Eating Disorder Recovery in the GLP1 Era
- Alexis Dawn Salima Gonzalez
- 2 minutes ago
- 5 min read
A dialogue between dietitian and client.
This post is for informational and educational purposes only. It is not a substitute for individualized medical or mental health care. It does not constitute a patient-provider relationship. The content of this post might not feel useful to you right now—please take the information that serves you and leave the rest.
Within the last year, there’s been a rising popularity of the use of weight loss medications. The most popular being GLP1-RAs (colloquially called “GLP1s”). You can read more about them here:
This rise in popularity has coincided with an increased cultural pressure to achieve thinness not dissimilar to the “body trends” of the 90’s and 2000s.
Clients who have put in hard work into their eating disorder recovery, work to heal their relationship with their body, seem to be presented with a new challenge. Clients who have felt stable in their recovery are now navigating what feels like new terrain.
The following dialogue is a script put together by me, Alexis, a registered dietitian. This dialogue is with a fictional client, I'll call her Sarah, based on the experiences of several clients over multiple nutrition counseling sessions. This blog’s conversation summarizes concerns about using weight loss medications while in eating disorder recovery.
Sarah: Alexis, all this GLP1 stuff has been making my head spin lately. I feel like I see it everywhere! I see ads in my social media, ads on the train, on TV... My mom is using one! My favorite body positive influencer even started using one. My head is spinning about it.
Alexis: Oh, I hear you! I think there’s an ad on every train stop on my commute too. What’s it got you thinking about?
Sarah: Well, I did all this emotional mental work to heal my relationship with my body accepting it and using intuitive eating. Now there’s a new medication that people are saying could help me change my body like I’ve always wanted. It feels like there’s something here that claims to give me the body I’ve always wanted without the pain that inevitably came with restricting food.
Alexis: It’s a lot of hard work to heal your relationship with food and body. What’s it like to be offered a new way to achieve this near life-long goal of weight loss?
Sarah: It feels hopeful. I think I might want to try using them. Can we talk about it?
Alexis: Of course. First, have you talked with a doctor about it? Do you trust your doctor to treat you holistically? Do they know your history of disordered eating?
Sarah: I like my doctor because she does treat the whole of me. She’s skeptical about me using a GLP-1 but won’t give me a clear answer as to why not.
Alexis: Hmm, that must be frustrating for you.
I know there are ads all over the place for these medications which make them seem trivial. But they are serious medications that change your body’s functioning significantly.
I hope your doctor is considering a cost-to-benefit analysis to deem its medical necessity. Some of the health and behavior factors typically considered are a history of disordered eating, BMI, gastrointestinal function, and medical history. Would you be open to hearing some concerns I have as your dietitian?
Sarah: Yes, please.
Alexis: We’ve done some good work with identifying and honoring hunger and fullness cues. These medications impact a body’s ability to send those cues which could be difficult to navigate in maintaining adequate nutritional needs. Some people feel more connected to their body during use while others feel a complete disconnect. Being connected to your body has been a foundation of your recovery so this medication can be a risk to trigger a relapse. There’s a possible psychological impact that may occur with weight loss. This could be destabilizing to your recovery and is a risk worth exploring with your therapist as well.
Furthermore, these medications can make you feel full longer by slowing your digestion and has side effects that disrupt your appetite like nausea, vomiting, and diarrhea. These symptoms pose another risk of relapse. Not to mention they could muddy up any GI problems you’re already experiencing.
You’ve been dieting, restricting, and binge eating for a long time with significant weight gain and loss throughout your life. We’ve addressed the psychological and physical impacts of weight cycling. Would this be another great shift in weight? Would the medication need to be for long-term use? Do we know the risks of using this medication long-term?
I recommend talking with your doctor and therapist. We are all here to help you make a well-informed decision. Is there anything about these meds that is especially calling to you?
Sarah: People keep talking about how rarely they think about food when they’re on them.
Alexis: I know food noise has been a problem for you in the past. Do you find yourself thinking of food often?
Sarah: Not as much as I used to.
After I started adequately feeding my body and allowed myself permission to have all types of food, I stopped obsessing about snacking or planning my next meal right after finishing my first.
But sometimes I think about food and I just wish I didn’t.
Alexis: It’s great that the food noise has dissipated a bit. Many of my clients that use these medications must put in a lot of effort to plan meals and snacks to maintain adequate nutrition needs. Doctors typically refer patients using GLP1s to dietitians partly due to the risk of nutritional deficiencies associated with restricting calories. It’ll now take more effort to maintain adequate nutritional needs to prevent possible muscle and bone density loss too. Thinking of food will still be on the table and may be just as frustrating. I hear you though, thinking of food when you’d rather not can get annoying.
Sarah: It might not even help me with my food noise? I used to be obsessed with thoughts of food so thinking about it even a little makes me feel defeated.
Alexis: Just like any medication, this one could alleviate one point of discomfort while creating a new discomfort in a different way. Thinking about food is a natural human experience. It would make sense that you’re still thinking of food simply because it’s a human need, not because you’re obsessed with it.
Sarah: Is this another part of my life I have to radically accept?
Alexis: Possibly! Thinking of food will likely be a part of your reality forever. Even if you could whittle it down to just taking a pill that gives you all the nutrients your body needs in a day, you’d still have to remember to take it. The more we fight the fact that we have a human need, the more pain we will experience when we push back on it. You said it yourself: when you started eating adequately instead of restricting, the food noise decreased. Do you have any more questions about GLP-1 concerns?
Sarah: I don’t think so. Thank you for taking the time to talk about my concerns and inform me of your concerns as one of my clinical providers.
Alexis: You’re very welcome! See you next time!
Please know support is always available. If eating disorder recovery has felt less stable or more distressing for you, a registered dietitian can help.
Onward,
Alexis