Content note: this post includes discussion of body image and weight loss talk. There is, I hope, no weight loss pressure coming from me, but it is me writing about how I feel about the subject in as honest and unfiltered a way as I can and I know that’s not for everyone.
I was originally thinking about writing something political, but kept putting it off because my heart wasn’t really in it, and I realized tonight I was ready to write about this instead. I’ll maybe write something political down the road.
In late October 2024, I paid a visit to Hartford Healthcare’s weight loss clinic, which is near my home and where a relative had recently had success losing weight with the assistance of medication. I was hopeful that they would be able to help me in a science-backed, healthy way - no unsustainable crash diets, please, I’ve done enough of those for one lifetime, just getting both the assistance of new weight loss drugs along with extra supports for building a healthy diet and exercise routine. (I had visited a different weight loss clinic nearby a while back and immediately decided the kind of very low-calorie diet, of course using the supplements they sold, they were pushing was not a healthy way to lose weight.)
The doctor I saw was nice and seemed like he knew what he was doing. We talked about the lifestyle adjustments I would need to make and discussed medication versus surgery. He looked over my blood work and EKG results and told me that he thought topiramate would be the best choice for me to start.
I was a bit nervous about this, since I’d previously tried Qsymia, which combines topiramate with the stimulant phentermine, and had a bad experience with it leading to heightened anxiety and suicidal thoughts. I’d expected them to recommend a GLP-1 receptor agonist like Ozempic or Wegovy instead. However, my doctor said he believed that the phentermine was the culprit of my bad reaction and that I’d likely do better with topiramate alone. He told me to stop taking it and contact the office if I had numbness or a tingling feeling in my hands or feet, but didn’t mention any other side effects.
At first, it seemed to be working. I lost several pounds without following any special diet and found that the appetite suppressant part was working as intended, I was able to eat smaller portions of food and still feel sated. I didn’t crave sweets like I often do. Topiramate does have the very odd side effect of making me (and most others who take it) unable to sense carbonation in beverages, but while I hated Diet Coke tasting flat and therefore unappealing, my doctor had said that I shouldn’t be drinking Diet Coke while trying to lose weight because of its effects on blood sugar and hunger, so I tried to take that as a positive.
And all through November, I chalked up my growing depression and fatigue to literally everything else.
In my defense, there was good reason to think it wasn’t the meds. There was, after all, an election not long after I started taking them, and it didn’t go well. I felt awful about what too many of my fellow Americans were willing to accept and vote for and terrified about what would happen next. I was also having a hectic semester, working hard on my asylum clinic client’s case - and of course, that wasn’t an escape from politics either. I was also working part-time in a job that I was finding really difficult and stressful, for a temperamental boss.
Yet the clues started to add up that something beyond those factors was wrong too. I asked a law firm that had previously reached out to me about job openings if they were still hiring and landed a part-time job that seemed better, but I was still struggling to get out of bed in the morning and my punctuality suffered. I couldn’t focus on studying for finals, even with a lighter finals schedule due to clinic work. I tried to rest as much as I could over Thanksgiving break but still felt worn out. I looked back at what I wrote over that break and, in retrospect, I can feel the depression practically ooze off the page.
The day after I turned in my final exam, I was scheduled to work. I woke up and had that familiar feeling of not being able to get out of bed. I opened up my email and called out sick from work, apologizing and promising to be back the next day.
A few hours later, I was fired from that job over email. I’d held it for a month.
I understand why. I simply wasn’t reliable enough. They had another law student intern who was apparently more dependable; she was going to pick up extra hours over her holiday break. I’d been majorly late once and a few minutes late other times. It doesn’t matter how good my work is (and it was good) if they can’t trust I’ll be there to do it. Frankly, I deserved it.
I went into a bad depression spiral over that day and the next. I don’t want to elaborate on the thoughts I was having; suffice to say they were dark. I felt like a total failure. I was berating myself as a fuckup who couldn’t hold down a job. And then, sometime around midnight, something clicked in my mind - I’ve had plenty of jobs before. I’ve been a reliable worker. Working during law school is tough, but I was able to work all through 1L year before I had to give up that job in the summer due to internship scheduling. What was different now?
So I Googled topiramate side effects, and wouldn’t you know it, two very common side effects are depression and fatigue. Suicidal thoughts are less common, but happen enough to be statistically significant.
I stopped taking the meds and sent an email to my doctor’s office informing them of why, and they agreed that it was the best choice. I started to feel better within a couple days of stopping the medication, which affirms for me that it was the right choice. I’ve been much more functional since. Not entirely better, since I still have plenty of stressors, the world is what it is, and depression and anxiety are still things I deal with even without weight loss meds making them worse, but I can drag myself out of bed and deal with all the rest much better now.
I’m pleased with my grades from fall 2024, though I do think I could have done a little better in employment discrimination law if I’d been able to hold myself to the same standards for outlining and practice tests that I usually do. My target GPA for the year is a 3.5, I finished the semester with a 3.7, no sense in beating myself up because it could have been a 3.8 or whatever. I’m very sad to have lost the job I was working, though, and wish I’d handled that whole situation better. But I’ll find something new.
But I took those meds because I wanted to lose weight, and that’s a thorn in my side. It hasn’t escaped my notice that most of the time, depression and anxiety are difficult but manageable things I live with, and two of the times they’ve stopped being manageable and left me in a really bad place in the relatively recent past were when, either pushed by a doctor or of my own accord, I started taking new medication to try to lose weight.
I don’t know yet that I want to give up entirely. I might go back to that doctor and ask to try a different medication, or pursue weight loss surgery. I know that diet and exercise alone aren’t enough for me to lose weight sustainably. My first diet was when I was 11 or 12 years old, and yet here I am at 34.
There are good reasons for me to want to lose weight. I’m very lucky that so far, it hasn’t led to any major health problems. My cholesterol has some room for improvement, but it’s not too bad, my blood sugar and blood pressure are in a healthy range, and I haven’t had any issues with things like heart disease or diabetes. That said, my weight is very likely a cause of my sleep apnea and plantar fasciitis - the former being legitimately dangerous if untreated and the latter a barrier to things I would like to do, like dancing all night at a friend’s wedding or hitting the streets to protest the guy in the Oval Office and his Nazi-saluting sidekick. And I know that just because I’m healthy now doesn’t mean I’m going to stay that way forever.
There are other reasons, too, which aren’t health-related but are no less real. I’ve been harassed by perfect strangers on the street multiple times who have called me fat and told me to lose weight. I love live sporting events, but my hips are wide enough that I don’t always fit in the seats comfortably and it’s sometimes even painful. I end up spending more money on less fashionable clothes than my straight-sized peers without any difference in quality. I look in the mirror and I don’t like what I see.
Is leaving that behind worth taking weight loss meds that make me feel awful?
A lot of people have embraced fat acceptance and body positivity as a mindset. I appreciate the movement’s emphasis on two things: overly restrictive diets are often bad for you and don’t lead to sustainable weight loss (in fact, people who do them often regain more weight than they lost), and being fat doesn’t automatically equate to being unhealthy, nor does being thin mean being healthy. Those are really important points that many people don’t realize, including some doctors who have absorbed weight stigma and push inappropriate weight loss methods on patients who don’t need it or insist that patients just need to lose weight when they come in with totally unrelated ailments.
Yet when body positivity comes up, it feels like a judgment on my own thoughts. Like it’s not enough work already to be a fat woman in a society that already puts forth so much effort telling me that because I’m fat, I’m unattractive, unfuckable, unworthy. I’m supposed to just pull myself up by my bootstraps and be happy about my body. And if I don’t, if I still want to lose weight or still don’t feel good about what I see in the mirror…shame on me, that’s not very body positive of me.
So where does this leave me? I don’t know. I had a follow-up appointment scheduled at the weight loss clinic for January, but I had to cancel it due to an asylum clinic obligation and I’ve been dragging my feet about calling to reschedule it (I can’t do it online). I’m hopeful that trying a GLP-1 wouldn’t lead to the same kind of mental health symptoms I’ve experienced on the weight loss meds I’ve taken previously, but the other side effects can apparently be really difficult too. Surgery would help me lose more weight than medication, but it’s also expensive and risky.
I wish I had a more satisfying note to end on, some kind of answer. But I’m not sure one exists. We’re all just trying to muddle through the best we can, including me. Love and solidarity to everyone else dealing with this, and maybe someday we’ll figure it out.