- Injectable prescription medications like Ozempic and Wegovy are in the news for their ability to help people lose weight.
- Some experts are raising concerns that the increased spotlight on these medications could contribute to eating disorders.
- Many people regain much of the weight they’ve lost after they stop using these medications, which can also lead to disordered eating and increased health risks.
Semaglutide, better known by the brand names Wegovy and Ozempic, has been making headlines over the last several months for the medication’s ability to help people lose weight.
Only Wegovy is FDA-approved for weight loss, though many people, including celebrities and online influencers, have been taking Ozempic off-label for weight loss, too.
In fact, comedian Chelsea Handler says her doctor prescribed her Ozempic in case she wanted to lose 5 lbs and Elon Musk credited Wegovy for helping him lose weight.
Some experts say the conversation has its benefits. After all, trials, including a double-blind one in 2021, indicate that taking 2.4 mg of semaglutide once per week, combined with lifestyle changes, could help people lose weight.
“It’s important to discuss some of these medications that might aid in weight loss and how these medications are used,” says Dr. Genna Hymowitz, Ph.D., licensed psychologist at Stony Brook Medicine and the director of bariatric and weight loss psychology. “These decisions can hopefully address misinformation and ensure these drugs are prescribed thoughtfully [as medically indicated].”
Still, the discussion became low-hanging fruit at the Oscars on March 12. During the broadcast, host Jimmy Kimmel poked fun at the situation.
“When I look around at this room, I can’t help but wonder, ‘Is Ozempic right for me?’” Kimmel quipped.
Not everyone is laughing.
The following day, British actress Jameela Jamil posted on her Instagram, “A lot of discourse about how skinny everyone is at the Oscars this year…a LOT..of people this year took weight loss injections…I’m not being judgmental. I just don’t want you to be triggered, or to make any sudden decisions, because of images of impossible standards that come about today.”
Though Hymowitz doesn’t deny the drug’s benefits for qualified patients, she agrees the discussion requires nuance.
“Sometimes, how these medications are portrayed in the media and particularly social media can be tricky, particularly if you have somebody who might be vulnerable to symptoms of disordered eating or already has body dissatisfaction,” Hymowitz says.
Why experts are concerned about the focus on new weight loss drugs
Disordered eating can present physically — rapid weight loss or gain or fluctuating weight. But there’s also a mental component.
“Eating disorders are brain disorders,” says Dr. Nicole Garber, the chief medical officer with Alsana, an eating disorder recovery community. “This means that someone can still be triggered with thoughts of weight loss when talking with friends, even if they avoid acting on certain behaviors.”
So, when someone brings Ozempic jokes at the Oscars or Wegovy in the news at dinner or while shopping with friends, they don’t mean harm. But it can make a person that’s vulnerable to or in recovery from an eating disorder think about weight, which can be unintentionally harmful.
Experts believe a significant issue is all the talk about weight loss and the desire to lose it — even those last 5 lbs. — and what it represents.
“Discussions surrounding weight loss drugs contribute to disordered eating by encouraging weight loss at all costs,” says Ashley Moser, LMFT, CEDS, the clinical Education specialist at The Renfrew Center. “It reinforces the message that all people should strive for thinness and be willing to do so with whatever means are available, even if there is a cost to their physical or mental health. Those in eating disorder recovery are especially vulnerable to these messages as they can normalize disordered behaviors in the pursuit of a smaller body.”
Hymowitz raised a similar flag.
“The main issue is the focus on these medications for cosmetic reasons perpetuates this idea of weight stigma,” Hymowitz says. “It also brings us back to this thin ideal and the idea that individuals should be evaluated based on how they look.”
What’s more, not everyone needs to be on these weight loss drugs.
Wegovy is approved for chronic weight management for individuals who are either obese or overweight with a weight-related condition such as high blood pressure or type 2 diabetes.
Ozempic is only approved for people with diabetes.
That doesn’t mean the drugs won’t do what they’re designed to do — in part, suppress appetite — if someone who does not meet the qualifications is prescribed or gets their hands on them. And experts warn that’s not a good thing, particularly in people in recovery from or at risk for developing eating disorders.
“While eating disorders are complex and often do not have a single identifiable cause, many people who develop eating disorders report dieting as a precursor,” says Moser. “Knowing this, anyone prescribed weight loss drugs is at risk for the development of an eating disorder.”
Yo-yo weight loss is problematic
Hymowitz notes that Wegovy was designed for long-term use. In fact, a 2022 study looked at people who had lost weight but stopped taking their weekly 2.4 mg doses of semaglutide. The results indicated that participants put two-thirds of the weight back on within a year of ceasing use.
“It’s important to consider how these medications work,” Hymowitz says. “These medications affect the hunger centers in the brain,…when stopping these medications, the hunger, appetite, and cravings return, and the weight returns because of the physiological process.”
Hymowitz adds that the medications help a person adhere to dietary guidelines. Without the drug’s assistance, they begin consuming more calories. Consequently, they may fall back into old habits to compensate, such as vomiting, over-exercising, and following an overly-restrictive diet to make up for the increased amount of calories they consume.
“It’s a slippery slope,” Hymowitz says. “With disordered eating, every pound lost or gained is significant. There are a lot of emotions…It can feed into this tricky mindset.”
And those regained pounds can feel emotionally crushing.
“Repeated cyclical changes in weight can cause persons to lose hope and motivation, making it more difficult to address health issues related to nutrition,” says Dr. Ryan Pasternak, MPH, an adolescent medicine physician with Children’s Hospital New Orleans who works with patients with eating disorders.
There are health risks associated with yo-yo weight loss, too. Among them, a 2022 study of nearly 81,000 postmenopausal women suggested a link between endometrial cancer and weight cycling.
A 2022 study of animals indicated that weight cycling could have adverse effects on metabolism. Though a 2017 study indicated that there is some evidence to suggest yo-yo weight doesn’t affect type 2 diabetes risk and may not have a significant effect on metabolism.
Hymowitz points out that it’s unclear how semaglutide will affect metabolism long-term. Regardless, she tries to help her patients avoid weight fluctuations.
“We’re not sure if we are going to see the same impact in terms of metabolism in terms of stopping these medications, but we will see weight regain,” she says. “In addition to stress, if someone has type 2 diabetes and was taking these medications and all of a sudden they are not, their blood sugars can become dysregulated, and they may start experiencing vision impairment and difficulty healing.”
Signs weight loss drug headlines may be adversely affecting you
Hymowitz says that the signs that weight loss drug headlines may be triggering you can include:
- Avoiding eating with others
- Viewing foods as safe or unsafe
- Cutting out entire food groups
- Eating rituals, such as moving food around the plate without eating it or cutting food into small pieces
- Body checking, such as pinching fat, weighing, and avoiding the scale
- Uncontrollable thoughts about weight, eating, body shape, and exercise
- All-or-nothing thinking around diet and exercise (“I have to work out for two hours or not at all”)
Hymowitz stresses that it’s important for patients who do qualify to take medications like semaglutide to receive holistic care, not just a prescription. She says this care team should include:
- An obesity medicine specialist who knows the risks, benefits, and contraindications of these medications and screens for disordered eating. (Preferably, they work with a behavioral health specialist specializing in disordered eating.)
- Behavioral health providers who can monitor or help patients work through disordered eating triggers and behaviors.
- Dieticians can ensure patients are getting the nutrients they need to thrive.
How to cope with triggers
If you’re feeling triggered by conversations and headlines about new weight loss drugs like Ozempic, you are not alone. However, experts say there are healthy ways to cope, including the following:
View social media and headlines through a critical lens
Moser suggests stepping back when you see a post or story on weight loss drugs.
“People in recovery are encouraged to consume media critically versus taking media at face value,” she says. “‘What is the purpose behind the media? Who stands to profit?’ are a few examples of questions to ask in response to exposure to media focusing on weight loss.“
Unfollow accounts on social media
You cannot control what the news reports or people post on social media. But you can curate your feed to make it a mentally and emotionally healthy space to scroll.
“It’s important to limit time spent on social media and reading some of these articles, especially for some individuals who might be more vulnerable,” Hymowitz says.
Unfollowing individuals that focus on weight and weight stigma can also help.
Find stress management tools
Even if you unfollow accounts that trigger you, you likely won’t completely avoid Ozempic-related headlines. A friend may make a joke in passing, or a news item may scroll across the TV while you’re at the gym. These instances make having coping tools in your toolbox important.
Hymowitz recommends hobbies and other activities like meditation or creative pursuits.
“It’s not going to take the stress away completely, but it can provide a buffer,” she says.
Lean on support
You don’t have to bottle up your feelings.
“People in recovery are encouraged to talk about exposure to headlines and how it impacts them with people who support their recovery,” says Moser.
“Engage with family and friends who are empathic and validating,” Hymowitz says, adding that therapists and support groups can also help. She says that the helplines, like the one from the National Eating Disorders Association, can also provide assistance.
Remember, the number on the scale does not define you
Despite what the headlines may imply, weight is not the be-all-end-all of health – or you.
“Although weight loss is celebrated in our culture, it isn’t a linear path to improved health – and it may actually be a marker for decreased health, psychological issues, or life stressors such as food insecurity,” says Garber.
Just like patients deserve holistic care, they — including you — also deserve to view themselves in a holistic way.
“It’s helpful to shift the focus away from the number on the scale and look at other factors that can indicate health, such as blood sugar and blood pressure, and it’s also really helpful for all of us to really remind ourselves that we are not the number on the scale or our appearance,” Hymowitz says. “We don’t have to be defined by them. We can think about other attributes that make us who we are.”
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