Up to 72 per cent of women and 61 per cent of men are dissatisfied with their weight or body image, according to a U.S. study. Globally, millions of people attempt to lose weight every year with the hope that weight loss will have positive effects on their body image, health and quality of life.
However, these motivated individuals often struggle to maintain new diets or exercise regimens. The rise of medications such as semaglutides, like Ozempic or Wegovy, might be viewed as an appealing “quick fix” alternative to meet weight loss goals.
Research led by our team and others suggests that such attempts to lose weight often do more harm than good, and even increase the risk of developing an eating disorder.
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Weight loss and eating disorders
Eating disorders are serious mental health conditions primarily characterized by extreme patterns of under- or over-eating, concerns about one’s shape or body weight or other behaviours intended to influence body shape or weight such as exercising excessively or self-inducing vomiting.
Although once thought to only affect young, white adolescent girls, eating disorders do not discriminate; eating disorders can develop in people of any age, sex, gender or racial/ethnic background, with an estimated one million Canadians suffering from an eating disorder at any given time. Feb. 1 to 7 is National Eating Disorders Awareness Week.
As a clinical psychologist and clinical psychology graduate student, our research has focused on how eating disorders develop and what keeps them going. Pertinent to society’s focus on weight-related goals, our research has examined associations between weight loss and eating disorder symptoms.
Eating disorders and ‘weight suppression’
In eating disorders research, the state of maintaining weight loss is referred to as “weight suppression.” Weight suppression is typically defined as the difference between a person’s current weight and their highest lifetime weight (excluding pregnancy).
Despite the belief that weight loss will improve body satisfaction, we found that in a sample of over 600 men and women, weight loss had no impact on women’s negative body image and was associated with increased body dissatisfaction in men. Importantly, being more weight suppressed has been associated with the onset of eating disorders, including anorexia nervosa and bulimia nervosa.
One proposed explanation for the relationship between weight suppression and eating disorders is that maintaining weight loss becomes increasingly difficult as body systems that reduce metabolic rate and energy expenditure, and increase appetite, are activated to promote weight gain.
There is growing awareness that weight regain is highly likely following conventional diet programs. This might lead people to engage in more and more extreme behaviours to control their weight, or they might shift between extreme restriction of food intake and episodes of overeating or binge eating, the characteristic symptoms of bulimia nervosa.
Ozempic and other semaglutide drugs
Semaglutide drugs like Ozempic and Wegovy are part of a class of drug called glucagon-like peptide-1 agonists (GLP-1As). These drugs work by mimicking the hormone GLP-1 to interact with neural pathways that signal satiety (fullness) and slow stomach emptying, leading to reduced food intake.
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Although GLP-1As are indicated to treat Type 2 diabetes, they are increasingly prescribed off-label or being illegally purchased without a prescription because of their observed effectiveness at inducing weight loss. Although medications like Ozempic do often lead to weight loss, the rate of weight loss may slow down or stop over time.
Research by Lindsay Bodell, one of the authors of this story, and her colleagues on weight suppression may help explain why effects of semaglutides diminish over time, as weight suppression is associated with reduced GLP-1 response. This means those suppressing their weight could become less responsive to the satiety signals activated by GLP-1As.
Additionally, weight loss effects are only seen for as long as the medication is taken, meaning those who take these drugs to achieve some weight loss goal are likely to regain most, if not all, weight lost when they stop taking the medication.
Risks of dieting and weight-loss drugs
The growing market for off-label weight loss drugs is concerning, because of the exacerbation of weight stigma and the serious health risks associated with unsupervised weight loss, including developing eating disorders.
Researchers and health professionals are already raising the alarm about the use of GLP-1As in children and adolescents, due to concerns about their possible impact on growth and development.
Moreover, popular weight-loss methods, whether they involve pills or “crash diets,” often mimic symptoms of eating disorders. For example, intermittent fasting diets that involve long periods of fasting followed by short periods of food consumption may mimic and increase the risk of developing binge eating problems.
The use of diet pills or laxatives to lose weight has been found to increase the risk of being diagnosed with an eating disorder in the next one to three years. Drugs like Ozempic may also be misused by individuals already struggling with an eating disorder to suppress their appetite, compensate for binge eating episodes or manage fear of weight gain.
Individuals who are already showing signs of an eating disorder, such as limiting their food intake and intense concerns about their weight, may be most at risk of spiralling from a weight loss diet or medication into an eating disorder, even if they only lose a moderate amount of weight.
People who are dissatisfied with their weight or have made multiple attempts to lose weight often feel pressured to try increasingly drastic methods. However, any diet, exercise program or weight-loss medication promising a quick fix for weight loss should be treated with extreme caution. At best, you may gain the weight back; at worst, you put yourself at risk for much more serious eating disorders and other health problems.
Samantha Withnell receives funding from the Social Sciences and Humanities Research Council of Canada.
Lindsay Bodell receives (or has previously received) funding from the Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Brain Canada Foundation, and Banting Research Foundation.
