Life on a GLP-1

Read This First

The prescription was the easy part.

Maybe it took a GP appointment, a long online questionnaire, an insurance fight or a lot of saving. Either way, the box is in your fridge now. You've done the first injection, or you're about to. The questions you have today are different from the ones you had last month. Why does breakfast make me feel sick? Am I eating enough? Is it normal to have no interest in food at all? Why has the scale stopped? What happens when I can't afford the next box? What do I say when my sister asks if I'm "on that jab"?

This book is about those questions. It's about the next twelve months and beyond: the side effects, the food, the muscle, the brain, the money, the comments and, one day, coming off. It is written for adults who are on semaglutide (Ozempic®, Wegovy®) or tirzepatide (Mounjaro®, Zepbound®), or who are about to start, with a prescription, and want to do it well.

What this book is

• A guide to living on the drug. How to get through the first month, manage nausea and constipation, eat enough protein when you're never hungry, keep your muscle, handle a plateau, plan for cost, and stop without losing everything.
• Honest. These drugs work. Most people in the big trials lost a lot of weight. They also come with side effects that almost everyone feels, and a few that put people in hospital. We say both.
• Built for the conversation with your prescriber. Every chapter has an Ask This box with the exact words to use, and what a good and a bad answer sound like.

What this book is not

• Not medical advice, and not a substitute for the clinician who prescribes your medicine. Nothing here tells you to change your dose, skip a dose or stretch a pen. Those are your prescriber's decisions, made with your history in front of them.
• Not a sales pitch. MediQuestAI does not prescribe, sell or dispense any medicine. We have no affiliation with Novo Nordisk or Eli Lilly, who make these drugs. Brand names are used so you can recognise what you hold.
• Not the risk book. If you haven't decided yet, or you want the full list of serious side effects, who shouldn't take these drugs, surgery and anaesthesia rules, pregnancy, and how to spot fake or compounded pens, read the companion book, Before the Needle, first. This book points back to it instead of repeating it.

About the stories

Each chapter opens with a person. Where a story comes from a court record, a regulator or a news report, we cite it. Some stories are composites; names and details are changed. A composite is built from the experiences many people describe, so it is true to life without being one real person. Composites never carry a precise statistic or a real clinic's name, and we label them where they appear.

About numbers in this book

This book contains no calorie targets, no goal weights and no body-mass index (BMI) charts for you to measure yourself against. That's on purpose. Appetite drugs can quietly push some people towards eating too little, and numbers like those can feed that. When we talk about food, we talk about what to put on the plate first, not how little to eat. If food has started to feel like something to beat, go to Chapter 10 now.

Every number we do give comes with a source you can check, listed at the back.

Danger now?

Go to the Go Now Card at the back of this book, or straight to an emergency department, if you have any of these:

• You can't keep fluids down for a day, or you're passing very little urine
• Severe belly pain that won't go away, especially if it spreads to your back
• Pain under your right ribs with fever, or yellow skin or eyes
• Shaking, sweating and confusion, especially if you also take insulin or a sulfonylurea, or you've been drinking
• Fainting, chest pain or a racing heart when you've barely eaten
• Thoughts of harming yourself

In the US call 911 (or 988 for a mental-health crisis). In the UK call 999, or 111 for urgent advice. In Kenya, go to the nearest hospital emergency department or call your local emergency number.

How to read it

You don't have to read in order. Chapters 1 to 4 are the daily skills: the first month, side effects, food and muscle. Read those early. Chapters 5 to 9 can be read in any order, when the issue comes up. Chapter 10, on eating disorders, is for everyone, including the people who live with you. Chapters 11 and 12 are about stopping and the long game, and they make the most sense once you've read the rest.

At the back you'll find the Go Now Card, the GLP-1 Living Plan (a plan you fill in as you go and take to every appointment), a glossary and the full list of sources.

About this book

This book is educational. It is not medical advice, and it is not a substitute for a clinician who knows your history. If you have warning signs now, use the Go Now card or call your local emergency number. For everything else, take the questions in this book to a doctor, nurse or pharmacist.

Before you turn the page

Take thirty seconds and write two things down, in your phone or on the Living Plan at the back:

1. Which week you're in. Not started yet, week one, month three, year two.
2. Your biggest problem right now. Nausea. Not eating. The scale has stopped. Money. Someone's comments. Thinking about stopping.

Then go to the chapter that matches. You'll get more from this book if you read it with your own week in front of you.

The First Month

It's Sunday night and the pen has been sitting on the kitchen counter for twenty minutes. Grace, 44, has watched the video from the pharmacy twice. She has read the leaflet, the part about thyroid tumours in rats, and then put it face down. Her partner is watching football in the next room. She hasn't told him she's doing it tonight.

The injection itself is nothing. A click, a few seconds, done. She waits for something to happen. Nothing does.

On Monday she eats half her usual lunch and pushes the rest away, which has never happened before in her life. On Tuesday she feels faintly seasick all afternoon. On Wednesday there's a burp that tastes of rotten eggs. On Thursday she steps on the scale and she's lost weight. On Saturday she steps on it again and some of it's back. That evening she watches a woman online say she lost a stone in her first month, and Grace starts to wonder whether her dose is "too low to do anything", and whether she should ask to go up early.

(Grace is a composite. Her story is built from experiences many people describe; details are changed.)

Sound familiar?

• You've weighed yourself every morning since the first injection.
• You've compared your first month with someone else's "month one" video.
• You've wondered whether the starting dose is doing anything at all.
• You've eaten your normal-sized dinner out of habit and spent the evening regretting it.
• You've thought about asking to go up a dose early, or taking the next one a day or two sooner.
• You haven't told anyone you've started.