At Christmas dinner, Jenny Burriss remembers eating exactly one bite of beef before feeling full. She had just upped her dose of semaglutide—the diabetes and obesity drug better known by the brand names Ozempic and Wegovy—and her appetite had plummeted. She had also lost her taste for alcohol, a side effect of the drug. So before her vacation a couple of months later, she decided to skip a dose. She was going to Disney World, and she wanted to enjoy the food—at least a little.
She was indeed hungrier after skipping her weekly injection, but not ravenously so. At the Biergarten buffet in Epcot’s Germany pavilion—where she might have once piled her plate high, justifying to herself that, after all, this is vacation—she was satisfied by just a small taste of everything. At the French pavilion, she savored a Grand Marnier orange slush. She didn’t lose weight at Disney World, but she didn’t gain any either.
Semaglutide works by suppressing the appetite and promoting a feeling of fullness. More fundamentally though, it works by altering one’s relationship with food. Doctors see the drug as a powerful biochemical tool to help patients build healthy long-term habits. Eating becomes a source not of comfort or pleasure, but simply of sustenance. “It takes a little bit of the enjoyment out of it,” Burriss told me. “But that’s healthy,” she added, for someone like her, who had a compulsive relationship with food. Semaglutide has helped her lose about 40 pounds. As the drug has exploded in popularity for weight loss, though, people who use semaglutide to reset their eating habits are navigating a world where food and the anticipation of it are still central to celebration. Semaglutide is meant to be taken regularly as a lifelong drug. So what to do on vacation, when enjoyment is kind of the point?
For some, deciding to forgo the dose while traveling is just a practical consideration. Semaglutide’s side effects usually taper off as the body adjusts, but they can range from the mildly inconvenient to the terribly uncomfortable: nausea, vomiting, fatigue, constipation, diarrhea, heartburn, sulfur burps. No one wants to get hit with a bout of diarrhea as a plane is taking off.
For others, staying on the drug removes the compulsion and distraction of thinking about food. They enjoy that peace, even on vacation. Semaglutide quiets what some patients call the “food noise” in their brains: waking up in the morning and immediately wondering what to eat today. Mexican? Pizza? Oh, let me look at some menus. It can be overwhelming to experience and exhausting to constantly counter. Fatima Cody Stanford, an obesity-medicine doctor at Harvard, told me that her patients on semaglutide like being able to attend a wedding or a party “without having to worry about overindulging.” Janice Jin Hwang, an obesity-medicine doctor at the UNC School of Medicine, says she tells patients not to see vacations as cheat days. “I don’t like to make it a dichotomy where it’s your normal time and your vacation time,” she says, advocating instead for a more balanced approach all the time.
People who want to skip while on vacation, though, are swapping tips and experiences online, sometimes in lieu of official medical advice. By and large, those I spoke with, like Burriss, told me that they were looking for a middle ground, not to go completely overboard on food. “I certainly didn’t want to pig out,” says Sarah, who skipped a dose for a 10-year-anniversary trip to the Bahamas. “I just didn’t want to have that weird nauseous feeling or not be able to enjoy wine.” Sarah, whose last name I’m not using to protect her medical privacy, has always loved researching the best restaurants on vacation. This time, she felt some of the thrill of anticipation, but she ate moderately and chose healthy options, such as fresh fish. Allyson Gelman, who skipped while on vacation in Mexico City, told me she still ended up canceling an eagerly awaited 12-course tasting menu. When she eats too much or too unhealthily on semaglutide, she has to vomit; she’s sometimes had to run to the bathroom after overdoing it in a nice restaurant. In Mexico City, she could still feel the drug’s effects lingering in her system, and she knew she wasn’t getting through 12 courses without throwing up.
Semaglutide does take several weeks to clear from the body, so skipping just one dose attenuates but doesn’t eliminate the effects of the drug. Marnie, whom I’m also identifying by only her first name for medical privacy, has been regularly taking her prescribed Wegovy every other week. In the second week, she can feel her side effects start to fade and her hunger start to return. For her, skipping is largely about managing her side effects, because the drug still leaves her very tired. She’s probably losing weight more slowly this way, she says, but she’s okay with that. In certain cases, Stanford, the doctor at Harvard, told me she has instructed patients who don’t need the full dose for weight loss to go longer between injections to modulate severe side effects. (Bafflingly, she’s found that insurance won’t cover a smaller-dose injection pen.)
The explosion of interest in semaglutide is so new, though, that doctors and patients alike are still figuring out what it means in the long term—not just in two or three years, but in 20 or 30. How long do the effects last, and how permanent are these new habits? Burriss believes that, for her, there is room for the occasional indulgence, during a special event or vacation. “It’s not an everyday thing,” she said. And indulging while on semaglutide is still nothing like bingeing without it.