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Weight-loss drugs are challenging for people with eating disorders

Many struggle with the thinness myth — that happiness, prosperity and good health come with thinness — and not their weight

An illustration of a person holding a pair of open scissors moving towards a yellow measuring tape that is constricting their waist.
(Celia Jacobs for The Washington Post)
5 min

As a psychiatrist, my first day on an inpatient eating-disorders unit was shocking and confusing. Not because of the patients’ actual weight, but because of how they perceived themselves.

About 90 percent of the patients strongly believed their bodies were hideous. Not one came close to their self-description, and they all believed that if they just lost weight, they would be happy.

Many of my current patients have similar perceptions and beliefs. And more and more of them are bringing up drugs being used to treat diabetes and obesity — semaglutide (Ozempic and Wegovy) and tirzepatide (Mounjaro and Zepbound).

These drugs can be helpful for people who are obese or have chronic conditions. But there’s a little-talked side effect of this interest in weight-loss drugs — the challenges it poses for people with eating disorders who are not overweight or who have body dysmorphia.

Challenges posed by weight-loss drugs

Eating disorders are a conglomerate of biopsychosocial illnesses characterized by a persistent disturbance of eating behavior and mood that negatively affect people regardless of gender, race, ethnicity, sexual orientation, body shape and weight.

I am passionate about helping those affected by eating disorders. I am equally committed to dispelling the thinness myth — the belief that happiness, prosperity and good health come with thinness. For many of my patients, escaping this incessant myth is nearly impossible, especially in the past years with the popularity of weight-loss drugs.

One patient with bulimia has been in recovery for two years from her eating disorder. Despite being of normal weight now, she said in December: “If I start Ozempic now, Christmas and New Year’s won’t be so hard. I could be happy this summer.”

She continues to have eating disorder thoughts, such as “You are still fat. People think you are disgusting, and everything will be better if you lost weight. You would be a better person.” She also has a negative body image, which is one of the last symptoms to resolve.

Everyone I treat is unique and has different needs. But I counsel my patients with eating disorders to have a realistic expectation of what the drugs can do and to recognize that they won’t always cause weight loss. The medications also can have serious side effects and be expensive.

I also encourage my patients to challenge the belief that everything would be okay if they were thin, and to see and appreciate the beauty and masterfulness of their bodies. By believing in this Ozempic-weight-loss fairy tale in hopes of one day obtaining the happily ever after of an “ideal” weight, we are not living in the present.

To start the unlearning process, ask yourself these questions:

What would be different if I were thin?

I have frequently heard answers such as the following:

  • “I would be healthy.”
  • “I wouldn’t hate my stomach and my thighs.”
  • “People would like me more.”

Think objectively about the veracity of each of these statements. We know thinness does not equate to good health. Someone can be of normal or lower weight and still have diseases such as hypertension, diabetes, asthma and seizures.

Your stomach and thighs may become thinner, but you may experience changes that come with aging, such as stretch marks and loosening skin. You may continue to dislike your body and see flaws where others do not. And you may still have the desire to lose “just a couple more pounds.”

Do I want to lose weight for me or for someone else?

Patients often tell me they want to lose weight for themselves. But upon deeper exploration, we find that they consider thinness as a tool to achieve acceptance and love. This, again, is dependent on others, which gives your power to someone else.

Do I have to be thin to attain the things I desire?

Many of my patients want health, acceptance and love — all of which can be achieved without thinness. If this weren’t a fact, individuals who are of normal or higher weight couldn’t be healthy or find love or have friends.

Your weight may not be what is stopping you from finding clothes that fit, to go out on a date or make new friends. It may be a fear of others rejecting you in the same way you have already rejected yourself based only on weight.

Don’t look at happiness as a destination when you can work on experiencing it now.

Will my efforts to achieve thinness be sustainable?

Once you have dropped some weight, you may not be able to dedicate the same time, energy and money you put into losing the weight to maintaining your new low weight. And you would be taking that time, energy and money away from the experiences and caring relationships that you wished to attain to begin with.

Do my beliefs of thinness perpetuate shame or joy?

You wouldn’t encourage anyone you love to believe that if they were just thinner, they could be happier. So try not to believe that about yourself and treat yourself with the same kindness you give others.

Identify and challenge your beliefs on thinness being the gateway to happiness, and focus on the things your body does for you that you may be overlooking, such as dancing, hugging someone and smelling flowers. You are much more than your appearance.

As you begin to honestly answer these questions, examine and question the thinness myth, and work on changing your beliefs that may be damaging your health. You can find happiness without thinness.

Pamela Ramos, MD, is an American Board of Psychiatry and Neurology certified adult psychiatrist specialized in eating disorders in private practice in Maryland and D.C.

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