Thinking about jumping on the weight-loss drug trend?
Maybe you are tempted by what you have heard – promises of being successful in your pursuit of weight loss or reducing mental obsessions about food. However, it is worth considering some of the emerging reports of risks.
And please, use an abundance of caution if you have a history of an eating disorder.
“My fear is that there is now a belief that anyone can and should achieve a certain body shape and size with the help of these medications, so there’s going to be an even greater drive towards a certain body type…”
– Tracy Richmond, Director of the Eating Disorder Program at Boston Children’s Hospital
New forms of weight-loss drugs are making waves across news media, the internet and celebrity culture, and are slowly seeping into society at large. You probably know one or more people who are taking them.
As medications like these become more popular, pay attention to the impact such drugs may have on the general population as well as the particular risks they pose for individuals with current or historical eating disorders.
Issues of Note
- What are the emerging risks?
- Who is screening for individuals with eating disorders?
- Why not refocus on sustainable, healthy eating strategies?
- How may these medications help or harm children?
Weight-Loss Drugs Defined
Just what is a weight-loss medication? Can such a drug enter your body and melt away unwanted fat stores? Not quite – the effect is indirect.
Most typical weight loss drugs are classed as appetite suppressants. These act on the first steps of consumption – by reducing your cravings, you may be less motivated towards food-seeking behavior. In most cases, the weight loss comes from the calorie deficit that eating less overall may provide.
When assessing risk, research in this field often also includes the effect of diet pills, although they have a different mechanism of action. These over-the-counter supplements typically provide apparent weight loss through temporary laxative or diuretic effects.
Benefits and Risks: Special Concerns in Eating Disorders
Nature reported findings of the study SELECT, which “enrolled 17,604 people who already had cardiovascular disease, but no history of diabetes”. Participants received injections of either the weight loss medication or a placebo. After being followed for five years, “those who got the drug had a lower risk of heart attack, stroke and death from cardiovascular disease than those who received the placebo.” Sounds promising, right?
Despite the good news, other questions remain such as:
- What are the reasons for the cardiac benefits?
- How can individuals maintain their weight after stopping the medication upon reaching their goals? Or, are these medications supposed to be taken long term? If so, is that information being shared at the outset?
- Why are some individuals experiencing a potentially life threatening stomach problem?
- How do individuals and their doctors balance potential benefits with the dangers of eating disorders? Is there an algorithm that is being implemented to make the decision?
For example, some studies have shown that patients tend to regain weight after stopping the new weight loss medications.
There are also concerns about food moving too slowly through the gastrointestinal (GI) tract, which is called delayed gastric emptying.
In recent months, there have been reports to the FDA that the new weight loss medications may result in stomach paralysis, or gastroparesis that does not stop, even after discontinuing the medications. As you can imagine, stomach paralysis is a debilitating disorder that can result in life-threatening complications.
A Gateway Drug?
The biggest concern when it comes to eating disorders and weight-loss drugs comes from research that showed diet pill use itself to be predictive of adolescents and young adults developing an eating disorder in the next five years.
Now that the FDA has approved weight loss medication for some children and teens ages 12 and older, will we see a rise in eating disorders which have a high mortality rate?
This has led to the use of such pills being dubbed “gateway behaviors” by Harvard professor S. Bryn Austin, who leads a strategic training initiative for the prevention of eating disorders.
Both diet pills and weight-loss drugs are immersed in diet culture, a trigger for those with an eating disorder history. For children and adolescents, their doctors may not know if they are genetically vulnerable to an eating disorder because they have not reached the average age of onset. While these medications may bring about weight loss, at what cost?
We know that eating disorders are strongly influenced by genetics. At the same time, epigenetics tells us that our environment, level of stress, behaviors, and co-occurring psychological traits may turn them on or keep them off. Weight loss is one condition that can flip that genetic switch.
For individuals with the genetic vulnerability for developing an eating disorder, certain stimuli may become conditioned to be experienced as highly rewarding, especially when related to measurements of weight loss.
Embarking on the use of weight loss drugs and witnessing numbers on the scale drop may act as a trigger for these conditioned stimuli, firing associated pathways in the brain that lead to the onset or resurgence of eating disorder behaviors and thoughts.
Another Yo-Yo Diet
Many individuals with a history of an eating disorder recall a desire to lose weight at its onset – engaging in unhealthy behavior to lose weight, relaxing the behavior, feeling shame, and then regaining weight.
Diet pills are particularly associated with those with behavioral cycles and the tendency to restrict food, then binge and purge, heightening the risk of a yo-yo pattern of behavior and weight change.
Unfortunately, there is a dependence associated with weight loss drugs. In 2022, Wilding et al. showed that users of one recently popularised weight loss drug regained two-thirds of the weight within a year of stopping the medication.
When halting the use of weight-loss drugs, those with a history of eating disorders may soon find themselves back at the weight where they started, and flipping the genetic switch back on and setting off this cycle once more.
There are potential side effects listed on all medications, but we often overlook them when they serve a need. Weight-loss drugs, particularly when first started, have been associated with side effects such as nausea and vomiting. Individuals who have experienced a purging-related eating disorder may find these side effects especially difficult. Purging behaviors are dangerous because they can lead to a sudden onset of electrolyte imbalance, damage the health of the stomach, throat, teeth, and mouth over the long term.
Therefore, individuals with such a history should be cautious when taking medication that could potentially exacerbate this damage.
What About Screening for Eating Disorders?
With all this in mind, are all doctors screening for eating disorders before prescribing such medication? Typically, no.
Since eating disorders cannot be identified by body shape or size, individuals in larger bodies who may be targeted for medically driven weight loss may be quietly struggling with atypical anorexia, binge eating disorder, or bulimia nervosa.
How about a Sustainable Approach to Health and Weight?
The Health at Every Size [HAES] approach promotes healthy eating practices without promoting weight loss. HAES interventions respect and support all of the following:
- Individual nutritional needs,
- attunement with sensations of hunger, satiety, and appetite,
- the development of positive body image for individuals of all shapes and sizes,
- and enjoyable, sustainable physical activities.
While some experts argue against the HAES approach, fearing that it leads to a passive lifestyle and poor nutritional choices that result in weight gain, this has not been consistently shown in the data.
For example, a recent study published in Frontiers in Nutrition (2022), described the impact of an HAES weight neutral intervention on cardiac, metabolic, and quality of life. The researchers found that, among study participants, weight loss was not the only outcome measure that led to a positive health impact.
The findings may surprise you.
80% of the participants reduced or maintained weight and experienced positive changes in their eating attitudes, body image, physical capacity, and quality of life.
“…improvements in cardiovascular risk factors and quality of life following an HAES®-based intervention were associated with weight loss. Indeed, beneficial effects were more pronounced in those who reduced body weight; however, participants who maintained or even gained weight also experienced benefits to some extent regarding cardiovascular health and quality of life.
These findings suggest that weight loss enhances, but does not determine, the beneficial effects of a weight-neutral, lifestyle-modification intervention….”
– Ulian et al. (2022)
The Summary: Sustainable Strategies
Weight loss drugs can be risky and they do not address beliefs or behaviors. So, where do we go from here?
Change your beliefs.
Unfortunately, health interventions that make weight loss the cornerstone goal of eating practices can be frustrating, marginalising, and downright dangerous due to:
- the common occurrence of diet and weight loss failures,
- the inherent message that there is one body type that is better than another,
- the promotion of body shaming,
- and the potential for worsening negative body image and eating behaviours that might lead to or maintain an eating disorder.
Embrace a weight neutral approach to having a healthy lifestyle. HAES, Intuitive Eating and Mindfulness Based Eating are three science-backed approaches that are based in a weight-inclusive paradigm for sustainable, healthy eating.
Act as a gatekeeper for children and teens.
Most importantly, iIf you are a parent whose child or teen has been prescribed weight loss medication, use the utmost caution and consider your child’s genetic vulnerability for developing an eating disorder. You are the gatekeeper for your child.
Acknowledge the risks.
You may want to ignore the known and emerging risks because weight loss drugs can provide temporary and efficient weight loss. However, this change is not likely to be sustainable, once an individual comes off the medication.
In addition, these drugs come with medical risks, the potential of triggering the onset of an eating disorder in children or teens, and the danger of relapse for adults with an eating disorder history.
Be proactive and holistic about your health.
Before taking weight loss drugs, have a thorough conversation with your doctor or professional about what is right for you. Take into account all aspects of your physical and mental health. And, if you have an eating disorder or have recovered from one, I strongly recommend that you work with an eating disorder specialist along with your medical provider when making the decision about what’s best.
“This is just another new tool in the toolbox for self-destruction for people who have eating disorders.”
– Dr. Kim Dennis, eating disorder expert
Hazzard, V., Simone, M., Austin, B., Larson, N., & Neumark-Sztainer, D. (2021). Diet pill and laxative use for weight control predicts first-time receipt of an eating disorder diagnosis within the next 5 years among female adolescents and young adults. International Journal of Eating Disorders, 54(7), 1289-1294. https://doi.org/10.1002/eat.23531
Lenharo, Mariana. (2023). Anti-obesity drug also protects against heart disease — what happens next? Clinical-trial data suggest that semaglutide, sold under the name Wegovy, slashes risk of heart attacks and other cardiovascular incidents. Nature Journal. August 10, 2023.
McLeod, S. (2023) Operant Conditioning: What It Is, How It Works, and Examples. Retrieved from https://www.simplypsychology.org/operant-conditioning.html
Obeid, N., Flament, M. F., Buchholz, A., Henderson, K. A., Schubert, N., Tasca, G., Thai, H., & Goldfield, G. (2022). Examining Shared Pathways for Eating Disorders and Obesity in a Community Sample of Adolescents: The REAL Study. Frontiers in psychology, 13, 805596. https://doi.org/10.3389/fpsyg.2022.805596
Reba-Harrelson, L., Von Holle, A., Thornton, L. M., Klump, K. L., Berrettini, W. H., Brandt, H., Crawford, S., Crow, S., Fichter, M. M., Goldman, D., Halmi, K. A., Johnson, C., Kaplan, A. S., Keel, P., LaVia, M., Mitchell, J., Plotnicov, K., Rotondo, A., Strober, M., Treasure, J., … Bulik, C. M. (2008). Features associated with diet pill use in individuals with eating disorders. Eating behaviors, 9(1), 73–81. https://doi.org/10.1016/j.eatbeh.2007.04.001
Dimitrov Ulian M, Pinto AJ, de Morais Sato P, Benatti FB, Lopes de Campos-Ferraz P, Coelho D, Roble OJ, Sabatini F, Perez I, Aburad L, Vessoni A, Fernandez Unsain R, Rogero MM, Sampaio G, Gualano B, Scagliusi FB. Health at Every Size®-Based Interventions May Improve Cardiometabolic Risk and Quality of Life Even in the Absence of Weight Loss: An Ancillary, Exploratory Analysis of the Health and Wellness in Obesity Study. Front Nutr. 2022 Feb 22;9:598920. https://doi.org/10.3389/fnut.2022.598920. PMID: 35273983; PMCID: PMC8902219.
Wilding, J. P. H., Batterham, R. L., Davies, M., Van Gaal, L. F., Kandler, K., Konakli, K., Lingvay, I., McGowan, B. M., Oral, T. K., Rosenstock, J., Wadden, T. A., Wharton, S., Yokote, K., Kushner, R. F., & STEP 1 Study Group (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, obesity & metabolism, 24(8), 1553–1564. https://doi.org/10.1111/dom.14725All Blogs