‘Game changing’ weight-loss medication? The perspective of an eating disorder psychiatrist

Dr Louise Beckford, Consultant Psychiatrist, Orri

Semaglutide, marketed as Ozempic and Wegovy, belongs to a group of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists. These mimic a hormone — GLP-1 — that makes the body produce more insulin, suppresses glucagon secretion and acts on brain receptors.  Appetite is reduced and gastric emptying slowed, contributing to feelings of fullness. These central and peripheral effects of the drugs promote weight loss.

The most well-known drug of this class, Ozempic, was developed to improve the management of type 2 diabetes. It has been shown to improve diabetic control and reduce metabolic complications of type 2 diabetes.

Ozempic was also found in a randomised controlled trial to have a significant effect on weight in people with a BMI above 30 kg/m2. The drug has become licenced in the UK for people with type 2 diabetes and people with obesity and at least one weight related complication.

Non-prescribed use of Ozempic and similar drugs has accelerated following press reports of its role in weight loss treatment, and it is now widely used for weight loss outside of the clinical populations that it was originally designed to help.

So far, the popular literature on drugs like Ozempic has focused on its weight loss properties, its potential for reducing the population effects of obesity and the hype and fascination surrounding its use by celebrities. I have only come across a handful of articles raising concerns relating to eating disorders.

Should we be worried about the potential impact of these new weight loss medications on patients with eating disorders?

The zeal with which some journalists and scientists have talked about Ozempic in particular, has been hard to witness as a psychiatrist who provides treatment for clients living with severe eating disorders. Phrases like ‘game changing’ have been expressed and there seems to be a current trend for celebrities openly guessing in public whether fellow celebrities have used the drugs for weight loss. For clients living with eating disorders, this must be very hard to witness. The focus on weight loss (outside of the clinical groups the drugs are intended for) as something that should be celebrated and championed will not help our relationships with our bodies.

I haven’t seen drugs like Ozempic used widely in the clients that I treat, but I worry that non-prescribed use could emerge in populations of clients with eating disorders. The potential physical effects, including hypoglycaemia, nausea and vomiting could be very significant. The long-term side effects of taking these drugs are unknown but animal studies have suggested possible alarming side effects such as thyroid malignancy and pancreatitis.

I also worry about the psychological effects of losing weight rapidly. Rapid weight loss is a significant factor that we take into account when assessing medical risk in eating disorders. The experience of rapidly losing weight could worsen eating disorder cognitions and behaviours, cause relapse in people with pre-existing eating disorders and potentially trigger new eating disorders in susceptible individuals.

Screening for eating disorders is in place for clients referred for bariatric surgery to treat obesity but is not in place for the non-prescribed use of medications such as Ozempic. It is hard to see how this could be achieved given the ease with which the drugs can be obtained without a prescription or medical recommendation.

I also recognise the potential for these drugs in helping weight management and type 2 diabetes management in people living with eating disorders that present with recurrent binge eating and obesity. A significant number of people living with eating disorders fall into these categories, and it is important to hold in mind that for some these drugs, administered as part of a wider therapeutic programme of care could indeed support meaningful change.

At Orri, we are able to offer specialised treatment across the whole spectrum of eating disorders. Safe and careful use of glycogen – like peptide 1 receptor agonists could therefore sit alongside a multidisciplinary eating disorder treatment approach in the future, which includes psychological therapy, somatic work, dietetic treatment, nursing, psychiatry, occupational therapy and family therapy.

Whilst this requires further understanding and consideration to look at the effectiveness of such an approach, recognition that for some this may be a useful intervention is important, and considerations as to how we can ensure that these drugs are used in a way that supports meaningful change whilst understanding that weight loss is not simply a physical experience, could prove to be an important development.  

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