An injection that gives people anorexia symptoms—what could go wrong?

Weight-loss drugs and eating disorders: Part 1

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The moment I learned about the newest weight-loss drugs, I felt a sense of dread. Because of course they would contribute to eating disorders and worsen anti-fat bias. And that was before I learned about the medications’ effects, which resemble common eating disorder symptoms: an inability to respond to hunger cues, combined with gastrointestinal distress that makes it harder to eat even when you want to.

If you’ve been up close to someone struggling with an eating disorder, or if you yourself have suffered from one, these symptoms may sound familiar. And terrifying. Yet millions of people are eager to take these drugs.

The popularity of these medications made me think about the time an acquaintance said, "I wish I had just a little bit of anorexia."

Um, no, ma'am. No, you don't.

But I get why she thought she did.

We live in a culture that makes most people want to lose weight—at almost any cost.

And why wouldn’t they? Everywhere we turn, we’re told that thinner is better—for our health, our self-esteem, our financial success, our social status, our love lives. Instead of interrogating and resisting anti-fat bias, we’re taught to question and fight against our bodies.

Just as it seemed we were reaching a tipping point of increasing acceptance and celebration of size diversity, BAM! Weight-loss drugs and before-and-after photos were suddenly everywhere.

The toll of weight stigma on wellbeing is significant, so it makes sense these medications seem almost magical. Fighting daily battles for basic respect is exhausting. Changing an entire culture feels impossible. And because BMI cutoffs can gatekeep medical procedures, many folks have little choice about whether to try these drugs.

When it comes to eating disorders, some people with binge eating disorder (BED)—the most common eating disorder—have experienced immediate symptom relief. In a moment, I’ll talk more about use of these injections in the context of eating disorder treatment

To be clear: I don’t judge anyone who takes these medications. I’m not questioning anyone’s lived experience of benefiting from them. And yes, I’m aware that every drug has side effects and risks.

Blaming our appetite has consequences.

We have been taught—and reminded every day of our lives—that the world prefers most of us to eat less and be smaller. Human appetite (especially women’s, as discussed so powerfully by

Kate Manne

) has been demonized and pathologized.

Eating more than the bare minimum to sustain existence is seen as excessive, gluttonous, diseased. If your body isn’t thin, you’re told you don’t deserve to eat enough even to meet your basic biological needs.

Eating disorders thrive in this kind of environment.¹

Body hatred, restriction, and other disordered behaviors are normalized and even promoted. In diet culture, if you’re thinking a lot about your next meal, it couldn’t possibly be because you’re hungry or because you’re supposed to get pleasure from eating. If you have a fraught relationship with food, diet culture says you’re somehow broken, not simply experiencing a predictable result of restriction.

But instead of getting permission to eat enough and the support to start healing a history of disordered eating, someone taking these new medications gets the opposite: even less food and a reinforcement of the notion that their brain and body can’t be trusted.

This diet culture double-down is complicated enough for the general public; it can be downright dangerous for people with eating disorders.

As far as I can tell, people are not being adequately screened for an eating disorder before being prescribed these drugs.

When Weight Watchers announced they were selling these medications through their new telehealth division, they assured everyone that customers would be screened using (wait for it) … BMI.

But BMI does not tell you whether someone has an eating disorder.

Yes, even including anorexia.²

And what’s to stop someone in a smaller body from entering inaccurate numbers into an online form to bypass BMI thresholds? As more telehealth companies have flooded the scene, a 5-minute online questionnaire and a credit card can get these drugs into almost anyone’s hands.

There is debate in the eating disorder field about whether these drugs constitute safe, effective treatment for symptoms of BED. I’ve heard from people with BED who started taking these medications and are thrilled with the reduction in binges and intrusive thoughts about food. I want to acknowledge the freedom and peace they feel, perhaps for the first time in decades.

And considering that eating disorder treatment (if you can access it at all) doesn’t have a great track record of helping people with BED, especially those in larger bodies, these injections can reduce a lot of suffering.

What I can’t stop thinking about, however, is the inevitable praise people with BED will receive when they start eating less and losing weight. It’s quieting what is often called “food noise” and perhaps reducing the individual’s experience of weight stigma (though not actually addressing weight stigma itself). But it’s simultaneously reinforcing beliefs and behaviors that probably turned up the volume on the food noise in the first place.

What happens to someone who has to discontinue these medications because they can’t access them, can’t tolerate the side effects, or have a contraindication? Their food noise is about to get really loud.

The response to the expected appetite resurgence and weight gain isn’t likely to be kind. Even people without a history of BED will be at increased risk for restriction, bingeing, negative body image, and other mental health concerns. I wish everyone in that situation could access the additional support they need to navigate the process. But I fear most folks will be left blaming themselves.

Eating disorders can hide in plain sight, now more than ever.

The availability of these drugs will make it even more difficult for friends, family, and doctors to recognize someone may have anorexia or another eating disorder. How could it not? Calorie restriction and visible weight loss can be chalked up to these medications (which they may or may not be using).

And since weight loss itself—even when entirely accidental—can catalyze an eating disorder, could taking these drugs trigger an eating disorder in those with a genetic vulnerability? I haven’t read much about this potential risk yet; if you know more, please point me in the right direction.

Are we allowed to raise concerns about these drugs?

If you happen to follow me on Instagram, you may remember I posted about this topic a few weeks ago. It’s the most engagement I’ve ever had, and not surprisingly, it came with the most negative comments and messages I’ve ever received.

It’s also the only post I’ve ever taken down. The personal attacks were tough to take but manageable. But hearing that I’d hurt people in recovery from an eating disorder is why I ultimately decided to remove the post.

Then I heard from so many folks who were disappointed in that decision. They expressed concern about a climate that doesn’t permit people to ask questions about these drugs.

This experience had me wondering, what other voices are being silenced?

What kind of informed consent is really possible if patients and doctors hear primarily about its “miracle drug” properties and not as much about its risks?

At a recent professional development webinar hosted by the Center for Body Trust, I learned that patients are often reticent to disclose side effects to a medical provider for fear of the drug being taken away.

If you are interested in a deeper dive into these pharmaceuticals, be sure to check out

Ragen Chastain

, whose Weight and Healthcare newsletter offers meticulously researched information presented in an accessible way.

Looking ahead to Part 2: What about kids?

I’m interested in the ways relentless weight-loss marketing can affect children, who are already vulnerable to food issues and body shame—and what parents and guardians can do to protect them. And that’s what I plan to explore in part two. I’d love to hear your questions and concerns on that topic.

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In other news:

It’s Girl Scout Cookie season! And that means our family is enjoying lots of Samoas, Thin Mints, and Tagalongs.

But it also means little girls everywhere are being bombarded with diet culture messages. I was grateful to be interviewed about this topic for People magazine.

I’m guessing diets were already in your “out” category for 2024, but just in case you’re feeling down about not following some kind of New Year’s nutrition goal, my latest piece for CNN is for you.

And one more announcement: I’m writing a book!

Last month I signed a publishing contract to write a book for parents and guardians navigating diet culture. I’m so excited to share practical resources, sample scripts, and real-life strategies for helping kids develop a healthy relationship with food and their body. Stay tuned for more details!

Thanks for reading, and I look forward to hearing your questions and comments. Let’s keep the conversation kind and curious.

1. Not all eating disorders are characterized by body image concerns. But diet culture does affect other eating disorders, such as ARFID (Avoidant/Restrictive Food Intake Disorder).

2. Although currently called by its stigmatizing and erroneous name “atypical anorexia,” anorexia in a not-thin body is still anorexia. Contrary to popular belief (even among some eating disorder treatment professionals), it’s not usually any less dangerous. In fact, people in larger bodies are often engaging in more intense and prolonged restriction and experiencing more severe eating disorder cognitions. Many people with “atypical anorexia” go undiagnosed (or are misdiagnosed with BED), and no doubt many of these folks are being prescribed weight-loss injections.