I’m a little light this month

By Alicia Bane

This story is just supposed to be about Zepbound. My life-long struggle with eating and being an obese woman is something I want to share. The benefits and side effects of Zepbound, and how to use it in the most beneficial way possible, is important for me to talk about. So, I’m talking about it.

But this story is not just that. Through this process, I’m learning about aspects of our broken healthcare system I didn’t know existed. Primary care doctors are being pushed beyond their limits; insurance companies are denying drugs to eligible patients; healthcare providers are becoming more effective advocates for their patients — if the patients can pay a steep quarterly fee.

Really, I’m writing two stories — but I can’t tell one without the other.

I’ll start with Wegovy.

May, 2024

My Primary care practitioner (PCP) gives me a free sample month of the GLP-1 drug Wegovy to help me with my weight loss goals.

I take the Wegovy shot once at the lowest dose. For that first week, I eat very little — I feel full after eating just one quarter of what I would normally eat.

The drastic decrease in my caloric intake makes me lose weight very quickly. Unfortunately, I start to feel miserable physically and emotionally. My stomach hurts badly during all my waking hours, and the pain makes it difficult to fall asleep and stay asleep. My anxiety and depression — two things I've struggled with since childhood — get steadily worse.

The pull to stay on the drug is intense. I tell myself I don't care that I feel sick and nervous and sad all the time, because losing weight is worth that price. I take my second shot the following week and try to stay positive.

I have an active imagination when it comes to hopes and dreams I have for my body. I often find myself daydreaming of becoming afflicted with a mysterious and dramatic medical condition that causes my body to waste away until I’m 200 lbs. lighter. I imagine a miracle cure saving my life and rejuvenating my energy when I’m on the brink of death — which happens just before bikini season.

I consider that this drug might be temporary suffering I’d been dreaming of.

I take Wegovy for a third week. My stomach pains get worse and the frequency of my panic attacks increase. I reluctantly decide to forgo the fourth and final free dose and stop taking Wegovy completely.

June, 2024

I visit with my PCP to tell him I’ve stopped taking the drug because of the side effects. He suggests I try Zepbound — another GLP-1. It is supposed to get better results than Wegovy in terms of weight loss, and some people who don't tolerate Wegovy do better on Zepbound.

I want to try it, so my doctor calls the prescription in to my local pharmacy.

The next day, the pharmacy calls to tell me my insurance won’t cover the prescription. My doctor tries repeatedly to get an approval, but they reject every attempt.

I’m disappointed, but my stomach is relieved. I believe this to be the end of my GLP-1 journey.

September, 2024

My PCP makes the decision to change his practice to a Direct Primary Care (DPC) model. This means that in order to keep him as my primary care doctor, I would need to sign up for his new membership-based clinic and pay a large quarterly fee for continued access to him. Additionally, he plans to drastically decrease his number of patients, so sign-ups will be on a first-come, first-served basis.

The idea of this feels immediately wrong to me. It appears, at least on the surface, that my doctor wants to cut a huge number of patients — and have the patients who stick around cover the financial loss with outrageous membership fees. It also looks to be a system that favors patients in a higher tax bracket, because people with larger incomes are the only ones who could afford to stay. Meanwhile, patients who can’t afford hundreds of extra dollars every month have to go through the arduous process of finding a new PCP. Which, it turns out, is no small task.

October, 2024

I call every practice within a three-town radius to find a new PCP that doesn’t require a membership fee. I find that most independent practices in my area are either brand new membership-based DPC models, or long-standing PCP practices that recently switched to DPC models. Most of the rest of the PCPs in my area are members of the larger Maine Health system, offering the standard services most folks are used to — no membership fees, just a co-pay for each appointment dictated by whatever insurance coverage the patient has. Any fees for individual services that insurance doesn’t cover or covers only in part are the responsibility of the patients. Patients are expected to wait weeks or even months to get an appointment with their PCP because of high demand.

DPCs are more accessible, and it is this privilege that patients pay for. The monthly, quarterly or yearly fees paid to these practices cover a variety of different tests and lab work, removing the need for insurance approval before testing. It also allows doctors to spend more time with their patients — they can have hour-long appointments rather than 15-minute ones — and allows patients to see their doctors as soon as they’d like. A pamphlet my doctor sent me in the mail about his new clinic, for example, expressed a guarantee that he would be able to fit any of his patients into his schedule within a couple of days.

Every DPC practice I find within a 20-mile radius is accepting new clients, and had one or more doctors who could see me within a matter of days. Every regular PCP practice, on the other hand, has either a list of people waiting to be accepted as a patient, or are booked solid for appointments at least four months out — with many booked out as far as nine months.

The earliest appointment I can find with a new PCP is late January 2025, 30 minutes away from where I live. The next soonest PCP appointment is March 2025, a full 6 months away. I sign up for the one in January.

November, 2024

I receive another pamphlet in the mail from my long-time PCP encouraging me to sign up for his new membership-based DPC clinic. This is the third pamphlet I’d received since September, and I had been throwing them in the recycling bin with feelings of frustration and anger stirring in my gut each time.

This pamphlet features a photo of my doctor on the front, with new fonts and new colors and a letter attached expressing how happy he is to be partnering with this new company because it means he can better serve his patients.

I still feel very angry, but something softens in me.

I’ve not had an easy time in my life when it comes to healthcare. Any fat woman reading this knows exactly what I’m talking about. I've had many different PCPs over the years, and nearly all of them treated me like less than a person. At best, I was baffling to them — a girl who didn’t care about her health as much as she cared about pizza and doughnuts. At worst, I was a blob who elicited feelings of disgust and amounted to little more than an inconvenience — or a lost cause.

PCPs, gastroenterologists, gynecologists, emergency room doctors, even pediatricians I saw as a child asked me painful questions. “Have you ever tried exercising before?” “Have you tried to getting a hobby to distract you from eating so much?” “Are you aware that you don’t have much follow-through?” “If you had done what I told you to do last time you were here, do you think you’d be crying right now?”

But the doctor looking up at me from this hopeful little orange pamphlet is someone I've trusted with my health for 15 years. He’s always treated me with respect. He brings up my weight with care and concern and, most importantly, understanding. He knows my whole history, and so do the nurses and the other PCP at his practice, who I see from time to time when my regular doctor isn't available.

The pamphlet has the number of the new practice, and bright orange letters encourage me to call with any questions I might have about the change. So, I decide to call.

I know the nurse who picks up and she knows me, expressing that she’s happy I called. I tell her all of my concerns about the new membership-based system. I step up on my soapbox and speak at length about how the new model unfairly impacts people with lower incomes, and how difficult it has been for me to find another PCP who could see me in fewer than 6 months. I tell her that, as a fat woman, it is difficult to find doctors who treat me with respect and make me feel valued, but that I always felt valued at this practice — until I learned about this change, which made me feel like I had to choose between being expendable or being a cash cow.

The nurse is very candid with me.

First, she validates my feelings. She says all of my concerns about the DPC model are things everyone at the clinic is cognizant of, but that they had to make a decision that, though painful, was necessary for the clinic to progress.

She tells me my doctor was seeing thousands of patients, working 18-to-20-hour days and sometimes working through the weekends. He was growing depressed and losing weight from the stress. She tells me that the number of people who need a PCP was growing so much that they eventually had to stop taking new patients — something, she said, that has been happening to PCP clinics all across the country.

PCPs, overworked with limited resources, are retiring early. Newer, younger doctors are not replacing them as they have in the past, because medical schools have gotten more expensive and the salaries of PCPs are not increasing to match. The job is not as desirable and lucrative as it used to be, with more and more doctors choosing to focus on specialty medicine and its higher salaries instead.

Additionally, she tells me insurance companies are becoming more demanding of PCPs — so much so that his hands are often tied when it comes to what avenues he can take to help people. He is stretched too thin to be able to jump through all the hoops necessary to get each individual patient what they need from their insurance companies.

So they decided as a practice how many patients could be seen without compromising on care and without my doctor working such long hours. They researched and found the best DPC network they could find that offered the most reasonable and accessible fees. The fees, she said, are to better serve the patients who stay, to ensure my doctor can keep the entire staff of his practice, and to provide a wider breadth of care with less reliance on cutting through insurance company red tape.

The phone call makes me feel a lot of compassion for my doctor — and a lot of anger at the healthcare system and insurance companies.

Still, I’m determined to not pay for a membership-based DPC. I keep my January appointment on the books.

December, 2024

My decision to switch to a new doctor is becoming more and more real. I’m growing anxious at the thought of starting with a new PCP I’ve never met before. I replay all of the horrible experiences I’ve had with other doctors in my head on a loop. I imagine a worst-case scenario in which my new doctor is condescending and incompetent, but I’m stuck with him because there are no other PCPs available for months. I imagine my new doctor being too busy or unavailable to call in my prescriptions in a timely manner. I think about how going without some of my medications for more than two days can cause debilitating migraines and nausea.

I consider my finances. My car will be paid off in full come January, which is when my doctor will officially make the change to DPC. The amount of my car payment is roughly what I would need to set aside each month to pay for the quarterly charge of the new clinic. It's a massive expense, and a choice I do not want to make.

But, ultimately, I do make the choice. I sign up for a membership and agree to pay $750 every three months for the next year. Even with my mixed feelings, and even with the recurring hit to my bank account, I don't regret the decision when I make it. I just feel an intense sense of relief.

February, 2025

Under my doctor’s new membership-based program, I undergo a massive battery of tests — all covered under the new system — that take about a week to complete. I get more types of bloodwork done than I even knew existed. I have multiple heart tests, lung tests, circulation tests, brain tests, eye tests and even an assessment of my walk and gait. I find out precisely how much of my body is made of muscle and how much is fat.

The results come in, and I visit my doctor to go over them. He hands me a packet filled with more information than I thought was possible to know about my body. It feels like overkill.

Then I consider how much money I am spending and will continue to spend to have this information, and suddenly feel the amount of testing is reasonable.

My doctor looks happier and healthier than I’ve ever seen him. After a long and extensive review of my test results, he asks me if I would like to try going on Zepbound again.

I reminded him that my insurance didn’t cover it when we tried last year.

“We're going to try again,” he says, motioning to my packet of tests.

A week later, my insurance company approves my Zepbound prescription.

I have a lot of feelings about being approved for this drug only after spending a lot of extra money to stay with my doctor, but I’ll share more about that later. First, I want to talk about Zepbound.

March, 2025

My mindset now is different than it was in May of 2024. When I went on Wegovy last year, I didn’t make any changes — I just hoped the injections would manifest the weight loss I was looking for without me having to put much thought into it. This time I want to do the opposite — change my eating and exercise habits to lose weight, with the injections playing a supportive background role.

I weigh myself on March 6 and find that I am 411 pounds. It is a massive number, but not the largest one I’ve ever seen glow on the little rectangle below my feet. At my heaviest, I weighed 422 pounds.

I decide not to start Zepbound today, opting instead to only begin the diet and exercise routine today and start the injections two or three weeks in. My experience on Wegovy informs the decision.

Some of the side effects of GLP-1 drugs are an increased likelihood of pancreas and gallbladder problems, and increased feelings of depression and anxiety — the things I experienced on Wegovy most intensely. However, my experience with those things is not limited to my time on that drug. I’ve had pancreatitis multiple times over the past 10 years, and I currently have a few small gallstones. I’ve had depression and anxiety since childhood.

I feel strongly that eating well and exercising would be the very best way to counteract those negative side effects, especially if I am well into the routine before my first injection. The types of foods that exacerbate those conditions should be flushed out of my system in that time, I hope.

On March 20, I am 8 pounds lighter. My food intake is limited to between 2000 and 2200 calories a day, and my meals are comprised of 2/3 vegetables and 1/3 lean protein. I avoid coffee and sugar to keep feelings of anxiety in check. I limit fatty foods and drink 100+ oz of water daily to help stave off pancreas and gallbladder issues. I use my treadmill and keep myself physically active to maintain my muscle mass, aid with my digestion and boost my mood.

I add Zepbound to my routine.

July, 2025

On July 4, 2025, I am 38 pounds lighter than I was when I kicked off my weight loss in early March. My weight loss continues at roughly the same pace it did in the two weeks before the injections, which might beg the question: Why use the drug at all?

Inside of my brain, among all of my lived experiences and memories, is a voice that bellows over every thought and feeling I have. The voice has been there all of my life. She learned to talk at the same time I did, and once she learned she started to say one thing and one thing only:

“Eat.”

Once she started, she never stopped.

Like most fat people, I’ve lost track of the amount of weight loss attempts I’ve made. I’ve done SlimFast and Weight Watchers. I was ‘Sweatin’ to the Oldies’ with Richard Simmons when I was 11 years old. I committed the original beginner VHS tape of Billy Blanks’ Tae Bo workout to memory — so thoroughly that I was able to do it without playing the tape. I had an elliptical machine that I used so frequently in the first few months that it broke and I had to purchase replacement pieces. I’ve had personal trainers and health coaches. I’ve used multiple weight loss apps, both free and paid.

I spent countless hours in weight-loss clinics — including a clinic where I was placed on a bariatric diet without surgery that limited my food intake to 1000 calories per day. The clinic’s branded protein shakes and soups were all I was allowed to eat, and I was warned that though my hair was likely to fall out and my breath would turn foul, it would all be worth it in the end. I lost 13 pounds in the first week. Shortly after that, I experienced a complete emotional breakdown. The clinic has since closed.

In each of these instances I lost between 25 and 35 pounds before reaching a plateau I was unable to get past. Whether my ‘failure’ was due to my own lack of will power, my immaturity, my lack of mental health resources or anything else, I can’t be sure. But one thing was true in every instance — I eventually grew exhausted by the volume and relentlessness of the voice in my brain. The more weight I lost, the louder and more forceful she would become. Her voice went from a constant groan in the background of my life, to a loud alarm in the front and center, making me feel that eating extra food was something I desperately needed to do to feel happy, safe and calm.

Zepbound, I’ve discovered, keeps the voice at a low groan no matter what the scale says.

When I reached the 30-pound mark of weight loss on Zepbound, I plateaued, just like always. The scale didn’t move for two weeks. While I did find that frustrating, I didn’t feel the need to turn to food. The feeling of intense emergency never happened. The voice wasn’t screaming at me. She was still telling me to eat, but the forcefulness and desperation was gone.

Meanwhile, a different voice in my head — the voice that represents the highest and best version of myself — grows stronger. She tells me I can feed myself in healthy ways. If I’m hungry, I can eat a salad or some fruit. If I’m not hungry, just frustrated or sad or uncomfortable, I can take a nap or go for a walk. If I’m bored, I can write or read or make art. The non-eating options don’t feel insufficient anymore, which makes healthy choices easier to choose.

I’m very happy I am here, but I am frustrated at what it took to reach this place. The road blocks that were there when they shouldn’t have been make me worried for people who do not have my level privilege and access to resources.

Prior authorization

According to a news release from Eli Lilly, the company that makes Zepbound, the drug is indicated for people who are obese, or people who are overweight and have weight-related medical problems.

If that’s true, approval should be easy. Stepping onto a scale should be the only data necessary to approve many people, while others would just need the scale number and a blood test, or a diagnoses of sleep apnea.

This information makes me wonder what, exactly, the reason is that I got approved for Zepbound in March of this year and not June of last year. I call my doctor’s office near the end of June 2025 and speak to a nurse — the same nurse, in fact, that I had spoken to about my doctor transitioning to a membership-based DPC system months before. I ask her if there are any notes in my file to indicate why I was approved for Zepbound now and not last year.

She says that this year, there was “prior authorization.”

I ask what prior authorization means, and she says that my doctor spoke directly, peer-to-peer, with someone at my insurance company about my patient history and weight and why the drug would benefit me. The nurse said that the file indicates prior authorization as the reason for my approval.

I ask why prior authorization didn’t happen last year, and she can’t give me a clear answer. She says my file indicated that my doctor tried multiple times last year to get me approved, and that I was still denied every time.

I don’t know for certain what the real difference is between my doctor’s failed attempts in June 2024 and his success in March 2025, but what I do know is that I was granted access to Zepbound after I paid a very large amount of money to become a member of a DPC clinic. My doctor, who did not have the time, energy or resources to battle with my insurance company as effectively last year, was able to get me approved this year after drastically reducing his patient load and charging extra money to patients who could afford to stay.

Most people do not have the privilege I have. I’m happy my doctor helped me, but this kind of help should be available to everyone, regardless of income.

Unfortunately, with the passing of the Big Beautiful Bill on July 3, 2025, it seems that things are only going to get worse for people who already struggle to get what they need. The vast majority of people do not have extra money to spend on private healthcare outside of what they already pay for health insurance coverage — and it’s looking as though many will be without even the most basic health insurance coverage very soon.

I want to share this story because it’s been weighing heavily on my mind. I want people to know how much of a game changer Zepbound is, and also how difficult it is to get help and resources that should be accessible to everyone. I want to show that even people who are absolutely, obviously eligible for help can often only get it if they jump through hoops and have money to spare.

More specifically, I want to share and emphasize the term “prior authorization.” It’s a term I’ve heard many times before, but I never really knew what it meant. Based on my recent experiences, it seems to me that this term could be a missing puzzle piece for a lot of people in need.

When a doctor prescribes a medication and sends it to the pharmacy, the patient’s insurance company will either approve it or deny it. If they deny it, there is an opening for prior authorization. Once denied, a person’s doctor can speak with the insurance company directly and advocate for their client, which can truly make all the difference.

If nothing else comes from this, I hope everybody reading my story can remember the term ‘prior authorization’ and use it with their doctor next time they are denied by their insurance company.

Hopefully, their doctor has the time to make a phone call.