Hunger in the Ozempic Era

People with eating disorders are usually afraid of hunger. The advent of the long acting GLP-1 agonists like Ozempic and Mounjaro not only reinforce this fear but create an environment for a more widespread aversion to this basic human function.

Hunger cues represent one crucial way our bodies can communicate with us. The cues can be subtle like a feeling of emptiness in our stomachs or an increased interest in food, moderate like feeling a bit weak or irritable or strong like lightheadedness or a gnawing need to eat now to the exclusion of any other thoughts or desires.

No matter the level of urgency, hunger cues allow our bodies to tell us what they need. Hunger increases our cognitive focus on food and, historically, ensures an increased likelihood of survival.

If society values thinness over many other necessities of life, hunger takes on a very different meaning. Hunger can feel like a nuisance, a weakness, a temptation or even a sign of loss of control. People very focused on weight will attempt to find ways to tolerate, avoid or negate hunger without eating.

To an even greater degree, people with eating disorders seek any way to neglect and ignore hunger cues at all costs. As I have written many times in the blog, people with eating disorders eat what and when they are allowed by the illness, not according to hunger cues.

There have been many pharmacological and surgical attempts to mitigate hunger, but none of have been nearly as successful as the GLP-1 agonists. Thus far, this new class of medications can suppress hunger for long stretches of time leading to periods of undereating and weight loss without allowing our biology to override the medication with rebound hunger. The jury is out about long term effects, but these medications have introduced a new dimension of medical intervention into modulating hunger.

Although there are many ways our attitudes about hunger, food and weight will change in this new world, my concern in this post is about hunger. The idea that hunger cues can no longer play a large role in daily life for many people is a monumental shift in daily functioning and in eating disorder recovery. Tolerating hunger and learning to read body cues have both been critical parts of eating disorder recovery. Many people may now choose medication over an essential part of recovery.

Just as concerning, children brought up in the world of GLP-1 agonists will believe hunger is a feeling that can be medicated away, not a physical sign that the body needs food.

Fear of hunger is very different from the ability to medicate hunger away. Is it safe to ignore signs of hunger? What are the risks of ignoring such a fundamental aspect of being human? That will be the basis of Part II in the next post.