How Ozempic Can Trigger Eating Disorder Thoughts

Another way Ozempic and the new class of drugs affects eating disorders is by normalizing food restriction and hunger. The medications enable people to eat very little, tolerate long stretches of hunger and lose weight.

Recovery from an eating disorder requires regular meals and snacks through the day. This type of eating plan not only gives the body the regular nourishment necessary to be well but also teaches the body how to regulate the cycle of hunger, digestion, absorption, metabolic function and hunger again. It’s necessary for anyone to get used to this pattern to get well.

These new medications ignore this cycle and instead promote hunger and food restriction as erroneously necessary for health. This message is dangerous for people with eating disorders.

If someone on recovery tries Ozempic, the weight loss and sustained low appetite will trigger old eating disorder thought patterns, most notably the fear of eating and of weight gain. Associating regular meals with weight gain rather than a normal part of life can lead to relapse quickly.

Even for people who don’t have eating disorders but instead have disordered eating thoughts, Ozempic can trigger a full blown eating disorder. The idea that a medication can provide the holy grail of low appetite and weight loss can convince people susceptible to become afraid of eating at all and certainly of ever getting off the medication.

The difficult next steps are how to address the presence of Ozempic and its cousins in the treatment of eating disorders. For now learning about how these new medications work will be most important. It’s better to understand the long term nature of these medications and consider the current and future risks of worsening the eating disorder epidemic than to turn a blind eye.

Doctors Need to Learn how to Treat Eating Disorder Patients

In this blog, I write much more frequently about the psychological and emotional effects of eating disorders. However, the medical and physical effects of these illnesses are real and often very serious too. Some of these conditions are reversible and some chronic after years of illness.

I have reviewed some of the more common medical problems caused by eating disorders in previous posts and wanted to highlight a different concern about eating disorder recovery, namely, the difficulty finding knowledgeable primary care doctors able to treat these patients.

Doctors are generally not taught about eating disorders and have limited knowledge about the subsequent medical complications. There are no other patients with long-term effects of starvation. Doctors with any limited knowledge about people with anorexia have worked in areas of the world which experience famine or who have worked with people with end stage cancer. However, even these experiences provide limited information to treat anorexia. And doctors have almost no knowledge how to treat the medical effects of binging, purging or laxative abuse.

Doctors instead will often make matters worse by either expressing their own bias or ignorance about eating disorders, by talking about their own fat phobia, by relating false information about weight and health, by praising people who lose weight or by using their authority to expound upon the latest exercise fad.

Many patients actively avoid seeing doctors for fear their eating disorder thoughts will be triggered by the appointment. Instead of receiving needed medical attention, people will risk further consequences of the illness since doctor’s visits can exacerbate the illness.

There are a few doctors who have decided to learn more about eating disorders, but many of them don’t treat adults 30 and over. As the incidence of eating disorder rises and the number of chronic patients age, the need for more medical doctors knowledgeable about eating disorders also increases.

The most effective method to help doctors learn is for treatment teams to find doctors willing to listen and learn about treating these patients. Hopefully, training programs will see that eating disorder patients are an increasing part of medical care and that teaching about how to care for these patients is imperative.

Ozempic and Eating Disorder Treatment

A few months ago, I wrote a post about the exploding Ozempic craze in this country. My initial thoughts were too quick and reactionary, and I hope to speak more evenly to the point in this post.

The medicalization of weight loss—through drugs and surgeries—is here to stay. Medicine treats maintaining a low weight as a virtue signifier of both health and morality with little scientific data to use as proof. With the entire medical community in tow, pharmaceutical companies and surgical centers continue to grow and provide more and more powerful and expensive means to produce weight loss without any concern for long term health risks of these interventions.

Ozempic and its cousins are the newest venture in pharma to capitalize on the desire to lose weight. Never has such a powerful medication for weight loss existed, and the financial windfall already portends many more medications to come. Online doctors are prescribing these medications to anyone who asks. Pharmacies can’t keep enough stock on the shelves. Canadian pharmacies stopped sending the drugs to insatiable US customers. And in some communities, literally everyone is on these drugs.

It’s a grand experiment to see the effects of a relatively new drug on millions of people.

Railing against the downside of this kind of medication has merit. It’s easy to find a slew of articles exploring the myriad concerns about Ozempic. We can’t ignore the new reality we all have to face including the effect on people with eating disorders.

Ozempic is a weekly shot which leads to prolonged decreased appetite, slowed digestion and weight loss. No medication has ever combined these three effects so powerfully and without interruption. Despite the minimal knowledge of long term effects, withdrawal syndromes and potential medical concerns, the drug’s effect is too strong for many to resist.

In the communities already focused on weight loss drugs or surgeries, many if not most people are already on the drug.

Acceptance of a medication like this as the norm only reinforces fat phobia, the erroneous link between weight and health and the vilification of fat.

For many people with eating disorders, the draw to try this medication will be too strong for to resist. Clinicians need to be prepared to see people with eating disorders on these drugs, understand the complicated factors around the decision to go off or stay on the drug and become familiar with withdrawal.

In addition, people with eating disorders are already witnessing others rapidly losing weight, a huge trigger. So even for many people who never take these drugs, the changing world around them can lead to a relapse.

In other words, Ozempic will become a new medication that worsens eating disorders like stimulants, Topamax or phentermine. The ever changing landscape of capitalism and weight loss will shift the risks for people with eating disorders. Clinicians will need to adjust to the new norm and learn to treat new conditions that arise.

The financial gains from weight loss is too great for companies to ignore. No matter the risks to public health and well being, we live in a world that promotes manufactured foods more likely to cause illness and new medications to balance these effects. The eating disorder treatment world may not be able to shift the tide, but it can be ready for the aftermath.

Understanding and Hope Mean Everything for Someone in Eating Disorder Recovery

Many people mistakenly believe that eating disorder recovery is a matter of willpower. If a person can summon enough resolve, gumption and energy, recovery is within their reach.

This assumption may have elements of truth but misses some key parts of getting better from an eating disorder, most importantly the fact that the eating disorder thoughts are very strong, if not overpowering, in that person’s mind. It’s much more complicated to find willpower when one’s own thoughts are determined to remain entrenched in the eating disorder.

Recovery still demands resolve and focus on identifying the eating disorder thoughts. It takes enormous effort to constantly try to disempower those thoughts and demands consistent action to eat at every designated time in a meal plan.

Rather than willpower, recovery requires bravery, persistence and determination. Helpful support in recovery focuses on the daily challenges necessary to get well rather than the simplistic concept of willpower.

Conceptualizing recovery as an ongoing struggle makes clear what the most helpful support can be.

People in recovery find a lot of comfort when someone “gets it.” This is a phrase people often use and that I often hear as well. These two words mean that a person understands the nature of recovery, the constant challenges every single day and the relentless onslaught of eating disorder thoughts which make recovery so hard. Often, knowing someone “gets it” helps people feel less alone and more able to reach out for support. Understanding is incredibly comforting for people in recovery.

Several factors of recovery make people feel hopeless that they can get better. The idea of willpower frequently implies that any failure at any point is a sign things won’t ever improve. The erroneous concept that people can’t recover from eating disorders is a common misconception which demoralizes people trying to get well. It’s too easy to say that someone who doesn’t get better using one type of therapy is treatment resistant. That label reinforces the idea that people can’t get well instead of creativity trying to find the right path to get well.

There is no easy cure for eating disorders. No magic medication, treatment modality or procedure. Recovery is a daily grind to implement changes that will eventually lead to being well. For any long term endeavor like this, support means everything. And the most helpful support is to be understanding of the challenges of getting better and inspire hope that recovery is a realistic goal.

People Can and Do Get Better from Anorexia

One of the hardest question I’m asked about recovery from anorexia is the following: what strategies or concepts are the most effective to combat the anorexic thoughts?

The reason this question is so hard is that there’s no simple or easy answer.

Despite decades of research into the biological underpinning for anorexia, there are no new data to use clinically that makes recovery and regular eating any easier.

Research into all different medications, including psychedelics, don’t show much benefit to make recovery different.

However, the lack of new information doesn’t mean we should disregard the decades of experience we have treating anorexia, nor the fact that treatment is much more nuanced and sophisticated than it was only a few decades ago.

First, we do know that consistent nourishment over an extended period of time will reverse the food and body thoughts for most people. Sometimes these changes are fast and other times slow.

Second, we know that regular food logs and consistent accountability helps people move forward in their lives. Recovery has nothing to do with willpower. Instead, people need external support and reminders to chip away at the power of the eating disorder thoughts.

Third, we know that treatment must include listening carefully to what people with anorexia say, think and feel. No one gets better by treating the illness and not the person. If someone in recovery is moving away from the illness and not moving towards something important to them, the changes won’t last.

Last, the process of recovery needs to center on hope. Any sense of desperation or hopelessness strengthens the illness and derails recovery.

In order to sustain hope, clinicians need to be well versed in the nature of eating disorders and recovery and to understand the ups and downs of the path to get well.

The less we all look for the magic bullet for recovery from anorexia and the more we use the available knowledge and tools, the more successful treatment can and will be.

Praise Doesn’t Feels Supportive to People in Eating Disorder Recovery

The last post about listening to people with eating disorders applies to family and friends as much as it does to clinicians and treatment.

Families often feel like their job is to monitor and assess food intake and adherence to a meal plan. Similarly, families want to reward following the treatment plan with praise. Yet this praise almost always backfires and actually strengthens the eating disorder—a fact hard for most people to understand.

The conundrum of how to support people in eating disorder recovery stems from the nature of the illness itself. The eating disorder thoughts are powerful and hard to resist. They bring comfort and a sense of accomplishment, no matter how destructive they are at the same time.

If family or friends praise progress in recovery, people with eating disorders struggle to hear the positive reinforcement as it’s intended. Instead, the praise betrays the eating disorder thoughts by reinforcing the idea that that eating normally is a failure. Other people recognize the changes and reveal the person is normal, like everyone else, something abhorrent to eating disorder thoughts. Moreover, the praise stirs up the frustration and sadness at leaving the eating disorder behind.

If instead families ask how to help or offer the opportunity to listen, people with eating disorders will likely be able to speak about how they actually feel. After being buried under eating disorder thoughts, it may take time before they feel safe to start to talk about how they’re feeling. However, without the pressure to perform and the feeling of being watched, exposed or even praised, they will feel more able to make their own decisions and not react to outside intrusions.

Of course, these thoughts don’t apply to people who are in medical danger, and the distinction between health risk and psychological stability is often not as clear as it would seem. In addition, different clinicians and families may be willing to accept more instability to provide a safe environment to start recovery. No matter the situation, an open, warm, loving environment is necessary for any successful recovery.

People with Eating Disorders Need to be Heard to get Better

If inpatient and residential treatment can be traumatizing, family based therapy doesn’t work for people 18 and over and people with eating disorders are trapped by the power of the thoughts of the illness, what are the other paths forward towards recovery?

The urgency for families and practitioners to do something, to have a concrete plan, is overpowering despite the evidence that these steps are unlikely to work after the first couple of tries. Even after many failed attempts at the options mentioned above, families and clinicians will often repeat the same plan futilely.

Increasingly, the focus of treatment is on meal plans and maintaining a symptom-free period of time at a determined weight as a magic cure. The evidence does show that remaining at a target weight long enough improves the chance of recovery. However, eating disorder thoughts often remain so strong at these weights that relapse is a common result. When this plan does not work, the patient is blamed.

Our culture tends to focus on the latest shiny object on social media and that is no doubt the case for eating disorder treatment. More and more, patients find their information about recovery on TikTok, but we have forgotten how much older information about treating eating disorders remains as useful as ever. Many of the lessons learned about eating disorder treatment in the past are fading into history.

Young people with eating disorders are often used to not being heard or seen. The eating disorder tends to be the only mode of expression younger people find effective after years of being seen as their illness rather than a real person. Expecting family and clinicians to ignore their thoughts and feelings as “just an expression of the eating disorder,” people in this situation express their frustration through even more severe symptoms until relapse feels like their only mode of being in this world.

A tried and true element of treating younger people with eating disorders is to listen to what this person is expressing through their illness and what they have to say. They feel so trapped and don’t expect anyone to care or listen to them. The isolation of being seen only as their illness leaves them no recourse to say how they feel. Really listening to their concerns can open a new path towards healing.

With treatment as an easy decision for clinicians, recovery often starts with ignoring what patients have to say. Before long, they have gone through a variety of outpatient programs and inpatient programs aimed at weight restoration only. Patients learn that the only way to be heard is through symptoms and behaviors. They learn there is no point in being honest because honesty is labeled as “the eating disorder talking.”

It would behoove families and clinicians alike to remember that people only get better from eating disorders when they are heard. Of course, food and health matter, but they are never enough to get better.