Maintaining Mounjaro Part III

So far, so good

Dec 13, 2023

This is me since, with the help of Mounjaro, I dropped from 245 pounds to 140. I’ve maintained a weight between 140 and 150 with little or no effort for several months now.

I eat when I’m hungry, exercise when I feel like it (mostly cycling or Rippetoe-program weightlifting) and frankly, think about my weight not very often, and not very much.

The biggest weight-related worries I have these days involve trying to make sure that my lifeline to Mounjaro is neither interrupted nor cut entirely. This revolves almost entirely around issues of temporary shortages, and for the latter, the possibility that either my insurance would, for some insane reason, stop paying for the medication, or that my primary care physician would stop prescribing it.

I knew, going in, that if Mounjaro worked from me, I’d be taking it for the rest of my life. I see “news” stories lamenting that, amazingly, people who lose a lot of weight on Mounjaro gain it back if they stop the med.

Just like everybody else who loses a great deal of weight. The “gain it all back” part is why the usual ignorant advice that the only thing fatties need to do is exert some willpower and restraint, eat less, exercise more, and their issues with overweight/obesity will be permanently solved is so malignantly counterproductive. The weight will come off, they say, and stay off, they say. Oddly, the fact that it doesn’t work that way for upwards of 95% of those who lose significant amounts of weight - and by that I mean 50 pounds or more - doesn’t seem to phase these people even a little bit.

In fact, the bigger your weight loss, the more likely you’ll have bigger problems in keeping it off. Medical scientists began to acknowledge this when they took a look at the terrible long term results contestants on the TV reality show The Biggest Loser experienced.

But in the years since, more than 100 pounds have crept back onto his 5-foot-11 frame despite his best efforts. In fact, most of that season’s 16 contestants have regained much if not all the weight they lost so arduously. Some are even heavier now.
Yet their experiences, while a bitter personal disappointment, have been a gift to science. A study of Season 8’s contestants has yielded surprising new discoveries about the physiology of obesity that help explain why so many people struggle unsuccessfully to keep off the weight they lose.

“Surprising” is apparently an understatement insofar as the professional medico reactions to what they learned.

Kevin Hall, a scientist at a federal research center who admits to a weakness for reality TV, had the idea to follow the “Biggest Loser” contestants for six years after that victorious night. The project was the first to measure what happened to people over as long as six years after they had lost large amounts of weight with intensive dieting and exercise.

In other words, after they had done exactly what conventional wisdom assured them would solve their weight problems. They managed to summon enormous willpower to undergo literal starvation via extreme diet and exercise and managed to lose, in many cases, hundreds of pounds and, in some cases, more than half their body weight.

Then something happened. Even with all that demonstrated willpower, they began to regain the weight they had lost.

The results, the researchers said, were stunning. They showed just how hard the body fights back against weight loss.
“It is frightening and amazing,” said Dr. Hall, an expert on metabolism at the National Institute of Diabetes and Digestive and Kidney Diseases, which is part of the National Institutes of Health. “I am just blown away.”

“Stunning.”

“Frightening.”

“Amazing.”

“I am just blown away.”

That is fairly florid prose from a professional researcher in the field of weight loss. Obviously, he had no personal experience with a major weight loss, because if he had, he wouldn’t have been so shocked. In fact, he would probably have regarded the weight regain as depressingly inevitable.

In fact, given his professional field, one wonders how he could have been so surprised. He must have seen the same loss-regain cycle in his patients over and over again. He probably even told them it was their fault they regained the weight. If they’d just continued to eat less and exercise more, which I’m fairly certain was his standard “prescription” for the overweight and obese, then they would have become, and remained, svelte and sprightly. But they didn’t, and rather than admit that his “best medical advice” was a miserable failure, he blamed the victims. As do most docs. Give him credit, though. He actually indulged in some original research on the matter, and was honest enough to admit he found the results shocking.

It has to do with resting metabolism, which determines how many calories a person burns when at rest. When the show began, the contestants, though hugely overweight, had normal metabolisms for their size, meaning they were burning a normal number of calories for people of their weight. When it ended, their metabolisms had slowed radically and their bodies were not burning enough calories to maintain their thinner sizes.

This is a bit confusing. What they mean is their calorie intake was too high to maintain their weight loss - even though they weren’t actually eating more, their bodies were burning less of what they took in. You see, calories burned has just as big an influence on weight as caloric intake.

Researchers knew that just about anyone who deliberately loses weight — even if they start at a normal weight or even underweight — will have a slower metabolism when the diet ends. So they were not surprised to see that “The Biggest Loser” contestants had slow metabolisms when the show ended.
What shocked the researchers was what happened next: As the years went by and the numbers on the scale climbed, the contestants’ metabolisms did not recover. They became even slower, and the pounds kept piling on. It was as if their bodies were intensifying their effort to pull the contestants back to their original weight.

Which was, of course, exactly what their bodies were doing.

The struggles the contestants went through help explain why it has been so hard to make headway against the nation’s obesity problem, which afflicts more than a third of American adults.

This article is from 2016. Today, obesity afflicts something close to 45% (42% in 2020, with the upward curve steepening) of Americans, nearly a fifty percent increase over 2016.

Despite spending billions of dollars on weight-loss drugs and dieting programs, even the most motivated are working against their own biology.

And your biology, unlike you and the clueless physicians still prescribing an obesity treatment with a 95% failure rate over time, never sleeps. It works against your weight loss 24 hours a day, seven days a week, 52 weeks a year.

And it will wear your best intentions down to a bloody psychological and physiological nub.

Their [Biggest Loser’s] experience shows that the body will fight back for years. And that, said Dr. Michael Schwartz, an obesity and diabetes researcher who is a professor of medicine at the University of Washington, is “new and important.”

It’s not new to anybody who has ever lost a significant amount of weight, but it is very important that the conventional medical establishment is finally finding out about it.

“The key point is that you can be on TV, you can lose enormous amounts of weight, you can go on for six years, but you can’t get away from a basic biological reality,” said Dr. Schwartz, who was not involved in the study. “As long as you are below your initial weight, your body is going to try to get you back.”
The show’s doctor, Robert Huizenga, says he expected the contestants’ metabolic rates to fall just after the show, but was hoping for a smaller drop. He questioned, though, whether the measurements six years later were accurate. But maintaining weight loss is difficult, he said, which is why he tells contestants that they should exercise at least nine hours a week and monitor their diets to keep the weight off.

Yet even then, they didn’t keep the weight off.

“Unfortunately, many contestants are unable to find or afford adequate ongoing support with exercise doctors, psychologists, sleep specialists, and trainers — and that’s something we all need to work hard to change,” he said in an email.

No, what’s unfortunate is that there are still docs out there “prescribing” a regiment that requires the active and continuing intervention of “doctors, psychologists, sleep specialists, and trainers” in order to make their favorite prescription - calories in, calories out - work with any degree of effectiveness at all.

Actually, what we all need to do is work hard to change this ridiculous and ignorant mindset, especially since we now have medications that can effectively treat overweight and obesity. Moreover, we need to really work hard to make these medications available to as many of those afflicted with obesity as possible. Because, unlike Dr. Huizenga’s starvation regimen that requires armies of medical specialists, Wegovy and, especially, Mounjaro, actually work.

The hope is that this work will eventually lead to new therapies that treat obesity as a chronic disease and can help keep weight under control for life.

It has. Sing hallelujah.

Dr. Proietto and his colleagues looked at leptin and four other hormones that satiate people. Levels of most of them fell in their study subjects. They also looked at a hormone that makes people want to eat. Its level rose.
“What was surprising was what a coordinated effect it is,” Dr. Proietto said. “The body puts multiple mechanisms in place to get you back to your weight. The only way to maintain weight loss is to be hungry all the time. We desperately need agents that will suppress hunger and that are safe with long-term use.”

Wegovy. Mounjaro. Zepbound. Can I hear a hallelujah?

“I used to look at myself and think, ‘I am horrible, I am a monster, subhuman,’” he said. He began sleeping in a recliner because he was too heavy to sleep lying down. Walking hurt; stairs were agony. Buying clothes with a 68 waist was humiliating.
“I remember sitting in a dressing room one day, and nothing would fit. I looked at the traffic outside on the street and thought, ‘I should just run out in front of a car.’”

People who’ve never had a weight problem think fat people enjoy being fat. We have a word for people who think that way. It is “ignoramus.”

But Dr. Ludwig said that simply cutting calories was not the answer. “There are no doubt exceptional individuals who can ignore primal biological signals and maintain weight loss for the long term by restricting calories,” he said, but he added that “for most people, the combination of incessant hunger and slowing metabolism is a recipe for weight regain — explaining why so few individuals can maintain weight loss for more than a few months.”
Dr. Rosenbaum agreed. “The difficulty in keeping weight off reflects biology, not a pathological lack of willpower affecting two-thirds of the U.S.A.,” he said.

I’m back at what I weighed in college, and I intend to keep it that way. And with the aid of Mounjaro and, perhaps, even better future medications, I fully expect to do so.

Previous Mounjaro essays:

Descending Mount Mounjaro Part I

Descending Mount Mounjaro Part II

Thank you for reading Maintaining Mounjaro Part III. If you found this essay useful, please feel free to share it.

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