Ozempic and Eating Disorders

educationBody ImageEating Disordersdisorderd eating
Written By Allison Tucker, RD

We hope you enjoyed Allison’s first post on Weight Loss Injections as much as we did. She’s back today to talk about how weight loss injections can impact the development of eating disorders. Take it away, Allison!

The following content discusses eating disorders, fatphobia, and provides examples of potentially harmful nutrition messaging. We understand this sensitive topic is complex and we hope to approach this conversation from a place of compassion and understanding. The dietitians and therapists at Collaborative Counseling take a weight-neutral approach to helping people through eating disorder recovery, disordered eating challenges, and body image struggles. We do not help people with diets or intentional weight loss. 

Ozempic and Eating Disorders 

We recently covered some of the dangers of GLP-1’s, or weight loss injections in a previous blog post but it’s essential to talk about another serious potential complication: the risk of developing an eating disorder.

How The Research Causes Harm

It’s bold enough that the Zepbound website (image: https://zepbound.lilly.com/) provides a figure demonstrating exactly how intentional weight loss through dieting backfires on a physiological level, but let’s lean in and look at the big picture: The healthcare industry is finally admitting that dieting for long-term weight loss does not work. So, it makes sense that doctors would be recommending these drugs as an alternative to diet & exercise.

…But, that’s not actually the case.

These drugs are meant to be used in addition to dieting. And, they fail to mention there are no differences when losing weight through dieting vs. losing weight with medication + dieting.

Your body will fight back in the exact same way.

How Weight Loss Injections Fuel Eating Disorders for the General Public

Research shows both losing weight and restrictive dieting increase the risk for eating disorders. Many assume a restrictive diet has a name, rules, and a specific duration, but the term “restrictive diet” simply refers to eating less than your body needs. Not only are GLP-1’s prescribed in addition to restrictive diets, but they also make following a restrictive diet much easier due to their mechanism of action: extreme appetite suppression and delayed gastric emptying.

Unfortunately, disordered eating thoughts have an open invitation from the get-go. The goal is weight loss and you’re experiencing reduced cravings? Skipping a meal suddenly becomes both tempting and nonchalant. After all, eating less is to be expected and signals to you that the medication is working, meaning disordered eating behaviors could go undetected or even praised.  

If you’re undereating, your metabolism slows to compensate. This stunted metabolism, in combination with a reduced calorie diet (and thus, the increased drive to eat) sets the stage for weight regain and the potential for us to distrust our bodies more than ever.  Weight cycling is associated with negative body image and low self-esteem.

Additionally, interviews continue to circulate on social media showing real medical providers recommending GLP-1’s as a weight loss kickstart for their patients -  even though the data shows weight gain is inevitable without the medication. This misinformation reinforces the idea that if you fail to keep your “kickstart” weight off, you didn’t try hard enough. Failing diets leads to trying new diets. With each diet, the risk of developing an eating disorder increases.

Could GLP-1’s treat Binge Eating Disorder?

There has been recent speculation around GLP-1’s and the treatment Binge Eating Disorder (BED). Let’s review the claim:

“Generally, if a medication causes weight loss, there is a good chance it will also reduce binge eating”.

That’s it. That’s the theory. With no backing research or discussions about how the medication could help with binge eating.

It’s important to highlight that binge eating disorder can transpire for many physiological and psychological reasons. These medications do not address any of them and are likely making it more difficult for an individual to recover from BED in the long run. The drug supports one of the major contributing factors of binge eating: restriction. There is no emotional or physical healing going on here; you cannot fix a problem by removing one of the only solutions - eating enough food.

How Weight Loss Injections Fuel Eating Disorders in Folks with Existing or History of Eating Disorders

It’s nearly impossible to avoid conversations or media surrounding weight loss injections. The hashtag #ozempic has 1.5 billion views on TikTok, with thousands of users sharing content to document their weight loss journeys. Ads for GLP-1’s have flooded Instagram and Google, and every other TV commercial is about weight loss injections. Their popularity alone emphasizes that as a society, achieving a smaller body is the end-all-be-all of acceptance, which fuels the very basis of a restrictive eating disorder- fear of weight gain.

Not only do these documented journeys increase exposure to body-checking content, but they also invite dangerous food comparisons. The medications normalize eating very small amounts of food and seeing evidence of this may deter an individual in ED recovery from progressing, especially if they already feel they are eating “too much”.

It is unfortunately common for medical providers to ignore the fact that most people (more than 90% of people) who have eating disorders don’t fit the criteria for a “typical” eating disorder, which supports the fatphobic misconception that if a person is not emaciated, they can’t struggle with restrictive eating disorders. Therefore, the screening for eating disorders may be skipped altogether, or worse, a patient’s lived experience may not be believed because this medication is marketed towards individuals in larger bodies.

However, this doesn’t mean people in smaller bodies aren’t also vulnerable.  One feature of a restrictive eating disorder is constantly thinking about food or experiencing food noise, regardless of body size. Having an opportunity to quiet that noise becomes particularly enticing when the drugs are everywhere. While we can acknowledge that the medications aren’t always in stock, or obtainable for financial reasons, pharmacies are compounding their own formulas for these drugs, and getting a prescription is easier than ever. More significantly, one trait of eating disorders is going to extreme measures to avoid weight gain (think compensatory behaviors like purging, over-exercising, and restricting calories). So, even if providers were screening for eating disorders before writing a prescription, with emerging telehealth services, it is all too simple to falsify anthropometric data or leave out important history to get your hands on a prescription.

Medical spas, telehealth services, and now even Costco is starting to offer the medication. If you search “Wegovy” online, the second and third results read, “Wegovy for Weight Loss, 15 min Dr. Consult for Rx” and “Wegovy, prescribed online”. 

How the Messaging Fuels Eating Disorders

Wegovy’s own website provides “weight management tips”, which you can see are very personalized and comprehensive:

They are promoting the same willpower-focused behaviors that they admit do not work.

And if you’re in recovery from an eating disorder, or you’ve ditched diet culture long ago, you might identify these as food rules, or even harmful eating disorder behaviors.

They are.

Sure, eating slowly and mindfully can help you tune into true hunger and fullness. But recommending you try tricking yourself into feeling full and satisfied does not work and is irresponsible messaging. It also turns up the food noise when you don’t have a medication actively working on your appetite and digestion.

To Summarize

Individuals starting weight loss injections may already have a complicated relationship with food and their body. There is no evidence to support GLP-1’s help with eating disorders, and it’s more likely they’ll contribute to the development of disordered eating. Even if we had data to support that these meds were safe long-term, and physically and financially sustainable, they are not currently available to the vast majority of the population. Should this make you mad at big pharma? Yes. Should it make you madder at the culture that prioritizes thinness over everything else? Absolutely. In a culture claiming to be all about self-improvement, there is no tangible destination when the underlying message remains: “You aren’t quite thin/healthy/fit/accepted enough, and we can help you do better & be better.”

We are not saying these medications don’t have a place in the medical field. But it’s ignorant to assume all providers know how to screen individuals for eating disorders when they could be virtually prescribing one. (If this sounds dramatic, some patients report having no appetite at all, yet say their provider increases their dosage anyway). We recommend establishing care with a trusted, preferably weight-inclusive healthcare professional.

Please remember every person on the planet could eat the exact same diet, have identical exercise regimens, and still exist in completely different body sizes & shapes. Your worth is not dependent on your weight.

Moving Forward

If you’re struggling to navigate the complicated health & wellness space, the dietitians & therapists at Collaborative Counseling & Nutrition are here to help. We provide 1:1 and group counseling and nutrition guidance for individuals struggling with body image concerns, disordered eating, and eating disorders. Check out our previous Blog Posts to learn more about Fatphobia & Weight.

Resources Used:

Collaborative Counseling & Nutrition is an outpatient nutrition and body image counseling center, with locations in Indianapolis and Carmel, that provides compassionate, holistic eating disorder treatment. Through practicing mindfulness, intuition, and Health At Every Size, we are on a mission to help you find a true state of well-being! We take an anti-diet, weight-inclusive approach with all our clients and work to help guide you towards a way of healthy living designed by you, just for you! This post is for education purposes only and should not be used as a substitute for treatment for an eating disorder. If you are looking for a registered dietitian or therapist to assist you on your recovery journey, please reach out today!

Allison Tucker, RD

Allison is a Registered Dietitian with a Masters in Nutrition. Learn more about Allison by visiting her profile on the team page

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