I’ve always felt like a fat kid. Whether “heavy” or — my 80s Wisconsin grandparents’ favorite — “husky”, being multiple standard deviations off of normal for my height has been a constant. Even when I’ve been quite fit I’ve still looked big. At the Naval Academy, I had a Marine Corps company officer, figuring I was overweight, suggest a run. I accepted and we did an outer. It’s a brisk 4.5 miles, with a tricky — and officially discouraged — run atop a boulder seawall as the homestretch. It left him heaving and he never suggested we go for a run again. During Mark’s Year of Running, I ran over 2,000 miles and ended up averaging nearly a 10-k per day.

But I was always heavy. Always saw myself that way. And while my weight fluctuates — often drmatically — when I revert to the mean, it’s a heavy mean.

Genetic die rolls

I’m fortunate because despite struggling with weight, I’m otherwise healthy and being heavy hasn’t stopped me from loving a bunch of sports over the years. However, as I’ve aged into one of the first male mortality danger zones, it’s something I’ve been more conscious of and discussed with my doctors. With almost 40 years of successes and failures, we had lots of data to work from and my doctor thought I might be a good candidate for one of the new weight loss drugs. We settled on tirzepatide.

Better living through chemistry

10 months later, it has been dramatic. 85 pounds, 2XL-to-Medium kind of dramatic. I’m about 5 pounds away from what I had picked as goal weight — dead average for my height and age.

All medications can have side effects. Tirzepatide in particular has some nasty ones, so be smart and talk to your doctor if any of this is interesting to you.

I don’t have experience with brain-altering drugs other than alcohol — as we say in the Navy, a day in port is a day wasted! — so how it has worked has been a really unusual experience. It’s a weekly injection, starting with a 5mg dose and ramping up to 15mg based on how you tolerate it.

For me, what the injection does for 2-6 days changes my brain pretty dramatically:

1. No baseline sense of hunger. I’m aware when I haven’t eaten in a while, but it doesn’t map to “hungry” in my mind.

2. The urge to snack vanishes. Particularly the “I’m bored/stressed/chewing on a hard problem, chips would help”-style of snacking.

3. When I do eat, the “yo, dawg, your stomach is getting full”-signal is loud, uncomfortably so.

I grew up with the Midwest tradition of eating my feelings — plus parents and grandparents who equated portion size with affection — so eating past full and bored snacking are deep, deep habits. When the injection is active, it’s like a switch has been thrown and they just stop.

My experience is that it doesn’t seem to do anything else — I still enjoy eating, I still look forward to cooking, to great meals. I still enjoy wine and bourbon. It doesn’t seem to do anything to my tastes, it simply has muted two previously loud signals and amplified a third one.

It’s not a huge change. Over decades of tracking calories, I already consume comparatively few calories by US standards, I’m genetically built for efficient processing — I’d do well in the apocalypse, less optimized for abundance. But it’s enough to lead to consistent weight loss.

(To those who will comment “hey, have more willpower, exercise more, eat less, don’t snack” etc, thanks, you’re right, I’ve definitely not tried to do that over the last 50 years. Glad it works for you.)

I’ve been fortunate in not having major side effects. My doctor recommended ramping up fiber, which I do. The fullness trigger means I have to plan meals differently — a full American dinner out portion is now more food than I can comfortably consume, which tells you something about default meal sizes.

By every medical measure I am much healthier, often better than metrics from a decade or two ago.

Whatever my sense of identity, I clearly look different enough that I’ve been having this conversation a lot over the last few months, so I thought I’d write it up. No idea yet what the experience of weight maintenance is going to be like, so lots more to learn and discover.