Crutch or Tool?

When I graduated high school WAY back in 1982 I was a lean 150lbs. I was used to my home and my school and my friends. Insulated, really. I was also unexamined, so I didn’t know about my introversion, my attachment style, my mood disorder, or my inherited trauma. I didn’t think about much other than music and girls. Sometimes not in that order.

So when I left for college I didn’t think much about it. No big deal, right? I’m just going to go live somewhere else other than basically the only place I’ve ever known. Given my lack of insight, I’m surprised I wasn’t required to wear a helmet.

I remember that first week in the dorms. Sleeping next to someone I hardly knew. Showering with complete strangers!!! I hadn’t been in a bathroom with someone else since I got body hair. We were Republicans then, so we were a modest family. Also, as a good Republican family in the 80’s, we didn’t talk about bad things. Negative emotions, negative experiences, failures, flaws. We kept those secret. So I didn’t know how to talk about what I was experiencing that first semester.

What I did discover, however, was that when I put rich foods in my mouth I was soothed. Lacking insight, I couldn’t have put together that sentence together back then, but that’s what was happening. It didn’t work with carrots or broccoli. But pizza, fried chicken, fried anything, bread, candy, chocolate, chocolate covered chocolate, and French fries made me feel good. Those foods distracted me from feeling uncomfortable in my own skin.

So in the course of about a year I doubled my weight. I found myself wearing 44 inch pants and weighing around 320lbs, give or take a large triple meat pizza. What helped me hide was, in my group of friends, I was the little guy. I hung around guys who were 500lbs, 450lbs, and 350lbs. I was svelt. When me and the big guy, Louie, ordered 100 white castle hamburgers on the way to a ballgame, he made fun of me because I could only eat 37 of them. He finished the rest.

As much as I loved those guys, I didn’t want to kiss them, and I was having trouble getting a date. So I decided to lose some weight. Not for health reasons, or because I was becoming emotionally healthy. I just wanted a girlfriend, and when I was 150lbs I didn’t have trouble getting a girlfriend.

So I lost over a hundred pounds that summer. It wasn’t difficult. I was back home, surrounded by comfortable people. I exercised two hours a day, cut out some bad foods, switched to diet soda, and there you have it.

From that season of my life until now I have battled a weight problem. When my third daughter arrived I had creeped up to about 275lbs (I never got higher than that), then I was tired of being tired so I lost the weight again. Still emotionally unwell, still lacking any insight whatsoever. So not surprisingly, the weight went up and down over the years. My modern weight travel over the last 30 years has fluctuated between 215 and 165. I’m at 213 as I write this. I have insight now. I have coping skills now. I’ve been to (and am engaged in) therapy. I have an examined life now. I know my weight goes up relative to my stress. And I know my life has been stressful this year. But I’m there anyway.

So it won’t be a shock to you that my doctor is mad at me. “Mad” might be a strong word. “Frustrated” might be a better word. Last year when my labs came back she had a serious talk with me about medications, my cholesterol, and a few other numbers that were outside that elusive green area on my health app. I generally don’t like medication. When we cleaned out our family home we collected at least two 55gal leaf bags full of prescription pill bottles from my mom. Maybe that’s why I don’t like medication? It’s not because I’m Amish.

So I told my doc, “Give me 6 months, I’ll get it it done on my own.” She relented. I did good for 3 months, but I lost my grip and by the time I made it back to the doc my labs were no better, maybe a little worse.

She put her foot down, “I’m prescribing you a semaglutide.” You might know this medication by the name ozempic or wegovy. Out of curiosity only (I had no intention of taking the medication), I called the pharmacy to find out what that would cost. Now, I pay about $2k a month for health insurance for a family plan. They wanted an addition $1,800 per month for the meds! Armed with this, I messaged my doc, “Sorry, Doc, I’m not paying that!” She had another plan and prescribed it a different way. That was going to cost an additional $400/month. I’m still not doing it.

I might be looking for a new doc.

Semaglutide is a pretty amazing medication. It operates through several mechanisms, primarily by mimicking a hormone called glucagon-like peptide-1 (GLP-1) that targets areas in the brain responsible for appetite regulation. Once semaglutide is administered, it binds to GLP-1 receptors, increasing the quantity of insulin your pancreas releases in response to sugar, which helps lower blood sugar levels. However, the weight loss effects are mainly due to its ability to decrease hunger and caloric intake. Studies have shown that individuals on semaglutide felt fuller longer and had reduced cravings, which leads to a lower calorie intake.

It also has an impact on the delay of gastric emptying. This means the rate at which your stomach empties food into the intestine is slowed down. As a result, you feel satiated for a longer period post-meals, which helps in reducing snacking and overeating.

Long story short, the medication curbs cravings. There’s some interesting research being done with semaglutide and addiction and the early results look like it might have a strong impact on those dealing with substance use disorder.

So, here’s my struggle: I don’t HAVE to give in to my cravings, do I? I mean, am I in control of my behavior or not? I can save $400/month and just choose NOT to eat, right? I did a fast once for 5 days. Only water. I just wanted to see if I could. And I did. I just chose not to put any food in my mouth for five days. So why would I pay $400/month to help me do something that I can already do on my own?

Except I’m not doing it. I can do it, I want to do it, I need to do it, but I’m not doing it. If I want to do it, but I’m not doing it, does that mean I can’t do it? Well, I’m doing it today. I’m hungry as I write this. And I won’t eat until dinner. But that’s today.

So is the medication a crutch or a tool? Given my propensity to choose the wrong thing, I’ll bet, only because I think of it as a crutch, that it is better defined as a tool. And I also bet that I am severely underestimating the power of craving. I’ve given in to craving and I’ve resisted craving and I can’t tell you what made the difference, other than getting tired of the consequences of giving in. But that’s a high cost (according to my doc, who I’m probably keeping). I understand this better when I’m working with a client who is struggling with craving. I accept the power of craving when I’m dealing with anyone but myself.

Maybe you can tell at this point that this post is really just me working out my own ambivalence? So it seems this is going to cost me one way or another. As of this writing I’m not sure what I’m going to do. Other than daydream about cinnamon rolls.