Mounjaro, three months on: ‘I have been sticking a tiny needle in my stomach'

Irish Examiner

10 hours ago

Three little words — effortless weight loss — seem to really trigger people, eliciting all kinds of opinions, reactions, and judgements. What, no suffering? Fat people have traditionally been viewed as weak, so suffering towards thinness is character building. Bypassing that suffering is, therefore, cheating.
We have long associated fatness with words like greed and laziness, so that sweating and starving provides a redemptive arc — hence the popularity of watching fat people attending boot camps. And yet here we are, ushering in a new era of effortless weight loss. Weight loss without hunger — something geneticist Tim Spector terms 'the holy grail'. What's not to like?
Every Friday for the past three months, I have been sticking a tiny needle into my stomach — so tiny, I can't even feel it. A new tiny needle each time, which I attach to a pen pre-filled with four weekly 2.5mg doses of tirzepatide, aka Mounjaro, which I keep in the fridge. Every month, my supplier mails me a new pen, and I send them payment. It's astonishingly straightforward.
I first tried Mounjaro last summer for a month but it made me nauseous so I stopped. Three months ago, I decided to give it another go, having read up on how to better manage side effects by eating little and often. It worked.
Since then, I have been losing weight easily, non-dramatically — I am 1.62m and started at 78kg, which translates to a BMI of 29.7. (A BMI of 25-plus is overweight, a BMI of 30-plus is obese, and a BMI of 40-plus is morbidly obese). Three months later, I am currently 70kg, with a BMI of 26.7. My appetite has been reset, while my pleasure in food has remained unaltered. Less is more.
Suzanne Harrington: "I have been losing weight easily, non-dramatically — I am 1.62m and started at 78kg, which translates to a BMI of 29.7. (A BMI of 25-plus is overweight, a BMI of 30-plus is obese, and a BMI of 40-plus is morbidly obese). Three months later, I am currently 70kg, with a BMI of 26.7. My appetite has been reset, while my pleasure in food has remained unaltered. Less is more." Pic: Andrew Dunsmore
Tirzepatide contain two hormones, GLP-1 and GIP, which are naturally produced in the gut; their function is to tell the brain when the stomach is full. The drug acts as a booster dose to these naturally occurring hormones — so instead of eating a whole pizza, you might eat one or two slices of pizza and then stop because you feel naturally full. The pizza is still delicious.
It has the same effect as bariatric surgery — you enjoy your food the same as you ever did in terms of taste and appetite but you feel full after far smaller amounts. The difference between bariatric surgery and Mounjaro is simple — no scalpel required.
The drug, manufactured by Eli Lilly, became available in Ireland in February on private prescription. It's not cheap but what you spend on your monthly dose you save on food bills. Prescribers suggest a month on 2.5mg, before increasing the dose to 5mg, then 10mg. This gradual increase is to prevent side effects like nausea, allowing the body to acclimatise.
Three months later, I am still using the lowest dose, because it's proving effective, with no side effects. It varies from person to person. A friend recently increased to the higher dose of 10mg after her weight loss began to plateau on a lower dose; another friend has just increased to 5mg after six months on the 2.5mg dose. All three of us have different body types, different heights, and different BMIs — morbidly obese, obese, and overweight — but have all experienced effortless weight loss.
Yet those three little words continue to bother people. The media dubbed Mounjaro the 'King Kong' of weight-loss drugs, implying some kind of feral peril — why? Then there was scaremongering around 'Ozempic face' (formerly lesser known as 'bariatric face'), which is when a reduction in facial fat can leave your face looking a bit, well, haggard. As though it were solely about looks, rather than health.
Carel Le Roux, professor of metabolic medicine at UCD, explains what Mounjaro is and what it isn't.
'This is a hormonal treatment for obesity,' he says. 'It is a disease-modifying drug, not a cure for obesity or an appetite suppressant. It's not a weight-loss drug but a health-gain drug. We know the side effects are 20% less heart attacks, 25% less renal failure, and 80-90% less diabetes.
'Patients post-bariatric surgery, or who are using tirzepatide, report how they do not feel hungry, how they think about food less often, and eat smaller portions, while retaining palatability. They reach a new balance point.'
Nor, he adds, should we scaremonger about how Mounjaro and related drugs will trigger anorexia: 'These drugs are not going to induce eating disorders. It just means that people using them eat less.'
As a PhD student, Prof Le Roux was part of the team which first infused the hormone into the human body 25 years ago. He adds: 'We then studied the effects of bariatric surgery and found that these same hormones were elevated in patients post surgery — they were three to four times higher in the body post operatively. Which means we have over 50 years' experience of these [elevated] hormones in the body.'
(Bariatric surgery, specifically the Roux-en-Y gastric bypass, has been around since the 1960s and has been the gold standard for treatment of obesity — until now. These hormone-mimicking drugs are also widely used to treat type 2 diabetes).
Suzanne Harrington: "Every Friday for the past three months, I have been sticking a tiny needle into my stomach — so tiny, I can't even feel it. A new tiny needle each time, which I attach to a pen pre-filled with four weekly 2.5mg doses of tirzepatide, aka Mounjaro, which I keep in the fridge." Pic: Andrew Dunsmore
SIDE-EFFECTS?
So apart from the positive effects of improved health, what about side effects? Is Mounjaro dangerous? Does it, for instance, increase your chances of thyroid cancer?
'You will not develop thyroid cancer on this drug unless you're a mouse,' says Prof Le Roux. 'Or if you lose weight too quickly, you can develop gall stones — this happens to about three people in a hundred.'
The most common side effect of Mounjaro, however, is common or garden nausea.
'Nobody should ever vomit or have nausea while using this medication,' he says. 'This was happening initially but now we are far more conservative with dose escalation — we do not want people to suffer side effects, as this will stop them using the medication. You go slowly, so that you are on a maximum tolerable dose rather than a maximum dose.'
The irony of treating a man-made problem — obesity — with a man-made solution — obesity drugs — is glaring. Almost as glaring as the correlation between widespread obesity and the mass consumption of ultra-processed foods. First, we had fat Americans; now it's all of us.
But until the food-industrial complex has been compelled to consign ultra-processed foods (UPFs) to the dustbin forever, until we all have equal access to fresh affordable wholefoods, and until we are all taught from primary school onwards how to cook from scratch, obesity will remain a man-made problem, and weight-loss drugs our man-made solution. Not that UPFs are always involved — I eat plant-based, don't drink, exercise regularly, and am still overweight.
I first came across the new weight-loss drugs in more detail when I interviewed author Johann Hari about his book Magic Pill. Before that, I'd vaguely heard of Ozempic as something people in Hollywood were using to get even thinner.
In his book, Hari recounts his own experiences of using Ozempic; how after his initial dose, he'd gone to his usual cafe for his usual breakfast and felt full after a few mouthfuls; how this feeling had continued, resulting in him experiencing effortless weight loss.
I knew how this felt, having had gastric sleeve surgery in 2019. I'd been fat since my first pregnancy in 2000, when I gained an impressive 30kg — and had been trying to lose it ever since. The gastric sleeve was the most successful intervention — I dropped from 92kg to 72kg.
But, six years later, my weight was slowly increasing again. I wasn't fat-fat — I'd regained around 8kg, which my bariatric surgeon in Estonia said was normal, and not to worry, but I was concerned about future-proofing my hips and knees and overall health.
Suzanne Harrington: "The irony of treating a man-made problem — obesity — with a man-made solution — obesity drugs — is glaring. Almost as glaring as the correlation between widespread obesity and the mass consumption of ultra-processed foods. First, we had fat Americans; now it's all of us." Pic: Andrew Dunsmore
INTERNALISED FATTISM
Also, after going to the trouble and expense of bariatric surgery, I was done with being fat. I was not going there again. And, yes, that is 100% my own internalised fattism — as a 50-something woman raised by a generation of fatphobics, the societal messaging growing up was that being fat and female was the worst possible combination.
Boys don't make passes at girls with fat asses. Imagine your kids hearing that now, even jokily. The highest compliment, genuine and well-meaning, was always 'have you lost weight?' This is not to blame previous generations, socialised to value female worth based wholly on appearance, which was calculated by prettiness and thinness.
The democratising influence of the internet on how we view bodies — how one size does not fit all — was still some way off. There was no Lizzo back then, just cottage cheese diets and the male gaze.
It was hard not to absorb this messaging. It's not always just a female thing either — a 57-year-old male friend, reared in a loving but fatphobic household, developed bulimia in his early teens that lasted into his 30s.
An 86-year-old friend still weighs herself every day, having taken up smoking during menopause in an attempt at weight management. How awful, I think. Then I remember that I stick a needle in my stomach every Friday so that I don't get fat again.
Does the availability of Mounjaro — and its effortless weight-loss stablemates — negate all the progress made by the body positive movement? Will fat acceptance cease to be? The aforementioned Lizzo has recently lost a significant amount of weight, as has Adele. Should fat public figures remain fat to make other fat people feel better? Or is that the same as pressuring people to be thin but in reverse?
Why should anyone owe anyone else fatness or thinness? Lizzo doesn't talk about body positivity — she talks about body neutrality; your body being nobody else's business.
Mounjaro, Wegovy, and Ozempic offer a way out of obesity that, until now, has only been available via bariatric surgery, something many people could not access.
This is an opportunity for metabolic reset; whether you use it intermittently, or longer term, it's a win-win. Whether your reasons stem from health concerns or societal conditioning — or a complicated mix of both — that's your decision, it's about your levels of comfort within the body you inhabit. For people living with obesity, it's a godsend.
Or, as Prof Le Roux puts it: 'We need to treat the disease of obesity the same as we treat asthma or high blood pressure or any other medical condition.'
Suzanne Harrington: "This is an opportunity for metabolic reset; whether you use it intermittently, or longer term, it's a win-win. Whether your reasons stem from health concerns or societal conditioning — or a complicated mix of both — that's your decision, it's about your levels of comfort within the body you inhabit." Pic: Andrew Dunsmore
HOW IT WORKS
Both semaglutide (Ozempic) and tirzepatide (Mounjaro) mimic a hormone produced in the body called GLP-1, released in the gut whenever we eat. This hormone signals the brain to reduce appetite while setting off increased insulin production. Mounjaor also mimics a second hormone, GIP (glucose-dependent insulinotropic polypeptide).
This is why tirzepatide is linked to greater weight loss. One study using data from two clinical trials of people with type 2 diabetes over 68 weeks, found tirzepatide resulted in a weight loss of 17.8% compared with 12.4% relative to placebo for semaglutide.