This issue of Peptide Purgatory looks at two novel uses for GLP-1 RA drugs — teenagers and cats. Asl your vet whether Zepbound is right for Fluffy!

GLP-1s for Teens: Because What Could Possibly Go Wrong?

If you’ve been wondering where all the Wegovy is going, here’s a hint: the kids are alright… because they’re getting priority boarding at the GLP-1 gate.

At ObesityWeek, a presenter from Nemours Children’s Health bragged about a quality-improvement project that could just as well have been titled “How We Blew the Roof Off Our Semaglutide Consumption.” After partnering their adolescent obesity clinic with a specialty pharmacy, they watched prescription volume rocket up a modest 1,680% in just one year. Yes, you read that correctly—sixteen-hundred percent. If Tesla’s stock chart did that, CNBC would have a stroke.

And the clinic didn’t stop at merely prescribing more drugs. Oh no. They built an entire logistical apparatus around feeding the GLP-1 machine:

• Weekly supply updates (because the supply chain is our new mood ring)
• Smart-phrase scripts to grease the skids
• Dedicated workflows for prior auths
• Auto-reminders to clinicians to re-up scripts before they run out
• A custom brochure so parents aren’t left wondering why their teen is suddenly on a $1,400 injectable

By 2024, the number of adolescents funneled into the specialty pharmacy increased by 1,057%. That is not a typo. That’s customer-acquisition growth that would make a Silicon Valley VC weep with joy.

And yes, adherence was—shockingly!—95.5%, which is what happens when a pharmacy holds your hand like an overcaffeinated concierge and your clinician calls you a week before you run out to make sure you don’t miss a jab.

But here’s where the confetti stops falling.

Nguyen ends with the understatement of the century:

“Increasing the use of GLP-1 receptor agonists in our clinic has created more work for providers and requires additional staff.”

You don’t say.

We’ve essentially built a pediatric GLP-1 industrial complex—one that needs ever more administrative workers to approve, dispense, monitor, and massage the process. The drugs are good tools, no argument there, but a system that must scale by 1,680% per year is not a system in control. It’s a system surfing a cultural and economic wave straight into the rocks.

And did I mention the presenter consults for Novo Nordisk? Purely coincidence, I’m sure.

If this is the future of adolescent obesity care—high-touch specialty pharmacy pipelines optimized for throughput rather than metabolic reasoning—then buckle up. We’re not treating a disease; we’re industrializing a demand curve.

But the lucky kids can have their cake and eat it, too, and spend 12 hours a day on their PlayStation for healthful recreation. A lithe body is just a jab away!

But if you think pushing the pricey drugs on teens is ridiculous, just read on. Cats are next! You’re not going to believe what follows, I promise. Although we are satirizing it here in Bullshit Corner, it was originally reported by ABC News, so it must be at least partially factual, maybe. Stay tuned as we see how the GLP-1 marketing geniuses are now expanding their fat-loss promising reach to corpulent felines.

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Peptide Purgatory chronicles one man’s ongoing experiment with Mounjaro, metabolism, and medical modernity. Side effects may include sarcasm, elevated skepticism, and mild tachycardia while reading policy papers. So, ask your doctor whether Peptide Purgatory is right for you!

For an annotated catalog of all my Peptide Purgatory and Mounjaro updates, visit my Mounjaro Update Catalog page.

Greetings, long-suffering Peptide Purgatory readers! Your favorite Mounjaro/Farxiga lab rat is here with another lengthy, boring issue for you. Self-disparagement aside, I hope some of you can benefit by reading my thoughts on the latest news about our GLP-1 RA medicated society.

And speaking of GLP-1s in the news, thanks to this miracle incretin, Eli Lilly now rivals the high-tech high-flyers as a trillion dollar corporation. During the week, Lilly’s market capitalization exceeded that magic, 13-digit threshold. How’s that for opportunistically converting the modern world’s deadly embrace of quick fat-loss cures to cash!

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Who in the Mounjaro Am I?

In other notable news this past week, I turned 79 years-old. Yeah, this Nittany Turkey, pictured at left at my AI-enhanced best, is a foul old fowl, indeed, about to bunker in to avoid the Thanksgiving chopping block that will be the fate of so many of my relatives. Along that long life’s pathway I’ve accumulated my share of old bird afflictions, notably metabolic syndrome, Type 2 diabetes, chronic kidney disease, osteoarthritis, gout, erosive gastritis, and nine million other major and minor ailments. I’m taking Mounjaro for the diabetes, Farxiga for the CKD, and a couple of other drugs. While I believe I benefit from Big Pharma’s finest money-making drugs, I frequently use this space to disparage their profit-motivated market manipulation, spurred on by their government buddies and the willing collaboration of the captive medical associations.

In This Week’s Issue

This week, we look at current research that continues to hammer down the proven fact that GLP-1 drugs cause loss of beneficial muscle mass along with the desired fat loss. To combat the muscular attrition, we must diligently pursue strength training while taking these drugs or we wind up living the final years of our lives frail and helpless. I’ve taken this aspect of GLP-1 RA therapy very seriously: Since starting on Mounjaro in June 2024, I’ve been pumping iron like Arnold and crusading for others in my position to pay more attention to their muscles. Use ’em or lose ’em!

I typically include tidbits from my personal health story to further bore you all (but, hell, writing them is therapeutic for me). If your attention span permits, you’ll see my cognitive testing results from the SOMMA research study. I felt I screwed it up because I took the test by phone on a very busy morning. So, checking it our might confirm your suspicions about my mental acuity. On the other hand, despite the less-than-perfect score, you’ll see that I still can juggle a shitload of mentally taxing tasks in my daily life.

Also in this issue, Bullshit Corner takes a piss on RFK, Jr. and his captive CDC removing the research-based statement that no proven connection between vaccines and autism exists. This wreckless bungle opens the door for RFK’s plaintiff-bar buddies, as well as endangering our babies. Join us for a cynical look inside the YouTube influencer-run madness of the HHS clown car under RFK Jr.

So, sit back, grab a donut (which you can now pee out if you take some Jardiance), and enjoy!

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Muscle Matters More Than the Scale

GLP-1s, Lean Mass, and How Not to Shrink Your Quads for Science

If you listen to the GLP-1 hype machine, you’d think the only number that matters is how many pounds fall off. TikTok: “Down 20% bodyweight!” Reality: “And 25–40% of that was lean mass, champ.”

A recent Healio piece made the point bluntly: yes, these drugs burn fat like a flamethrower — but some of what disappears isn’t fat. The question is whether you’re shedding acceptable “support structure,” or quietly trading diabetes for frailty.

Lean Mass: Not Just “Muscle,” Not Just Vanity

DXA doesn’t isolate muscle; it counts:

• skeletal muscle
• organs
• connective tissue
• and a whole lot of water

So when you hear that 25–40% of weight lost on semaglutide or tirzepatide is “lean,” part of that is simply shrinking fluid compartments as fat melts. But part of it is muscle and bone — the stuff you need to stay upright and avoid breaking like a breadstick.

How Much Are We Losing?

The trials say:

• Tirzepatide (SURMOUNT-1): ~25% of lost weight = lean
• Semaglutide 2.4 mg (STEP-1): ~39% = lean

If you drop 50 pounds on semaglutide, you might lose ~30 lb fat and ~20 lb lean. For someone going from 350 to 260, that might be fine. But for older adults, the frail, the osteopenic, or anyone who’s already wobbling on the edge of sarcopenia, that’s a real problem.

Kashyap notes unpublished data showing ~10% hip bone loss in 17 months on an incretin. That should make anyone over 60 sit up (carefully). [How long have I been on Mounjaro? Coincidentally, 17 months. –Ed.]

Pharma Smells Opportunity

The minute someone whispers “muscle loss,” biotech startups come sprinting in:

• Bimagrumab + Semaglutide: 22% weight loss, minimal lean loss
• Trevogrumab + Semaglutide: lean loss cut in half
• Apitegromab + Tirzepatide: preserves ~4 lb of lean mass

Translation: “We fixed your weight loss; now we’ll sell you the muscle-protection DLC.”

Problem: we have absolutely no proof whatsoever that these combos improve function. Right now, it’s just prettier DXA scans and better p-values.

The Boring Stuff That Actually Works

The lifestyle advisory from obesity and lifestyle-medicine societies is the part everyone ignores because it’s not sexy:

• Protein: 1.2–1.6 g/kg/day
• Strength training: at least 3×/week
• Aerobic work: ~150 minutes/week

These work because drugs don’t decide what you lose — your behavior does. GLP-1s suppress appetite; they don’t send a memo to your quads saying, “Don’t worry, we’ll spare you.”

The Real-World Way to Not Become a Frail GLP-1 Success Story

1. Treat your muscle like critical infrastructure.
Goal is not “lighter at any cost.” It’s less fat, same or better strength.

2. Don’t inadvertently starve yourself.
GLP-1s make under-eating easy. Under-eating makes muscle loss inevitable.

3. Hit your protein like it’s medication.
Spread it across meals. Each one should trigger protein synthesis, not pity.

4. Lift heavy-ish things.
Push, pull, hinge, squat, carry. The compound load-bearing movements that keep you from becoming a fall statistic.

5. Watch function, not vibes.
If stairs get harder while weight drops, you’re losing the wrong stuff.

6. Be skeptical of expensive biologics until they prove functional benefit.
Saving 4 lbs of lean mass on paper means nothing if you still can’t get off the toilet without using momentum and prayer.

Bottom Line

GLP-1s are phenomenal for diabetes and obesity. But they’re agnostic about what you lose. You have to supply the stimulus that tells your body:

Keep the muscle. Keep the bone. Burn the fat.

Muscle isn’t vanity weight — it’s your glucose disposal system, your metabolic gearbox, your anti-fragility hardware. The drugs are the miracle; protein and barbells are the engineering that keeps the miracle from collapsing.

And around here? You know damn well which side I’m on.

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Meanwhile, Back at SOMMA… (Now With 79 Years of Superiority)

While the rest of the SOMMA participants were shuffling into the cognitive testing dungeon like extras from a low-budget zombie flick, your soon-to-be-79-year-old correspondent sauntered in, casually posted a 27 out of 30 on the MoCA, and walked out without even breaking a synapse.

I had been concerned that I screwed up the test. I know I could have done better. When they asked if I was in a quiet place with no distractions, I lied. That morning had been a comedy of interruptions at inopportune times, and I was still mentally juggling the day’s priorities when the scheduled cognitive testing call came.

Well, apparently, I did better than I thought I did, which would be good enough for some old farts, but still disappointing to me. If you insist, though, I’ll gloat about it.

The Mind/Body Connection

I keep telling everyone strength training pays off, and now we have proof: somewhere between the deadlifts, the monster walks, and the leg presses that would make a 40-year-old rethink his life choices, my brain apparently decided it should try to keep up. Neuromuscular adaptation? Hell no — neurovascular domination. At this point, every barbell I lift probably generates enough BDNF to power a small research lab.

And it’s not like I’m strolling through life carefree, eating bonbons and solving Wordle.

I have cognitive load that would bring a lesser, 79 year-old mortal to his knees:

• Negotiating the ACA insurance labyrinth, where the reward for hours of navigating contradictory government websites is the privilege of paying a thousand bucks a month so my not-yet-Medicare-eligible wife can be assured of catastrophic coverage if she ever needs it (and maybe a “free” gym membership).
• Bracing for the inevitable “Medicare Solvency Plan,” which will raise eligibility to 85 — conveniently just after she turns 65.
• Performing my weekly duties as Awards Secretary of a national ham radio organization, herding directors, soothing officers, writing five-year plans that actually require five brain cells to read, and championing fee increases like some geriatric Alexander Hamilton.
• Coexisting with Big Pharma, the PBMs, Dr. DeLorean, Dr. Macallan, and all the other characters in the ongoing medical sitcom that is my life.
• Managing a workout schedule that would make an Olympic trainer say, “Sir, please sit down, you’re making us look bad.”
• Designing networks, running APRS experiments, patching Proxmox clusters, and keeping eight computers, multiple VLANs, and a FlexRadio behaving.
• Maintaining a dozen or so Geocaches involving serious bushwhacking that is far less of a strain than is dealing with inflexible bureaucrats in the Florida Department of Environmental protection.
• Writing a twice-weekly column about Penn State football, especially in a season everybody would prefer that we permanently erase from our memory banks.
• Living in a toxic HOA environment with multiple warring factions clamoring to either depose the President or put him in jail. Yea, verily, a neighborhood where “Signgate” approached Watergate proportions in the annals of HOA history and where every YIELD sign is a comedy act.

And still:

Twenty-seven out of thirty.

The SOMMA team should be studying me as a confounding variable. Hell, the statisticians probably had to huddle afterward to determine whether to classify me as an outlier, a mutant, or a rounding error in God’s spreadsheet.

Let’s face it:
What I call “screwing up” is what most people would proudly frame on their refrigerator next to their kid’s participation trophy.

So when this piece hits Peptide Purgatory, your humble narrator will have officially completed 79 laps around the sun, each one apparently sharpening my cognitive edge while everyone else is losing their car keys inside their own pockets.

I’d say “I hope that reassures my readers,” but let’s be honest — most of them have already fled.
The remainder are here for the spectacle, and I’m just here to blow my own damn horn for a while.

And I aim to keep delivering.

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Expanded Bullshit Corner

And now, the feature you’ve all been waiting for. Bullshit Corner takes a cynical stab at the latest Trump Administration unabated HHS circus, captained by the plaintiff bar’s favorite partner, Ringmaster RFK, Jr.

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Wrapping It Up: Smaller, Weaker, Dumber Is Not the Goal

So that’s this week in our brave new incretin world:
Wall Street is throwing confetti at Eli Lilly for turning GLP-1s into a trillion-dollar cash printer, the medical-industrial complex is still pretending muscle is optional hardware, and RFK Jr. is busy converting the CDC into a content partner for his antivax fan club.

Meanwhile, in the real world, the trade you’re being quietly offered is simple:

• We’ll shrink your waistline.
• In exchange, we’d like some of your muscle, a chunk of your bone density, and maybe a little bit of your common sense if you start taking YouTube medicine seriously.

If you’ve made it this far into the issue, you probably already suspect that’s a bad deal.

The gist is not complicated:

• GLP-1s and tirzepatide can be incredibly useful tools for diabetes and obesity.
• They do not care what you lose — fat, muscle, or bone.
• Your muscles, bones, and brain are your responsibility. That means protein, iron, barbells, walking speed, and occasionally saying “no” when the scale looks great but your legs feel like overcooked pasta.

I’m 79, allegedly cognitively intact, and still annoying enough to write all this instead of quietly fading into Medicare brochures. If there’s a point to this whole Peptide Purgatory enterprise, it’s this:
Use the drugs if they help you — but don’t abdicate the parts of your health that Big Pharma, RFK, or TikTok are never going to fix for you.

Muscle matters. Balance matters. Brains matter. The rest is just billing codes and stock charts.

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Thanksgiving Send-Off: Congratulations, You’re an Endangered Species

If you’re still reading, congratulations: you are now part of a critically endangered subspecies — the Adult Human With an Attention Span Longer Than a Reels Clip.

You’ve survived:

• A lecture on lean mass and GLP-1s,
• An old man flexing his 27/30 MoCA like it’s a Super Bowl ring, and
• A full tour of RFK Jr.’s Department of Health and Harm Services, featuring a supporting cast of YouTube grifters and supplement peddlers.

For this, you earn my deepest respect and absolutely no tangible reward.

Here’s your homework until the next issue:

• Lift something heavier than your phone.
• Eat enough protein to keep your quads from entering hospice.
• Treat any federal website that suddenly sounds like a podcast guest with the suspicion it deserves.
• And if you’re on a GLP-1, remember: the drug can curb your appetite, but it doesn’t get to decide what kind of old person you become. You do.

Thanks for slogging through another overlong installment of Peptide Purgatory.
Now get out of your chair, go move something, and try not to let the CDC, RFK Jr., or Eli Lilly make you both smaller and weaker.

Until next time,
— Your foul old fowl, still lifting, still bitching, still here.

HAPPY THANKSGIVING TO ALL MY TURKEY READERS AND MY FALLEN HOKIE COMRADES!

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Peptide Purgatory chronicles one man’s ongoing experiment with Mounjaro, metabolism, and medical modernity. Side effects may include sarcasm, elevated skepticism, and mild tachycardia while reading policy papers. So, ask your doctor whether Peptide Purgatory is right for you!

For an annotated catalog of all my Peptide Purgatory and Mounjaro updates, visit my Mounjaro Update Catalog page.