Why it can be hard to talk about weight loss injections (and why I’m doing it anyway)

I've been writing and speaking about weight loss injections (GLP-1s such as Wegovy, Ozempic, Mounjaro) a lot recently, which I feel is important, but it doesn't always feel easy. I'm certainly not short of things to say on this topic, but it is an emotive one which people have a lot of opinions about, often conflicting.
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When I hear others talk about the subject, they're often trying to approach it with understandable nuance and respect. It's important not to add to the judgment of people who choose to take weight loss injections. Comments online can be cruel, which sadly isn't a surprise, with people saying it's the easy way out or that it shows laziness. This is absolutely not the case. Many people struggle with low self-esteem and painful thoughts around food and their bodies. Eating distress goes far beyond what fits neatly into an eating disorder diagnosis, and far more people struggle than we realise.

I understand the harmful nature of appearance pressures, the thin ideal, and diet culture. I also understand how damaging weight stigma can be, both from a professional and personal perspective. As someone in a larger body, I've in the past experienced the same desperation that many people face. I know the pain, the struggle, and the shame that comes with it. This is why I would never judge any individual who chooses to take weight loss injections or engages in any other weight loss intervention.

However, as an eating disorder therapist and an advocate in this area, I feel I need to speak out on the potential harms and risks of weight loss injections. I appreciate the nuanced conversations I've heard, but I sense that people are often tiptoeing carefully, not wanting to offend. It feels as if we're not allowed to say negative things about weight loss injections. I've encountered defensive and angry responses myself. It's understandable that people feel strongly and push back, as many believe weight loss injections are life-saving.

This is why I like to make a clear distinction. How I work with individuals in therapy is different from how I speak publicly about issues such as weight stigma and weight loss injections. I respect people’s right to body autonomy and choice, and I understand that many feel weight loss injections are beneficial. But many people are being harmed by these drugs, and the wider social impact is extremely concerning. So far, this hasn't been given nearly enough attention.

I'm aware that I may ruffle feathers when I speak about this in trainings, on podcasts and in my blogs. I may encounter pushback and disagreement, which I'll need to be open and resilient about. Putting myself out there in this way feels vulnerable, especially as someone who used to have low self-worth and a strong inner critic that still shows up at times. But I feel passionately about raising awareness of the harms of weight loss injections in contrast to the overwhelming positive discourse and societal pressure to lose weight.

My perspective is from an eating disorder lens, so I'm usually not talking about people who take these drugs for diabetes or those prescribed them through the NHS. Hopefully, these individuals are receiving good support with managing the injections, including starting and stopping them. My concern is more focused on the many others who are accessing weight loss drugs through different routes, often online, without the necessary checks, support, and care.
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Many people using these drugs are not in larger bodies. Celebrities and influencers, and even an athlete (Serena Williams) have spoken about and endorsed them. Jonathan Van Ness from Queer Eye (who was not in a larger body in the first place) shared on Instagram that they were using weight loss injections to “treat” binge eating disorder. There's no evidence or research to support this claim. Advocating in this way is dangerous, as it could encourage others with eating disorders to turn to these drugs. Weight loss drugs are appetite suppressants, which can be very harmful to anyone with disordered eating, including those who binge eat, as this only fuels binge cycles.

Sadly, many public strategies to “tackle obesity” are harmful to people with eating disorders, who are often overlooked. I worry it may take a tragedy in the tabloids, perhaps a young person with anorexia taking weight loss injections, before people take this issue seriously. I really don't want it to reach this point, but I believe these drugs act like rocket fuel for eating disorders.

This is why I can't adopt the tiptoe approach. It wouldn't feel ethical for me as an eating disorder therapist. I'm going to maintain a critical stance on weight loss injections, both the drugs themselves and the wider social implications (never on the individuals who take them). I'm glad to see other eating disorder organisations and professionals highlighting harm too, such as Dump the Scales, for whom I wrote a guest blog - read it here. 

This stance is necessary against a sea of positive and so-called balanced discourse, when in reality that balance can be skewed towards favouring weight loss drugs. A critical perspective on weight loss injections, highlighting risks and harms, is the balance we actually need.
 
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