Losing 60 Pounds With and Without a GLP-1

I've lost 60 pounds twice. The first time I did it with no medication and kept it off for more than five years. Then I gained it back. The second time, I lost 60 pounds on a GLP-1, and I've now been in maintenance for about two years.

These were two completely different experiences. A lot of people ask me whether they should try to do it on their own or go on a GLP-1, so I want to walk through the differences: what the weight loss actually looked like, how my body felt, how hard it was to eat better, what exercise was like, and what maintenance has been like.

If we haven't met: I'm Sabina, and I make content about GLP-1s, mostly about access, systems and comparing your options. I'm also the founder of GLP Winner, a free tool for comparing the telehealth providers you see advertised everywhere.

A little background

I'm 40, and I've been on a GLP-1 for a over three years. I wasn't a kid who struggled with my weight. At most I was 10 or 15 pounds "politely chubby." If anything, there were stretches of my life when I wasn't eating enough, in an unhealthy way.

I started gaining weight in my early 20s. I lost it in my late 20s, kept it off into my early 30s, and then lost it again in my late 30s. So there's about a decade between my two weight losses, and I think losing weight gets harder as you get older.

One more thing before we get into it: I'm clearly pro-GLP-1, but there are real cons. I get a lot of side effects. You can look like a great fit on paper, try it, and find you can't tolerate it. It's not for everyone.

Part 1: losing 60 pounds the natural way

The first time, I lost the weight mostly on keto, and I stayed on it, more or less, for over five years. (This isn't an endorsement of keto. It just worked for me at that point.) Losing weight without medication was the hardest thing I've ever done. I'm an entrepreneur. I've started companies and hired and fired people. This was harder.

It took over my life

What finally worked was that I wanted to fix my weight more than anything else. It was the most important thing I did every single day. The first day was the hardest, then the first three days, the first three weeks, the first three months. The hard rules of keto, with no cheat days for months on end, are what got me through.

I counted every calorie. I could look at a plate of chicken and vegetables and tell you how many calories were on it. I talked about calories constantly, and I'm sure I was obnoxious to be around.

The food noise never stopped

Even at the fittest point of my life, I had constant food noise. I always needed to know where my next meal was coming from. I knew the menus of every restaurant within two miles of my house. My body and brain were screaming for more calories, and that's what made it so hard.

Why I eventually stopped keto

After five years, my weight was getting very low, I was working out all the time, and I was dealing with low energy and brain fog. I was also isolating myself. I'd turn down invitations to bars and restaurants if I hadn't checked the menu first. So I stopped keto, though I mostly kept the weight off afterward.

How I gained it back

The pandemic hit, and I put on 10 or 15 pounds. No big deal. Then my dad got sick. He has dementia, and he could no longer live on his own, so I became one of his caregivers while also working a demanding job. Keeping my weight off was suddenly not the most important thing I did every day, and that's when it came back.

I had to buy all new clothes. I probably needed a seatbelt extender on planes, but I told myself I didn't. And I realized something I hadn't noticed the first time: in a larger body, I was in pain all the time. In heels, I'd be in agony after 5 or 10 minutes. At a lower weight, it took 45 minutes to an hour before heels even bothered me.

It's not your fault if you gain weight or struggle to lose it. Obesity is a chronic disease, and "calories in, calories out" oversimplifies what's going on in your brain. Hormones, environment, emotional state and things like trauma or ADHD (which I was diagnosed with only in the last two years) all play a role. Body fat is also part of your endocrine system, and the longer your body holds onto it, the harder it is to lose. Someone who gains 10 pounds at Christmas and drops it in January is dealing with something very different from someone who's carried extra weight for years.

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Part 2: losing it on a GLP-1

In 2023, things with my dad had somewhat stabilized and I was planning my wedding. I'd never been more motivated. I'd read the medical research on GLP-1s and thought they seemed legit, but I told myself I could do it on my own. For six months I counted every calorie. I lost the first 10 pounds quickly, and then nothing. Something in my body and my metabolic health had changed. So I started a GLP-1.

What the scale did

Losing naturally, I averaged about a pound a week, and the scale moved in small, steady steps. (Yes, I weighed myself every day. I know that's toxic. I'm not endorsing it.)

On a GLP-1, it looked different. I lost consistently for the first three months and then stalled. I was on semaglutide and couldn't tolerate a higher dose. Going up took me from my usual side effects to throwing up three times a week. So I spent months on what was probably too low a dose, stalled out.

Even when it was working, the loss came in stairs, not a ramp. I'd go a week, sometimes almost a month, with barely any change, then suddenly drop. And during stalls I could still see my body changing, even when the scale wasn't moving.

The side effects (I get all of them)

From my first shot, it felt like someone had jump-started my entire digestive system. I get basically every non-serious side effect: nausea, headaches, injection-site reactions, rashes, constipation and diarrhea. I would take my shot, have diarrhea for two days, then be badly constipated the rest of the week. I couldn't win. Most people don't get side effects as bad as mine.

My body's signals for hunger, needing the bathroom and so on changed, and I had to relearn how to read them. Most of it showed up as nausea, so I joke that I had to treat myself like an infant. When a baby cries, you run through the list: hungry? Needs to burp? Needs to poop? I'd do the same with my nausea. Is it the time of day I usually need to go? Do I need to burp? Have I eaten and had enough water?

Water was a surprise. I have a history of kidney stones, so hydration matters for me, but on a GLP-1 I just wanted to put fewer things in my mouth. Before, I could force down a glass of water. Now I can be thirsty with water right in front of me and still struggle to drink it.

Honestly, learning to manage the side effects was harder than learning to eat better on a GLP-1. I've gotten them much more under control.

Eating, cravings, alcohol and coffee

The food noise went quiet

This is the biggest difference. Before, even in maintenance at my goal weight, I thought about food constantly and counted down the minutes until lunch. Now I'll bring lunch to a video call, get absorbed in the conversation, and realize my food has gone cold. Then it's less appetizing, and I don't finish it. That never would have happened before.

Eating healthier was far easier, though it still took effort, especially while I was stalled on a low dose and felt hungrier. I came close to not needing to count calories, but I couldn't turn my brain off completely. I still pay attention to fiber, protein, water and what I'm eating. Some people on a GLP-1 don't have to think about it at all; others still have to work hard. Everyone is different.

Food aversions

In my first week on semaglutide, I saw a magazine ad for Oreos and was disgusted. At a birthday party, I moved to the other side of the room to get away from the cake. That's faded, but heavy, greasy foods still feel like too much. A double bacon cheeseburger used to sound great, even when I knew I couldn't "afford" the calories. Now I want a single patty with lettuce and tomato.

I stopped drinking

I've had periods in my life where I drank a lot. While I was on keto I was disciplined about it, sometimes just liquor on ice to keep carbs down. On a GLP-1, the desire mostly disappeared. One drink a week easily became once a month. When I did have a cocktail, I didn't want to finish it; it felt heavy. Then it was once a quarter, and then I decided to stop altogether, because the health difference between drinking once a month is significant.

Caffeine got intense

I've had periods in my life where I drank six cups of coffee a day. On a GLP-1, I'd take a few sips of cold brew and leave the rest. Caffeine started to feel heavy and too intense, and since I'm more sensitive now, it's become a reliable migraine trigger. I still love the taste, so occasionally I'll have decaf. Is it as good? Obviously not. But it's fine.

What changed in my head

Losing weight the natural way didn't change my mental state much, other than feeling starving all the time and believing that if I cheated once, I'd fail completely.

The GLP-1 changed more than food noise. I used to ruminate. I'd still be angry about something someone did five years ago and think about it constantly. Within the first two weeks, that stopped. When I think about those situations now, how I feel has not changed, but I'm not emotionally back there. Given the early research on GLP-1s and addiction, it made me wonder whether I'd been, in a way, addicted to ruminating.

There's a flip side. In maintenance, I sometimes notice something like anhedonia: not caring about things I used to care about. Some people describe being on a GLP-1 as a feeling of contentment, and I can see why. Sometimes it's good, and sometimes it's not.

It also changed how I see other people. Early on, I had a series of conversations with my partner, who has always been a healthy weight and forgets to eat lunch. We realized we'd been living two different lives in our heads. Some people truly get full at the right amount of food, and their bodies don't hold onto it as fat. Seeing that firsthand proved to me that obesity is a disease, not a willpower problem.

Exercise and how my body changed

The first time I lost weight, I was incredibly unfit, so I just started walking, eventually two-plus miles, which was a lot for me then. Once I reached a healthier weight, in-person exercise classes worked for me, and I worked out six days a week. I got to the fittest point of my life. But keeping my weight that low while staying fit made it hard to eat enough to build muscle, and I was often completely exhausted.

On a GLP-1, I started from a better fitness baseline, but I was older and dealing with some injuries. I still get tired, just not as wiped out as before. My worry is that building muscle is harder. Sometimes it feels like I'm treading water.

A note if you're starting from very unfit in a larger body: a lot of the workouts you see online may not be safe for you. Don't go from zero to running. Start slow.

The surprising part was how my body looked. At similar weights, I had less stubborn fat, especially around my midsection, and it came off with less effort. Even when I wasn't working out much, I looked more muscular than I'd earned. Everyone's experience is different, but that was really interesting to see.

Maintenance, and would I ever go back?

I got married halfway through my GLP-1 journey, about 30 pounds down. Choosing a dress that would need to be tailored was stressful, so I modeled it out. Historically I'd averaged about a pound a week, so I projected where I'd be on my wedding day. I landed within a pound of my estimate. Being a yo-yo dieter has its uses: I know what my body looks like at different weights. After the wedding I lost another 30 pounds, probably over 70 in total.

Within the first month or two, I knew something had changed in my brain, and that I'd probably want to be on a GLP-1 long term, or at least cycle on and off because of the side effects. Now that my side effects are more under control, I don't see myself stopping.

Would I try to lose or maintain weight the natural way again? Probably not. The exceptions would be if I couldn't afford it, lost access (one of my biggest fears, and something I make a lot of content about), or couldn't tolerate it for a medical reason. I also tried topiramate for my migraines, which can cause weight loss, and it was nothing like a GLP-1. Part of me regrets not starting sooner. But trying the natural way one more time showed me that something in my body had really changed, and it deepened my understanding of how much harder this is for people who have lived with obesity their whole lives.

The bottom line

When I was getting started, I didn't see anyone with an experience like mine: a yo-yo dieter who lost about the same amount both ways and gets every side effect. That's why I wanted to share this. I'm just one person, and nothing here is financial, legal or medical advice.

If you're considering a GLP-1, you can compare your options on GLP Winner. We list FDA-approved and compounded options with transparent pricing, sourcing and reviews, and for compounded meds you can see which pharmacy a provider uses and read reviews of it. Prices have come down a lot, with some options around $125 for all doses (at the time of writing). There are a lot of providers out there, and not all of them are good.

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I Lost 60 Pounds Twice: Once Without a GLP-1, Once With One