A therapist tries a GLP-1

In graduate school and beyond, we’re taught to be extremely careful with self-disclosure. Anything we choose about ourselves, as therapists, can affect our clients and their care. The core principle I think about is, “will this disclosure help or hurt clients?” Next, I think “Do I feel confident and settled in this part of my life where I won’t regret sharing it.” After thinking about those things, I decided to share.

When I turned 42, my labs fell off a cliff. Specifically, my A1C, cholesterol, and other markers of physical health suddenly started changing with no change in my diet, exercise, or lifestyle. Sure, I’d gained some weight but so did my family members at the same age so I tried to accept it. I exercised almost daily. I ate pretty well, most of the time. I rarely ate processed foods. I never drank soda. I bought clothes to fit my body rather than trying to fit my body into clothes. I was doing the “body positivity” and “Health at Every Size” thing as well as a woman can do it in our fat phobic society.

When those lab results came back, I became more mindful of what I was eating, how often I was exercising, and as much as I’d like to say I worked on my stress levels, I have three kids and two dogs, and a husband who works his butt off at home but still has a demanding job. Stress comes with the territory. After a year of strong effort, my labs were even worse at 43.

So I kept on keeping on - exercising more, eating less, eating differently. But as I worked hard, my body started to show all of the telltale signs of perimenopause. I wasn’t sleeping well. I was waking up hungry at night and not just “I could eat or go back to sleep,” hungry. This was “wake up now - you are having an emergency” irrational hunger that I had only experienced in pregnancy. At 44 I started hormone therapy for perimenopause and as my A1C reached just below the diabetic threshold, I begged for Metformin after explaining to my doctor how hard I was working at lifestyle changes. She agreed and for that year, I was able to stabilize my A1C and lipids. Unfortunately, after so much work, I couldn’t seem to get the numbers down anywhere close to the normal range.

In August of 2025, my youngest child took a picture of me in my underwear when I wasn’t looking (yes we had a VERY stern discussion about how we don’t take photos of people undressed). I could see how much weight I was carrying around the middle of my body. Sure, I had some subcutaneous fat but this looked like visceral fat. All I could think about is how I was in full blown metabolic syndrome before age 50. I was ready for medical intervention. I simply could not restrict my diet more and exercise EVEN MORE than I was already doing.

Unfortunately, the “progress” I’d made stabilizing my A1C disqualified me from insurance reimbursement for GLP-1 drugs. I understand why there’s a threshhold, but it’s also frustrating to know that the only way to get coverage for a clear diagnosis is to let it get worse first.

Injecting medication was easier than I thought it would be. Insulin needles are very tiny. The prescriber of the medication sent along instructions on managing side effects, things to think about when eating, and otherwise, what to expect. I’ve had some intermittent nausea and headaches but otherwise no debilitating side effects. I noticed lack of interest in food during the first two weeks on the medication and then for approximately two weeks after dose increases. After the first couple of weeks, however, I am interested in eating but traditionally “healthy” foods are much more satisfying. I feel genuinely good when I eat a diet of fruits, veggies, tea, water, whole grains, and small amounts of sweets. I also feel genuinely icky when I eat things with little nutritional value or too much spice or fat.

My first labs back showed progress and I’m waiting on my next round of results. Signs so far are that this has reversed the metabolic dysfunction that was so evident in August. On the weight front, I’ve lost approximately 15 pounds in three months. Unfortunately, many of the nice outfits I’ve bought myself in the last few years are now too big so I’m trying to learn to tailor clothes by taking them in a bit.

Psychologically, this process is complicated. Before this medication, I think I was doing a reasonable job at accepting my aging body as it was, extra weight and all. However, it’s such an incredible relief to feel like I’m not in an out of control slide into chronic disease anymore. As sad as I am to say goodbye (or see you later?) to some of my favorite clothes that are now too big, there’s another part of me that is happy to have lost weight. I’m more comfortable in exercise and movement. I like how my clothes fit. My body feels a bit more familiar. But I also feel like I’ve somehow failed at living the “health at every size” values that I think are core to the wellbeing of myself and so many other people.

So I guess my conclusion is that weight and health are complicated in our society. While health and weight are somewhat related, they’re not the same thing. While I want to believe that my GLP1-GIP journey was 100% motivated by those lab values and my desire to be here as long and well as I can for my family, I know that I am not immune to the pressure to be thin. I hear the siren song of the privilege that comes with thinness. I can’t honestly say it wasn’t a factor in deciding to start this medication. I also know that because I developed metabolic disease at such a young age with otherwise “good” lifestyle habits, that I probably have to stay on this medication forever. That is only enabled by the relative privilege I have to pay for the support. That doesn’t feel good either.

I think it’s OK to seek the help you need, even when your motivations aren’t “100% pure.” Life is complicated and so are we.