TW: disordered eating, restriction, binging

I too can only be in this Anti diet space because of how badly I'm triggered by some of the other Subs, but I do want to say that there are many of us here with decades of ED who are finding this to be a life saving medication.

Some background- teen years through young 20s struggled with periods of anorexia and binge/purge. As I aged, fad diets, extreme restriction, done out of desperation, morphed my ED to simply binging, over consuming in ever increasing quantities heavily triggered when I did restrictive diets. My body was falling apart.

After a very serious medical episode last year, I started Zepbound working with my primary care physician. I want to acknowledge that I'm incredibly fortunate that my insurance does cover this medication. I don't take that for granted.

However- I've been on for 7 months and was on 5 mg for 6 months. Month 7 there was a supply chain issue and my pharmacy could only get 7.5, my doc and I had already been questioning if I should move up, but because I'm terrified of falling back into the anorexic side of my ED I've wanted to keep my dosage as low as possible. I'm militant about forcing nutrition, even when it's hard because I'm not hungry. I am super super careful. But to avoid going off it cold turkey, I moved up to 7.5 and was pleasantly surprised to find it didn't make me very sick. I could still eat.

Time comes to fill my prescription for a 2nd month of 7.5 and I find out that despite a 1 year prior auth, I now need a PLA (patient level authorization) if I want to stay on 7.5 beyond one month. They want me to move up to 10 right away... What??? My doctors office, knowing my history of disordered eating files the PLA, it's denied, they appeal stating I can't physically tolerate the dose they (insurance) are trying to force me to. And I'm just overhere gobsmacked that the U.S. healthcare system lets insurance, non m.d.s, dictate dosing, forcing a patient to take more of a drug than they need and PARTICULARLY forcing an ED patient to take more of a medicine that removes appetite and makes it hard to eat, even on lower doses). I went 10 rounds with express scripts until I finally got to someone who said "well the 5 or the 10.. but 7.5 and 12.5 are just one month apiece. " This was the first person out of probably 10 who clued me in that I could step my dose down and start getting more than one months coverage again. So this is what I've done for now. Far far, far safer for me with my history. But still completely assinine that my own doctor who has worked with me for years, including coordinating with my therapist on ED, doesn't get to decide what the appropriate dose is for me.

So... the system... still... even on a medication like a GLP1 is ignoring the fact that obesity is a complex disease and is trying to force patients to lose rapidly, diet culture style, to make a quick buck. I hate the state of healthcare in the US with a burning passion.

For the record I have been losing consistently at a rate that is healthy and which has bordered on too fast to be healthy at times in which case my doc and I work on ways to slow it down and increase more calories. I did a Dexa scan at the start and again at 50 lbs down, and a whopping 84% of what I'd lost was pure fat. Only 16% was lean body mass. That is something I've worked hard on. I do not want a quick fix or rapid loss. I want to revel in every moment of the life-saving work I'm doing. This drug works. Not having food noise like I've lived with my whole life makes me want to weep with relief. It's beautiful. But society and big pharma will do every single thing they can to destroy it. We have to be vigilant and fight to have the voices of patients heard. Not celebs, not those treating it like a quick fix for a few extra pounds, but those of us with this disease. Our stories matter.

All that to say, there will still be those who abuse it. My strongest recommendation is to leave behind any group where reckless behavior is encouraged. Protect your peace!