What’s the Deal with Weight Loss Injections?
Allison is back for another post this week, sharing important details about weight loss injections. Take it away, Allison!
The following content includes discussions around weight loss. 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.
The popularity and accessibility of weight loss injections require a discussion; however, this piece is not meant to shame any individual who is currently using or has considered using weight loss injections. The pressure to shrink our bodies in a world obsessed with thinness can feel overwhelming, especially if it’s being recommended in the name of health. Today we’ll be discussing how weight loss injections work and how they could potentially harm our mental and physical health.
We acknowledge the complexity and sensitivity of this subject along with any thin privilege held by a number of CCN clinicians. Our goal is to approach this discussion from a place of compassion and understanding while shedding light on the potential harm this phenomenon may cause.
What’s up with Weight Loss Injections?
Weight loss injections have consistently increased in popularity for the last few years. So how did we go from a medication being used to manage blood sugar to being used as the punchline of every joke this award season?
The weight loss injections we’ll be discussing today all fall under the class of GLP-1 receptor agonists. You may have heard various drug names like semaglutide, liraglutide, or tirzepatide, or popular brand names like Ozempic, Wegovy, or Mounjaro, though there are several more.
The Background
First, let’s review a bit of background on these drugs. By this point, most of us are aware that some variations of these medications have been approved for use as a treatment for Type 2 Diabetes for some time (since 2017). These drugs mimic a hormone made in our small intestines called glucagon-like-peptide-1, or, GLP-1. Simply put, researchers found that individuals taking the drug for blood sugar management were also losing weight. Soon after, semaglutide is approved for weight loss. The caveat? It was approved at 2.4x the max dose of the diabetes treatment form of the drug, where clinical studies have yet to exceed 2 years of research to determine the long-term safety. In clinical studies, most individuals receiving weekly weight loss injections lost 15% of their body weight, with 1 in 3 individuals losing more than 20% of their body weight over a 68-week timeframe.
While there are a few mechanisms of action related to blood sugar control, we’ll focus on how it works as an effective tool for weight loss. Research shows GLP-1’s act on a part of the brain that controls appetite regulation, meaning changes to messages about fullness and satiety. More significantly, it works by slowing down gastric emptying. If you’re wondering what the heck that means, it’s a fancy way of saying we stay fuller longer, because food is physically staying in our stomachs longer than it normally would. So, weight loss occurs because people are eating less food; and fewer overall calories. The delayed gastric emptying could also help explain why the most commonly reported side effect is nausea.
Other common side effects include vomiting, diarrhea, constipation, and abdominal pain. More severe though less common side effects include pancreatitis, kidney issues, and worsening diabetic neuropathy. Moreover, the medication has a black box warning for the development of thyroid tumors, and recent lawsuits have been filed linking the drug to gastroparesis and gallbladder disease. Not everyone encounters side effects, just as not everyone who uses GLP-1 injections will lose weight.
Well, every drug has side effects. Don’t the pros outweigh the cons here?
When we think back to how GLP-1’s works, we must compare the marketing to the science. A lot of social media buzz credits the drug for helping individuals understand true hunger and fullness. However, the drug websites themselves (along with doctors, med spa techs, and the comments section of TikTok) remind patients they need to use this drug in combination with a reduced-calorie diet, with some guidelines promoting daily calorie intake between 1,000 – 1,500 calories per day. If a medication was helping someone truly tune into their body’s healthy hunger and fullness cues, patients would be feeding themselves more than what a school-aged child needs to maintain optimal metabolism and functioning.
But Isn’t all Weight Loss Healthy?
Not necessarily.
In most cases, these drugs are being prescribed assuming patients have a decent enough relationship with food. When the drug is being prescribed, are the questions, “How many diets have you been on?” and “Are you already undereating?” asked? Not likely.
If assessed, I would bet the majority of patients would report multiple attempts at weight loss, each with a new diet as the focus. Otherwise, it’s unlikely they’d try an injectable medication as a first line of defense. So, when someone has intentions of losing weight, knowing they also need to cut calories to sustain said weight loss and is taking a medication known to reduce hunger, it can create the perfect storm. When you don’t feel hunger, you don’t second guess it; that must mean it’s working. Maybe, you rejoice, finally feeling like this time, it’s going to be a little easier. It can become tempting to skip meals or knowingly cut calories, and this may cause you to eat way under your actual calorie needs, or energy requirements. The potential for periods of intense restriction can lead to a slowed metabolism and can also increase the risk of malnourishment. Worse, the malnourishment may go unnoticed, as our healthcare systems often validate the notion that malnourishment couldn’t possibly occur in persons in larger bodies. In all cases, undereating and weight loss increase the risk for the development of eating disorders.
Someone taking a GLP-1 may report fewer cravings for fatty foods. While GLP-1’s do act on parts of the brain, these changes in cravings are more likely due to the fact that delayed gastric emptying makes it more uncomfortable for the body to try to digest fat. Additionally, some people report eating healthier, but too often, we assume simply eating less means we are eating healthier, and that’s not the case. Remember:
You can’t eat better if you aren’t eating enough.
What if someone needs to lose weight for health reasons?
That’s a fair question! A lot of praise for weight loss injections highlights the improvements in blood work, like reduced blood pressure, better lipid profiles, and naturally, improved blood sugar management. However, we aren’t hearing much about how these markers change once weight is regained. Not only is weight cycling itself proven to increase the risk for cardiovascular disease, but it also increases the likelihood of body dissatisfaction and even depression. Remember that all aspects of health and wellness are important.
As mentioned, we now have the research to support individuals must stay on the medication in order to sustain the majority of the weight loss. The disconnect? That’s not how it’s being prescribed or socialized. Many individuals I have talked with who have been prescribed weight loss injections report their provider only wants them to take it for a few months, or until they reach their goal weight.
But this medication is supposed to be used for life!
That’s right! So, let’s say your provider prescribes this medication with the best of intentions, but you aren’t able to stay on the medication long-term. This could be due to issues with availability, cost, changes with insurance coverage, or your quality of life due to various side effects.
Would you believe that pharmaceutical companies, healthcare providers, and your great uncle are all finally admitting intentional weight loss using diet and exercise is unsustainable? It’s true! Additionally, we now know that once people come off weight loss injections, weight gain comes back for the vast majority of patients.
So…. If we know “eating less” and “moving more” in fact, does not work for weight loss in the long term, (and by does not work, we mean in 92-95% of cases), why on earth is it still being recommended when patients come off the drug, knowing weight gain is inevitable without the drug?!
The disconnect is insurmountable.
How It’s Causing Harm
Claims are being made that classifying “obesity” as a disease will help end weight stigma.
How can that be true if the same, fatphobic, underlying message remains: “Your body is a medical problem, and you need to continue to try to fix it, but you can’t do it alone! The only way you can do that is with our drug.” … “(but once you can’t afford, access, or tolerate the drug’s side effects, we’ll go back on what we said and continue to recommend you give it your best efforts the good old-fashioned way)”
In the end, fat folks continue to lose. Shame and blame are being placed on individuals right now, and it seems there is no way to win:
If you live in a larger body, and you take the medication, you’re attacked for stealing the drug from the diabetic population.
If you live in a larger body and you don’t “take advantage” of the medication, you’re attacked and labeled a moral failure, even though these drugs are not accessible to the vast majority of the population, at least for long-term use.
Please take a moment to consider who is actually benefiting from you taking this medication.
To Wrap it Up
Intentional weight loss almost always results in weight regain. The bottom line is these stats don’t change with the temporary use of weight loss injections.
If you want to use weight loss injections as a weight loss tool, it’s important to ask yourself what you hope to gain from losing weight (no pun intended), and whether or not you will be OK with weight regain, from a physical health & body image perspective. Are you willing to potentially sacrifice your relationship with food and your body? If not, recognize that you may need to rely on this medication for the rest of your life. Please take the time to speak with your trusted, preferably weight-inclusive healthcare provider and consider the long-term cost: financially, physically, and emotionally.
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.
We encourage you to continue to ask questions and advocate for yourself in the healthcare setting. Check out our previous Blog Posts to Learn More about Fatphobia & Weight:
Sources Used:
Bartel, Sara et al. “Use of glucagon-like peptide-1 receptor agonists in eating disorder populations.” The International journal of eating disorders vol. 57,2 (2024): 286-293. doi:10.1002/eat.24109. Retrieved on Feb 11, 2024 from https://pubmed.ncbi.nlm.nih.gov/38135891/
The Cleveland Clinic. “GLP-1 Agonists”. The Cleveland Clinic. Retrieved on Feb 19 2024 from https://my.clevelandclinic.org/health/treatments/13901-glp-1-agonists
Holcombe, Madeline, “The Questions Eating Disorder Experts have about Weight Loss Medications”. CNN. February 26, 2024. Retrieved on March 3 2024 from https://www.cnn.com/2024/02/26/health/semaglutide-weight-loss-eating-disorders-wellness/index.html
Puhl, R. M., & Heuer, C. A. (2010). “Obesity stigma: important considerations for public health” American Journal of Public Health, 100(6), 1019–1028.
Shu, Yamin et al. “Gastrointestinal adverse events associated with semaglutide: A pharmacovigilance study based on FDA adverse event reporting system.” Frontiers in public health vol. 10 996179. 20 Oct. 2022, doi:10.3389/fpubh.2022.996179. Retrieved on Feb 11, 2024 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9631444/
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!
