There’s been a lot of talk about the “miracle” weight-loss drug semaglutide lately. In my opinion, way too much talk—much of it inaccurate and dangerous.
Sold via prescription as Ozempic (for diabetes) and Wegovy (for weight loss), semaglutide is a synthetic hormone-like substance that can increase the production of insulin in people with diabetes. This helps control blood sugar.
When prescribed for weight loss, semaglutide slows down the digestive process and may contribute to feelings of fullness and prolong satiety. This may lead to an overall decrease in food consumption.
That’s the basic chemistry. The reality is that semaglutide causes so many alarm bells to go off for us eating disorder clinicians that it’s hard to know where to begin. Let’s start with the big picture.
Our culture’s take
For much too long, our society and the traditional healthcare system have been overly weight-centric in their perception of human health. This weight stigma has led to the perception that weight directly correlates with health, creating a very narrow view. Weight loss advice is everywhere and clinicians often prescribe weight loss without much consideration for other factors that influence well-being. It’s as if weight is the only health metric that matters.
That’s like saying your heart rate or blood pressure is the one key health metric, so take care of that, and you’ll be fine.
Our society’s media-driven weight obsession spills over into all areas of life. You want to be happy? Lose weight at any cost.
No surprise, the media barrage to lose weight plays a significant role in what we’re now facing, which is millions of people struggling with eating disorders.
The magic bullet that isn’t
Into this never-ending quest for the holy grail of thinness drops…semaglutide.
Some quick background: In 2017, the FDA approved this drug to treat people with diabetes under the brand name Ozempic.
In 2021, the FDA approved Wegovy, a more concentrated form of semaglutide to treat medical obesity based on BMI, and in some cases for overweight individuals with comorbid medical issues.
Both remain prescription-only, and both can be effective—Ozempic at controlling blood sugar, Wegovy at helping certain people lose weight. Semaglutide in those two forms is meant to be taken under the supervision of a medical professional as part of a comprehensive treatment plan that includes lifestyle modifications and behavioral therapy.
The problem is, people with disordered eating or eating disorders may misuse this medication because it promises quick weight loss. Many are finding it on the internet, it’s not being prescribed or supervised by a medical professional, and people aren’t taking it as part of a treatment plan.
Bad things can happen on semaglutide
Seen through an eating disorder lens, taking semaglutide to lose weight in the absence of any medical condition is very risky. It can feed into the endless pursuit of thinness. (Danger #1)
Taking semaglutide, especially if you’re self-medicating and not under medical supervision, can also cause serious side effects. (Danger #2) These may include frequent nausea, fatigue, diarrhea, or severe constipation. In rare cases, semaglutide use has even led to gallstones and pancreatitis. For those already living with an eating disorder, the medication can increase the risk for undernutrition, electrolyte abnormalities, chronic GI issues, and increased risk of infection, depression, and anxiety.
As I mentioned earlier, semaglutide can slow stomach digestion, which signals to your brain that you’re full. This leads some people to unintentionally restrict their overall intake of food, which may result in potentially serious deficiencies. (Danger #3) That can cause your eating plan to become dangerously out of balance.
Don’t believe everything you read (or see, or hear)
When tempted by drugs like semaglutide in any of its forms, it’s important to first educate yourself about them using reputable sources such as the National Eating Disorder Association, the American Medical Association, and others.
In contrast to those authoritative organizations, shady individuals and fly-by-night telehealth companies have flooded into the semaglutide market in hopes of making money. They’re selling knock-offs and analogs and making all sorts of claims about safety and efficacy that aren’t true.
Educating yourself on this drug will help protect you from these irresponsible claims and practices. I urge you to do that.
The real issue is weight stigma
This bears repeating: The allure of self-medicating with semaglutide often starts with the thinking that weight is the problem, and weight loss is the solution.
Medications for weight loss are a symptom of a more serious issue, which is the pathologizing of weight. That is, the view that higher weight is a medical condition and the cause of poor health. Moreover, prescribing medications that suppress weight can set off dangerous weight cycling that is associated with many significant health consequences.
And in instances where there are other health conditions or behaviors present, weight often gets the blame for them. Again, as if it’s the only health metric that matters and that drives everything else. Collective tunnel vision, in other words.
Final thoughts
As a proponent of the Health at Every Size (HAES) approach, I believe that a person’s well-being and healthy habits are more important than any number on the scale. Fact: You can be healthy across a wide range of weights.
From the HAES perspective, taking semaglutide to lose weight in the absence of any weight-related condition perpetuates weight stigma and discrimination and may lead to the exacerbation of mental and physical health conditions.
It’s true, for a small percentage of people, taking semaglutide may work well as part of a comprehensive treatment plan under the supervision of a medical professional. People considering this medication should be screened and treated for disordered eating and eating disorders before drug therapy is started. We know that the overemphasis on weight does not address the underlying eating disorder, and may lead to the worsening of behaviors.
If you’re considering semaglutide, learn as much as possible about the drug so you’re aware of the potential pros and cons. Always work with a qualified medical professional if you’re considering starting this medication.
Finally, when researching semaglutide and drugs like it, stick to legitimate, scientific sources. Social media sites like TikTok, Instagram, and Reddit are filled with misinformation and may encourage dangerous uses for this medication.
