For whatever reason, the post on which I was writing this novel in response was removed, but I still hope it’s helpful to folks. 

What I wish I knew from the very beginning: 

1. Hydrate, hydrate, hydrate. I have 3 water bottles (32 oz each) that I fill first thing every morning and make sure I’ve drained each of them by the end of the day (love my Owala free sips). Then any additional liquid is a bonus (coffee, beverages with meals, protein shake, etc.). 

2. You are supposed to have an appetite/feel hungry. This is a medication that helps to regulate your metabolism (and often your body’s mistaken belief that it is starving). It is not meant to cause you to adopt disordered eating behaviors. I have a dear friend whose spouse is struggling mightily with the health consequences of anorexia, and challenging as the health consequences of obesity are, in my opinion the health consequences of years of anorexia are even worse. For me, I eat throughout the day: breakfast of avocado toast with a fried egg; morning, afternoon, and evening snacks of things like edamame, roasted chickpeas, cottage cheese, fruits, yogurts or skyr, etc. My lunch is usually a protein shake as I’m often in zoom meetings at lunchtime and a sensible dinner (and I usually eat a full plate of food). Fueling and hydrating my body and activity has been, I believe, essential to both avoiding side effects and having excellent results.

3. If you experience fatigue, as soon as you can possibly manage, do some light exercise (e.g., go for a walk). I found the fatigue I experienced when adjusting my dose upward receded much faster when I pushed through it (and of course fueled and hydrated my body properly). 

4. Add in exercise, especially resistance training, when you can. I’ve had to back off due to some back issues and I can’t wait to get back to it (just got cleared to do some light core work at home and yoga and strength training are on deck). 

5. Try to figure out the difference — for you — as early as possible between food noise and normal hunger. Hunger is nothing to be afraid of; sustained reemergence of food noise is a sign to consider increasing your dose. 

6. There is a happy medium between those that insist you should fully plateau for months before titrating up and those who go up every month whether indicated or not. I never fully hit a plateau during my active loss phase, but it was generally clear when things were slowing down enough that I should titrate up. Maintaining a middle road on this helped me maintain a healthy rate of loss while also minimizing side effects. 

7. Faster weight loss is NOT better weight loss. Many of the nastier side effects are more likely if you’re losing at an unhealthily fast rate (I’m looking at you, gallstones). Your goal is 0.5%-1% of body weight loss per week. So when I was a little over 200 pounds at the start, my goal was 1-2 pounds of loss per week. When I was closing in on my final goal, my ideal loss rate was down to 0.6-1.3 pounds per week. Don’t be that person who comes and complains that you haven’t dropped 30 pounds in a month. Your body — and your mental health — will benefit for a philosophy of slow and steady wins the race. I knew going in since they were an incidental finding on a different test that I already had asymptomatic gallstones, so that made me conscientious about ensuring a healthy rate of loss (and I understood that even then, I may eventually need to have my gall bladder removed through no fault of the Zepbound). 

8. If you can, buy at least a few outfits that fit your changing body along the way. You’ll feel better and more accomplished if you’re walking around in clothes that don’t make you look like you’re playing dress up. For women, a good bra fitting (or two or three) along the way makes a world of difference. I am a huge fan of the Evelyn & Bobbie Beyond Bra, as they’re flexible enough to work through a range of sizes (I started as squeezing into a 42DD and am now about a 34DD). I got my first E&B after about 25-30 pounds of loss and only had to buy a second size when I was closing in on my goal weight. Regular bras have a much shorter window in which they’ll fit your changing body (ask me how I know). 

9. Use an app like zozofit to track the changes in your body shape. 

10. Work closely with your doctor to monitor your other health issues, especially if they’re related to your obesity. For example, if you’re on meds for high blood pressure, make sure you’re monitoring at home and working with your doctor on adjusting your meds down accordingly. 

11. You’ve got this! Congrats on taking this step to address your health! And remember: obesity is a disease. The biggest gift this med will give you is a visceral understanding that your obesity is not your fault. 

Advice to Newbies