Are GLP-1's Harmful to Disordered Eating Recovery?: My Opinion As An Eating Disorder Therapist in Raleigh, NC
The prescription and use of GLP-1 drugs like Ozempic and Wegovy have increased sharply over the past few years.
These drugs have historically been used for the management of Type 2 Diabetes but are being used for off-label weight loss. It’s hard to escape media stories of dramatic celebrity weight loss and even ads from entities like Weight Watchers applauding the use of GLP-1 medications for losing extra pounds or weight management.
For clients in recovery from disordered eating and chronic dieting who still struggle with body image, seeing this news can bring up questions of whether or not they should explore using GLP-1 medications. Add these questions to the voices of influencers on social media (even those who once touted body positivity and weight neutrality), the pharmaceutical industry, and the diet industry and you can understand how the allure of GLP-1’s can create confusion among people trying to recover. Beyond the individual, we’re living in an era of upheaval and loss of control (societally, politically, interpersonally, etc.), so the siren song of a quick fix for weight loss or weight management can feel like an anchor in the storm.
But we have to ask the hard questions and use critical thought about the use of these drugs. Here’s my take on GLP-1’s and disordered eating recovery.
What are GLP-1’s?
GLP-1 (Glucagon-Like Peptide-1) is a hormone naturally produced in the intestines that plays a crucial role in regulating blood sugar and appetite. Here’s how they work: First, GLP-1 is released by intestinal cells in response to food intake to help regulate insulin and glucose metabolism. Then, it stimulates insulin production from the pancreas and manages blood sugar. GLP-1 also signals the brain to reduce hunger and slows gastric emptying, making you feel full longer. It’s been used to treat Type 2 Diabetes, but some medications like semaglutide (Ozempic, Wegovy) mimic GLP-1's effects and are increasingly used for weight management and diabetes treatment. These medications work by binding to GLP-1 receptors and providing similar metabolic benefits to the natural hormone, helping patients manage blood sugar and potentially lose weight.
My Take On GLP-1’s
If you have a history of an eating disorder, a funky relationship with food/body, or you are a chronic dieter, then you’ve probably read all about GLP-1 medications (from now on, I’ll refer to them as GLP-1’s). Take a moment to see how your brain reacts to reading the paragraph above. Does it feel interested in checking out GLP-1 use? Does it feel hopeful like it’s something that will “fix” those extra pounds? Do you want to lose weight (even if you don’t need to)? If your answer is yes, then check your diet mentality. Because that’s what it is.
GLP-1’s can feel “triggering and enticing,” says Cole Kazdin in their Times Magazine article - I agree because I’ve heard this from my clients, too. It’s enticing (and triggering) because the use of GLP-1’s is a fancy (expensive) diet. Plus, diet ads bring the allure of hope, change, and getting control of something that isn’t always controllable: our bodies.
These medications are a diet without saying it outright. They tend to create an environment in which hunger lessens, so folks eat less.
Doing so creates a calorie deficiency that starves the body, so weight loss happens. Once off these drugs, people usually gain back the weight they lost and more (which is a key side effect of dieting).
Another issue I have with GLP-1’s is that using an external hunger modulator can further muck up a person’s ability to tune into their bodies. Folks with a history of eating disorders and chronic dieting usually have difficulty interpreting their hunger and fullness cues and when they do they’re often influenced by diet culture, real or psychological restrictions, food rules, shoulds or should nots of eating, and messages from the culture about ignoring hunger. In addition, people often use these drugs in addition to extreme weight loss methods such as overexercising. Many times, these behaviors are normalized by doctors, but they’re actually symptoms of an eating disorder.
Furthermore, the medical implications of GLP-1’s are still being discovered, so it’s a little bit of the Wild West in terms of the impact of using these for longer than two years (which is the max of the longest study done). In addition, most people will need to stay on these meds for the rest of their lives in order to maintain weight loss.
Another issue I have is with the expense. These are incredibly expensive drugs that aren’t always covered by insurance. This puts the economic burden on consumers (and reinforces the whole bootstrapping, spending tons of time, money, and energy trying to lose weight aspect of diet culture). Also, I find it shady that there’s a lot of money to be made by prescribing these due to consumer interest and demand. There is an economic incentive for GLP-1’s to be overprescribed.
These are just a few lesser concerns I have about GLP-1’s. Keep reading for more about my concerns related to eating disorder recovery.
How GLP-1’s Harm Recovery Efforts
As folks with an eating disorder history know, the allure of weight loss can be a quick slip into relapse. Even considering GLP-1’s for weight loss can lead to diet or disordered eating thinking, which is a slippery slope for people in recovery. In addition, the pursuit of weight loss with medication perpetuates diet culture thinking, reinforcing the impossible standards of diet culture and the thin ideal that encourages weight loss at all costs.
Furthermore, taking these drugs can cause hunger cues to disappear so it’s easier to relapse into restrictive disordered eating. There’s also evidence that upwards of 25% of chronic dieters develop an eating disorder, making this “wonder drug” a possible gateway to a clinical eating disorder.
Additional physical and mental health impacts include:
Malnutrition with the reduction of caloric intake due to reduced appetite and side effects like nausea, vomiting, headaches, and fatigue
Increased mood disorder symptoms like anxiety and depression
Health problems like gastroparesis that causes nausea and vomiting which can trigger relapse of bulimia
Possible changes in metabolism once off these drugs, weight gain, and relapse into the cycle of trying to diet to lose the weight
Weight cycling (or yo-yo dieting) which causes cardiometabolic issues such as heart disease, slower metabolism, and difficulty navigating hunger/fullness
Other health problems like pancreatitis may be long term effects of using GLP-1’s
Bottom line: GLP-1s’ can be harmful to recovery from disordered eating. They put a bandaid on the deeper issues often related to eating disorders. If you have a history of an eating disorder, I strongly recommend staying away from them.
The Issue With “Food Noise”
Proponents of GLP-1 medication argue that they take it to reduce the amount of food noise that they experience. Food noise includes things like thinking about what you're going to eat next, if you ate too much or too little, what foods are going to be better or worse for you, cravings, etc. Clients who come to me for chronic dieting and disordered eating recovery experience a lot of food noise. Most of the time this food noise comes from a sordid history of diet and exercise rules, body dissatisfaction, and living in a culture that stigmatizes larger bodies. Other times, food noise comes from ignoring actual hunger cues.
The biggest problem I see with the food noise argument is that most people who experience this phenomenon have a very difficult time tuning into hunger and fullness because they've been taught (often over decades) that their hunger and fullness cues are not to be trusted. The push for GLP-1 medications reinforces the idea that your natural cues aren’t reliable. Thus, these meds become an external regulator for hunger and fullness by reducing appetite in patients. Because we live in a culture that praises self-control, and willpower, and ignores our own bodily desires, this is exactly the kind of Puritanical prescription that reinforces the idea we need external regulation for our corporeal desires.
What if food noise is actually just hunger? What if food noise is a metaphor for the kinds of desires we suppress that our intuition screams for us to align with?
When people engage in disordered eating recovery and tune in to their hunger, fullness, and satiety cues they often find that the food noise decreases. In addition, they find that tuning into their bodies helps tune into their intuition and body trust. Diet culture and eating disorders keep us hungry (physically and metaphorically), snuffing out the self. It’s really hard to think and do life when your body is undernourished. It’s hard to take up space within a culture that tries to keep people as small as possible in mind, body, and spirit.
Yes, food noise is real. It’s annoying as hell. But what if it’s trying to tell us something? Weight loss medications are a bandaid. It keeps the food noise at low volume but doesn’t help folks learn how to listen to and deal with the physical cues, emotions, behaviors, and food rules underneath it. Studies have shown that once you stop a GLP-1 the food noise comes back, so you haven’t actually learned the skills to meet your body where it is regarding hunger and the diet messages that tell you to resist it. What I’d love (as an eating disorder therapist) is for you to do the work of dismantling real and psychological restrictions, diet messages, food rules, etc. so you can get in touch with hunger and fullness cues without having to use a GLP-1.
Considerations and Nuance with GLP-1’s
So far, I’ve really railed on GLP-1’s. I think they need some flack to take the shine off their celebrity status. However, I want to acknowledge that the impact of weight stigma and fat phobia in this world may drive people to explore using GLP-1’s in order to eliminate the pain that comes with that. The world has a long way to go in the realm of fat acceptance and inclusivity for size diversity.
Diet culture reinforces weight stigma, which is a very real issue that has serious impacts on health and mental well-being. I can absolutely understand the view of “if you can’t beat ‘em join ‘em” when you’re unable to fit in an airplane seat or ride a rollercoaster due to weight limitations. There is nuance here, which is why I won’t tell people to absolutely not use these drugs, but the bottom line is that they can cause harm if you have an eating disorder history.
Another piece of nuance: for people with diabetes and cardiovascular concerns who are using these meds for that purpose, the benefits may outweigh the risks - they have been proven to help with these issues and their effects are better studied on these diseases than for things like weight loss. If this is your experience, then GLP-1’s may be a good choice for you.
Ultimately, as an individual with autonomy, you get to choose your own adventure. If you decide to explore the use of GLP-1’s it’s vital to work with a doctor who will closely monitor the impact of these drugs on your body and recovery mindset. Do not work with someone who perpetuates and normalizes disordered eating behaviors such as further calorie restriction, over-exercise, monitoring macros, weight, etc. as this is grounds for relapsing into chronic dieting and disordered eating.
Where To Seek More Support For Recovery
If you’re juggling questions about GLP-1’s and struggling with recovery, you’re not alone. It is tough having a body. It is tough living in a culture that praises thinness at all costs. The best we can do is acknowledge that and continue to align with our values and essential selves.
To sort through these questions and maintain recovery, here are things to do:
Work with a therapist, weight-neutral nutritionist and/or support group to maintain accountability for staying adequately and consistently nourished
View social media through a critical lens
Unfollow accounts that talk about weight loss, dieting, and disordered eating or disordered fitness
Use alternative coping strategies besides scrolling, restricting, over-exercising, weighing, body checking, binging or purging
Change the topic away from diet culture and use of GLP-1’s
Lean on supports who understand the nuance and complexity of recovery in a culture that applauds weight loss
Start Working with an Eating Disorder Therapist in Raleigh, NC
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Start addressing the limitations of GLP-1’s!
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At Counselor Kate, I aim to provide compassionate support to help individuals process and overcome their eating disorders. I’m also happy to offer support with releasing trauma stored in the body through trauma and somatic therapy. Rediscover a harmonious relationship between food and your body through my intuitive eating services! Visit my blog or resources page for more helpful info today!