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  • Writer's pictureMeg

Semaglutides, Diabetes, and Fatness, oh my!

The first time I heard about Ozempic I knew it was only a matter of time before it was prescribed to me. Great diabetes drugs are great, and I really need them but I know part of the calculus of choosing to prescribe Ozempic or another GLP1 inhibitor (also known colloquially as semiglutides) to me would be my endocrinologist’s deep wish that I would lose weight. I’ve been seeing her for 12 years (first for a thyroid problem and PCOS, later for diabetes) and twice yearly I sit in her office while she tells me to lose weight. She tries to be kind about it but she is very clear. This is the path. This is the way. Lose the weight, save your life.

As I heard more and more about Ozempic I wanted it less and less. I had people in my life crow about how it made them completely uninterested in food (like that’s a feature not a bug). I read news stories about the amazing weight loss drug. The more people talked about it as a way to eradicate fatness, eradicate fat people, eradicate people like me, the more fervently I prayed to never need it.

A month ago my average blood glucose level was in the high 300s. That’s really really bad. My doctor suggested Mounjaro a semiglutide that is supposed to be especially good for weight loss. Scared of my numbers and picturing a future of severe diabetes complications, I said yes. My average blood glucose is now in the low 200s. That’s a miracle. I’m on the lowest dose and my doctor is about to decide whether to increase it. I imagine she will. I have fantasies of being in my ideal blood glucose range most of the time. I might keep my feet, keep my vision, keep my kidneys working properly, avoid the agony of diabetic neuropathy and more. I feel hopeful about my body’s future for the first time in a long time.

I also feel sick.

I’m nauseated almost constantly. It is 6:30 pm. About thirty minutes ago I was vaguely hungry and ate a few handfuls of blueberries. Mistake. I now feel like I am going to vomit. I wake up nauseated. If I eat even slightly more than the amount I’m hungry for the nausea gets worse. Usually the worst of it is over by late afternoon but the blueberry debacle has pushed today’s nausea to the end of my work day. The nausea saps my energy and makes it hard to do the activities of life. If I am careful with how I eat I can be almost normal in the evenings. I have plans tonight at 7:30. If I don’t eat until after the plans I should be normal while spending time with my friend. I’ll eat something around 9 and then go to bed so the worst of the nausea passes while I sleep.

Semiglutides do four things. One, they reduce appetite. Two they help your pancreas produce insulin. Three they suppress your glucagon production in the liver. Four they slow gastric emptying. The gastric emptying is what causes the GI side effects. Slowed gastric emptying can cause nausea, gas, bloating, and stomach pain. Slow gastric emptying is its own disorder called gastroparesis, so basically semiglutides give you a whole fancy new disorder.

Slowed gastric emptying helps diabetics. Increased insulin production helps diabetics, the glucagon suppression helps diabetics. Depending on who you talk to the decreased appetite can also be helpful for diabetics, but given that I don’t have any desire to lose weight it’s problematic for me. Semiglutides, if you are diabetic, are a medication you are going to be on for as long as they continue to work, potentially for the rest of your life.

Decreased appetite and slowed gastric emptying (which keeps you feeling full longer) are helpful for people who are trying to lose weight. I understand the appeal. We live in an intensely fat phobic society. Anti-fat bias is everywhere. It is incredibly difficult to be a fat person in this country. I don’t judge people who are so desperate for weight loss that they are willing to endure significant side effects and unknown future complications (these drugs are new enough that we have no idea what they do in the long term). Fifty percent of users of semiglutides report moderate to severe side effects. That feels worth it to a lot of people and that is their choice to make. One important thing to note is that semiglutides as a weight loss drug are not intended to be prescribed for life and that research shows that once you go off, the weight comes back.

I strongly judge pharmaceutical companies who are making money off that desperation. I do judge the society we live in that makes it feel better to feel sick constantly than to be fat. On a systems, fat liberation level, semiglutides are a disaster. Semiglutides are an agent of death for fat folks, another way the medical establishment is seeking to eradicate us. Medicalize fatness, “treat” fatness medically, make fatness go away. Not only make fatness go away but get rich doing it. Pharmaceutical companies are making truly wild amounts of money off people taking these drugs. Weight loss companies like WW and Jenny Craig have figured out ways to incorporate them into their programs and they are making money. Some (not all) doctors get financial incentives for prescribing these meds. That is a lot of money going into the pockets of people who already have significant wealth and power. That provides a big incentive to keep prescribing meds that make people sick and that we don’t have any long term data on.

The huge number of people looking for semiglutides to lose weight has made it difficult for some people who need the meds for diabetes to get them. It is my understanding that the FDA approval for Wegovy to be used on label for weight loss will lead to greater production of Wegovy and hopefully it will be easier for diabetics to get the meds they need for long term health.

Sometimes, as a fat liberationist, I feel guilty about my Mounjaro usage. I feel like I’m not a good enough activist if I won’t martyr myself for the cause. That is imposter syndrome at its most dangerous. I’m diabetic. I need the medication to control my blood sugar. If I lose weight that’s a side effect; it’s not the goal. It’s hard to hear so much anti-semiglutide discussion in fat lib spaces but I have to keep reminding myself that they aren’t talking about me. No one is disputing that these medications help people with diabetes. No one is asking me to martyr myself for the cause. I am working hard to reduce my imposter syndrome and embrace the hope Mounjaro is bringing me. I’m also working hard to manage my nausea because even this hope comes with a cost.

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