Navigating the Ozempic Craze in Eating Disorder Recovery
By: Alison Ross, LMFT, CEDS
As an eating disorder specialist, I'm navigating the semaglutide medication craze right along with you. Here are some of my thoughts on how it could effect people struggling with binge eating disorder...
Remi Bader recently shared her experience with Ozempic on the Not Skinny but Not Fat Podcast. She revealed that after stopping the medication, she regained twice the weight she had lost, and her binge-eating worsened. And we're hearing similar stories from other people who are using semaglutide medications like Ozempic. As an eating disorder specialist, I want to share why I think this might be happening to some people with binge eating disorders (BED) who use semaglutide medications.
First off, having personally struggled with my eating in a manner similar to Remi, I can understand why individuals with binge-eating disorder might want to try these medications. They are known to suppress the appetite, and some users of the medications report that they can also reduce obsessive food thoughts - a classic struggle for those with binge-eating disorder. The idea of no longer feeling constantly hungry and being able to quiet the mental food chatter can seem like much needed, and deserved, help for someone going through this. But, it's important to remember that these medications weren't created or tested specifically for binge eating disorder, and using a medication to suppress the appetite could actually do more harm than good for people struggling with BED.
Attempting to address binge eating disorder by suppressing an overactive appetite presents a paradox. Consider this - the development of binge eating disorder is often linked to malnutrition resulting from efforts the person already made to suppress their appetite using restrictive eating strategies, diets, exercise, pills, hormone shots, supplements, and other methods. Individuals with binge eating disorder often have a history of being shamed about their natural body size or shape and eating habits. This leads them to engage in restrictive dieting to try to conform to familial or societal body standards. However, dieting efforts often result in inadequate nutrition, triggering survival mechanisms in the brain and leading to the strong food-seeking drive and compulsive food thoughts seen in BED. In other words, people with BED have already suppressed their appetite, sometimes repeatedly, and it's those efforts that paradoxically contributed to the overactive appetite and compulsive food thoughts associated with the disorder.
Let's delve into how Ozempic promotes weight loss. One of its mechanisms involves suppressing appetite and creating food aversion. Similar to food restriction aimed at weight loss, individuals using these medications may initially experience reduced hunger causing them to eat less, or to fail to get enough nutrition. This could lead to malnutrition, eventually triggering intense food-seeking thoughts and behaviors, and escalating compulsive food thoughts and binge eating. In essence, these drugs could initially induce nutrient restriction and weight loss, but later lead to extreme hunger, weight gain, and an increased food-seeking drive. This may explain the experiences of Remi Bader and others with BED who report heightened binge eating during and after using the medication.
Another of my concerns is that while these medications have a strong impact on the gut, they may not address the aspect of Binge Eating Disorder (BED) that is strongly influenced by the brain's reward pathway. In BED, the reward pathway forms a deeply ingrained food-seeking loop that can persist even when individuals are taking appetite-suppressing medications. The potent circuitry of the reward pathway can still trigger the addictive process, driving food-seeking behaviors, even when a person is medicated. In essence, individuals using the medication may not feel hungry or have the urge to eat, but their brains might still compel them to binge. Alternatively, the compulsion to eat could transfer to other feel-good substances or experiences such as alcohol, drugs, excessive exercise, or calorie counting. In some cases, we might find that, being on these medications, people with BED will trade one addictive process for another instead of improving their overall physical and mental health.
To effectively address Binge Eating Disorder (BED), it's crucial to reduce the urge to binge by taking a holistic approach that encompasses both the physical and psychological aspects of the condition. In my practice, I strive to help clients move away from attempting to suppress their appetite and instead focus on regulating it. This involves, in part, addressing the feelings of shame, chronic stress, and the mindset of food restriction that contribute to malnutrition and an overactive appetite. By addressing the underlying causes, we can restore the appetite's natural function to consistently guide a person toward fulfilling their nutritional needs in a body-attuned manner. Once the body is nourished and the mind and nervous system find balance, individuals with BED can experience the relief of having an appetite that has returned to its natural state.
Based on what I've seen thus far, these appetite-suppressing medications seem to alleviate the food-seeking drive associated with Binge Eating Disorder (BED) for some individuals and for some period of time. But it's important to note that the manufacturers of these medications have never claimed they are designed or should be used for the purpose of treating BED. Some early user reports indicate that these drugs may exacerbate BED symptoms during and after use for certain individuals. Instances of heightened binge eating and addiction transfer while using these medications underscore the complexity of BED and the potential risks of self-medicating with them.
If you suffer with Binge Eating Disorder and are using or have tried semaglutide medications, we'd love to hear about your experiences. Your real-world insights mean a lot to our community, as they can help us navigate the trend of using these medications for weight loss and how they truly effect the lives and health of people with BED and other eating disorders. We want to provide a space for all perspectives. Share away!