Eating Disorders in a GLP-1 World
This weekend a friend asked me how my work in the eating disorder space has been impacted by the increase in GLP-1 usage. I asked her how many hours she had to chat.
I’ll start with a caveat. Yes, you are allowed to want to be thin. Goodness knows our society is not kind to folks in bigger bodies. I don’t blame you for feeling pressure. But when the tradeoff for thin creates restrictiveness, rigidity, and negative physical and/or emotional health consequences to achieve a smaller body, then we have crossed from preference to maintain a certain aesthetic to disordered. And if you are in that space - please know there is help and you don’t have to suffer. This place of body dysphoria and thin-at-all-costs - my colleagues and I who work in the ED space are deeply committed to helping folks rise out of this place.
One gigantic issue with the GLP-1 craze has to do with direct-to-consumer advertising. I suggest following and reading everything William Hornby has to say on this topic. I’ll summarize some thoughts from his recent piece “The GLP-1 Ad Plague” here: The US is one of only two countries (New Zealand being the other) in which pharmaceutical companies can directly target consumers. “Ask your doctor if XYZ drug is right for you!” And guess what! Your doctor is likely to greenlight the prescription, regardless of your overall metabolic health - your labs, your lifestyle, your diet, your movement routines, whether there is any evidence to support positive health outcomes from the drug. Did your doctor even ask you about your relationship with food? If you have ever suffered from an eating disorder? Or if you suffer currently?
Just like that you can start taking the shots in the name of health - just like Serena Williams and Charles Barkley. The drug manufacturers are counting on diet culture’s vice-like grip on Americans, rampant fat-phobia, and the assumption that anyone - nearly ANYONE - could benefit from being thinner. The moral designation that thin equates health is deeply problematic and it is not factually correct. Okay - but what about metabolic health and diabetes and heart disease and the dangers of obesity? Well, right now, we’re not talking about that. Yes - there are some folks with heart disease, diabetes, and/or strong family histories who also have a significantly elevated BMI who may benefit from lifestyle change which may include weight loss. But those folks are not the topic of this piece.
I am talking about how almost anyone can now get a script for a GLP-1, and we don’t even yet know (though we can make an educated guess) what the long-term consequences of these drugs are - particularly on the growing population of peri- and menopausal women taking them. Would a medical expert who supports GLP-1 use for healthy folks please weigh in (pun intended) on what we might expect when women who are already losing muscle mass and who are at risk for bone mineral loss and who are, on one side of the menopause discussion, being told to “lift heavy and eat lots of protein” are also benefiting from going from a size 6 to a size 00 within a matter of months due to appetite loss and gastrointestinal distress masquerading as health?
What does this have to do with eating disorders? Back to my point. As people in “normal” bodies see their own body shapes and sizes less frequently represented, they may feel increased pressure to achieve the new GLP-1 look, to achieve the lean - no, wasted - look of someone who has lost their appetite and desire for food. And if we continue to normalize this, we risk stepping into a whole new level of preoccupation with being thin, self-criticism for having a robust appetite, and a deepening into the abyss of body dysphoria and size discontent.
And as I alluded to above, another major problem is that by and large, doctors are not screening patients for eating disorders/disordered eating before prescribing GLP-1s. If someone is presenting with a BMI considered within normal limits (or even above) it typically does not cross anyone’s mind that they may be struggling with their relationship with food and their body, and that what they need more than a weight-loss drug is a referral to a good health-at-every-size aligned therapist and dietitian before anything else.
I, for one, am here to support anyone who is struggling with body image and confusion over what healthy looks and feels like. You can trust your body with food without a drug. Dietitians and therapists can help. Reach out.
