WEST LEBANON — Charlie Remy has never believed in diets. Even though he’s always struggled with his weight, counting calories and restricting his eating seemed like a futile approach to weight loss.
“Diets typically don’t work; you gain the weight back,” Remy, 41, said in a May interview.
But Remy still wanted to slim down, which led him to Dartmouth Health’s Weight Center, where he started a prescription for the GLP-1 receptor agonist Zepbound.
Under the guidance of a team of medical professionals, including a dietitian and a food psychologist, Remy, a West Lebanon resident who works as an electronic resources librarian at Dartmouth College, lost 78 pounds in just over a year. His new weight as of September was about 200 pounds.
Originally prescribed as a type-2 diabetes medication, GLP-1 receptor agonists mimic the GLP-1 gut hormone released after eating and help regulate blood sugar and hunger and slow digestion, according to the Cleveland Clinic. People who take GLP-1s, which come as injections or pills under several names, often feel fuller for longer, aiding in weight loss.
With the potential to yield 15% to 20% total body weight loss, GLP-1s “are our best drugs that we have to treat obesity,” said Dr. Sarah Finn, Dartmouth Health’s obesity medicine section chief.
But GLP-1s are hardly a magic cure-all. The way the medications work often requires people to take them indefinitely to maintain a lower weight. Rarely covered by insurance when prescribed for weight loss, the medications can also be expensive or impossible to access under most policies.
Losing weight on a GLP-1 has bolstered Remy’s confidence and assuaged his concerns about developing weight-related health problems. But it has also spawned new questions about his relationship to his weight, and how his body will continue to change from the medication.
“Will it prove itself too good to be true?” Remy said in May, just over a year after his first appointment at the Weight Center.
Remy is one of an estimated 11% of Americans currently taking a GLP-1 for weight loss. He spoke candidly about his experience and gave the Valley News permission to speak with his doctors.
Comprehensive and compassionate care
A native of Gorham, Maine, Remy has been overweight since childhood. Though he was never bullied about it at school, he often felt self-conscious taking his shirt off to swim in front of his peers.
“There was a little bit of shame, particularly as a boy. I had breasts, if you will,” he said.
He didn’t play sports, but he was still an active child who loved to ride his bike through Gorham’s web of streets.
“It gave him a little sense of independence,” his mother, Heidi Remy, said in a phone interview.
As an adult, Remy fell in love with hiking and taking long walks around his neighborhood for exercise. A few years ago, he also started lifting weights at the gym a couple of times a week.
Even though he led an active life, Remy struggled with overeating, especially at night when he was alone at home. Food was a source of comfort, of pleasure.
“I’m an emotional eater. I don’t drink.… And so I feel like food has been kind of my reward system,” Remy said.
Those late-night snacks “cancel out the benefits from my exercise,” he said, and as he got older, he started to worry about developing health problems like diabetes or high blood pressure because of his weight, even though his bloodwork had always looked good.
Still staunchly opposed to dieting, Remy got on the wait list at the Dartmouth Health Weight Center about two years ago.
In April 2025, Remy had his first appointment with Dr. Minda Gowarty, an obesity medicine physician at the Weight Center, who prescribed him a low dose of Zepbound, to be injected once a week, which he began taking that July.
Gowarty slowly increased the dose over the following months, as is routine for patients on GLP-1s at the Weight Center, and the pounds began to fall away.
As of August, Remy had lost 73 pounds. By then, he was taking 15 milligrams of Zepbound, the highest dose.
His face was thinner, his limbs lankier, and at 205 pounds, he was regularly buying clothes in size large instead of 2XL. On a recent visit to his parents, even his dad’s size large swimsuit was too big.
Remy was floored by his progress. “I would never have guessed that I’d be wearing that, ever. It makes it feel real. It makes it very concrete that I have lost this,” he said.
His life has changed in a number of small ways, too. Planes are more comfortable. He no longer worries about breaking plastic chairs, and long walks and hikes often feel like a breeze.
The GLP-1s also quieted what Remy calls ‘food noise,’ including his nighttime cravings, and he stopped bingeing and snacking between meals, though he insists he still always has dessert.
“I will not deprive myself of the good stuff,” he said.
He praises the Weight Center for its comprehensive and compassionate care. “I feel like I’m doing this with good guidance from multiple professionals,” he said.
Obesity is ‘a disease state’
While the onus is often placed on overweight people to change their bodies through diets and exercise, the Weight Center’s care providers operate from the position that obesity is “a disease state where the body is trying to protect and defend a too-high fat mass,” not a moral failing, the Weight Center’s Dr. Sarah Finn said.
Often patients at the center harbor shame that they “could have out-lifestyled” their obesity, Finn said, which can make them reluctant to accept treatment like a GLP-1.
Remy has struggled with that shame, too. When people compliment him on his weight loss, he often feels a twinge of embarrassment about using a GLP-1.
“I have not lost 73 pounds because I’ve done all this extra work mentally and physically,” he said in August. “It’s been an assist.”
In reality, lifestyle changes such as adopting a regular exercise routine typically account for 3% to 5% of total body weight loss over time for patients with obesity, Finn said.
The causes of obesity vary from person to person, and so does how well a given treatment works, researchers wrote in a 2023 letter in the journal eClinicalMedicine.
The hope is that “when patients really firmly accept the disease state, that helps because then they stop blaming themselves if things don’t go well” in treatment, Finn said.
When Gowarty, Remy’s doctor, meets with a new patient, she starts by inquiring about why they want to lose weight. Answers can vary from wanting to play freely with their children to sleeping better.
“It isn’t necessarily about a number on the scale; it’s about what the weight loss will mean for that individual,” Gowarty said.
From there, she and the patient discuss treatment options, which generally fit into four categories: lifestyle changes – which make up the foundation of every weight loss therapy at the Weight Center – endoscopic interventions, such as inserting a gastric balloon that takes up volume in the stomach, bariatric surgery and GLP-1 medication.
Part of GLP-1s’ pull is that they’re less invasive than bariatric surgery, which involves significantly reducing the size of one’s stomach, sometimes permanently. Only 1% of the Center’s eligible patients opt for the surgery, Finn said.
Patients who choose the GLP-1 pathway start on the lowest dose. About a month later, they check in with a nurse about how they’re faring and whether they’ve developed any negative side effects such as constipation, heartburn or nausea.
Remy hasn’t experienced any of these, he said.
Throughout the process, patients also meet regularly with a food psychologist who supports their well-being and offers treatment for disordered eating.
“Trying to understand weight or think about weight in a vacuum really would do a disservice to patients,” Gowarty said. “We really need to think of the person as a whole.”
Roughly 30% of people with obesity also have disordered eating, Finn said, and not all eating disorders respond the same way in patients using a GLP-1. Anorexic patients tend to do worse on the medication, for example, while patients with binge eating disorder often find a GLP-1 helps quiet their cravings.
An ongoing expense
As patients continue their treatment, they slowly increase their medication dose, which generally leads to new stages of weight loss.
Patients typically need to keep taking the medication to maintain weight loss, though a small subset can keep the weight off without it, Gowarty said.
While GLP-1s might be effective for weight loss, in Vermont and New Hampshire they’re rarely covered by insurance, which can make accessing the medication, let alone a facility like the Weight Center, unaffordable for many.
Enough Zepbound medication for a month’s worth of injections costs about $450 out of pocket, Finn said. Because GLP-1s often must be taken indefinitely, patients have to be prepared to pay that amount, or more, for life, unless the drugs come down in price.
As a Dartmouth employee, Remy is covered under the college’s insurance policy and pays less than $30 a month for Zepbound.
“I’m very grateful to Dartmouth College,” Remy said.
Unexpected changes
Taking GLP-1s has allowed Remy to achieve the weight loss he was hoping for, but it’s also changed him in ways he didn’t expect.
Since losing weight, he’s noticed that he’s started to have more judgmental thoughts toward fat people.
Almost unconsciously, he’ll view them as “lazier” or “defective,” he said. Or he’ll wonder why they’re not taking a GLP-1 to manage their weight.
“It’s just kind of a thought that I have that passes from time to time that seems kind of new to me,” he said.
It’s also the sort of judgment that Remy himself is familiar with.
As an adult, whenever he told his parents about his struggles with dating, they’d recommend that he lose weight.
“The opposite sex likes somebody in good shape,” his father, George Remy, 85, said in a recent interview.
Those comments struck Charlie Remy as “tone-deaf” to the challenges of losing weight and of dating. He eventually shut them down.
When he did slim down, his dad was “Oh-so happy for me,” Remy said.
“I never expected him to lose that kind of weight recently,” George Remy said. “It blew my mind.”
Even though Remy maintains that he started GLP-1 medication to be “proactive” about his health, there’s a part of him that feels that losing weight was a “gift” to his dad, who lives with Alzheimer’s.
“I see the joy in him with regard to my weight,” Remy said.
For George Remy, that gift is knowing that his son has a chance at a healthier life.
“I believe he’ll live longer as a result” of losing weight, he said. “I love him dearly.”
Losing weight also hasn’t dissolved all of Remy’s challenges with his self-image. There are still parts of his body that he wishes looked different.
Seated in his living room on an August morning, he looked down at his thighs. “I’d like them more narrow,” he said, then gestured to his stomach. “It’s not flat. It’s fat still; it’s not perfect.”
But Gowarty assures him that he’s reached a weight that meets his health goals, Remy said.
That difference of opinion, and reduced weight loss over the past several months, has left Remy with a conundrum: Does he keep trying to lose weight, or does he focus on accepting his body as it is?
“I think I’m in the middle,” Remy said. “Part of me still would like to, but the other part of me is like, well, the doctor says you’re fine from a health perspective.”
His success on GLP-1s also has opened the door to new questions about what comes next. Remy worries that he won’t be able to maintain his new weight, that his body will build up a tolerance to the medication.
Recently, he’s noticed that he’s begun to snack more. One evening, he ate a cookie before a dinner of pasta and salad, then found himself craving a Klondike bar later that night.
“I didn’t need it; I wasn’t hungry,” he said.
These cravings get more pronounced toward the end of the week, when the medication is wearing off, though Remy times those days to fall when he naturally has less of an appetite because he’s anxious about the work week ahead.
When asked if he’d ever consider forgoing the medication, his eyes widened.
“No, hell no. I’m on this indefinitely. I’m not going to risk getting off of it, no way,” he said.
People who stop taking GLP-1s typically regain more than half of the weight they lost within the first year without the medication if they don’t seek alternative treatment, according to the Cleveland Clinic.
Should that happen to Remy, it would feel like “a failed experiment,” he said. Another diet.