Over the last few years, we’ve witnessed an explosion in the use of GLP-1 agonist medications. According to a 2024 survey, 12% of Americans have tried a GLP-1, and this number is likely higher now and will continue to grow for the foreseeable future.
Individuals seek GLP-1 medications for a variety of reasons. Often, they are prescribed to assist with blood sugar control or blood pressure management. These medications have been associated with a reduced incidence of major cardiovascular events (e.g., heart attack, stroke) in those who have Type 2 diabetes and established cardiovascular disease. Additional benefits may include slowing in the progression of kidney disease and possible anti-inflammatory effects. These are, of course, important health benefits.
And then, there is the pursuit of weight loss, a common motivation for folks who begin taking GLP-1s. These medications can simultaneously reduce appetite and increase satiety. Significant weight loss has been demonstrated with both semaglutides (Ozempic, Wegovy) and tirzepatide (Mounjaro/Zepbound). In fact, much of what we hear among friends and family and in the media involves the weight-loss effect of GLP-1s.
If this all sounds too good to be true, it’s possible it could be. To start, these medications are not without side effects, many of which are gastrointestinal related. Common side effects include nausea, vomiting, abdominal pain or discomfort, diarrhea, constipation, and more. These experiences may be particularly challenging at the onset of treatment or with any dose increases. For some, these effects are significant enough to result in medication discontinuation.
There are some more concerning side effects, which are rare but significant. Some reports show an association between taking GLP-1 medication and the development of hypoglycemia, gallstones, kidney problems, and pancreatitis. Those with an eating disorder history might experience a relapse on these medications and as such, shouldn’t be prescribed them. In some cases, medication-related mood changes have been reported, along with the experience of suicidal thoughts.
The reality is, that while the above are some of the known side effects, we have no idea what might result from long-term use. The FDA approved the first GLP-1 agonist in 2005, making this class of medication much younger than many others. Most people taking GLP-1s haven’t been on them that long, and longitudinal research is necessary to uncover what is possible with longer term use. So we have yet to see what might arise when folks are on the medications for years or even what they might experience years after stopping them.
One of the most challenging costs associated with taking GLP-1s is just that, the cost. A month’s supply of these medications can run upwards of $1000, and insurance coverage isn’t a given. Even if people are able to access GLP-1s at a lower cost, they are still more expensive than most medications, and this can place a financial burden on patients and might result in short-term use. Related to this, the benefits discussed above , such as reductions in blood sugar and weight loss, aren’t permanent and are generally reversed when the medication is stopped. For this reason, GLP-1s are considered a chronic, versus temporary, intervention.
Ultimately, every person considering taking GLP-1 medication must weigh the costs and benefits for their individual bodies and circumstances. Having collaborative conversations with medical doctors and mental health professionals can help with the decision-making process. If a provider prescribes this medication to you, don’t be afraid to ask about the downsides. Ask how long they think that you’ll be on it. Ask what happens after this. Decisions are best made with all this information available beforehand.
As a practice specializing in eating and body image issues, we will acknowledge that we are concerned about the proliferation of these medications both for individuals who might struggle with disordered eating and for the general public. Many people who begin GLP-1 medication take it to quiet what they refer to as “food noise.” But as eating disorder specialists, we are well aware that chronic restriction is the primary cause of food noise and that practicing intuitive eating can radically shift this experience. Those who insist that they’re eating enough and still experiencing constant thoughts about food are typically under-nourishing themselves toward the goal of weight suppression. Diet culture is so loud and proud that we often don’t see how it can impact almost every aspect of our lives.
Additionally, we are tracking the bigger-picture impact of GLP-1s on how our culture views and treats body diversity. As providers and as a field, we have witnessed slow but steady progress in the body positivity/body diversity/fat acceptance movements over time. With so many people taking GLP-1s for weight loss now, we are experiencing a reversal in this progress. Celebrities who once stood for body positivity are shrinking as we speak. Many of us have friends, family members, and colleagues who are doing the same. It’s safe to say we all know people who don’t mention they’re taking them and mysteriously drop weight, which they then attribute to other causes.
And yet, we understand the pull. Living in a fatphobic world that bullies, marginalizes, and refuses to accommodate larger bodies can lead to significant stress and threats to well-being for those who don’t fit the thin ideal. The promise of a medication that can ultimately lead to more acceptance, respect, and access is certainly alluring. It’s safe to say that the decision about whether or not to take GLP-1 medication is complicated. Every individual is entitled to make this choice for themself. Your body, your choice. And yet collectively, we worry about the impact of these medications on the incidence of eating disorders, diet culture, and the body liberation movement.