Think about these issues first.
If you’ve spent any time on social media recently, you’ve probably caught wind of the latest trending topic in weight loss: use of Ozempic, Wegovy, Trulicity, and Saxenda. This class of prescription medications, GLP1RAs, is not new, but its use for weight loss is; previously they were used to reduce blood glucose levels in individuals with Type 2 Diabetes. In 2022, Ozempic began to gain popularity in the mainstream media due to rumors of use by celebrities.1,2
So how do GLP1RA medications actually work? These drugs mimic a naturally-occurring hormone (GLP-1) which is produced shortly after eating and helps the pancreas release insulin to lower blood sugar levels.3 Mounjaro, which was approved for use in patients with Type 2 Diabetes in May 2022, works on receptors for both GLP-1 and GIP, a similar hormone.4 These hormones also slow down digestion and increase feelings of fullness, which typically leads to reduced food intake and eventual weight loss. Unfortunately, there are several common (and unpleasant) side effects of GLP1RAs including nausea, vomiting, constipation, and diarrhea.3 For some, these side effects come and go; for others, they are more persistent.
Responses to GLP1RAs
Many of my clients prescribed GLP1RAs report a reduction of hunger cues, as well as taste changes and food aversions, even to favorite foods. If you struggle with binge eating behaviors or feel that you are ‘addicted’ to food, this may sound like a welcome change. Although many may experience desired weight loss while taking the medication, if they are unable to sustain treatment (due to lack of insurance coverage, negative side effects, medication shortages, etc), they will likely see a return of disordered eating habits and weight regain. In fact, a 2022 study found that participants gained ⅔ of their previously lost weight 1 year after discontinuing semaglutide.6
GLP1RAs have continued to be a hot topic on TikTok where influencers have shared their experiences. While many praise the effects of these medications for weight loss and ‘curing’ their binge eating disorder, not all journeys have been so positive. Remi Bader, for example, recently shared that her binge eating disorder (BED) symptoms were managed while on the Ozempic but returned in full force after discontinuing the medication.5
Beware of underlying conditions
One concern with the popularization of GLP1RAs for weight loss is the potential for underlying eating disorders to go unnoticed and untreated. If you’ve lived with overweight/obesity for a long time, you are likely no stranger to ‘yo-yo’ dieting, and you may even identify as having a disordered or volatile relationship with food; a higher weight status is actually often a byproduct of years of diet attempts, followed by rebound weight gain (keep in mind, a significant predictor of weight gain is dieting!)7 as well as the impact of weight stigma/fatphobia.8 Feelings of ‘food addiction’ often result from food restriction, which increases preoccupation with food and likelihood of overeating/binge eating.9 If this is not addressed, drugs such as Wegovy and Ozempic may only act as a Bandaid for a deeper problem. To address the psychological aspects of eating disorders and help heal damaged relationships with food, evidence-based treatments such as CBT/CBT-E are best.
If you’re interested in pursuing treatment with weight loss medications, a registered dietitian should be an integral part of your medical team before, during, and after treatment for several reasons: 1) to help identify and treat underlying eating disorders/disordered eating behaviors, if you have any; 2) to optimize your nutrition during treatment, particularly when navigating negative GI side effects and diminished appetite; 3) to provide guidance related to non-food behaviors, including physical activity, hydration, and sleep; and 4) to support you if you choose to discontinue treatment for any reason.
Although they are not a magic bullet for weight loss, GLP1RAs are extraordinary medications – particularly for those with insulin resistance, pre-diabetes, and Type 2 Diabetes. Further evidence shows a significant benefit for individuals at risk for heart disease.3 Ideally, the personal decision to start a GLP1RA for weight loss should involve careful consideration of all pros/cons, as well as a discussion of disordered eating behaviors and history.