Last summer, on work trips to Portland, Oregon, and New York, and in the fall, while visiting London and Paris, I went out of my way to meet up with old friends, college classmates, and former colleagues, hoping someone would ask the question I’d waited so long to hear: Had I lost weight? I was prepared to tell them everything, starting with how strange it felt the first time I stabbed myself in the abdomen with a 34-gauge needle. This deeply unnatural act requires a degree of disassociation; for the longest time I just sat there staring at my hand. Once I tricked my body into violating itself, it was just a matter of pressing down on a small button to push a dose of semaglutide out of an Ozempic-branded pen dispenser, through the thin needle, and into my flesh.

By the time I bought my first Ozempic pen at the start of April 2025, one in eight American adults had taken semaglutide or some other GLP-1 receptor agonist. This class of medications, which are sold under brand names like Ozempic, Wegovy, and Zepbound, suppress the appetite and regulate blood sugar by mimicking the glucagon-like peptide-1 hormones our bodies release after we eat. Prior to 2021, when off-label use of GLP-1 drugs for weight loss exploded among the wealthy and well-connected, they were used almost exclusively for the treatment of type 2 diabetes. In Japan, where I have lived off and on for over a decade, I learned I could get a prescription for GLP-1 drugs for the purposes of weight loss, provided my body mass index score fell within the ranges classified as “overweight” or “obese.” When I visited a Tokyo clinic specializing in these drugs in April, the doctor took one look at me and stated his diagnosis plainly: “Obviously, you meet the necessary criteria.”

If he’d asked me to step on a scale, it would have told him I weighed 291 pounds, which, at five feet ten, gave me a BMI beyond the 40.0 threshold separating class II obesity from class III obesity, putting me at the far end of the spectrum, which is to say the end where no one wants to find themselves. I’d been lingering there about a decade, and in all that time I had somehow never accepted the reality of my situation. It was a state of denial rooted in my unblemished record of bouncing back from previous bouts of plumpness. Once, in my early 20s, I’d gained something like 70 pounds in the course of two years, before obsessive distance running got me into the best shape of my life. I chalked this up to the excesses of early adulthood. As the child of addicts, I avoided drugs and alcohol, but moderation in diet and exercise didn’t come naturally to me. Later I took up competitive road cycling seriously enough to win the odd race on the elite amateur circuit, and grew accustomed to putting on a few pounds in the offseason, then losing it all in preseason training camps. I was still a lean, strong 165 pounds when I went back to college at age 30, and though I would gain 100 pounds by the time I started graduate school four years later, I told myself this was only temporary. I’d lost it all before, and once things fell into place I would lose it all again.