Reflections of a Body Image Therapist in the Age of GLP-1 Medications

When I began my practice in eating disorder treatment & body image therapy, I knew I would be up against Wellness Culture (and every rebrand of it’s incessant spawn). I wasn’t yet seasoned, but I understood the gravity of this illness, and I was convinced that through the movement of Body Positivity, we would notice a cultural shift— at least around body image & dieting. For a while, the Gwyneth Paltrow’s of the world felt more comical than threatening. Diverse bodies were given more platform, and the conversation shifted from diet-obsession to self-compassion & inclusion. Then I blinked.

Enter the rollout of GLP-1’s. At first it seemed restrained— these medications were difficult to get, unless “medically” necessary. Grad school, practicums, training— nothing prepared me for where we are now. I don’t know how to heal an entire culture focused less on each other and more on their own thinness. The Body-Positive-to-Ozempic shift became less about the “collective” and more about exclusivity and individual gain. 

I think that’s my hardest pill— we are seeing the normalizing of frailty in the media, and the romanticization of malnutrition— and instead of disgust, we are envious. Because that kind of thinness is elusive and glamorous. If you’re affluent enough to afford the steep monthly cost of a GLP-1– you still don’t have enough privilege. We forget that 99% of us lead real, demanding, stressful lives. The “privilege” to be weak and underfed only exists for the wealthy. The rest of us are being made a promise of better lifestyle, and the only realistic outcome is bone density loss (and increased fatigue, muscle loss, increased mental stress, obsessiveness, anxiety, sleep disturbances, etc. etc.). 

So What’s it Like Being a Body Image Therapist When Everyone’s Using Weight Loss Medications?

Some days I’m really at a loss. It’s increasingly hard to teach Body Neutrality when people are actively trying to erase their insecurities instead of heal them. I never expected to work so closely with rapid weight loss, without any alarm or cause for diagnosis. 

These drugs are designed to plateau.

They work—until they don’t—resulting in having to increase, increase, increase. If you choose not to increase, too bad, and good luck! Enter: shame cycle. It feels like I’m pushing against a wave some days, because how do I convince people they were set up for failure? How do I motivate people to tolerate the discomfort of healing negative body image instead of opting for a “quick fix”?

“I’ve Struggled with Food & Body Image My Whole Life”

This is most often the sentiment I’m hearing. I have so much empathy— this is nothing short of exhausting and painful. Anyone who’s lived in conflict with their own body is a warrior. I understand the relief of finally feeling in control— of finally feeling like you have a front row seat to exclusivity. Health effects aside (I’ll get to that shortly), I can’t help but wonder, if we all shift our perspective to hyper-individualism, who gets left behind? 

Not to get all “social worker” but the threat of Neoliberal-Healthism & atomization was pounded into my head from Day 1 of junior year. When cultural focus shifts from collective to individual responsibility, we lose all accountability to each other & community. GLP-1’s have made us obsessed with controlling our own bodies (in a new, faster, exciting way), and has given us ownership amnesia. 

So, If Someone Hates Their Body and Loses Weight to “Feel Better”— What’s the Problem?

The problem(s) are: 

• We know this kind of weight loss is unsustainable, unless you’re prepared to use it for the entirety of your life. Meaning: if you come off of the drug, you will gain weight back, and inevitably put back in the same guilt cycle. This will be internalized as your fault, your failure, your shame to carry. 

• These medications directly influence the path of body image-acceptance work. What about future generations developing skills to accept their own bodies? Hyper-individualism promotes shame, isolation, and disconnection. It is selfish— I’m sorry, but it is. The collective is broken if we are pushing thinness at the expense of the people around us or after us. 

• GLP-1’s and peptide production are notably “catastrophic” for the environment. I have enough fires to put out, I don’t need to speak to this further, but see for yourself.

Some Observations I’ve Made: Clients on GLP-1‘s

I really thought “surely, at very least, these drugs won’t be accessible to people with eating disorders”.

How naive I was.

While companies make it harder for people with eating disorders to access medications, I have learned it is far from impossible. In fact, clients & individuals with the most severe body image issues are accessing them, with ease. 

Not only are these drugs widely accessible, the healthcare professionals prescribing these drugs are questionable. I have heard horror stories— measuring BMI (an extremely outdated and unreliable source of measurement), extreme calorie deficits (think, lower than the daily intake needed to sustain organ function alone), and unachievable goal weights (often monumentally lower than a client’s lowest weight while active in a restrictive eating disorder).

If you’ve never experienced an eating disorder, body dysmorphia, or disordered eating— consider yourself lucky— but also consider people who have. Imagine trying to exist at peace in a world celebrating malnutrition, and trying to keep you sick.

Symptoms of Malnutrition vs. Medication Side Effects 

I have nothing to say about the “side effects” of GLP-1’s. Like any other medication, there are always side-effect risks. The observations I’ve made in sessions are less about the side effects of injectable/oral medications, and more about the effects of malnutrition. I’m not a medical doctor— I won’t claim to understand the depth of malnutrition on organs, bones, or muscles. I’m a therapist, who has devoted her career to mental illness & eating disorders. What I can speak to is the increasing fragility of people’s minds and self-esteem. 

Clients are frequently (if not entirely) detailing: heightened anxiety, sleep issues, obsessive thoughts, compulsive eating/body behaviours, food fear, negative self-image, body dysmorphia, and overall impeding sense of failure. The brain is a major organ, a vital part of the nervous system, that needs calories to function properly— without balanced nutrition I am noticing an influx of low mood, higher anxiety, and overall poorer mental health. 

I won’t blame the consumer— I understand how enticing these medications can be. I blame media, advertising, patriarchal beauty standards, and the systemic failures that have led us to individual gain above humanity. But I also beg consumers to be very careful— I believe this epidemic is bigger than beauty. I’ll take my tinfoil hat off when I say this— but if we’re all starving and frail, who does that benefit? Not each other, that’s for sure. 

Why is Body Image Advocacy Important?

I will forever die on the hill that body image is a reflection of mental wellness & emotional capacity— not a reflection of the body you see in the mirror. I’m pausing to say “we’re moving backwards” because this honestly feels worse than the 90’s/2000’s. Eating disorders remain the most common cause of mental illness-related death. 

People are dying, Kim.

“Nothing tastes as good as skinny feels” is no longer a funny trope, because this is an empty promise built off the backs of people who are alarmingly ill. You can call it weight loss, but I’m going to go ahead and call it what it is: malnutrition. 

I am vocally not consenting to glamourizing eating disorders, and I sure as hell will not stay quiet when the next generation is being born into body shame. I urge everyone to be informed, to consider collective & generational wellbeing, and to disrupt this system in the only way one individual can— nourish your body.