Michael Ferguson, a 56-year-old hydrographic surveyor, found his recent holiday to Aegina, Greece, completely altered after starting Mounjaro weight loss injections.
Ferguson, who works off-shore on a four-weeks-on, four-weeks-off schedule, began taking the medication at the start of June. Two weeks later, he and his wife Zoe spent 10 days in Greece adapting their traditional holiday habits to the drug's side effects.
He has already dropped from 110kg to 95kg, losing 15kg towards a target of 25kg, but the effects kicked in the day after his first dose. He immediately felt a lack of appetite, accompanied by the burning sensation of acid reflux and indigestion.
Mounjaro and similar GLP-1 medications suppress appetite and slow the rate at which the stomach processes food.
Changing the menu
In his mid-twenties in the 1990s, Ferguson lived in Halkidiki, Greece, working as a casino croupier. His days involved lolling in the sun with ice cream and bottles of ice-cold beer while looking out across the Aegean Sea, before walking home from night shifts via a bakery for a cheese and chilli crepe or a fresh pastry.
He would regularly gorge on hot slices of pizza, gyros filled with shredded lamb, chips and salad, feta cheese, filo pastry drizzled with honey, and healthy servings of sticky baklava. On later holidays, the smell of a local bakery would prompt him to rush back to his accommodation with arms full of pastries before coffee was brewed.
Now, Ferguson says he just looks wistfully at rows of hotel breakfast croissants, and that gyros, baklava and ice cream are out of the question. Where dining in Europe is largely a social experience, he found he could only manage a single octopus leg.
He said he feels awkward leaving food in restaurants, receiving hard stares and shaking heads from waiters when he tries to explain: "I'm sorry, I'm on the fat jabs, and I can't eat as much as I'd like to."
Shared meals
The experience was an improvement on a holiday last year when Zoe was using Mounjaro and Ferguson was not. She started the injections last June and suffered from nausea so badly she barely wanted to eat.
Ferguson described those holiday mealtimes as atrocious. He would slowly enjoy his food and drinks while Zoe finished half an hour earlier and picked at the remainder of her plate. One evening, she could only manage two pieces of lamb souvlaki, leaving them both miserable.
This year, with both of them on the injections and experiencing similar appetite levels, they shared a starter and side salad for lunch, followed by a main and another salad for dinner. If a main course sounded too filling, they shared that as well.
Ferguson's appreciation for Greek food has shifted from rich desserts and chips to the high-protein, high-fibre Mediterranean diet of grilled meats, fish and salads, which works well with Mounjaro.
New routines
Because the medication processes food slowly, the couple regimented their mealtimes to ensure they were hungry for the next dish. They ate a small breakfast at 5am or 6am, lunch around 11am, and dinner between 6pm and 7pm. The early schedule gave them a couple of hours before bed to avoid an acid taste while trying to sleep.
Ferguson has also quartered his alcohol intake. Last year in Greece, he drank beers on the beach before and after lunch, shared up to two bottles of wine in the evening, and finished with ouzo until he was tipsy. This year, he limited himself to one or two beers a day and a couple of glasses of wine or ouzo at dinner.
He said he anticipated being miserable for six months but hopes not to worry as much once the weight is gone, noting that at 56 he does not need a beach body. He is tempted to retire in Greece and be a "fat Greek man walking around in a budgie smuggler," adding that having to put his hands in his pockets to keep his shorts up is an incredible feeling.
Dietitian advice
Hazel Shore, a SCOPE-Certified Obesity Specialist Dietitian at Phlo Clinic, said all-inclusive holidays can be an opportunity to try new foods without committing to large portions. She advised guests to keep rough regular mealtimes to avoid grazing all day, and to walk the full length of a buffet to size up favourites before taking a plate.
She recommended using a "T plate model" consisting of half vegetables or salad, a quarter protein, and a quarter carbohydrates. Hotels repeat their meals across the week, meaning there is no need to load a plate on the first day, she added.
Shore suggested focusing on quality over quantity to enjoy a destination's food culture, eating small plates like tapas, mezze, and street food markets, or sharing dishes with others.
Managing side effects
For alcohol, Shore advised setting a start time, a cut-off time and a drinks limit, and having the first drink with a meal rather than on an empty stomach. Tolerance is usually lower on GLP-1 medications, increasing the likelihood of nausea.
She warned against creamy cocktails like pina coladas, where the fat content can make patients feel worse, and recommended alternating every alcoholic drink with water.
Hydration is the primary concern, Shore said, as heat, alcohol, and side effects such as nausea, vomiting and diarrhoea all raise the risk of dehydration. A suppressed appetite can also cause patients to forget to drink. She advised aiming for two to three litres of fluid a day, limiting caffeine, and carrying a water bottle.
Because foodborne illness symptoms mirror medication side effects, she told patients to eat from hygienic places and not automatically assume the drug is at fault. Eating little and often helps with nausea, while gentle daily walks keep constipation at bay.
Addressing patients who consider pausing their treatment for a trip, Shore said the medications have a long half-life. Skipping a dose before flying means the drug remains in the system, maintaining side effects and appetite suppression, before hunger eventually returns and catches people out mid-holiday.
If the pause is to plan a blow-out, she suggested patients ask themselves if they would do the same when they reach their goal weight. If not, the holiday is a chance to practise new habits rather than break them.
