This was supposed to be a diary of my first two months on the diabetes drug recently recast as a miracle shortcut to weight loss – and a catalogue of its excruciating side effects. But it became something else entirely. This is a story about realising I’d lived a false life as a slim person for years – and finally admitting to my obesity, then dealing with it...
The doctor peered over his spectacles at me from the other side of his desk and I pulled my blazer tighter around my stomach, not meeting his eye, trying to appear cool and unruffled, trying to ignore the tears running down my face as I digested what he had just told me: that I could, at my BMI, qualify for bariatric surgery.
“I know I’m overweight,” I whispered. “But… a gastric band?!” To my mind this was something for proper obese people – American ones with their own reality shows, like the “1000lb sisters” who had to go to a junkyard to weigh themselves on industrial scales because regular bathroom ones would break.
Yes, I eat too much cake and recently my go-to suppers, when I’m not eating out, have been those posh bung-in-the-oven Waitrose meals, but I also know about macronutrient ratios, I drink green stuff from Joe & the Juice and do Reformer Pilates in Lululemon athleisure-wear.
Sure, I’d come to this private clinic for a prescription of the so-called weight-loss wonder drug Ozempic, but mainly because an ex-Vogue editor had written about it and great swathes of Hollywood are rumoured to have taken it too. Talk of surgery was unexpected and seemed more than a little extreme.
The doctor watched me carefully: “Why don’t you tell me how you reached this weight.”
I drew my blazer tighter still. “Oh, you know, I’ve just got a sweet tooth.” I tried to sound breezy. “My mother hid the KitKats at the back of the freezer when I was young so my dad and I wouldn’t scoff them all.”
I laughed, waiting for him to do the same then hand me a prescription, but he said – kind but piercingly direct – that my answer wouldn’t cut it. “Nobody becomes morbidly obese from having a sweet tooth.”
I baulked at this. Err, morbidly obese? “The NHS doesn’t call it that officially any more,” he explained gently. “But it used to, and your BMI of 35 would put you in that category. So… how do you believe it happened?”
Hours later I emerged, blinking, on to Marylebone High Street – sweaty, mascara-streaked, but oddly clear-headed. The consultant, Dr Ralph Abraham, a specialist in endocrinology and diabetes, and the first doctor in the UK ever to have prescribed Ozempic, was also the first person to address my obesity head-on, for which I’ll be forever grateful.
No friend or relative or therapist had come close – only my friend’s three-year-old daughter, who once announced, as I was admiring her unicorn dressing gown and asked teasingly if I could borrow it: “You’re too fat.” I’d baulked then too, but laughed it off.
Besides that, no one. I’d never even addressed it to myself. That conversation with Dr Abraham shattered the glass of decades of denial. I can’t tell you the day I became fat. Or even the day I first realised I was. Deep down I still don’t quite believe that I ever was. That I am.
It was a slow creep that began, probably, when I left home for university. One day, as I cram-read Paradise Lost, I opened a family-size packet of chocolate Hobnobs and demolished the rest of the book and the entire packet in one sitting. Utter bliss.
After that, I suppose I just kept eating… I ate to socialise. To catch up with friends, to celebrate birthdays. I ate at 4pm in the office because I was stressed, or had a headache. I ate when I was badly depressed in my early 20s, but also when I was happy in past relationships, or just because there was delicious-sounding stuff on restaurant menus.
I snacked incessantly too. I’d find it impossible to open a chocolate bar and take one chunk – a voice in my head would keep prodding until I finished it, even if this gave me a stomach ache.
Growing up, my mum prepared delicious homemade meals, and for most of my 20s, and even as a student, I cooked from scratch too – one university friend, who considered a bag of Haribo a balanced dinner, looked on in bewilderment as I baked chicken breasts and sautéed leeks. But by my mid-30s, living alone, I had started to eat more processed food, albeit the fancy sort that you can trick yourself into imagining is homemade.
I ate it because I loathed cooking for one, but also because I’d arrive home from work ravenous but too busy (with a project I was working on in the evenings) to cook.
Occasionally I also ate because I was irritated by the way others ate, like when a friend deliberated over the salads on a menu then “caved” and ordered the pork belly as though this was the most outrageous act of rebellion, or when a colleague enjoyed a mid-morning packet of crisps, then announced she was off to the gym to burn off precisely that number of calories. Stubbornly I’d eat the same but without self-flagellation. I was irritated, not by their individual acts, but by this universal culture, and I refused to participate, save for short bursts when I would try unsuccessfully to change my diet too.
And yet at the same time I developed a weird disconnect in my mind between what I put in my mouth and the size of my body, as though there was no correlation. Obviously I was growing outwards – I recently discovered that since starting my current job seven years ago, I’ve put on four stone, tipping me from overweight to ‘grade II obese’ – but by then I’d stopped looking, and if I didn’t look maybe it wasn’t happening.
By my 35th birthday I was careful to have no full-length mirrors in my flat, and I’d shower in the dark. I’d simply not look at my body. I bought clothes online, not in shops. This was the best way to find designer bargains, I’d tell myself, pushing down, somewhere deep into my subconscious, the real reason: the dread of asking a shop assistant, “Do you have it in size xx?” (I still can’t admit my number), then the shame as they hollered it to a colleague to check the stockroom.
I’d convince myself that they were thinking, “What’s she even doing in a shop like this?” That everyone was thinking it. More likely, it was just me.
By 36 I avoided sitting down on Tubes in case my arms spilled over on to my neighbour. I could fake body confidence for short spurts while dating, but then this year I stopped doing that too. And I forbade anyone from photographing me – a selfie at most, angled to give the impression of a jawline. If anyone protested I’d make a joke or else change the subject entirely, a master of deflection.
Of concealment too: clothes were chosen based on what best disguised me. I discovered the joy of giant cocoon coats, boyfriend blazers, oversized floppy cashmere. Black. Only ever black. And I lived in sports bras to hoist myself in, to minimise the spreading of myself a little more.
Yet the disconnect remained. If I heard or read anything to do with obesity, I’d listen with mild interest but the same detachment as if I was learning about someone with a rare blood disorder, or a stranger who had won the lottery; as if it had nothing to do with my own experience.
It’s easy to pretend you look different than you do when your closest friends are varying degrees of slim. I suppose looking at them across dinner tables, never at myself, meant I could believe I looked that way too.
This is not to say that everyone should strive to look the same. Plenty of people with bodies the same size as mine or larger are, rightly, perfectly happy with how they look, with how their bodies feel. And, just as some obese people have sedentary lifestyles, others can run marathons and, like Lizzo, dance for hours barely breaking a sweat.
The body-positivity movement has also made great strides in challenging the unhealthy culture of fat-shaming, skinny-shaming and body-judging, whipped up by those weekly magazines of the ‘90s and 2000s that my friends and I once binge-read. But all of that can exist and I can still want to lose weight; I can still not be happy with my own body feeling fat, something that feels somehow transgressive to admit today.
I have tried to lose weight: SlimFast. The Atkins diet. Noom. Basic calorie-counting. Mad exercise routines. HIIT classes. Boxing against competitive men. Boot camps. I even subscribed to a health-food company for a six-month supply of home-cooked, high-protein meals, delivered to my front door each morning, spanking the four-figure fee on a credit card. I was still paying it off long after I’d stopped stomaching these mountains of meat that all had the same tang of old cabbage.
The problem was, unless I focused, making it my top priority, it fell by the wayside – and there were so many more interesting and fun things to do, and to achieve. Plus the more I tried to change my diet, the more I became fixated on foods I shouldn’t eat. Eventually I’d give up, figuring that if I went back to my old eating habits, I’d end up consuming slightly less as I wasn’t thinking about food as much.
The only occasions when I lost significant weight were unintentional – after two break-ups that left me so nauseous I couldn’t stomach much. Besides that, weight stuck to me.
I never spoke to anyone about this, not even a therapist I once had. I am an oversharer – a nervous tic really – but weight was my taboo. Anyway, what was there to say? The problem was, I assumed, entirely self-inflicted.
I internalised all possible criticisms: the trolling that an article like this will inevitably generate is nothing on how harshly I trolled myself. No self-control. Greedy. Burden on the NHS. You’ll die of a heart attack. Who’ll fancy you?
Over time I just accepted it. Then one morning I woke up, and just like that I didn’t. A Wednesday in May. My alarm buzzed and, bleary-eyed, I reached to hit snooze but instead sat bolt upright. Maybe it was the recent bout of pneumonia that had left me feeling vulnerable and concerned for my health in a way I’d never previously been.
Or maybe it was the gynaecological procedure I’d had, where I’d learnt how obesity affects fertility. Or maybe I was just fed up with not liking how clothes sat on my body. But there, from bed, I downloaded an app for a private GP service and booked an appointment for that morning.
I would, I decided, ask for The Skinny Jab, the weight-loss panacea that everyone – on my Instagram feed at least – was talking about.
I first heard the word ‘Ozempic’ last year. “Oz-what?!” My best friend, who lives in New York, is my barometer for all crazes before they catch on here – rented clothes, Harry Styles, ‘edibles’ – and as we sat drinking negronis, she told me about an antidiabetic injection that Real Housewives-types were using off-label to lose weight fast.
We googled pictures of ‘Ozempic face’, the unfortunate drooping effect said to afflict those who take it. “Who would go to such extremes to lose a few pounds?” I asked. “Ridiculous,” she agreed.
But soon, Ozempic crept into the news. Its weight-loss potential was incredible: one study had found that overweight and obese people taking semaglutide (the active substance in these drugs), alongside other lifestyle changes, lost an average of 15 per cent of their body weight in 68 weeks.
It works by mimicking the hormone GLP-1 and activating GLP-1 receptors in the body and brain, which triggers a reduction in the amount of glucose released by the liver and – crucially – slows the rate at which the stomach empties of food, making you feel fuller for longer.
As well as Ozempic (a weekly injection), there’s a daily tablet called Rybelsus (with the same effectiveness), plus another injection, Wegovy, with a higher maximum dosage.
Headlines described the mad scramble to buy it in the US and UAE; how Wegovy would soon be offered by the NHS as part of certain weight-management services (now delayed to later this year); how Ozempic and Rybelsus are already being prescribed off-label here privately. Even Elon Musk tweeted in praise of semaglutide.
The side effects were well publicised too, including some infrequent but serious ones like a risk of pancreatitis, plus a warning about possible links with thyroid cancer. But that morning I woke up determined to get hold of it.
I could barely look at the GP as I admitted shyly what I wanted. I might as well have been asking for crack. But she said she couldn’t prescribe it; I’d have to go to a private weight-loss clinic.
Which is how I found my way to London Medical, which offers a weight-management service – and to Dr Abraham. After that first appointment, and after measuring my height and weight, taking my medical history, blood tests and checks on my blood pressure and glucose levels, he – hallelujah – wrote me a prescription off-label for Rybelsus.
Only by then his clinic’s pharmacy had sold out. Desperate, I bought it from an online pharmacy, paying £169 (NZ$353) for a month’s supply. (It’s staffed by registered pharmacist prescribers and I was made to do eligibility checks digitally, but these were less thorough than through the clinic; I wouldn’t have done it had I not seen a consultant first.)
Dispatches from the bathroom floor
Then a little brown box arrived by post. On 7 June, I swallowed my first pill. One month on. A Saturday night in July. I’m lying on my bathroom floor, face pressed to the tiles. I’m hot, my heart is racing, but worse are the stomach cramps that come in waves, making me rush to the loo. Afterwards, I crawl back on to the floor – at least it’s cooler down here.
I’ve been on Rybelsus for 31 days and today I increased my dose from the entry level of 3mg, to 7mg, as recommended. In another month, I’m to increase further to the maximum of 14mg. Only I can’t imagine doing that; the side effects are horrible.
The next day, still weak and sickly, I meet my mum at the Royal Academy but I wander around listlessly, struggling to concentrate. Understandably she’s concerned and tries to persuade me to stop taking it.
But I felt similarly unwell when I started the 3mg dose and the side effects had tapered off after a week. Plus I’ve already lost one stone and two pounds (7.6 kilograms). I show her an article about some people who say they defecated in their sleep after taking semaglutide by injection. “See, it could be worse,” I joke.
Five days later, my side effects have mostly subsided, except the relentless nausea. But one night as I’m walking into the Tube station, I feel a familiar, frightening sensation: a wave of hopelessness, an overwhelming, “What’s the point?” It jolts me back to episodes of depression in my early 20s.
I could turn to the clinic – it offers support for side effects – only this time around I know what to do myself: I sit in my garden, call a friend for a chat, have a good night’s sleep. The next day, I force myself to eat proper meals even though I’m so nauseous I’d rather fast: a little porridge for breakfast, veg soup for lunch, nuts and a banana to keep my brain going, salad and chicken for dinner. My mood doesn’t lift entirely but I know I’ll be fine.
That same week, the European Medicines Agency announces it is conducting a review of some weight-loss jabs, including Ozempic and Wegovy, after being alerted to a possible link to thoughts of suicide and acts of self-harm.
A search on YouTube throws up videos of people who say they have experienced similar thoughts. One young woman with 2 million subscribers details her experience on Ozempic in a video posted earlier this year. She describes feeling a “life-ending” doom; an “I need to run and jump off the highest thing that I can feeling”.
She recalls shaking and crying. “For me, it’s not worth [the mental-health aspects].” It’s impossible to verify whether these YouTubers took semaglutide made by pharmaceutical company Novo Nordisk – knock-off versions have reportedly started to emerge in the US – but either way it is concerning.
So, when two friends tell me they’re toying with buying some online – one wants to shift two stone to reach her pre-pregnancy weight – I’m horrified. Don’t do it, I say. I wouldn’t recommend this to anyone except those needing to lose a very large amount of weight for their health; it’s not like popping a vitamin tablet.
Then why are you on it, they say. Why don’t you just eat less, and exercise more? This is the hardest part to explain. Imagine spending your adult life going about your ordinary business while voices are screaming in your head. You can’t turn down the volume and they barely pause except when you’re sleeping. Then, one day, you find a switch and you flip it, and – gone. Silence.
This is the only way I can describe what happened. I’d never even realised how loud that noise was until suddenly I was free. There is no clinical definition for food noise. But clearly it afflicts millions, as videos related to ‘food noise explained’ have had two billion views on TikTok alone.
Going to the supermarket feels different too. I can walk along aisles with complete dispassion, zero temptation. At first I assumed this was just because I wasn’t hungry, but soon I realised there’s more to it.
‘Neuromarketing’ is nothing new. For years there have been discussions, even talk of lawsuits, about the extent to which food packaging can elicit a neural response – or, put crudely, potentially hijack the brain and influence what you put in your trolley. I’d never realised how enormous that influence was on me until it shut off. For me, this is the real magic of the drug.
Food still tastes good, but what I’m drawn to has also changed; not sugary snacks and Charlie Bigham lasagnes but fresh grilled chicken, crunchy salads, simple vegetables pulled from the ground, sourdough with lashings of avocado, nuts and seeds, pure soups. Others I speak to on the drug say similar; one colleague has kicked his daily KFC habit. To ensure I’m getting enough nutrients, I now log what I eat on an app, MyFitnessPal.
Some days, I get a bit tangled and find myself in front of the vending machine at 4pm on autopilot, about to buy a Mars bar, then thinking: what am I doing here? My stomach is churning and doesn’t want it. My head is split and I stand there in a muddle, not fancying it but confused at why I don’t, and also scared of going too far the other way and becoming too restrictive.
I ask NHS dietitian Jo Hollington what on earth is going on in my brain. Not just my mini existential crisis over a Mars bar, but why has my food noise dulled, my palate changed?
“We know that GLP-1 plays a role in hunger and satiety, and with delaying gastric emptying,” she explains. “But the other things you’ve experienced – we hear of them but there’s no clinical paper.
“I don’t think anyone knows the exact way it’s working, which is why it’s so fascinating.”
Five weeks into my ‘experiment’, I catch up with a friend over dinner. She had an eating disorder as a teenager and worked hard to re-establish a healthy relationship with food. Her husband has Crohn’s disease, which requires him to live with a colostomy bag. For years I’ve seen them manage all of this, and now, as I tell her what I’m doing, shame creeps in. It seems frivolous and I suppose self-inflicted.
It makes me question: why am I leaning on this drug? Why – when so many others can lose weight – have I struggled? Is it just a lack of willpower?
Again, I put this to Jo Hollington, whose specialism, in her work at a leading London hospital, is obesity, but when I use the word “willpower”, she shudders. “Eurgh.” This, she tells me, is one of the common misconceptions.
Other medical professionals say the same: that obesity is complex, with many factors leading to it – not only behaviour, but environment, genetics, even other medications. Predisposition to weight gain can date back to the womb, Hollington explains. “It starts at conception because the body weight of the mother can influence epigenetics.
“Then it’s the quality of diet throughout childhood, and is it full of processed foods? It’s not even just to do with the food products but packaging – there’s research about the influence of microplastics on metabolic health and body weight.”
Then there’s the impact of lifestyle and mental health; “how much we get outside, our mood, social media – it’s all intertwined in our drive for dopamine”. Hollington has been working with patients with obesity since 2017, but has observed a concerning change since the pandemic.
“The severity of patients coming in and how unwell they are is noticeably worse… I have patients with BMIs of 60, 70, 80, and one with a BMI of 102.”
So, is semaglutide the panacea, I ask? This is, after all, a national crisis, given that 64 per cent of adults in England are overweight or obese, and obesity costs the NHS an estimated £6.5 billion a year.
Hollington is hopeful, but to a point. “It will help, but I see it as a very, very, very large puzzle and this is just one piece of it.”
Regain is one concern. “Evidence is showing that people regain after they come off,” she tells me. I’d assumed it was simply a case of changing my eating habits first but, she explains, there can be other factors at play for those who have lost significant weight.
“When somebody has gained through overeating canteen-style foods, it can disrupt your set weight point [the weight your body tries to get back to]. The body does this in two ways: it increases hunger and slows your metabolic rate.”
Meaning it’s not impossible to keep weight off, but it’s harder. Under current NICE [the UK’s National Institute for Health and Care Excellence] guidelines, NHS patients will be prescribed Wegovy for a maximum of two years, as part of a weight-management programme. There’s no ceiling for NHS patients taking semaglutide to manage diabetes, nor for private patients using it off-label for weight loss.
Personally, I’m not sure I want to be on it for so long, given my side effects. And then there are the shortages, affecting diabetes patients, which I’m worried I’m contributing to. When I speak to Dr Abraham again, he tells me he is particularly concerned about these shortages.
“The situation has changed dramatically in the last two weeks,” he says. “We’re having huge difficulties in obtaining supplies, as is everyone. Priorities have to be restricted to diabetes and severe obesity.”
Then on 18 July, the Government’s Medicines and Healthcare products Regulatory Agency (MHRA) issued a nationwide alert to medical professionals to “strongly discourage” the prescribing of GLP-1 agonist drugs (including semaglutide) for management of obesity, owing to a shortage that is expected to last until at least mid-2024.
“The supply issues have been caused by an increase in demand for these products for licensed and off-label indications,” it said. Dr Abraham’s clinic has, for now, stopped taking new patients on its SmartWeight programme, as a result.
I ask Jo Hollington if there is another way to hack my set weight point, rather than relying on the drug long-term? “The theory is to go back to unadulterated, unprocessed whole foods, a balanced diet in line with the Mediterranean-style diet,” she says.
“So healthy oils, lean proteins, whole grains, fruits, vegetables, and avoiding ultra-high-processed foods.”
‘You seem quite on edge’
Six weeks in. My mum texts to ask if I’m still taking the pills, concerned about the mental-health impact. I tell her I am. “You seem quite on edge to me,” she replies, “I feel your hunger.”
I tell her curtly that I’m not hungry, this is just my personality. Yet on reflection, I am more prickly – the constant nausea is taking its toll. But then I can’t imagine I’d be a barrel of fun if I was losing weight the traditional way and battling constant hunger and cravings, either. I’m also confused about what to actually eat.
Originally I decided not to sign up to the dietitian support offered by London Medical, thinking I was well educated about nutrition, but now I feel overwhelmed with information and it’s hard to know what to follow; I get in a tizz laboriously avoiding every processed food, chastising myself over my morning bowl of bran flakes.
So I try to relax and remember that my habits will change gradually, not overnight, and if I’m to sustain change, it needs to extend beyond what’s in my fridge. Conscious of the links between stress and weight gain, and mental health, I look into other sources of dopamine too: painting classes, tennis lessons. I also book a holiday: not my usual beach flop-and-drop but a trip to a country I could barely spell the name of until recently, to stay in a yurt by a lake, to hike and live among nomads, to go back to basics.
Almost two months in, I’ve dropped a dress size and lost one and a half stone; I’m inching my way to my target of five. The nausea has been bad, but this too is tapering off. And – if you’ll forgive the overshare – my, err, gut health has never been better.
This week I have a check-up with Dr Abraham. I’ll tell him that my food noise has gone, that I’m constantly full. But I’ll also tell him how this has all opened up an honest conversation with myself about my weight. This time around, if he asks how I reached this number, I won’t shrink in my chair.
Because alongside all the ‘miracle’ injections and pills, all the kale and the squats, the only way to lose it – and keep it off – is to go back to the start, to look deeply at how I got here. And to sit, however uncomfortably, with why.
