The Holy Grail of Ozempic

The juxtaposition between the medical diagnosis of obesity and the epidemic of eating disorders has become a battlefield in the social and health sectors of our society.

The idealization of thinness at all costs continues to supersede body acceptance and to supplant overall health as a goal. In fact, the diet industry has dangerously co-opted the term “healthy” as synonymous with the term thin. The medical establishment frequently uses social norms instead of medical research to promote thinness as well.

Striving for thinness already is the number one risk factor for developing an eating disorder. As long as sanctioned dieting is culturally acceptable, the incidence of eating disorders will continue to rise.

The pharmaceutical industry is a cog in the machine of dieting, but no drug has been as successful as Ozempic. A weekly injection that suppresses appetite continuously and indefinitely is completely new to the weight loss market. A culture desperate for this wonder drug can’t get enough of it. Ozempic flies off the shelves, was out of stock for weeks and has been glamorized by celebrity culture as the must-have drug.

So we are all entering the grand experiment of an extraordinary number of people trying a new drug that stays in our bodies for weeks at a time with possible cancer risk, let alone other risks we aren’t aware of yet, all in the name of weight loss. Many people taking the drug don’t have any supposed medical reason to try it either. They just want to lose weight.

Previous medications used for weight loss have had similar results for many people: short-term benefit followed by periods of binging as a reaction to prolonged undereating. In addition, so many people are exposing themselves to unknown medical side effects. No magic drug exists yet, and it’s unclear one ever will.

It’s hard not to believe that Ozempic will fall into this category soon enough. When will we, as a culture, stop valuing thinness over everything? When will we realize the powerful industries which benefit mightily from our desire to do anything to lose weight, no matter the personal risk? When will we all stop acting like lemmings seeking the holy grail for weight loss?

As of now, no changes are likely to happen until the Ozempic craze ends.

Imperfect Eating Disorder Recovery

Eating disorder treatment currently focuses so much on meal plans and weight maintenance that one essential aspect of recovery goes by the wayside: life goals.

There is a point about halfway through recovery when people suddenly find they’re not completely focused on food, weight and body. This moment is shocking and often frightening. As all encompassing and miserable as eating disorder obsessions are, these thoughts are grounding and calming; they serve as a foundation to assess every day and every decision.

People in recovery talk at length about a day when these thoughts aren’t so consuming, when there will be room for other parts of life. But when this time comes, they’re often lost and unsure what to think, how to function and where to find comfort and security.

A common reaction to this key moment is to run furiously back to the eating disorder and hide. The current eating disorder treatment world readily interprets the retreat to behaviors as a relapse and ships the person back to residential treatment.

Rather than encourage recovery, the decision to go back to treatment reinforces the identity of having an eating disorder. The message is that the eating disorder is your identity, and the brief glimpse into a world not focused on eating disorder thoughts is too scary to contemplate.

Instead, the initial moment of seeing another way to live needs to be applauded and recognized for the accomplishment it is. The stronger pull of the eating disorder in that moment is to be expected.

The person and treatment team need to embrace this time in recovery, even if it entails an uptick in symptoms, as an important moment to recognize that other parts of life are important and may indeed take precedence over the eating disorder one day.

The creation of other parts of one’s identity outside the eating disorder is necessary for recovery. Just repeating the fantasy that “life will get better” doesn’t help anyone.

Treatment providers need to embrace the moment and realize residential care isn’t always the best option. Sometimes living imperfectly in the world makes recovery much more likely.

Choosing the Right Eating Disorder Treatment

The array of eating disorder treatment has grown significantly in recent years and the new options are even more numerous since the pandemic began.

In years prior, one of the biggest hurdles in outpatient eating disorder treatment was the lack of options. There were few residential treatment programs, ill-equipped hospital programs and a limited number of clinicians who treated people with eating disorders. Outpatient programs had limited insurance coverage and were inaccessible to most people across the country. Just finding any care was the biggest challenge.

Prior to the start of the pandemic, several financial firms bought the most successful eating disorder programs and used the brand to expand rapidly across the country. The programs tried to institute the philosophy of these small programs to the new franchises, but the rapid growth combined with inexperienced staff lowered the quality of care almost immediately.

Virtual care, in its infancy only a few years ago, exploded both due to the pandemic and the continued expectation that remote treatment is an option. Accordingly, many of the new programs offer remote outpatient care, and clinicians do more remote work than ever before. There are even some new programs designed only for virtual care started in the last year.

Another change is the continued growth of eating disorder coaches, people often without formal training but skilled in a variety of supports and able to work around the formal relationships between clinicians and patients/clients.

Questions abound, and even the most diligent patients and families are quickly overwhelmed by the options. It’s necessary yet difficult to individualize treatment now more than ever. There is no one size fits all. Despite the lack of access several years ago, at least the options were much more clear. Now there appear to be unlimited options and no way to make any reasonable decisions.

Here are a few guidelines.

1. Use hospital and residential treatment sparingly and primarily for medical and nutrition stabilization. Few programs have clinicians experienced enough to further the psychological part of recovery.
2. Research outpatient programs thoroughly focusing on two things: the experience of the staff and the clinical focus of the program.
3. Individualize the outpatient team. There are so many more options now so the standard therapist and dietitian may not be the best choice anymore. Creativity may be more beneficial.

Overall people need to think hard about treatment decisions. Programs just recommend more treatment often to bolster the bottom line. Individual clinicians may have more perspective. Treatment is available to most people now, which is a needed change, and finding the right fit can make all the difference for recovery.

The Pros and Cons of the Diagnosis of “Atypical Anorexia”

I’ll take a break from the recent series of posts to write a few thoughts about the diagnostic construct of “atypical anorexia” recently described in the media.

The concept is not new, but the recently coined term is. People’s bodies and minds respond differently to food restriction or starvation. Anorexia until now referred to people who severely restricted their food and whose bodies lost a significant amount of body weight. The medical effects on their bodies combined with the psychological effects of being chronically underweight outlined a constellation of symptoms treated as Anorexia Nervosa.

The illness was also borne out of a societal obsession with thinness and a morbid curiosity of severely underweight girls. Accordingly, both the culture and the medical field has had strong feelings about the illness and in fact glorified a potentially fatal condition as the apotheosis of self-control.

There have always been people who severely restrict their food and whose bodies respond differently. Some people maintain a typical weight and others paradoxically end up at higher weights from restricting.

The reason is that metabolism—the way a body digests and uses energy from food—adapts to food restriction. Some people store the energy and can function at a high level on much less energy than others, while some use the energy and lose weight rapidly.

The ability to conserve energy is an adaptation to survive famine. Often these people don’t experience food and weight obsession as intensely as people who are at very low weights and see limited decline in cognitive function the way people who are very underweight do.

A more accurate assessment of restrictive disorders is to separate the illnesses into categories. “Atypical anorexia” implies that anorexia has a common and uncommon variant, but these are simply the body’s differing response to food restriction. It makes more sense to name these as separate illnesses in order to make clear what distinguishes them and to differentiate the treatment as well.

Anorexia Nervosa is a specific illness that ought to continue to describe the symptoms and disorder already known medically and culturally. Other restrictive disorders need a new nomenclature.

Although it’s valuable to broaden the scope of eating disorder diagnoses, a more thoughtful approach to the classification will avoid confusion and misguided treatment for all eating disorder patients.