Desire, GLP-1s, and Weight Loss

The word “desire” tells its story in its own name – in the French, “de” – of, “sir” – father. Desire is of the father (or Source, or God, or Universal Intelligence, or Spirit, or whatever word feels right to you to call it). I am no expert in theology or existentialism, but I’d wager to say we are wired from the get-go to want what we want.

Some of our desires are shared, like a desire to connect, a desire to love and be loved, a desire to experience pleasure, and some are fairly unique, like a desire to swim with and film sharks, or a desire to design the longest and sharpest fake fingernails that people can buy. We have different things that turn us on and thank goodness for that.

In my time as a clinical pharmacist, I saw a lot of people with their desire pushed down so far into their body, they didn’t recognize it anymore. This can happen when you’ve put yourself and your own needs at the bottom of your list of priorities for as long as you can remember. How are you supposed to keep feeling that childhood desire to make people laugh by selling rubber chickens or that urge to become an aerialist flying over people’s awestruck faces if you can’t first honor your body’s cues to drink water or sleep 8 hours per night? You might have trouble feeling the urge to pee, let alone feeling the urge to become a world-class poodle trainer. We all get a little lost sometimes.

The thing is, as much as we push down the unique desire we’re born with, it doesn’t go away; it’s still there, but it starts popping up as urges that we will honor, like eating. Whenever I sit down to write, I get the munchies. It’s this bizarre tug of war in my brain. I know that my deepest truest self wants to be a writer. I was the little kid writing poems and the English major in college, and then I squashed it all down because I didn’t think I was good enough. So now, when I have the audacity to sit down to write, I start craving the sweets and salty crunches. I didn’t honor my deep desire to write for so long that my body had to satisfy its sense of want in other ways, and I always listened to the desire when it popped up as a craving for food. Now that I am paying better attention, I still have the cravings for food, but at least I know why. I’m still afraid I’m not good enough to be a writer, and my brain is trying to protect me from shame and humiliation by having me stuff my face instead of bearing my soul. It’s a funny kind of dance.

But I digress. I met many people in the same boat while I worked as a diabetes educator and prescriber of weight loss medications, many people who had abandoned and forgotten the real desire in their lives and whose desire had taken shape in other forms, like cravings for food.  

Then came the GLP-1 receptor agonists, AKA weight loss injectables AKA Ozempic/Wegovy/semaglutide/Mounjaro/Zepbound/tirzapetide. These drugs magically, rapidly change people’s cravings. I watched them work wonders for people who were trying to lose weight. I watched people’s A1cs come down to goal for the first time in a long life of managing diabetes. I heard people say how relieved they were to be taking these medications. So much good news!

But there were other stories too. Like the stories where I was initiating these weight loss injectables for people in their 20s who would now take them forever. That’s what the guidelines say – the weight comes right back when the drugs are discontinued, so we don’t discontinue them. There were also the stories of people doing great on paper, but feeling like crap – the nausea, the listlessness. I had a patient who had lost the weight but she broke down in tears in my office because she didn’t enjoy anything anymore. Maybe this wasn’t because of the drug, but when we consider how these drugs are shifting our desire, I think it’s a fair possibility. The most insidious story, though, was my musician patient who was doing well, who felt great, who had lost the weight! And he didn’t even seem to mind that he also lost his interest in playing his guitar.

The drug had so altered my patient’s desire to play music that he didn’t feel called to it at all anymore, and he was cool with that. It was the fact that he didn’t mind that he had lost this desire that troubled me most. It was a forced moment of reflection on the question: who are we without the unique desire we come with into this world?

I decided in that moment that I did not want to further squash down desire with the GLP-1s – we do that enough to ourselves on our own. So now I try to approach the matter of weight loss from the other direction; if we gain the weight because we’re not listening to our innermost desire, let’s start there; let’s kindle and stoke and nurture our passion. And maybe we don’t know what that passion is –  how wonderful! We get to figure it out.

Let’s spend time outside, let’s explore our curiosity, let’s make things, let’s dance and wiggle and sing, let’s try something new and take a risk to grow, let’s unpack and release the pent-up guilt and fear and shame holding us paralyzed in place.

As much as I don’t love that I crave pretzels every time I sit down to write, I’ll take it because I want to want to write. It makes me feel alive and human and flawed and weird, and I love it. As far as I know, I have one shot at a life in this body in this moment, and I want to want every second of it.

Is there a place for the GLP-1s? Absolutely, I’ve seen the good there too. But let’s counter-balance the prescriptions with encouragement for people to find their fire. Let’s point folks in the direction of coaches who can nurture their goals and dreams and highest motivation for change. And for goodness sake, let’s do everything we can to not have people take these drugs forever.