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Should You Take Ozempic For Binge Eating? (A Dietitians’s Thoughts)

by | Mar 27, 2024

We are in an interesting era with body positivity and weight loss drugs violently crashing into each other. The conversation about body weight, health, disordered eating, and this “new” class of weight loss drugs, Ozempic, Wygovy, and other glp-1 receptor agonists, is complex to say the least.

Because celebrities and high-profile influencers are losing weight on these drugs VERY publicly (and because women’s bodies are highly policed in our society), we are hearing A LOT about them.

Alongside this highly profitable explosion in popularity, many people, including some public figures are shouting “Revolution!” from the rooftops. Unfortunately, other equally opinionated folks are not getting that same attention. Those who are trying to alert the public of the potential harm this is causing and how our conversation must be more nuanced than it is currently.

But this clash isn’t just a debate; it’s a reflection of the deeply complex relationship we hold with our bodies and the societal pressures that shape them. It reflects two sides of a deep disagreement.

In this article, I’ll be explaining why this second group is getting zero airtime and explain why I, as an eating disorder dietitian who sees lots of folks with binge eating and binge eating disorder, am highly concerned for my patient’s well-being, especially those taking Ozempic for weight loss. 

What Are GLP-1 Receptor Agonists (Ozempic, Wygovy, etc)?

This class of meds have been around since 2005, so they aren’t actually new. They cause more insulin to be released from the pancreas when blood sugar gets high. They also slow digestion in the stomach and intestines, and tell the brain you’re getting full sooner. In folks with insulin resistance, these drugs also stop or slow the release of more glucose into the blood from the liver. 

These drugs were initially designed to help folks with type 2 diabetes manage blood sugar, especially those who were having trouble managing their blood sugar with their current medications. These drugs are extremely helpful for those with diabetes, and especially those with other conditions such as cardiovascular disease or those at risk of cardiovascular disease. 

This is not new. What is new is that now they are being rebranded and redosed (MUCH higher) for intentional weight loss. Weight bias, drug company profit, and ease of use are causing them to be extremely popular.

Novo Nordisk and $$$

Just want to leave this here since it’s always important to consider how much the drug company has to gain from more people taking a drug.

It costs $12,000- $24,000 per year for one person to take this medication for intentional weight loss and if you don’t have a medical condition that warrants it, insurance is unlikely to cover it. Novo Nordisk had made $1 Billion as of the end of 2023 from Wygovy and Ozempic alone.

As Dr. Erlanger, a weight-neutral family physical in the Seattle area pointed out so well in a talk by Weight Inclusive Nutrition & Dietetics that I attended recently,

What would happen if we gave that billion dollars to fat people? What if that money went into providing a safe and equitable healthcare environment? Blood pressure cuffs and chairs that fit, knowledgeable staff and surgeons trained on larger bodies? Would their health improve due to the likelihood they would attend more doctors appointments and feel less shame about their size? Perhaps.

Dr. Erlanger

Binge Eating Disorder (BED)

Binge eating disorder is a relatively new diagnosis (as of 2013) but is definitely not a new phenomenon. BED is the most prevalent eating disorder, affecting about 3% of the population. Binge eating is also a key aspect bulimia nervosa and is also seen with other eating disorders. With BED, however, no “compensatory” behaviors are used – like purging, using laxatives, or over-exercising.

BED is characterized by:

  • Eating a subjectively large amount of food in one sitting, often to the point of physical discomfort at least once a week for 3 months
  • Feeling out of control or unable to stop eating
  • Serious distress and shame about the binge eating

Folks struggling with BED commonly have very poor body image, significant shame and self-loathing, rarely talk to friends and family about it, and feel very lonely in their disorder. Not everyone with BED recognizes binge eating in themselves, but might think of it as emotional eating, being addicted to food, or being compulsive with food.

Not all people with BED are “overweight”. And not all people with anorexia are underweight. This bias is a huge part of the problem with diagnosis and treatment of eating disorders, and in our healthcare system in general.

Although it can be hard to fully understand this if you’re inside the eating disorder, binge eating is very often a reaction to a physical or psychological sense of “not enough”. The brain and body are acting out in an attempt to get your needs met. Effective treatment must include addressing what those needs are, not cutting off the behaviors at the neck.

About 30% of folks seeking out bariatric surgery have binge eating disorder. The actual number could easily be higher than that, due to low diagnosis and treatment rates, as well as anti-fat bias. It stands to reason that at least 30% of those seeking out these drugs would be the same. And if that is the case, eating disorders need to be part of every conversation a doctor has before prescribing these meds.

Why Ozempic Is Risky For Eating Disorders 

Most of what we know about GLP-1s and eating disorders is anecdotal because we don’t have good research on eating disorders and Ozempic. This might be because these drug companies don’t want to fund this type of research.

Maybe.  

In my experience, here’s what’s being ignored: To my knowledge, not one single doctor who has offered this drug to a patient of mine for weight loss has asked them about disordered eating, about their relationship with food, or warned them that this drug might be extremely disorienting. 

That said, we are still learning a lot about this medication and how it impacts folks long-term. Things have yet to be revealed and as always, science is always evolving.

My goal is to provide an exploration of how these drugs could cause harm, disconnect you from your body, and cause or exacerbate an eating disorder so that you may decide what is right for you. 

So, Here’s My Professional Opinion:

As humans, our appetites are a core part of our survival mechanisms. Messing with this system is going to cause disruption. Anything that disconnects someone from the natural rhythms of their body is bound to have some kind of unintended consequence.

Since these medications cause dramatically reduced appetite and pretty severe gastrointestinal side effects, they are unsafe for those with eating disorders. Food restriction exacerbates all eating disorders.

GLP-1’s have not been approved to treat eating disorders, including binge eating. Yes, it’s possible that these meds can (temporarily) reduce binge eating, but they are also likely to worsen the underlying problem, and exacerbate the condition in the long run, especially if the person is not very carefully monitored for their disordered eating, and maybe even if they are.

Myself and other eating disorder dietitians are concerned that binge eating and binge eating disorder is once again, just being thrown into the “body size problem” category and so much is getting missed.

Here is a break down of the reasons we need to be screening folks for eating disorders (at least) before prescribing these meds for weight loss and why I don’t recommend them for anyone with disordered eating, including binge eating, or severe body image distress.

Ozempic is a diet (the weight loss probably won’t last)

We know very well by this point that most people who try intentional weight loss gain it back, and most of them eventually gain more throughout their lives than those who never attempt significant weight loss to begin with. Weight cycling is worse for your health than never starting a diet. This is true for adolescents, kids, and adults. It’s really unfortunate, but that doesn’t mean we should keep denying it.

We don’t have good studies that show this high dose of medication is safe and effective long-term, and we DO have plenty of evidence that the appetite suppressive effects and side effects cause many people to come off of the meds. It’s pretty safe to assume that for most people on these drugs, weight loss will plateau or they will regain the weight that they lose

Weight cycling causes cardiovascular issues like increased cholesterol, loss of lean body mass, and impaired blood sugar control, which are all well known causes for high risk diseases and mortality.

Plus, dieting is a well-established risk factor for binge eating and other eating disorders for many reasons, including worsening body image, depression, and pathological weight loss.

Someone taking these drugs would be at risk of all of this if they ever come off of the meds, or if the drugs stop working to suppress their weight or appetite, or frankly, regardless of these things.

How Ozempic Is Affecting People Getting Treatment For Chronic Dieting

The majority of my clients have been on and off every diet under the sun their whole life. I spend a lot of time helping them unpack the damage that trying to lose weight has caused.  

I now also have several clients who have been on these medications for weight loss, have lost weight, and had one or many other intolerable side effects. They’ve come off the drugs for one reason or another – side effects, availability, cost, or just feeling like they reached their goal weight and immediately feel totally preoccupied with food again.

Their appetite and weight come back with a vengeance, just like every diet they’ve ever been on. 

This is really damaging. I already feel like many of these folks are at their wit’s end. They have been blaming themselves and their body for being wrong and broken. So in comes this miracle drug which is supposed to fix everything. 

But then it doesn’t. So it’s just another roller coaster, doing harm to the people I’m trying to help. 

Ozempic can exacerbate – and is not a treatment for – BINGE EATING

Eating disorders cause you to have an incredibly hard time nourishing your body consistently and adequately. They come with severe psychological distress. People with eating disorders are at 5x higher risk of suicide

A cornerstone of treatment for any eating disorder, including binge eating disorder, is consistent, adequate nourishment. This is essential no matter body size. You need structure and ENOUGH food. You need to ride the waves of your food urges, lean into discomfort, and explore your thoughts about food. You need to seriously reduce rules about what you “should” eat.

These drugs may make the “food noise” or obsessive thoughts about food quiet down TEMPORARILY, but they are not a solution to binge eating, or any eating disorder.

The binging behaviors are just the tip of the iceberg and treatment must include addressing what’s underneath. For many people with BED, constant thoughts are due to being in a constant state of wanting to eat less, body shame, impulsivity, and nervous system dysregulation.

Any drug that actively worsens someone’s appetite, causes nausea, and other digestive upset is going to exacerbate a disconnection if one exists, likely worsening the eating disorder down the road. Kicking the can.

I totally get why this is a relief.

If you’re used to constantly worrying about what you should and should not eat, feeling like you want to eat more than you “should”. Having those thoughts disappear is a HUGE relief.

I want that for you too.

I just want to make sure we’re having a conversation about the underlying issue and what type of treatment that issue might need, as well as any harm that may be caused by quieting those thoughts with a medication.

Our focus is to get you out of the nervous system response that is triggering your drive to be constantly worried about getting enough food. And the first way we do that is by nourishing ENOUGH. Adequate nourishment helps someone’s mind and body calm down and get them out of the reptilian scarcity brain.

Reconnected with one’s body and learning to respond to hunger signals is a central part of eating disorder treatment. These medications do the exact opposite.

What I’m saying is: binge eating and restriction are happening for a reason and that reason is not being addressed.

Ozempic can cause eating disorders

Just as bariatric surgery does not “fix” an eating disorder and can create or exacerbate an existing one, it’s likely these medications will do the same thing.

For the most part, eating disorders develop in people who are vulnerable to them, those with a family history, depression, anxiety, a trauma-history including sexual trauma, obsessive-compulsive disorder, or with a history of chronic dieting. 

When someone loses weight quickly and dramatically, they may develop an extreme fear of gaining weight and an oversized preoccupation with staying thin. This could be incredibly hard if someone is unable to keep the weight off, which is likely.

This over-identifying with one’s body size and shape is a hallmark of many eating disorders and body dysmorphia. 

Because these drugs make folks literally forget to eat, they make it so much easier for someone to spiral into very low food intake. It becomes easier to skip meals, eat as little as possible, and see how long they can go without eating, amplifying risk of developing anorexia nervosa (or atypical anorexia). Folks in larger bodies who are in starvation mode might not lose much weight, but can still experience all the medical complications of anorexia.

These drugs could also cause someone who has recovered from an eating disorder to be triggered into their old thought patterns and behaviors. Recovery comes with an outrageous amount of relief, peace, and health, but it doesn’t always come with a smaller body, and that’s okay. 

3 plus-size women in bathing suits, smiling.

Ozempic is Perpetuating Diet Culture and Anti-Fat Bias

Because of weight stigma, folks in larger bodies are less likely to be diagnosed with an eating disorder, and even when they are, their higher weight can be seen as a bigger problem than the disordered eating, so weight loss is still presumed to be a good option, even though it will not help them recover.

Oprah and other celebs losing weight are getting the giant bulk of the airtime – not surprising. This is the side of the drug companies, the systems of oppression that hates fat bodies. 

Some amazing fat liberationists are screaming and writing and doing a damn good job of fighting back against the onslaught. People in eating disorder recovery are struggling right now to keep distance between themselves and all of this media attention. Virgie Tovar is being targeted by the drug companies. and so has been writing pieces and posting on social media about how accepting her body has made her so much happier and she would never risk that by losing a few pounds.

If we want to really end weight stigma and eating disorders, we need to stop recommending weight loss.

If You Are Binging and Might Take (Or Are Taking) Ozempic, I Want You To Know:  

As I’ve made clear, I do not thinking taking one of these medications is going to help you recover from an eating disorder. Get real help to heal if you can. Reach out to me if you want to talk about working together to heal from binge eating. I specialize in this!

If you need support for eating issues, call or text the National Eating Disorders Association helpline at 800-931-2237.

you need to eat enough, even if you’re pumped about weight loss

I know it’s hard, but the best thing you can do (if you’re committed to losing weight despite it’s low success rate) is try to lose weight slowly. Make sure you’re consuming adequate calories, fats, proteins, and carbs. Do not let your brain convince you it’s okay to skip meals, to starve yourself, or to go as long as you can without eating. 

If your appetite is super poor, or your GI symptoms are making it impossible for you to eat, call your doctor. 

Take your side effects seriously

If you have serious side effects, it is very important you tell your doctor. Serious acid reflux can cause throat cancer. Low urinary output and kidney issues are common. If you’re very nauseous and unable to eat at least 2 meals a day, the side effects are too high to continue.

Don’t gaslight yourself.

Remember that you can heal binge eating without it (have you tried?)

Eating disorders are serious mental illnesses, but they are also very treatable. Binge eating disorder is absolutely something you can heal from. I recognize that treatment is difficult, and often expensive. But how much are you currently spending on this drug? How much are you spending on diet plans, supplements, and other means of shrinking your body?

What if you put all of that money into finding someone who can really help you?

Obsessing about food is your body telling you something

Try and remember that your brain is not broken and you are not addicted to food. All those voices in your head, worrying about what you should and should not eat, are actually your brain trying to protect you from starvation and victimization. Letting go of the obsession with losing weight can do wonders for your relationship with food. 

If you have an eating disorder and are considering trying these drugs, I suggest thinking very seriously before you start. Also recognize it’s super normal for you to feel tempted. Please don’t blame yourself or anyone else for taking these medications.

Despite the fact I disagree with these for binge eating, I recognize that this drug can also dramatically improve someone’s life. I recognize our society is biased against plus-size people. Losing a significant amount of weight can dramatically change someone’s life. Even if these outcomes would likely only be available short term. 

I want you to have all of the information so you can make an informed choice that is right for you. If you are wanting help with your eating disorder, please find help.

Treating binge eating must include treating the underlying issues, not the body weight. Book a discovery call and we can talk about what of my services would be best for you.

And if you’re looking for other resources and perspectives on this topic, here are a few I recommend:

About Emily

Emily Van Eck, MS, RDN specializes in Intuitive Eating, eating disorders, body image, women’s reproductive health, and healing from years of weight-bias and disordered eating. She helps women+ find balance, consistency, and peace with their eating habits so they can feel confident to get outta their heads and into their bodies. Emily is a registered dietitian and certified intuitive eating counselor with a master’s degree in nutrition science. Read more about her practice, values, and experience here.

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Hey there, I´m Emily

A non-diet and weight-inclusive dietitian, intuitive eating coach, and body image healer. Here on the blog, I focuses on exploring intuitive eating, gentle nutrition, the complex arena of body image and feminism, anti-oppression, and all the ways these things intersect. I want us all to be free to own our appetites, and our desires, and eat really, really well. 

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