Microdosing is the latest A-list trend. Times fashion editor Harriet Walker talks to the private doctors who are prescribing “bespoke” weight-loss drugs and asks, could this be the future?
As this paper’s fashion editor, this year I have been surrounded by people who are suddenly quite a lot thinner. In celebrity, influencer and rich-person circles, Ozempic is ubiquitous. It’s obvious in people who are literally half the size they once were, but the keener-eyed can spot “fridge packs” of drugs in the background on Instagram or the tiny telltale bruise of an injection in bikini selfies.
“On the pen,” someone next to you will say at Fashion Week as so-and-so takes their seat in newly tight, very small clothes. Or, “Definitely had a few clicks,” of someone who looks indefinably healthier with a sharper jawline. It was once this way with Botox; now there are more botoxed than not. Without a doubt, the same thing will happen with weight-loss drugs eventually too.
Because even the real-life demographic is already growing: I know ad execs, retirees, working mums and head teachers paying for Ozempic, not all of whom satisfy the NHS requirements. Bogus BMIs, photoshopped images of where the needle points on the scale — I’ve heard of magazine editors asking their picture desks to doctor holiday photos so they look big enough for the proliferating online pharmacies to prescribe it. One 1.8m glamazon swears blind on the forms that she is 1.6m.
I’d been curious, of course — I’ve tried every diet under the sun. But my weight doesn’t bother me enough to countenance the nausea, eggy burps and constipation that upping the dosage each month, as recommended, is known to bring. Then I heard about the “Ozempic secret” — microdosing.
First, there was the friend of a friend who had increased her dose but came back down again and felt better. Then someone who only jabbed one week every month or two. Gay guys having Ozempic parties a week before Pride so they could look their best on the day. People cutting out crap rather than ceasing to enjoy food entirely, and tuning out the grazing instinct now known as “food noise”.
Microdosing — usually of psychoactive drugs such as LSD or the psilocybin found in magic mushrooms — is the practice of administering tiny amounts every so often to feel the benefits without the full effect. It started in Silicon Valley; now it’s everywhere.
While the micro-zempic crowd is at the moment limited to a small (and wealthy) elite — and are more focused on the aesthetic outcome for now — scientists believe the practice could have wider benefits too. Semaglutide is in clinical trials to treat Alzheimer’s, liver and cardiac diseases and addiction; research suggests similar peptide treatments could reduce both inflammation and risks for cancer.
“I prefer the phrase ‘lowest most effective dose’,” says Dr Mukil Menon, a London-based private prescriber who offers a short-term option alongside the usual weight-loss programme. “Where a small dose of LSD does something for everyone, not everyone feels appetite suppression at the same rate on weight-loss drugs.”
His is a bespoke service, dispatching syringes of Mounjaro, which works like Ozempic but is the peptide tirzepatide instead of semaglutide, rather than the usual click-measure pens, which means those taking them can, under his guidance, increase or decrease at half the usual dose if they feel the need, stay at a starter dose or only inject when they need a boost. This is already a popular option — for those who can afford the thousands of dollars it costs, of course — in the States, where compounding laws (tailoring medicines to an individual rather than following regulated doses) are less strict than in the UK. Menon charges £250 ($554) per month, and is one of a few doctors here offering it.
“If you have a bad relationship with food, sugar cravings, addictive personality, Mounjaro just turns down the noise,” he says. “It takes around three months to reset, then I offer a rescue pack that you can use preventatively.”
A simple weight-loss goal
Three kilos. It doesn’t seem like much, but I’ve been trying to lose it for as long as I can remember. I know from experience that I feel better without those 3kg, from the fit of my clothes to how easy it is to exercise and — increasingly — how much my almost 40-year-old joints want to carry.
A week into microdosing Mounjaro, that 3kg is gone. So is the sciatic pain I have suffered on and off since my second pregnancy. A pair of jeans I haven’t been able to sit down in for a year fit again within four days of my first jab. After a month, I am drinking less than I ever have, sleeping better and worrying less.
I know, I know: these drugs are not for me. At 1.7m and 66.6kg, I’m not even technically overweight. It feels vain and unsisterly — the way, if I am honest, I have always considered cosmetic surgery. It is as hypocritical of me as the body positivity I preach to my children, around whom we don’t use the words “fat” or “diet”, despite my having been on one, in some form, since the age of about 14.
Yet I am a product of my own formative years during millennial size-zero culture, when magazines ringed celebrity waistband “muffin tops” and called Kate Winslet chubby. I don’t judge other people’s bodies — I delight in how so many younger women seem to feel a confidence in their natural shape that I have never had. But the inner voice critiquing my own is constant and vicious.
I’ve never had an eating disorder, but my entire relationship with food is out of whack. Too little, then too much; sanctioned versus forbidden; momentary enjoyment then intense self-loathing. I think about what to eat next most of the time, empty a plate then crave the same again.
Since the welcome advent of body positivity over the past 10 years, we have been rightly encouraged not to talk about food as though it is a problem — which is fine if, like my daughter, you have a clean slate metabolism and nobody telling you, aged seven, about “empty calories” or things that are “not worth getting fat for”. It’s fine, too, if you understand that most food in shops has been engineered to ensure you will never feel full, and find it easy to avoid. For those like me, however, whose circuits are already fried, resetting requires a willpower I am yet to find on my own.
I suspect many women — and more men than might admit — recognise this state: a fairly healthy diet and active weekends but a sedentary job, snack-centric evening sofa habits and the longstanding belief that alcohol is a reward. Protein-rich wholegrains, white fish and veg, then a whole bag of Percy Pigs and three beers after the kids are in bed. A life of denial is miserable, but I want to see what it is like being able to say no and mean it — just for a while.
Before embarking on what I think of as my vanity project, I talk to a few doctors. I am not getting these jabs illegally or lying to procure, but I do not want to be like one of those women who die in Turkey after bum surgery. In November, news emerged of the death of the Scottish nurse Susan McGowan from pancreatitis after two low-dose injections of Mounjaro. Are there risks associated with taking semaglutide or terzepatide if you’re a healthy BMI?
“Is this off the record?” replies one doctor friend. “None, whatsoever.”
“That poor lady must have had something underlying,” says another. “Once you get to a certain weight or BMI, you’re more likely to have pancreatic and pre-diabetic issues.”
Another suggests that nothing is more of a health risk than being unable to turn down “hyperpalatable” obesogenic ultraprocessed foods, as long as you maintain muscle mass while on these drugs by eating protein and doing resistance training. The final one I ask turns out to have been on the pen for some time already. All of them believe that, once the patents on these drugs expire around 2030 and they become cheaper, taking them will be as commonplace as Botox.
There are signs already of what trend forecasters are calling “neo-zempic future”. In May, Nestlé announced a range of frozen products aimed at those on the drugs: pizzas fortified with the protein and extra vitamins recommended while taking semaglutide. Restaurants in affluent, high-use areas are pivoting their menus to cater for appetites that seek small plates, salad and not much booze. Those who trade in bariatric surgery are seeing bookings decrease, while the rise of “Ozempic face” — gaunt, spare jowls — means fillers and facial sculpting are booming.
‘The future is new formats, such as daily pills’
“The future is more competitors and new formats, such as daily pills,” says Dan Hastings-Narayanin of the trends and strategy agency the Future Laboratory. “But I’m not overly optimistic around big corporations suddenly trying to sell us healthier food.”
Dr Tyna Moore is a naturopath based in Oregon, who preaches peptide microdosing to her 278,000 Instagram followers and guides almost 500 people who have signed up to her online course on how to do it. Most are not looking to shed extra pounds but to optimise their health. For her, glucagon-like peptide-1 receptor agonists — GLP-1s such as Ozempic and Mounjaro — are not just for weight loss, but can help with high blood pressure, inflammation and autoimmune problems, even brain fog. She says GLP-1s fixed her after a period of chronic stress and eliminated her mother’s acute joint pain.
“Peptides are not going anywhere,” she says. “They are going to be used more and more because, as the data shows, they do remarkable things throughout the body. They mend your metabolism — but cranking them at superhigh doses is going to get folks into trouble.”
The drugs come in a prefilled dispensing pen and Moore believes this dose is too high for most people. She also maintains that the reported shortages of semaglutide — which has an impact on the health of diabetic users who were using it well before the weight-loss craze — is actually a shortage of pens. In America at least, there is enough of the generic version of the drug available at pharmacies, which could be better tailored to those taking it.
“I was taught [at medical school] to prescribe medications at the lowest possible dose, to improve lifestyle and overall health. I’ve done physiological microdosing to get people back on track with my patients, my family, myself — and the results have been astounding.”
I injected the starter 2.5mg of Mounjaro, and I have no plans to increase it or to be on it for long. The starter dose of Ozempic is 0.25mg. With the former, tirzepatide, doses usually increase by 2.5mg per month, while semaglutide doubles to 0.5mg, then 1mg. Standard practice is to increase the dose to lose weight, then stay on a “maintenance” dose indefinitely. Because the drugs come in a pen that regulates each dose with two clicks, there is a growing trend online for “counting clicks” — that is, hacking the dosage to take less than prescribed. Other users talk of prolonging what is in their pens by injecting less often.
“It’s not something we’d advise because it’s not the way the drug is licensed to be used,” says Dr Sarah Welsh, a former gynaecologist and founder of the women’s wellness brand Hanx, which offers jabs online through a CQC-registered clinic. “Once opened, the pen has a limited shelf life [30 days for Mounjaro and 56 days for Ozempic], so if it’s being used for longer than that, they’d be taking it after it has expired. As for staying on low doses, it’s not unsafe per se — it’s more that you risk your weight plateauing. But we wouldn’t tell someone to step up their medication if they weren’t ready.”
At this low dose, I am eating regular — if smaller — meals and I don’t feel the need for the usual sugary snacks between them. One evening, I have a square of chocolate and feel completely indifferent. Usually, I would have most of a family-sized bar and hate myself.
What surprises me most is not that I barely think about food, but when I do, all I want is crisp veg, lean meat, soup, nuts. The thought of processed food, the buttery pastries I love and fear equally or chocolate makes me feel a bit sick. Nausea is a common side-effect on these drugs but I only have one small bout early on.
For me, what Mounjaro does is place all decisions around food at an objective, less emotional remove. Between meals, when stressed, bored, lonely, tired or cold, I begin to notice my instinct on a pre-brain level is to get myself a treat. Now I’m jabbed, I can recognise this as neither real hunger nor a fix for the emotion behind the impulse. I feel more rational all round, less sensitive and more clear-headed. (I could swear the eczema from which I have always suffered has abated too, something I put down to the placebo effect, but then read that other GLP-1 patients have reported an improvement in their psoriasis.)
Often, I pick while making my kids’ tea, but I don’t feel like it. Likewise, going in for a really good bit of crackling left in the roasting pan, after a Sunday lunch of which I have just eaten a normal but smaller than usual portion (plus pudding). My husband and I go to a gig in a pub where I have one and a half pints in three halves instead of matching him at somewhere closer to five. For the first time ever, I am just not that interested in booze.
I worried I might feel joyless or apathetic — as some people report on these drugs — but I am more energetic and optimistic about almost everything. Whether this endures once I’m post-jab remains to be seen, but the idea of topping up maybe once or twice a year is appealing.
“I’ve treated people who’d come home from dinner and stop at Tesco for a snack,” Menon says. “Who’d eat a family bag of crisps meant to be shared. Now they get the occasional craving but can eat and then stop. They’ve never been able to do that before — and that’s even after stopping the injections.”
‘It’s not a matter of willpower’
All of this is a privilege: a privilege being able to afford these syringes, a privilege not having much weight to lose, a privilege not having lived as an obese person and experienced the prejudice against them and their bodies.
Fat remains a feminist issue and trying this drug doesn’t mean I don’t also want to see proper-sized female bodies on the catwalks, in adverts, on the television.
But what food companies have done to our appetites and diet is one of the great scandals of our age and I want to know whether this drug will help me shake off their influence. I don’t want to judge or shame people for finding it hard to limit food that is proven to be as addictive as cigarettes — especially given most of it is the cheapest option — but these habits are killing us and bankrupting our health system. Those companies should be paying not only for the weight-loss jab prescriptions the NHS must now cover but for a wave of education that will ensure generations after us won’t need them.
Alas, Hastings-Narayanin of the Future Laboratory is not optimistic.
“I think we’ll see a new age of class disparity,” he says. “Obesity will become a sign of the working class, and the new status symbol will be being able to forgo food entirely.”
I can think of several Fashion Week “dinners” where that is already the case.
“I do get models who want to maintain a low weight asking me for it,” Menon says. “And I don’t prescribe it for them, because they’re teetering on underweight. The private sector is different from the NHS — when I see people who are not overweight but who want to break bad habits, I can be more forgiving.”
In March, Oprah Winfrey hosted a programme called Shame, Blame and the Weight Loss Revolution in which she and guests on GLP-1 drugs spoke openly about how the prescriptions had changed their lives. Winfrey compared obesity to alcoholism: not a lifestyle choice but a disease, more to do with genetics and life chances than simply eat less, move more.
“It’s not a matter of willpower,” clarified Dr Scott Butsch from the Cleveland Clinic, where Winfrey has been treated for weight loss. “People who are [naturally] thin might never think about food the way people with obesity do.”
Personally, being able to think “normally” about food for a month has been both an education and a relief. Should everything revert to type after these injections, I suspect I will miss the new quietness in my head more than I will rue the half-stone returning.
Written by: Harriet Walker
© The Times of London