The Return of Idealizing Thinness at All Costs

I have written extensively about the GLP-1 medications over the last couple of years because of the impact on people with eating disorders. Posts have ranged from concern about this new powerful class of medication, the ease with which people can attain them basically unsupervised, the potential benefits to some people with eating disorders and the haphazard regulation of the use of this new medical intervention.

The most significant effect of the widespread use of the GLP-1’s is the societal shift over the last few years about body and weight, especially for women. In light of the last few posts in this blog, I feel compelled to discuss the changes.

Prior to the explosion of Ozempic use, there had been a movement towards body acceptance, also called body positivity. Despite the many complicated factors about this movement, one effect for many women was the possibility of seeing their bodies, and often themselves, in a new and less critical light.

I found that body positivity enabled treatment to be more successful for many of these women with more progress than I had seen before. Instead of the constant battle upstream against the current of idealizing thinness, some women could visualize a body that did not fit the societal ideal but instead matched who they were physically as a person. The newfound freedom to see herself more clearly allowed for personal growth as well.

Ozempic and the like pushed even the most conservative women about medication to consider and often try the new drugs. Without any medical indications for use, women can easily find ways to procure them for the sole purpose of weight loss. Even though many people can’t tolerate the drugs, enough women now are in much smaller bodies and the societal pressure to be thin has rebounded very powerfully headlined by the message that weight loss is attainable for all.

Women finally seeing the possibility of settling into a place of acceptance and even comfort with their bodies now suffer with negative thoughts about their bodies and themselves again. The end of any semblance of body positivity renewed the onslaught of women’s body hatred.

I don’t think these new medications are intended for social ills. The benefit for diabetes, metabolic disorders and some eating disorders is profound. The pharmaceutical industry, however, is a for profit business so the pressure to take as much of the financial pie always wins over thoughtful and regulated use of powerful new drugs.

Patients and clinicians alike need to face the reinvigorated desire for thinness by doubling down on work aimed at giving women freedom and direction. Life needs to mean more than the number on a scale or meeting the societal norm at all costs. GLP-1’s or not, these goals can’t change. External factors will come and go. The overvaluing of body won’t stop being a way to disempower women any time soon, but treatment needs to see the barriers and continue to move forward.

Why are Men Treated Differently for an Eating Disorder (and What It Means)?

The eating disorder field purports that an eating disorder diagnosis is much more common in women than men. The fact that the original diagnosis included skipped periods reveals that the diagnosis was created solely with women in mind and wasn’t very open to men having these disorders in the first place.

Early on my practice, I often would see men, young and old, for an initial appointment to discuss eating disorder symptoms only for them to never to return. The shame of admitting to the symptoms of what was deemed a women’s disorder was too strong to overcome. This fact may have changed to some degree, but the underlying belief that only women have eating disorders is intact.

Various media outlets, but especially social media, have made it increasingly clear that many men have eating disorders of all kinds. Just as with women, men experience symptoms which range from restricting food, obsession with low weights, binging and purging and excessive exercise. In fact, there is no discernible difference.

The only question is why eating disorders are still largely considered to be for women and why the treatment industry focuses almost exclusively on women.

The first component is that societal focus on body and weight remains much more interested in women’s bodies. Starting with the magazine industry prizing of thinness for women in the 1960’s, media continues to encourage women to base identity and success on their bodies. Some men feel the impulse to perfect their bodies and control food, but society bases a man’s success on many other things than body and weight.

Second, the coupling of life success and body image for women creates a dynamic that routinely disempowers even the most successful women. No matter how much women accomplish, they are burdened by the sense of failure and loathing about their bodies, encouraged to nitpick and drown in disgust at their physical selves. Men aren’t typically hampered by these external demands in the same way.

Third, the treatment industry and programs know that families will scapegoat and hospitalize their daughters much more easily than their sons. Societal pressures on families still values the expectations for success of sons over daughters, no matter how far feminism has changed our norms.

Financial firms which have bought and multiplied treatment facilities to amass insurance money know the profit lies with the treatment of women, who are much more likely to comply with enforced programs, repeat admissions and longterm care.

The next obvious question is why aren’t men with the same symptoms treated the same way?

This question reveals much less about actually clinical knowledge and research and much more about societal prejudice. Mental health treatment acts to disempower women now as it has for decades. The progression of illnesses created to reflect and enforce societal bias is ongoing for decades: hysteria, borderline personality disorder and now eating disorders span almost a century of psychiatric diagnoses.

These medical labels isolate and scapegoat a group of women and use clinical medicine to support the social order. That social order also includes the organizing principle that men are in power, even if they have what we call eating disorder symptoms.

Women in treatment programs need to be heard, not sequestered away. They need to be given a chance to grow and experience life, not languish in wards and centers meant to render them silent and impotent. They need to stop being seen as an impediment to our society and to be given a shot at life.

The treatment programs don’t work. All clinicians in the field know the success rate is low, but we have all been brainwashed into thinking it’s the only way to treat these patients, the large majority of them being women. Instead, we need to stand up and speak the truth so women who are scapegoated and isolated from the world get their due.