Descending Mount Mounjaro Part 1

How I effortlessly lost 75 pounds - 30% of my body weight - in six months

CAVEAT: I am not a medical professional, and none of what follows is to be considered medical advice. This is a recounting of my experiences after starting the Eli Lilly drug Mounjaro, no more, no less.

Somewhere in mid-2022, I started seeing reports of an eye-popping study of a new Type-2 diabetes medication from Eli Lilly called Mounjaro (the brand name) or, generically, tirzepatide. The study showed that participants taking the new drug at the highest dosage were losing up to 22% of their body weight.

I did a quick mental calculation and thought, “That would be about fifty pounds for me.” Which would be significant, because it would drop me from an obese 225 (at that time) on the BMI scale to 175, right on the razor’s edge of normal weight. Well worth looking into further, although I didn’t really dig into the technicalities of the study for a few weeks. Another damper on my immediate interest was that it was an injectable drug only, and I really, really don’t like being stuck with needles.

My A1C results had been rising, and my doctor had started me on Metformin about a year before. At which point, for reasons I’m not entirely clear about, my weight suddenly ballooned by twenty pounds, to 245. I’d gone off my strict keto diet, but I’d done that before without seeing that sort of gain, and I’d returned to it, though the new weight hadn’t gone away. It never does, it seems. Then came more bad news. My September A1C results came back showing that I was now officially a Type 2 diabetic. I had already scheduled a doctor visit to discuss my test results for the following month, and I decided to ask her about the possibility of giving Mounjaro a try.

As it happened, I didn’t have to bring it up, because she did first. She asked me if I had heard of Mounjaro, and would I be interested it trying it? I said yes to both questions, and she handed me a box containing four 2.5mg injectors. 2.5mg is a dose intended for acclimatization purposes, and is not expected to show clinical results.

She had me take my first dose right there, to ensure that I was clear on the method. It was surprising simple, and not at all the injection ordeal I had feared. And so, at a weight of 245, on November 16, 2022, my descent from the peak of Mount Mounjaro began.

Here’s how it went, bottom line. That’s what you want to know, right? Did it work? Did I lose weight?

Well, yes.

A different view of the same graph will give you a better idea of just how drastic this change has been:

But there’s something else you’re interested in too, right? That word “effortlessly” in the subtitle of this piece. Anybody who’s ever spent much time on the fat roller coaster knows about losing weight, and almost none of them have ever called the process “effortless.” Although, perversely, the process of regaining all the weight you lost, and then some, really does seem effortless, doesn’t it?

So let’s discuss what I mean (and I suspect most dieters would mean), about that term. What takes the most effort in the weight-loss process? For me, it was always about overcoming hunger, and overcoming it strongly enough to maintain net calorie deficits sufficient to keep on losing. Yes, it does take a net calorie deficit - calories in, calories out, blah, and blah - in order to lose weight. But what the smugger than thou crowd, who think a diet means losing five pounds so they can get into those summer swim trunks never consider - because they’ve never had to consider it - is what happens when your body discovers that you aren’t feeding it enough to maintain the weight it thinks you should be maintaining.

It doesn’t matter whether you arrive at this calorie deficit by running fifty miles a day, sewing your lips shut, or locking yourself in a jail cell and dining through a straw, your body will react in the same way every time. It will do everything it can to force you to erase that calorie deficit. Why? Because it thinks it is starving to death, and a couple million years of evolution have developed an entire range of responses to protect you against that outcome.

Calories in, calories out works both ways, and the body has a great deal of influence and control over both sides of that equation. For instance, when faced with a calorie deficit, the first thing your body does is slow down your metabolism, in hopes of making that calorie deficit no longer a deficit, because your slowed metabolism now needs fewer calories, and so the deficit vanishes and your weight loss comes to a screeching halt. That’s the calories out side of the thing.

On the calories in side, your body then unveils a witch’s brew of hormones, proteins, peptides, processes, and probably things we don’t even know about, let alone understand, that all add up to one simple thing: hunger. Eat more! your body cries. Go on! Eat that donut, that steak, that salad, whatever. Just eat. I’m dying here. Save me. Give me calories! Damn it, I’m hungry. And so you are.

And that is where you find yourself when you start your diet. But it gets worse. The bigger the deficit, the longer you run it, the more pounds you lose in your march toward starving to death, the more your body fights you with every tool at its disposal. Your metabolism continues to slow as your hunger continues to grow. You get hammered from both ends, and the hammering never stops.

It can even make you crazy. One of the most famous experiments ever done on weight loss, The Minnesota Starvation Study, had some rather surprising outcomes.

Among the conclusions from the study was the confirmation that prolonged semi-starvation produces significant increases in depression, hysteria and hypochondriasis as measured using the Minnesota Multiphasic Personality Inventory. Indeed, most of the subjects experienced periods of severe emotional distress and depression.[1]: 161 

The rehab phase proved to be psychologically the hardest phase for most of the men with extreme effects including self-mutilation, where one subject, Sam Legg, amputated three fingers of his hand with an axe, though the subject was unsure if he had done so intentionally or accidentally.[6] Participants exhibited a preoccupation with food, both during the starvation period and the rehabilitation phase. Sexual interest was drastically reduced, and the volunteers showed signs of social withdrawal and isolation.[1]: 123–124  The participants reported a decline in concentration, comprehension and judgment capabilities, although the standardized tests administered showed no actual signs of diminished capacity. There were marked declines in physiological processes indicative of decreases in each subject's basal metabolic rate (the energy required by the body in a state of rest), reflected in reduced body temperature, respiration and heart rate. Some of the subjects exhibited edema in their extremities, presumably due to decreased levels of plasma proteins given that the body's ability to construct key proteins like albumin is based on available energy sources.

Here’s a before-and-after of one of the guys before he started, and then after he’d lost 25% of his body weight. (Interestingly, I’ve already lost 31% of my body weight).

Weird History, Part 4: The Great Minnesota Starvation Experiment – Emily Jacobs: Freelance Writer

There are many, many things to take from the Minnesota Starvation Experiment, even today. It taught us how little caloric restriction is necessary before psychological effects set in. (Compare the amount of calories the men consumed during the starvation phase with the recommended caloric intake of many diets.) It also shows that there is no “one size fits all” solution for proper nutrition, exercise, and caloric intake. The scientists were constantly adjusting the men’s rations based on their individual bodies and behaviors.

One of the main findings of the experiment was that starving people need lots of calories in order to recover—not a complex mix of vitamins and minerals or a delicate balance of protein and carbs, but pure calories.

In the end, all they thought about was food. They obsessed about food to the point that they became mentally ill. That’s called hunger, folks, that thing all those who have never been actually hungry for more than a day in their lives dismiss with a smug sniff and an admonition to eat less, get off your fat ass, and exercise more.

So What Does Mounjaro Do?

Well, it does quite a few things of a very technical nature, and if you would like to get into the tall weeds of that, feel free to check out this explanation: How Does Mounjaro (Tirzepatide) Work?

Back in the real world, though, Mounjaro does one simple thing that makes it a godsend for dieters who need to lose a lot of weight.

It kills hunger.

That’s it. No more, no less. Take Mounjaro and you won’t feel hungry. At least I didn’t, and by almost all reports I’ve seen, most other people lost their hunger as well. Certainly they lost enough of it to make it relatively easy to restrict their calorie intake enough to create a considerable net calorie deficit. It is easy not to eat if you are not hungry.

You might even say it is effortless.

You can go ahead and do all the other stuff that gets mentioned - eat a more healthy diet, increase your exercise, develop a comprehensive approach to diet and exercise if you wish. I did none of that. I went back to my customary keto diet, and stopped eating almost entirely, because I was not hungry. Sure, I might get an occasional pang, but if I ignored it, it almost aways went away after a minute or two. Or if I looked at my food diary see what I’d eaten that day, and thought I should take in a little more, I ate something. Usually quite a small amount of something, because I discovered that even just a couple of bites might fill me up. I became one of those people who always takes most of their restaurant meals home in a doggie bag. By the way, I discovered that old people like to play a one-upmanship game about how many future lunches and dinners they will be able to get out of the take-homes from their one restaurant dinner. That was weird.

I now deal with food the way I remember doing when both I, and my weight, were normal. I eat when I’m hungry (which isn’t often), and if I’m not hungry, I don’t eat. Most of my concerns today revolve around macros, especially protein. I want to be certain I’m getting enough to prevent muscle cannibalization, and I make sure I do. Hard boiled eggs and I are great friends these days, although I’m also partial to grilled Thai BBQ chicken.

Carbs and Mounjaro don’t play well together. I’ve noticed that the general opinion in the (large) Mounjaro sub on Redditt is that those who have the most, or the worst, gastric side effects (nausea, vomiting, diarrhea, burping) are those who eat a lot of carbs, especially refined carbs. I occasionally have a “dessert” of one or two teaspoons of Kroger chocolate chip cookie dough ice cream. I’m about 2/3 of the way through the half gallon of it I bought six weeks ago.

Implications: Social, Cultural, Medical

The rest of this piece isn’t focused as much on the usefulness of Mounjaro as a weight loss drug, as it is on some of the larger issues you may run in to, or may want to consider as you make a decision whether to take Mounjaro or not.

Glenn Reynolds posted at Instapundit back in April about Mounjaro, and kicked off a mega discussion thread that surprised me at its contentiousness. My view that Mounjaro was an unalloyed good as far as helping overweight and obese people to lose weight seemed to be shared only by a minority, and not an especially large one. Those who didn’t see it that way were all over the map, but in general could be divided into these groups.

1. You don’t need no darned drugs, just put down your fork, get your fat ass out of the chair, and go run a few miles!

2. Oh, phooey! Another pill? There’s a darned pill for everything now. We’re become the pill-popping people!

3. Trust the pharma companies? You kidding me?

4. Fat is healthy.

5. How are you going to keep the weight off, assuming you are able to lose it?

6. You people, always taking the easy shortcut.

7. An almost visceral dislike of the drug, for mostly inchoate reasons. They just don’t like it, without really being able to explain it. They are just offended by its existence, it seems.

In order.

1. That is calories in, calories out, and it has been an abject failure as long as doctors and nutritionists have been recommending it.

2. Yes, and so? Get back to me when you dump your blood pressure and cholesterol pills.

3. Point, but they generally are not deliberately in the business of murdering their markets, unless goaded by governments or murky NGOs (maybe).

4. No, fat is not healthy. Too much of it is, in fact, a demonstrably deadly danger to your health and wellbeing.

5. By continuing to take the medication that allowed me to lose the weight in the first place. Just as I continue to take BP and cholesterol meds, even though both conditions are normalized in my case.

6. Assuming that the easy shortcut works, and you are rational, why would you not?

7. This one deserves further explication, rather than a simple dismissal for obvious reasons, so here goes.

I mentioned this on the Mounjaro sub-Redditt, and somebody responded that if somebody had undergone the horrific hunger grind of losing fifty or more pounds, they might naturally resent somebody else doing the same thing with comparative ease.

Since being able to take the drug at all is highly insurance-sensitive, people may resent some being able to obtain the drug, and others, like themselves, cannot.

There is an undeniable streak of unspoken puritanism in America, in which anything that is “the easy way” and does not involve hard work is somehow intrinsically suspect.

Even more unsettling is a similar range of responses within the medical community itself. Some doctors are uninformed about the drug. One Redditor said her doctor had told her that average overall weight loss was less than 12 pounds, so it was hardly worth prescribing it. No study of Mounjaro has ever been done that demonstrated an average total weight loss of less than 12 pounds.

Another doc told her patient that she never appealed insurance company rejections of coverage for any weight loss drug. Reason not given.

More than a few doctors simply refuse to prescribe it for anything but lowering blood sugar, and continue to recommend the massively failed calories-in, calories-out model. My personal opinion here is they just hate to admit how wrong they’ve been all these years, and prefer to go on blaming the victims of their own medical malpractice.

Our government also seems to share a dislike of weight loss medications. No federal program, including Medicare and the VA, will pay for any weight loss drug. This seems perverse, given how many deadly diseases and conditions are directly caused by overweight and obesity, or exacerbated by them. Including Type 2 diabetes, for which these programs will cover Mounjaro and other drugs like it.

As someone who thinks and writes a lot about the future, I’ve been waiting for, and expecting, drugs like these for a good while now. I’m glad to see they’ve arrived in time for me to be able to take advantage of them.

I leave you with this thought: Obesity is a metabolic disease. Now that we have a drug that is effective in treating it, I suggest that we do just that.

UPDATE: I will post a follow-up article in a month or so, dealing primarily with whatever long-term maintenance program I decide on, as well as more data on side effects and warning surrounding Mounjaro. And, of course, any news about FDA approval of Mounjaro for use with medical weight loss strategies.

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Part II is here.