Restaurants, Wine, and Telling People

The clinical part of month four was uneventful, which is the point of month four. Same dose, steady trajectory, no new symptoms. If this entry were only about the medicine it would be four sentences long.

The social part was not uneventful at all.

I live in a city where a great deal of professional and personal life happens across a table. Los Angeles is not a place where you can quietly decline dinner for a year. And somewhere around month three, the fact that I was eating differently stopped being invisible.

The restaurant problem, solved mechanically

I want to give you the practical version first, because it is genuinely useful and nobody hands it to you.

A restaurant entrée in this country is somewhere between one and a half and three times what I can now comfortably eat. That is not a discipline issue. It is a volume issue, and it is the drug working as designed.

What I do now:

• I order the protein and treat the rest as optional. Fish, chicken, steak, tofu — the thing that protects my muscle gets my limited capacity first.
• I ask for the box when the food arrives, not at the end. This is the single most effective thing on the list. Half goes into the box immediately and the negotiation never happens.
• I do not order fried or heavy dishes in the 2 days after my injection. I learned this the way everyone learns it.
• I stopped treating a full plate as an instruction. There is a whole childhood in that sentence and I am not going to pretend I have finished dismantling it.

None of this requires announcing anything at the table. That matters more than it sounds like it should.

I have also found it genuinely helpful to log restaurant meals in Zenday App as I go, rather than trying to reconstruct them later. When your appetite is suppressed it is remarkably easy to eat two hundred grams of food across an entire evening out and have no idea, and the protein target does not care that you were at a birthday dinner. Having the running total in front of me is what stops a social week from becoming an under-eating week.

The wine I stopped wanting

The strangest thing about month four is something I did not decide.

I have enjoyed wine my entire adult life. Not problematically — a glass with dinner a few nights a week, more on a good weekend. It was, unambiguously, one of my pleasures.

Somewhere in month three it stopped being interesting. Not forbidden, not a struggle. I would pour a glass, drink a third of it, and notice an hour later that I had not touched it again. The pull simply was not there.

I assumed this was an idiosyncrasy until I started asking patients, and then I stopped assuming, because the answer kept coming back the same.

It turns out this is real, and it now has proper evidence. A randomised clinical trial published in JAMA Psychiatry in 2025 found that low-dose semaglutide reduced alcohol craving and the amount participants drank in adults with alcohol use disorder. An earlier randomised trial of exenatide found reduced heavy drinking in participants with obesity. The proposed mechanism is straightforward once you know where these receptors live: GLP-1 signalling reaches brain circuitry involved in reward and motivation, not only in hunger.

I want to be careful with this, because it is the kind of finding that gets turned into a headline within a week. These drugs are not approved to treat alcohol use disorder, the trials are early, and nobody should be seeking a GLP-1 for that reason. But if you are on one and you have noticed that you have stopped wanting your evening drink and quietly wondered whether you were imagining it — you are not.

I have complicated feelings about it. It is almost certainly good for my liver and my sleep. It is also another pleasure that got quieter, and I wrote about [that particular grief in month one](/journey/the-first-4 weeks) and it has not entirely resolved.

Who gets told

And then there is the question everybody eventually faces, which arrived for me at a work dinner in February when a colleague I like said, warmly, “You look amazing — what are you doing?”

I want to say I had a graceful answer ready. I did not. I said something about lifting weights, which is true and was not the answer to the question she asked, and I felt slightly grubby about it for a week.

So I thought about it properly, and here is where I have landed.

You are not obliged to tell anyone. Your medication list is private health information. The fact that a particular treatment attracts moral commentary in a way that a statin does not is a fact about our culture, not an obligation you have acquired.

But decide your default in advance, because the improvised answer is where the discomfort lives. Mine is now: “I’m working with my doctor on my metabolic health, and it’s going well.” True, complete, and closes the topic without either lying or opening a debate about whether I have cheated.

Some people do need to know, and this is not optional. Every clinician you see. Your surgeon. Your dentist. Above all your anaesthetist, if you are having any procedure with sedation — delayed gastric emptying means your stomach may not be empty after standard fasting, and the periprocedural guidance around this has been actively revised. Say it out loud in pre-op, unprompted. Do not assume it made it into the chart.

And there is the version I chose, which is to write all of it down in public. I do not recommend this to most people. I did it because I could not find it written by anyone with the training to also explain the physiology, and because the silence around this seemed to me to be doing more harm than the disclosure would.

The part I did not expect to be hardest

Months three to five are, I now think, the socially difficult stretch. The change is visible enough that people notice. It is not yet established enough that you have a settled story about it. And you are still, internally, working out what you think.

There is an enormous amount of published work on weight stigma in and out of medicine, and I have cited it for years. What I did not anticipate was how much of the difficulty would come from people being nice to me — and from not knowing what to do with that.

I am going to come back to this. It gets sharper at month six, and I am still not finished with it.

The wine question turned out to have a proper answer, which I wrote up in drinking alcohol on a GLP-1 — including why a smaller amount goes so much further, and the one situation where it is genuinely risky rather than just surprising.

For the record at this point: 1.7 mg, month 4, protein held at roughly 1.4 g/kg a day, and 3 lifting sessions a week that I did not miss even in the weeks I ate out most.