity continues, people must work harder to combat anti-fat bias—not on a technicality, but as part of the expansive vision of justice fat activists began articulating more than 50 years ago. For semaglutide, tirzepatide, bariatric surgery, and their ilk are neither miracles nor cures. There have always been fat people, and there always will be, whether they’re “non-responders” to treatment, refuseniks, or languishing on the waitlist. Notably, even those who experience dramatic weight loss after surgery or on injectables may still be overweight or obese, depending where they started.

Perhaps most importantly, the American weight loss discourse must move away from a reflexive scientism, which has enabled biomedicine to subject the entirety of human experience to its single-minded scrutiny. Weight, like almost every aspect of embodiment, is not an exclusively biological phenomenon or a clear-cut medical “problem” to solve. It is shaped by countless factors, like power distribution in society, personal psychology, and that most frightening of forces: the desire for more.

If you or a loved one is struggling with an eating disorder, the National Eating Disorders Association Helpline is available at (800) 931-2237.

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