I Was Wrong About Weight Loss

A surgeon’s reckoning with shame, failed diets, and the biology we ignored until GLP-1s forced us to pay attention

Shame.

If you have ever had even a few pounds to lose, you probably felt it, that quiet, creeping sense that something about you has gone wrong, that you have slipped in a way that is not merely physical but moral, that you have somehow failed a test you were supposed to pass without thinking. It does not arrive announced. It seeps in, through comments, through glances, through that ever-present cultural hum that insists this is all within your control, that if you were just a little more disciplined, a little more careful, a little more committed, you would not be here.

I know that feeling, not as an observer, but as someone who lived it.

Because I felt the shame, and what I realized slowly and somewhat uncomfortably, is that while I never blamed my patients, I absolutely blamed myself. I ran support groups for years, sat with people carrying that same burden, and helped them see that this was not a moral failure, that this was biology, that they deserved treatment and not judgment. I could say that clearly, convincingly, even compassionately. I just never extended that same reasoning to myself. I assumed, quietly but persistently, that I should do this on my own, that if anyone could will their way through it, it would be me.

Just Try Harder

Photo by Dylan Gillis on Unsplash

And so I did what many of my patients did. I went on the diets. I tightened things up. I ate vegetables, cut out foods, added others back in, adjusted, refined, optimized. And like many of those approaches, they worked, at least for a while. Weight came off, enough to reinforce the idea that I had found the answer, that this time it would stick.

But it never did.

And if there is a profession built on stubbornness and willpower, it is surgery. We train ourselves to push through fatigue, override discomfort, stay focused when everything in the body says stop. If this were simply a matter of discipline, then I should have been the success story that proves the rule.

I was not.

Because the problem was never simply discipline. It was the constant, low-grade insistence of hunger, the persistent signaling beneath awareness, shaping decisions, narrowing attention, creating a friction that accumulates over time. You can manage it for a while, but management is not resolution, and eventually the system reasserts itself in ways that feel, and are often described as, failure.

And the truth, the part that took me longer than it should have to accept, is that I never did it on my own.

Then I started Zepbound

I am down fifty pounds now.

Not because I suddenly discovered a deeper reserve of willpower, but because the biology changed, and once it did, the behaviors followed in a way that finally felt sustainable rather than forced.

When you look at the data, the personal experience aligns with what has been observed again and again. Long-term weight loss with lifestyle alone is not just difficult, it is uncommon to the point of rarity. We see early success, often meaningful, followed by gradual regain, as metabolic adaptation lowers energy expenditure and increases hunger. The Diabetes Prevention Program, Look AHEAD, and numerous observational cohorts all tell the same story in different ways. A small percentage of people maintain significant weight loss at five years, often cited in that narrow band of three to five percent, and the rest, through no lack of effort, drift back toward where they began.

Which is why the advice to simply try harder has always rung hollow, even when I told it to myself.

The Cycle Where Your World Shrinks

Because weight gain is not just a number on a scale, it is a loop. Sleep worsens, appetite rises, movement becomes uncomfortable, so it decreases, and food becomes more rewarding because it is one of the few reliable sources of comfort. The loop feeds itself quietly and effectively. And when that loop is interrupted, everything begins to change.

With GLP-1–based therapies, as I saw with surgery and now experienced myself, the first thing that goes quiet is the noise. That persistent signaling softens, and with it the cascade begins to reverse. My sleep improved almost immediately. My snoring stopped. My sleep scores shifted in a way that was not subtle, and that alone alters appetite, energy, and capacity to engage with the day. Movement followed, not as a prescription, but as a possibility. Where I had avoided the yoga studio, attending occasionally out of obligation, I now go several times a week because I want to, because the body I am in responds differently, because movement feels like something I can do rather than something I must force.

And that is the part that is so often misunderstood when people say this is the “easy way out.”

There was nothing easy about fighting biology for years. What is different now is that I am no longer fighting it.

The People Who Shame Want You To Think a Pill or Surgery is the Easy Way

And the people who matter in that space, the ones who actually help, do not shame you. But too often on social media I see these coaches fat shaming people who take GLP-1. Saying they will regain if they stop (yes, we will, and if we stop exercising with you we regain too).

My yoga instructor never shamed me. He was simply glad I was back. He helped me find better alignment, better movement, better balance. He met me where I was and helped me improve from there. I have not lost muscle mass in the 19 months I have been on a GLP-1. It is easier to go to yoga, I feel better I want to go.

That, I suspect, is what the future looks like. Not coaches who insist there is one way, their way, delivered with the certainty of an evangelist.

But coaches who understand the biology, who are not threatened by medication, who can take someone using a GLP-1 and help them build strength, improve movement, add muscle if they want it, refine nutrition without turning it into a moral exercise.

Because the truth is, the old model is already breaking.

The idea that you must suffer through restriction, that you must prove your worth through discipline, that there is a single dietary truth that will save you if only you adhere hard enough, that model depends on failure. It depends on people cycling through attempts, blaming themselves, and trying again.

And it depends, above all, on a lack of empathy.

Because it is very easy to prescribe discipline when you have never had to fight your own biology to achieve it.

So if you think you should sign on with a coach who thinks a pill or short or surgery is the easy way out - I would advise you not to.

We want you to exercise, to eat better, to move more. Not because of maintaining your loss, but because it is opening the world for you. It will help you live better, live longer, live healthier.

Eli Lilly’s New Oral Medicine

It is also worth noting that this field is moving quickly, and the medications we are talking about today are not the endpoint. Recently, Eli Lilly announced results for a new oral GLP-1–based therapy, orforglipron, being developed under the brand name often referred to as Foundayo, which represents a meaningful shift in how these treatments may be delivered. Unlike current injectable GLP-1 receptor agonists, this is a non-peptide oral agent, designed to activate the same pathways without the need for injections, and early trial data suggest weight loss in the range that begins to approach what we have seen with established agents.

That matters, not because it replaces what we have, but because it expands access and normalizes treatment. The more options we have, the less this becomes a niche therapy and the more it becomes what it should have been all along, a standard part of treating a common, chronic, biologically driven disease.

And perhaps that is the thread that ties all of this together, the part I wish I had understood earlier, the part I tried to teach my patients but failed to apply to myself, which is that this was never about proving something.

You do not have to earn the right to treatment.

You do not have to demonstrate sufficient suffering to deserve help.

You do not have to win a battle against your own biology to be taken seriously.

What you need, and what I needed, was the recognition that the system itself could be changed, and that once it was, everything else became not effortless, but finally possible.

And that is not failure.

That is medicine catching up to reality.

Paid Section: The Biology We Ignored

What we have been calling “willpower” is, in large part, a negotiation with reward circuitry that was never designed for the modern food environment. The brain regions involved, particularly the hypothalamus and the mesolimbic dopamine system, constantly integrate signals about energy status, nutrient availability, and reward. In a natural environment, this system works elegantly. Food is scarce, effort is required, and reward reinforces behaviors that keep you alive.

You can no more will yourself to not have food noise than you can will your blood pressure, heart rate, or breathing rate to change. It is a program.

In the paid section, we will talk about hyper-processed food and how it triggers this.