There's a Mounjaro midlife crisis ... and dire consequences

“Are you on it?” she whispered as we swam out into the lake. It was a beautiful, sunny day and I was leading a group of midlife women — or Queenagers, as I like to call them — on a rejuvenating retreat. I didn’t need to ask what “it” was. The whip-smart fifty-something meant Mounjaro, or Wegovy — those miracle jabs that aid weight loss are sweeping through the midlife female population like a particularly contagious cold. It’s now so common for women of a certain age to be taking this medication that if — like me — you’ve shed a few pounds just by walking, swimming, and cutting out processed foods, no one believes you.

The next weekend, I sat down next to a friend on a camping trip. She was wearing tight jean shorts and a fitted top (unusual, as she is often quite body conscious).

“I feel great,” she said. “I’ve finally shifted my meno-belly and am back in my old clothes. It’s costing £200 a month, but it’s worth every penny!” The fact that she was on “the pen,” as these injectables are known, didn’t even need to be spelled out. She was messianic about how the food noise in her head had been silenced and how, after a lifetime of always feeling too large, she had finally reached her “ideal weight.”

My friend was only a size 12 before she started the jabs; she certainly didn’t have a BMI of 35 or above, which is meant to be the threshold for a Mounjaro prescription. “Oh,” she said breezily, “I lied to the online clinic. I told them I was 10 kg heavier than I am and sent them a really unflattering old photo where my tummy had rolls and looked huge.”

But what about your health? I asked. Her expression said it all: Who cares? I’m thin!

Many women I know are having a Mounjaro summer. And many, I think, are having a Mounjaro midlife crisis too. Which is worrying on a number of levels. These injections were originally developed to treat type 2 diabetes and morbid obesity by activating two receptors called GLP-1 and GIP, which increase the level of incretins — hormones that raise insulin levels and reduce the amount of sugar produced by the liver. The NHS is still only prescribing them for those with a BMI of 35–40 who have tried everything else, and only in conjunction with a nutrition plan, an exercise regime, and a psychotherapist.

Side effects can include gallbladder disorders, acute pancreatitis, a higher risk of thyroid cancer, indigestion, bad breath, constipation, muscle wastage, and bone loss. It is also worth noting that there is still no peer-reviewed evidence on how these new medications interact with female hormones, because the large-scale trials weren’t done on women, but on men.

My friend ignored my well-meant objections. I wasn’t surprised. Like many of us born in the ’70s, she had been raised by a mother obsessed with weight — not for nothing did that generation believe you could never be too rich or too thin and were taking amphetamines decades before they were declared Class A and became ‘speed’ at their daughter’s raves.

My generation are sitting ducks for this nonsense. We came of age during the “nothing tastes as good as skinny feels” era (thanks, Kate Moss), and went from the heroin-chic ’90s to the circle of shame in the noughties, where muffin tops were the enemy. We’ve been fed a constant media diet of eschewing bingo wings and cankles — and were taught to judge ourselves harshly by a beauty industry intent on selling us highly profitable products. Now in our fifties, we’re experiencing entirely normal weight gain linked to the drop in oestrogen during menopause, and suddenly £200 a month feels like a small price to pay for a monthly injection that will transform us to our twenty-something weight. As my friend (a highly respected therapeutic practitioner) said, “I just feel better about myself if I am thinner.”

She is not the only one. A whole swathe of the population are lying about their BMI to access these jabs. It even has a name: “micro-dosing.” “I see so many women who are taking these jabs short-term to lose weight for a holiday, wedding, or job interview,” says Dr Nighat Arif, expert in Midlife Health and author of The Knowledge: Your Guide to Female Health from Menstruation to Menopause. “The side effects include feeling horrible, headaches, low mood, bone loss, and muscle loss — all of which are particularly important to consider in midlife, when perimenopausal symptoms can already cause heightened anxiety.”

Dr. Nighat is particularly concerned about the way social media and private clinics are marketing these drugs to midlife women. “I hate the term ‘meno-belly’ — what it describes is a totally normal weight gain of two to three kilos. As we age, the body creates sex hormones in fat cells to counteract other hormonal changes going on within.”

“Pushing Mounjaro and Wegovy to menopausal women is simply preying on their vulnerability. Companies are profiting from women’s anxieties and normal body changes.”

Even worse, she explains, is the lack of female-specific data in clinical trials. “The effects on women are hidden in peer-reviewed trials, and we still don’t know exactly how these drugs interact with HRT due to limited long-term data. Yet the market is flooded with messages claiming these jabs cure menopausal weight gain.”

She refers to guidance from the British Menopause Society: “Semaglutide (Ozempic) and Tirzepatide (Mounjaro) result in delayed gastric emptying, and gastrointestinal side effects are common. The impact of these medications on the efficacy of co-prescribed oral hormone medications within HRT is unknown.” Clinicians are advised to switch orally taken progesterone to patches due to slowed digestion. (It also advises that oral contraceptives may not be effective.)

As a midlife expert who runs a community of women in this life stage, I feel uncomfortable with how quickly so many of my peers are resorting to pumping themselves with injections often sourced from the internet. Most people on these jabs (estimates are up to 1.6 million Brits) do not meet the official prescription criteria. It feels regressive. What happened to all the midlife rhetoric about empowerment, about not giving a damn, and moving into our confidence?

It really is a midlife epidemic. Look around: many of your friends are shrinking in body mass (“being eaten from inside” is how one woman described it this week); their faces are drawn, their bodies gaunt, and their breath bad. That once-fun dinner companion who now pushes food around the plate and leaves early because they are exhausted.

Last month I attended the launch of a new initiative at the House of Commons called What Women Want — a national conversation about improving women’s lives. It aimed to highlight global inequality, violence against women, rape in war, and the gender pay gap. To kick off the conversation, Good Housekeepingmagazine surveyed readers about what they wanted. The answer, depressingly, was: to lose half a stone.

So here we are. A generation brainwashed into believing we are only as valuable as the number on the scales, rushing to spend huge sums on drugs intended for the clinically obese. And the cost may go beyond our bank accounts. Emily Hohler, a nutritional therapist with NatureDoc who specialises in menopause and midlife women’s health, worries there’s a price to pay with our health too.

“I see many perimenopausal and menopausal women with stressful lives, fluctuating hormones, and debilitating symptoms like anxiety and weight gain.

“I understand the appeal of these drugs, but there are downsides. Women naturally lose up to 5% of muscle mass each decade after age 30. The perimenopause is especially vulnerable due to falling oestrogen, which affects muscle strength and health.

“Rapid weight loss often includes muscle loss. Maintaining healthy muscle mass is crucial, which is why I always stress protein intake and resistance training at this stage — especially for those not on HRT.”

There’s also the issue of diminished appetite. Are women getting the nutrients they need? Used alongside a healthy diet and exercise, these drugs can help wtith unhealthy weight gain. But used as a substitute, the consequences could be serious. Some people report hair thinning and loss as a particularly distressing side effect.

A colleague of Hohler’s works exclusively with weight loss clients using Metabolic Balance, which emphasizes preserving muscle mass while reducing fat. She has seen many women experience miraculous early results with these jabs, only to plateau before reaching their goals. And when they stop injecting, weight often rebounds quickly.

Some women micro-dose without any medical oversight. Some aren’t overweight; they simply want to be thinner. There is often no psychological support to address emotional eating. “Women overeat for a reason,” the practitioner says. “When they stop the drugs and the food noise returns, they can feel more out of control than before.”

Hohler believes the path to long-term health lies in high-quality wholefoods, regular exercise, and sleep. “I get that these drugs can help prevent serious consequences of obesity. But for women with minor midlife weight gain, simple lifestyle changes can not only help,but also give them back their sense of agency — and that is a wonderful thing.”

Another private doctor I spoke to, who asked to remain anonymous, echoed these concerns, saying the women using these jabs are often the ones already getting tweakments, lip fillers, and IV vitamins. They’re micro-dosing and not using the drugs as they were intended.

“These pin-thin ‘lollipop women’ are losing touch with reality”, she says. “One woman who came to me had lost so much weight, I suggested she eat more protein. She said, ‘After months on the jabs, protein makes me gag.’”

“There’s a strange belief in our culture that thin equals healthy. But if you’re eating junk (just not much of it), drinking heavily, and skipping exercise, you might be skinny but you’re not healthy.” Nor will your strength or fitness improve — both of which are vital over 50.

The Mounjaro midlife crisis is a toxic mix of thin-culture, gendered ageism (especially in the workplace), and a screen-obsessed society. Filters and Photoshop fuel a fear of ageing, pushing even sensible women to make poor health decisions. Are they ready to be on these drugs for life? And if so, what are the consequences — beyond pharmaceutical companies having hit the jackpot? On Loose Women, Sharon Osbourne said that after losing over 40 pounds on Ozempic, she now struggles to gain even 10 lbs back. “The injections worked,” she said, “but now I can’t put anything on really.”

It already feels like we’re living in a real-life spin of The Substance.

This makes me sad. I see so many amazing, intelligent, wonderful midlife women trying to embrace their authentic selves. My rallying cry is that we come into our prime as Queenagers. That 50-plus is when we become the people we were always meant to be, shedding the programming that says we’re only valuable for our looks.

I understand why so many midlife women are falling for the Mounjaro trap. I just wish they understood that you really can be too thin — and that frailty (the mental state and a physical one marked by being underweight and under-muscled) is never a good look.

This piece originally appeared in The Independent.