Ozempic in Eating Disorder Treatment

Eventually Ozempic and similar medications will not be the cultural phenomenon they are currently. The immediate craze and urgency to try them will pass. Some people will benefit greatly from them. Some people won’t be able to tolerate them. Others may have some negative consequences. This pattern of patient reactions tracks will all new medications. The only difference will be that so many more people try these medications.

However, all doctors have a responsibility to learn about, prescribe and work on figuring out the appropriate usage of new treatment options for their patients. Despite my initial misgivings about this class of medications, my professional obligation is no different.

In the eating disorder clinical world, there is no guideline currently about how these medications may be effective, but there are some initial thoughts and trends.

First, these medications may be very effective for treating intractable cases of Binge Eating Disorder. For those who have not had much benefit from CBT or other medications, Ozempic can curb binge urges and allow a patient to normalize eating habits and meal planning. Committing to Ozempic would be a long term decision and one not to take lightly, but the potential benefit can be significant for someone in this case.

Another possible use is to stabilize metabolism for a patient with damaged metabolism after long-standing Anorexia Nervosa. It’s unclear if Ozempic may just keep weight down rather than heal metabolism and also whether or not a patient would be able to stop Ozempic. So this use of the medication is still in question.

A third option is for people who have normalized eating patterns but continue to have extreme compulsive thoughts about food. For some people, Ozempic decreases “food noise,” a relatively new term meant to indicate persistent, obsessive thoughts about food. For most patients, these thoughts ease after months or even a year of stabilized eating. For some the thoughts don’t seem to abate. There is some potential benefit using Ozempic at micro doses to curb these thoughts.

Use of Ozempic and this family of medications in eating disorder treatment remains new and untested. Potential long-term risks, difficulty stopping the medications and even sustained benefits are all still unknown. However, the eating disorder community needs to consider all options for treatment to help patients in recovery.

The Mystery of Binge Eating Disorder

The information available about eating disorders is widespread and available across many platforms. National organizations link people to diagnoses and basic understanding of these illnesses. Social media shows a plethora of individuals speaking about their own experiences. Journal articles give more clinical information and research discussions. And the DSM-V, the psychiatric bible, offers the criteria used to make the diagnoses.

Despite the multitude of ways to learn about eating disorders, Binge Eating Disorder (BED) remains a mystery to so many people, even those suffering for many years.

It’s not uncommon for me to see people who have suffered with BED for many years only learn about their own diagnosis at a first appointment.

There are several reasons for this anomaly and also some consequences.

The most common eating disorder symptoms people know about are restricting food, binging and purging. When most people think about eating disorders, these symptoms are typically the ones widely known.

Widespread fat phobia and fat shaming in our culture promote the idea that being fat is a result of personal weakness and shame. Thus, most people with BED believe they are flawed and ought to bury their heads and feel awful about themselves. They often don’t consider they may have an illness.

The medical field knows about Anorexia and Bulimia but are so focused on the faulty association between weight and health that they almost never screen for BED and instead only reinforce the fat shaming in our society.

The end result is that people with BED hide from doctors, feel trapped by shame and often don’t learn about their illness until much later in life, often well into adulthood.

The most unfortunate result is that people with BED, in my experience the most easily treated of a difficult set of illnesses, don’t receive treatment until the eating disorder has had a profound effect on their adult lives. Once starting CBT, as discussed in the last post, these patients start to see benefit within a few months, if not sooner.

A comprehensive screening of primary care patients can make a big difference in diagnosing these patients earlier. People with anorexia and bulimia have signs doctors can see more easily: low weight, missing their period, low bone density for anorexia or electrolyte abnormalities, excessive tooth decay or swollen eyes and face for Bulimia.

To screen for BED, primary care providers need to ask a few simple questions about dietary patterns and specifically if someone ever eats an amount of food significantly larger than a typical meal at any time. One question may open the door for diagnosis, education and treatment. Earlier diagnosis of BED can truly change the course of someone’s life.

The Changing Face of Eating Disorder Treatment in Recent Years

In many ways eating disorder treatment has improved over the last 15-20 years. Despite the concerns I often express here in this blog, it’s important to recognize the progress.

First and foremost, the most significant change is increased access to care. Fifteen years ago one ever present problem was available options for higher levels of care. There were very few hospital and residential programs. Waitlists were long. The best treatment often involved travel across the country. Insurance didn’t cover most care. Accordingly, most people could not even consider more intensive treatment and had very limited options. Now there are many more programs, many of which accept insurance, and major metropolitan areas often have many treatment options. Rural areas are still limited, but virtual treatment is starting to fill in that gap too.

More comprehensive care opens the door to treating people with eating disorders through the day and in their homes. Traditional mental health care involved a handful of appointments per week to address the eating disorder. Since thoughts and behaviors are pervasive, outpatient treatment ignored the need for ongoing care through the week at home. Eating disorder coaches, meal support and virtual programs and groups fill in the gaps of support throughout the day for people in recovery. These new options create an environment at home much more able to promote recovery.

Last many more clinicians have experience treating people with eating disorder. Because there are more treatment programs, there also are more opportunities to train younger providers to learn how to help people with eating disorders. Over time there also is increased availability of these providers in the community—a significant change from a few decades ago.

The one element of treatment that is not prevalent enough is the kind of treatment known to be most beneficial. Cognitive behavioral therapy is the most studied treatment modality for people with eating disorders, yet this approach is neither used nor taught regularly. Addressing eating disorder thoughts and behaviors in a systematic way using CBT provides structure and direction for therapy that is invaluable. Let’s hope that using this approach becomes more recognized, taught and used by the growing eating disorder clinical community.

Inclusivity in Eating Disorder Treatment

Eating disorder treatment began in the late 1970’s and early 1980’s as an affliction only for girls and women. Some of the original causes for these illnesses related to pressures on women and body shape, and these issues exist to this day.

However, the idealization of thinness has expanded past just girls and women to include everyone else. Medical, aesthetic or personal issues around body shape all are the root of many eating disorders. Moreover, the media and social media coverage for eating disorders creates an environment ripe for breeding these illnesses.

Treatment has been slow to adapt to the changing population who have eating disorders. Many treatment programs only accept women with just a few starting to treat others as well. Much of the rhetoric around eating disorder treatment, body image thoughts and meal plans are geared to women and need updating to include the entire population with these illnesses.

Inclusivity needs to broaden to all people suffering with eating disorders: women, men and non-binary people, all of whom need specific attention to their own individual eating disorder and recovery process. As clinicians, we need to consider a much broader sense of recovery and open the door to all people suffering rather than exclude people who don’t fit our own assumptions about what people with eating disorders look like.

Many of the fundamental issues remain the same. Setting a meal plan and following it remain difficult initial steps. Body image is a very challenging and often long lasting part of recovery. Inclusivity of all people with eating disorders will broaden the understanding of recovery while also giving hope to everyone that they can get better.

Older eating disorder treatment were built from feminist theories and originated at a time when eating disorders grew from an unspoken cultural message to disempower women. Although this pressure is still very present, eating disorders are now an epidemic that affects all sorts of people for other reasons as well. Individual providers and treatment programs can include all people by recognizing the current population and alter treatment for everyone’s needs.