By now you have probably heard the names. Ozempic. Wegovy. Mounjaro. Zepbound. Maybe you have taken one yourself. Maybe someone you love has. Or maybe you have just seen them everywhere and wondered what all the fuss is really about. I want to talk about them today, but not the way most people do.
Before I stpecialized in eating disorders I spent over ten years working as a Certified Diabetes Educator. I watched these same medications change lives for people with diabetes long before they became a household name. So when they started showing up in weight loss conversations, I was not reading about something new to me. I was watching a medicine I already knew well step into a completely different conversation, one that touches the most vulnerable people I work with every single day.
Here is something most advertisements will not tell you. These medications do not just work on your stomach. They work on your brain.
Your body already makes a hormone called GLP-1. After you eat, it tells your brain you are full and it slows down digestion a bit. In some people, those signals get crossed. Hunger stays loud when it should go quiet. Fullness never quite registers. These medications are a stronger, longer lasting copy of that hormone. They turn the full signal way up and turn the hunger noise way down.
For the right person, that can be life changing, and sometimes life saving. Research has shown these medications can lower the risk of heart attack and stroke in people with heart disease and obesity. They help control blood sugar. And the genetics behind hunger and fullness are real.
Scientists have found specific genes that affect how much a person needs to eat before their brain finally says enough. This is not about willpower. It is biology.
I will say one more thing here, because I believe it. We do not tell someone with high blood pressure that they are cheating by taking medicine for it. We should not say that about this either. My mom always told me to mind my own business if something is not hurting me. Grown adults get to make their own choices about their own bodies and their own health. We do not have to make the same choice ourselves. We do not even have to like it. But everyone deserves the same respect.
Now here is the part that worries me most, and the reason I wanted to write this.
If you have ever struggled with restrictive eating, even years ago, even something that never got an official name, please talk to your doctor and your treatment team before starting one of these medications. The very same effects that help one person can feed an eating disorder in another.A quiet appetite and a smaller hunger are not signs of healing. For someone with a history of restriction, that quiet can feel like exactly what the illness has always wanted. DON'T LET THE EATING DISORDER FOOL YOU!
Right now, these medications do not carry any official warning about eating disorder risk, and most prescribers are not trained to screen for it. That is the trap this article is named for.
There is also early research suggesting these medications may help reduce binge eating episodes for some people with solely binge eating disorder. It is a hopeful sign, but the studies are still small, and we do not yet know what happens once someone stops taking the medication.
My hope in sharing all of this is simple. These medications have a real and important place in medicine. They also need real screening and real care, especially for anyone who has lived with disordered eating in any form. Both of those things are true at the same time. If you are even a little unsure whether this conversation applies to you, that unsureness is reason enough to bring it up with someone on your team. Be honest with yourself or your loved one.
Taking care of you,
Iris
P.S. If anything in this email made you pause, even for a second, hit reply and let me know. I read every message.
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