For years, Sabrina fought a losing battle with her weight.
The Texas-based realtor and mother-of-three had been slim for much of her life.
But after the birth of her youngest child, she found herself carrying extra pounds she simply couldn’t shift.
It wasn’t for want of trying. She dieted, exercised and even hired a personal trainer. And while she could lose weight, keeping it off seemed impossible.
She had become so uncomfortable in her own body that even an occasional burger and fries could leave her feeling bloated and miserable.
‘If I ate a cheat meal while dieting, like a burger and fries, I would get so swollen,’ she says. ‘I always felt so uncomfortable in my clothes.’
Then, in September 2022, she discovered Mounjaro – the diabetes injection that has since become one of America’s most popular weight-loss treatments. A routine checkup had revealed that Sabrina was prediabetic, meaning her blood sugar levels were approaching the threshold for type 2 diabetes.
Her doctor discussed several treatment options, including metformin, a drug commonly prescribed for diabetes, but Sabrina was particularly interested in Mounjaro, which appeared to offer better results than some of the medications her relatives had tried.
Sabrina, mother-of-three from Houston, Texas, started taking the GLP-1 medication Mounjaro, also known as tirzepatide, in September 2022 after being diagnosed with prediabetes
Seven months after her dramatic weight loss, in April 2023, she began experiencing digestive problems
She decided to give it a go – and the results were extraordinary.
Within seven months, she had lost 75 pounds, dropping from 206 to 131 pounds. She felt healthier, more confident and finally comfortable in her own body. For the first time in years, she wasn’t battling constantly to keep her weight under control.
Better still, she had experienced few, if any, side effects.
But just as Sabrina thought she had found the answer to her problems, things began to go wrong.
It started with what seemed like ordinary indigestion.
‘I started noticing some acid reflux in the morning. It really stung and gave me some nausea,’ she recalls.
She knew that digestive problems were a common side effect of Mounjaro, so initially she wasn’t particularly concerned.
‘I just thought it was the medication, because that is a side effect – a general upset stomach,’ she says.
The discomfort didn’t go away. Instead, Sabrina began experiencing sudden attacks of sharp, agonizing pain high in her abdomen, just beneath her breastbone.
At first, the episodes were relatively mild and short-lived.
‘I just thought they were not that big of a deal,’ she says. ‘But then they started to happen at work.’
By June 2023, two months after the first symptoms appeared, the pain had become so severe that one attack left her doubled over at her desk, wondering whether she needed an ambulance.
‘I was kneeled over to a point where I’m like, “do I need to go to the emergency room, or do I need to call an ambulance, because what is going on?”‘
When she finally sought medical help, her doctor arranged an emergency ultrasound.
The results revealed her gallbladder was severely inflamed and needed to be surgically removed.
What she had dismissed as an unpleasant but relatively harmless side effect of her weight-loss treatment was, in fact, a potentially serious complication.
Sabrina in the hospital before her gallbladder removal surgery
An incision update four days post surgery
Before and after comparison of Sabrina when she started Mounjaro versus when she reached her goal weight
And she is far from alone.
Gallstones and gallbladder inflammation are recognized complications associated with weight-loss injections, including Mounjaro, Wegovy and Ozempic.
Now, amid the extraordinary popularity of these drugs, doctors are warning that patients need to be alert to symptoms that can easily be mistaken for the ordinary digestive problems the injections can cause.
Gallbladder disease is already a major health problem in America, with researchers estimating that around 935,000 gallbladder removal operations are performed every year.
A 2024 study, drawing on national healthcare databases, also estimated that gallstone disease accounts for roughly 1.2 million emergency room visits annually.
And with millions of Americans now taking weight-loss injections, experts are concerned that more patients could develop complications.
Research has found that people taking GLP-1 medications are more likely to develop gallstones and gallbladder inflammation – and to require surgery to remove the organ.
A major analysis of 76 clinical trials involving more than 103,000 patients found that those taking the drugs were 37 percent more likely to develop gallbladder or bile duct problems than people given a placebo or another treatment.
They were also 27 percent more likely to develop gallstones, 36 percent more likely to suffer gallbladder inflammation and 70 percent more likely to require surgery to remove the organ.
Importantly, these are relative increases in risk – the overall likelihood of an individual patient requiring surgery remains comparatively low.
But the enormous popularity of the drugs means even relatively uncommon complications could affect substantial numbers of patients.
The gallbladder is a small, pear-shaped organ beneath the liver that stores bile, a digestive fluid produced by the liver to help the body break down fats.
Normally, when we eat, the gallbladder contracts and releases bile into the small intestine.
But if the bile contains too much cholesterol, hard deposits known as gallstones can form.
Many people have gallstones without ever experiencing symptoms. However, if a stone becomes lodged in one of the narrow ducts carrying bile, the result can be excruciating pain.
If the blockage persists, it can also cause serious inflammation or infection.
There are two possible reasons why weight-loss injections may increase the risk. The first is rapid weight loss itself.
When large amounts of body fat are broken down, cholesterol can be released into the bloodstream and subsequently secreted by the liver into bile, increasing the likelihood of gallstones forming.
‘Fat tissue stores a lot of cholesterol,’ explains Dr Sameer Berry, co-founder and chief medical officer of US-based digestive healthcare provider Oshi Health.
‘When you lose fat quickly, that cholesterol is released into the bloodstream, the liver clears it and secretes it into bile, and the bile ends up carrying more cholesterol than it can dissolve.
‘That is how stones form. Eating much less fat also means the gallbladder empties less often, so the bile sits there.’
Scientists have also investigated whether GLP-1 drugs themselves affect the way the gallbladder works.
These medications work partly by slowing the rate at which food leaves the stomach, helping people feel fuller for longer.
Research suggests they may also alter the way the gallbladder empties.
A 2018 study involving liraglutide, an earlier GLP-1 medication marketed for weight loss as Saxenda, found that the gallbladder took longer to reach its maximum contraction after eating.
This could allow bile to remain inside the organ for longer, potentially encouraging the formation of stones.
Dr Berry says that while he has not personally seen an increase in GLP-1-related gallbladder disease, he has witnessed a ‘massive uptick’ in patients seeking help for digestive side effects associated with the medications.
These include nausea, constipation, bloating, abdominal pain and acid reflux. A survey commissioned by Oshi Health, involving 1,012 GLP-1 users, found that 75 percent had experienced digestive symptoms that caused them concern.
This presents a problem for patients: how can they distinguish the uncomfortable but generally manageable side effects of weight-loss injections from the early signs of something potentially dangerous?
For Sabrina, the distinction was far from obvious. She had been taking an increased 7.5mg dose of Mounjaro for around two months when the painful attacks began.
At the time, she assumed the symptoms were simply part of adjusting to the medication.
Dr Berry says digestive side effects are often most troublesome when patients first begin treatment or following an increase in dose.
A separate 2023 meta-analysis of 9,871 participants also found tirzepatide users had nearly twice the risk of developing gallbladder disease (small sac highlighted in red on the left)
‘Most of those symptoms normally improve after about 30 to 45 days of people being on the medication, though they can return briefly after each dose increase,’ he explains.
However, persistent or worsening pain should never simply be dismissed.
‘Anything that is severe, keeping you up at night, or not getting better at all is going to be something to worry about,’ he says.
‘Usually, GLP-1-related abdominal pain is mild and gets better over time.
‘The severe issues related to GLP-1s, like gallbladder infections and pancreatitis, don’t get better. They actually get much worse.’
Gallstone attacks typically cause sudden pain in the upper right or central abdomen, sometimes spreading to the back or right shoulder.
Fever, chills, yellowing of the skin or eyes, and persistent vomiting can indicate a more serious complication requiring urgent medical attention.
Dr Berry also warns that patients should seek immediate assessment if they experience severe pain, chest pain, or blood in their vomit or stools.
‘If you have fevers, chills, persistent vomiting where you can’t keep food down, blood in your stool or vomit, chest pain, or just severe pain, that’s when you should get evaluated,’ he says.
Some people are more vulnerable to gallstones than others.
Women, people over 40 and those with a personal or family history of gallstones are already at greater risk. Losing a substantial amount of weight quickly can increase that risk further.
In Sabrina’s case, the weight had fallen off remarkably fast. She lost six pounds in her first week alone.
When she learned that her gallbladder needed removing, her immediate question was whether Mounjaro was responsible.
‘The first thing I asked was, “Was this the Mounjaro?” I wasn’t afraid to ask that question,’ she says.
‘After reviewing my medical history, the doctor actually believed it was the weight loss itself that was responsible – possibly the rapidness of it.’
Whatever the precise cause, Sabrina was devastated by the prospect of surgery.
‘I was glad they knew what was going on, but I was nervous,’ she recalls. ‘It was so scary, especially that day of.’
The operation, performed laparoscopically through small incisions in her abdomen, took around an hour and was successful.
But recovery proved much harder than she had expected.
For the first seven to ten days, she says she was in excruciating pain, and she needed help from her husband, mother and eldest daughter with basic everyday tasks.
‘I wouldn’t have been able to do anything without them,’ she says. ‘To me, it was an awful nightmare that I wouldn’t wish on anyone.’
She also struggled with bloating and digestive discomfort, and found that eating fatty meals could trigger further episodes of pain.
Although the gallbladder is not essential for survival, removing it changes the way bile enters the intestine.
Instead of being stored and released in response to food, bile flows continuously from the liver into the gut.
Most people can return to a normal diet afterward, but some experience diarrhea, indigestion or abdominal discomfort, particularly after fatty meals.
Sabrina eventually learned to manage her symptoms by changing what she ate.
Her experience has also changed the way she thinks about the potential risks of medication.
She has shared her story on TikTok, where she has more than 73,000 followers, hoping to alert other weight-loss jab users to symptoms she wishes she had recognized sooner.
Yet despite everything she endured, Sabrina insists she does not regret taking Mounjaro.
For her, the benefits of finally getting her weight under control have outweighed everything.
She wants other patients to understand the potential complications and speak up when something feels wrong, rather than assuming every new symptom is simply part of treatment.
‘If you are putting anything in your body, you have the responsibility of doing your own research and being your own advocate,’ she says.
And her verdict on the medication that transformed her life, despite the surgery that followed, remains emphatic.
‘The amount of good days this medication has given me outweighs having my gallbladder removed a million percent.’
