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Sunday, April 14, 2024

A New Drug Switched Off My Appetite. What’s Left?

A decade ago I lost 100 pounds. I did it in my web-nerd way—by building a custom content management system using the Django framework in the Python programming language. Every day I would enter calories ingested, calories expended through exercise, my weight, and whatever thoughts occurred to me. It became a job. I produced charts and compared the results of different kinds of exercise. I put it all online at OHLIH.com, which stood for One Huge Lesson in Humility.

It worked very well. For the first time in my life my doctor seemed glad to see me. People noticed. They said: Are you going to open-source this? Sure I was! Of course, I knew that scientists had found, in study after study, that basically everyone who loses weight gains it back, and then some. But there was no chance I would eat my way back to misery. I had a system! And a PostgreSQL database! And I could buy pants in a normal department store! Guess what happened.

Obviously genetics were a factor. (I remember when my uncle died, someone whispered, “My God, how much does this funeral weigh?”) What health professionals call my morbid obesity—that “morbid” is a helpful reminder—is what you see. But it’s a side effect of what I am, which is insatiable. Literally: I never seem to feel full. In practice this means that at certain times of day, I watch in horror as my body reaches for the cheapest, easiest calories nearby—out of the pantry, out of a vending machine, at a party. I scream, “Stop!” But the hand keeps reaching.

You might say: Come off it! What happened to good old-fashioned willpower? There’s a sin for this—it’s called gluttony! Or you might say something less judgy-sounding that means the same thing. All I can say is I tried: I downloaded calorie-tracking apps. I taught my phone to buzz every 15 minutes to remind me that I should not eat. I paid therapists to train me on better behaviors, researched gastric bypass, rode my bicycle, talked with experts, experimented with radical self-acceptance. Nothing stuck. While culture kept making smaller airplane seats, science backed me up: Humans are servants of their satiety. Even gastric bypass falters for lots of people.

While it is possible—more possible than many think—to be fat and healthy, and sometimes I managed that, I could feel my health slipping, prescriptions adding up in the cabinet. So I accepted that, well, I knew how I would die, and that we might need an extra pallbearer. (I can make that joke.) A pretty good life, save for that one thing. I put money away for my kids, and every day I tried and failed to solve a lonely puzzle of self.

Then one day my endocrinologist was reviewing my A1C blood sugar levels as we Zoomed. He had me on Ozempic, a weekly shot that stimulates the body’s insulin production, which makes it a great alternative to insulin injections for type 2 diabetics. The drug’s side effects include slower digestion and increased satiety. You may have heard of it because it’s increasingly prescribed for weight loss (and is linked to many Hollywood diets). I’d been on it for a while and lost a few pounds, and I appreciated it, but the shrieking satiety siren had never ceased.

“Well,” my doctor said, “if you’re not losing weight with Ozempic, try Mounjaro.” This one was FDA-approved last May, with an atrocious name. So off I went, from one shot to the other, from Novo Nordisk to Eli Lilly. Whatever.

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“Something’s happened,” I told my wife. She is a veteran of watching me try to fix my body. I told her: Where before my brain had been screaming, screaming, at air-raid volume—there was sudden silence. It was confusing. Would it last?

I went alone that night to a Chinese restaurant, the old-school kind with tables, and ordered General Tso’s. I ate the broccoli, a few pieces of chicken, and thought: too gloopy. I left it unfinished, went home in confusion, a different kind of sleepwalker. I passed bodegas and shrugged. At an office I observed the stack of candies and treats with no particular interest.

Decades of struggle—poof. Apparently the Mounjaro molecule targets the same hormone as Ozempic, plus a second one, so it doesn’t just stimulate insulin production but also boosts energy output.

“I urgently need,” I thought, “an analog synthesizer.” Something to fill the silence where food used to be. Every night for weeks I spent four, five hours twisting Moog knobs. Not making music. Just droning, looping, and beep-booping. I needed something to obsess over, to watch YouTube videos about. I needed something to fail at every night to feel normal. And I was also manic, dysregulated, and wide-eyed, sleeping five hours a night, run-walking, with pressured speech; my friends, happy for me but confused, called me “cocaine Paul.” I bought more synthesizers off a guy from Craigslist, meeting him in Bushwick, Brooklyn, with a grand in cash. A body is not designed to lose 25 pounds in eight weeks, starting during the holidays. Beep. Boop.

With the relief come new anxieties. What if it stops working and I slide back into the vale of infinite noise? Compounding that, these drugs are hard to get, both because of supply chain problems and because they are being prescribed off-label for weight loss instead of diabetes. I can’t get a steady prescription from the pharmacy. I’m developing a rationing plan, stretching from an injection every seven days to one every eight or nine to build up a stockpile.

I can see my anxiety mirrored in the wave of reactions starting to appear—op-eds, TV segments, people explaining why it’s good, actually, that the vast majority of those using this drug lose a quarter of their body weight. On social media, fat activists are pointing out that our lives were worthy even without this drug. The wave of opinion will not crest for years.

And that’s fair because this is new—not just the drug, but the idea of the drug. There’s no API or software to download, but this is nonetheless a technology that will reorder society. I have been the living embodiment of the deadly sin of gluttony, judged as greedy and weak since I was 10 years old—and now the sin is washed away. Baptism by injection. But I have no more virtue than I did a few months ago. I just prefer broccoli to gloopy chicken. Is this who I am?

How long is it before there’s an injection for your appetites, your vices? Maybe they’re not as visible as mine. Would you self-administer a weekly anti-avarice shot? Can Big Pharma cure your sloth, lust, wrath, envy, pride? Is this how humanity fixes climate change—by injecting harmony, instead of hoping for it at Davos? Certainly my carbon footprint is much smaller these days. Are we going to get our smartest scientists together, examine the hormonal pathways, and finally produce a cure for billionaires?

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When I let the domain name for my diet blog expire, I accepted that there was no technology that could change my biological responses to my own satiety. Now there is, and the part of me that tracked every meal, searched for solutions in apps and programs, wrote code, and took notes is obsolete. Was that time wasted? God, yes. But I did learn a ton—about nutrition, about exercise, about myself. All of those lessons are a joy to apply now, without the panic of self-destructive hunger.

Lately I’m finally less manic. Still losing weight, but much more slowly. Exercising more. At night I play with my synthesizers and watch online classes in music theory. Headphones on, processing all those years of futile effort. As I fiddle with knobs I am sometimes angry, sometimes ashamed, and often grateful. I don’t know how long this post-appetite era will last, or how it will end. Just that, once again in our lives, everything has changed. 

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