Diet culture is back. Are GLP-1s creating a perfect storm for eating disorders?
Ozempic has transformed weight loss — and could be helping diet culture make a comeback. Experts explain what that shifting landscape could mean for eating disorders.
After famously singing “I ain’t no size two,” singer Meghan Trainor now looks like she might be getting close to it. Her latest videos showcase fitness routines — and a dramatically slimmer figure.
The “All About That Bass” songstress is now all about Mounjaro, a hormone-like GLP-1 drug approved for diabetes and weight loss, that helped her drop 60 pounds, according to her Instagram posts and multiple interviews in various news publications.
Serena Williams, Oprah Winfrey, Andy Cohen, Whoopi Goldberg and other celebrities have also experienced similar transformations, after using GLP-1 drugs as they have each publicly disclosed.
After years of body positivity pushing weight ideals to the sidelines, has American culture gone diet-crazy again? And what does it mean for people struggling with eating disorders — medical conditions involving debilitating disruptions in eating and body image — or those at risk for developing one?
“Every generation kind of has these magic diet pills,” said Northeastern University’s Bouvé College of Health Sciences professor Ashleigh Shields.
Many have since landed in the U.S. Food and Drug Administration’s discard pile. Fen-phen, a 90s blockbuster, led to a $3.75 billion class-action settlement due to potentially lethal complications from taking the pills. Supplements based on the herb ephedra are also banned by the FDA.
Unlike their dubious predecessors, GLP-1s are mainstream and legit — and a godsend for those who need them, Shields confirmed.
But in solving one problem, has another one been made worse?
“People are rushing to do these things without really thinking about or understanding the consequences,” Shields warned.
And for people struggling with eating disorders, those consequences can be deadly.
According to the National Eating Disorder Association (NEDA), a nonprofit, 9 percent of the U.S. population has faced a bout with the condition at some point in life. That’s nearly 31 million Americans, or more than four times the population of Massachusetts.
And every 52 minutes, a person dies as a direct consequence of an eating disorder, NEDA reports.
Officially diagnoses such as anorexia and bulimia miss the gamut of “disordered eating” behaviors that don’t fall into strict criteria — including ones Shields herself struggled with when she was younger.
While initially told it was a “teenage phase” she would outgrow, Shields now recognizes disordered eating as problematic. Cutting her food into tiny pieces to make a little bit go a long way, she would take a few bites and toss out the rest. She counted grapes as her go-to “safe” food, but imagined pasta as “worms” to kill her appetite. Gum and mints filled the gaps, keeping hunger at bay.
Then came the exercise. Shields powered through at least two daily workouts lasting hours at a time to burn off the little that she did eat. By college, she was training for marathons, logging around 12-18 miles per day.
“I would be in a bad mood if I didn’t work out,” she said.
Food and body image took up so much real estate in her mind that she grew increasingly isolated.
“I call them DEEDs,” she explained, using an all-encompassing term that combines abbreviations for Disordered Eating and Eating Disorders.
There’s no single trigger that sets them in motion, Shields said. She described DEEDs as “kind of a puzzle” pieced from genetics and environmental factors coming together in a perfect storm.
And the GLP-1 craze isn’t helping, she added.
NEDA notes that the full extent of the effect of drugs like Ozempic on eating disorders is still unknown. However, it urges caution with GLP-1s due to potential risks to these groups. Recent research and many anecdotal reports have also documented misuse.
And the potential risks aren’t confined to what happens after an injection. Experts say the weight loss culture that has sprung up around the drugs may pose concerns of its own.
Alexis Conason, author of “The Diet-Free Revolution,” which focuses on mindful eating and self-acceptance, told Northeastern Global News that the airtime GLP-1s are getting — combined with a shift away from body positivity — sets up an unhealthy dynamic.
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“Prior to the Ozempic era, there was more of a sense of rejecting the diet mentality,” Conason said. The idea was that weight wasn’t something you could — or needed to — control, since bodies of different sizes could be equally healthy.
GLP-1s have flipped the narrative, Conason said. Now that weight seems controllable, being thin looks like a matter of personal responsibility.
As weight loss returns to center stage, beauty standards follow, Shields added.
“Unfortunately right now heroin chic is back,” she said. The waifish waistlines and gaunt cheekbones of the Y2K era that marked the transition from the late 1990s to the early 2000s and spawned cultural upheaval and social unease have returned as “Ozempic body.”
The drumbeat of weight loss-related messages could pose a threat to those vulnerable to DEEDs, Shields said. For those who actually take the drugs like Ozempic, however, the potential eating disorder link takes on another dimension. There’s an extra layer of risk — especially given how rapidly and effortlessly the pounds seem to come off.
Years before GLP1-s were on the scene, Shields found that the process of losing weight can take on a life of its own. The same is true for many: what starts as a plan to shed a few pounds before swimsuit season suddenly feels like a runaway train.
“Once you get to that number, it’s never enough,” she said.
There are biological and psychological reasons for this effect, she said. When the eating disorder is calling the shots in the brain, it acts as a sort of filter distorting the reflection in the mirror even if you cross into the underweight range.
“When I look back on when I was at my lowest weight endpoint, I’m like, oh my gosh, how did I not see that?” she recounted, calling the experience “very disorienting.”
Meanwhile, well-meaning compliments from family and friends fuel the desire to keep going. Once weight loss becomes synonymous with success, the message is hard to erase, Shields said.
The speed of GLP-1-fueled weight loss, in turn, could give that runaway train some extra fuel.
Moreover, anyone looking for a quick fix eventually runs into a problem: GLP-1 tolerance builds over time. This often means you may end up regaining what you lost and then some, Shields said.
The rebound weight gain can land people in a vulnerable place, making them susceptible to DEEDs.
“It’s a slippery slope,” Shields summed up.
So what can you do if you notice you’re slipping?
For those caught in the cycle, Shields likened recovery to a kind of “deprogramming” — recognizing the language and messaging around weight loss you may have absorbed, unlearning it and separating it from what you genuinely believe. It’s not unlike leaving a cult, she said. Give your DEED a name, whether it’s the classic “Ed” or something totally random, like Carl or Mildred. Learn the science behind it. Trade in triggering materials for recovery and survivor stories. As Shields suggested, all of these methods can help create distance.
So swap that scroll for “Sounds Like a Cult” — or turn up “All About That Bass” for old time’s sake.
