GLP-1 Medications: What a Weight-Inclusive Dietitian Wants You to Know
Over the past few years, medications like Ozempic, Wegovy, Zepbound, and Mounjaro have become household names. These medications belong to a class called GLP-1 receptor agonists (and related GLP-1/GIP medications) and are increasingly prescribed for weight loss.
As a registered dietitian who specializes in eating disorders and practices from a weight-inclusive lens, I have watched the conversation around these medications become increasingly polarized. Some people describe them as life-changing. Others describe severe side effects, worsening food fears, or a resurgence of eating disorder symptoms.
Let's approach this topic with nuance.
GLP-1 medications are legitimate medical treatments that can be beneficial for some individuals, particularly those with type 2 diabetes and certain metabolic conditions. At the same time, they are not risk-free, and the potential implications for eating disorder risk, recovery, and long-term well-being deserve much more attention than they are receiving.
What Are GLP-1 Medications?
GLP-1 receptor agonists were originally developed to help manage type 2 diabetes. They work by mimicking hormones involved in blood sugar regulation, appetite, and digestion. Due to these mechanisms, they have also been observed to reduce hunger, increase feelings of fullness, and slow the rate at which food leaves the stomach. These effects can lead to significant weight loss in users.
Common medications in this category include semaglutide (Ozempic and Wegovy), liraglutide (Saxenda), and tirzepatide (Mounjaro and Zepbound).
The Side Effects People Are Hearing About
The most common side effects are gastrointestinal and can range from mild to severe.
These include:
Nausea
Vomiting
Diarrhea
Constipation
Abdominal pain
Bloating
Early fullness
Reduced appetite
These symptoms are so common that many people report needing to change how they eat simply to tolerate the medication.
While some individuals experience only mild discomfort, others report symptoms significant enough to interfere with daily functioning, social eating, exercise, hydration, and adequate nutrition.
Serious Medical Risks
Although less common, GLP-1 medications are also associated with serious complications.
Documented risks include:
Gastroparesis (delayed stomach emptying)
Bowel obstruction or ileus
Pancreatitis
Dehydration
Kidney complications related to severe vomiting or fluid loss
Loss of lean body mass (muscle tissue)
Potential thyroid-related concerns in certain populations
For people who already have digestive disorders, chronic constipation, gastrointestinal motility concerns, or conditions that affect nutritional status, these risks may warrant particularly careful consideration and medical monitoring.
The Eating Disorder Concerns We Need to Talk About
As an eating disorder dietitian, this is where my greatest concern lies.
Many of the effects that make GLP-1 medications effective for weight loss are also characteristics that can overlap with eating disorder symptoms:
Appetite suppression
Reduced interest in food
Eating significantly less
Skipping meals because hunger cues are absent
Rapid weight loss
Increased focus on body size changes
For someone with an active eating disorder, a history of an eating disorder, or a high vulnerability to developing one, these effects may reinforce restrictive eating patterns and make it more difficult to recognize when nutrition is becoming inadequate.
Appetite Suppression Is Not the Same Thing as Healing Your Relationship With Food
One of the most troubling narratives I see online is the idea that eliminating hunger or reducing "food noise" automatically means someone has healed their relationship with food.
Eating disorders are not simply about appetite.
They involve complex relationships with body image, self-worth, control, perfectionism, anxiety, trauma, and cultural pressures around weight and appearance.
Suppressing hunger may reduce some eating-related thoughts for certain individuals, but it does not automatically address the underlying emotional, psychological, or social drivers of disordered eating. These medications may also interfere with internal hunger and fullness cues, which are important aspects of eating disorder recovery.
Rapid Weight Loss Comes With Nutritional Risks
Weight loss is often falsely portrayed as inherently positive, regardless of how it occurs.
However, rapid weight loss can increase the risk of:
Malnutrition
Micronutrient deficiencies
Muscle loss
Fatigue
Reduced physical function
Hormonal disruption
Loss of bone-supporting nutrients
For individuals with eating disorders or chronic dieting histories, these risks may be compounded by pre-existing nutritional deficits. The reduction in lean body mass seen with GLP-1 use is particularly concerning because muscle tissue plays important roles in metabolic health, physical function, and aging.
The Problem of Weight Cycling
Another concern is what happens when people stop taking these medications.
Research and clinical observations suggest that many individuals regain a substantial portion of the weight lost after discontinuation. This is not a failure of willpower. It reflects powerful biological mechanisms designed to protect the body from perceived starvation.
For people with eating disorder histories, cycles of weight loss and regain can be emotionally distressing and may trigger renewed restriction, binge eating, body dissatisfaction, or other disordered behaviors.
We Cannot Separate GLP-1 Medications From Weight Stigma
A weight-inclusive perspective requires us to examine the broader cultural context.
We live in a society that glorifies thinness, pathologizes larger bodies, and often treats weight loss as a moral achievement. In this environment, it is difficult to discuss GLP-1 medications without also discussing weight stigma.
Many people are pursuing these medications not because of medical necessity, but because of immense social pressure to become smaller.
When a medication becomes widely celebrated primarily for making bodies thinner, we must ask important questions:
Who benefits from this messaging?
What happens to people who cannot access these medications?
What happens when weight loss becomes viewed as the primary path to health?
How does this affect individuals vulnerable to eating disorders?
These questions deserve thoughtful consideration alongside discussions of efficacy and side effects.
A HAES-Aligned Perspective
A Health at Every Size® approach does not require us to be "for" or "against" GLP-1 medications. Instead, it encourages us to ask better questions.
Rather than asking: "How much weight can I lose?"
We might ask:
How will this affect my relationship with food?
How will this affect my mental health?
Am I able to meet my nutritional needs while taking this medication?
Do I have a history of disordered eating that deserves consideration?
What are the potential benefits and risks for my unique situation?
Am I pursuing this from a place of self-care or self-punishment?
These questions are more important than the number on the scale.
Final Thoughts
GLP-1 medications are neither miracle cures nor inherently dangerous for every person who uses them.
They are powerful medications with meaningful physiological effects, real side effects, and important unanswered questions—particularly regarding eating disorders and long-term psychological outcomes. Research examining their impact on eating disorder risk remains limited, and experts continue to call for more comprehensive screening and monitoring of vulnerable individuals.
As eating disorder professionals, our responsibility is not to promote or condemn these medications. It is to ensure that people have access to accurate information, informed consent, compassionate care, and support that extends beyond weight alone.
