As the Collaborative of Eating Disorders (CEDO), we are extremely concerned about the lack of consideration for eating disorders in Oprah’s Special: Shame, Blame and the Weight Loss Revolution that aired on March 18, 2024. While Oprah’s personal journey and body autonomy is very important, the Special unfortunately perpetuates diet culture and anti-fat bias, which can often fuel the development of disordered eating and eating disorders.
We are disappointed that information regarding the use of GLP-1s and eating disorders were not present in the Special. The use of GLP-1s in pursuit of weight loss can increase the risk for developing an eating disorder, contribute to relapse for those who have previously struggled, and exacerbate the symptomatology in individuals who are currently struggling. Eating disorders affect more than 29 million Americans and cost our country more than $400B/year in combined financial costs and loss of well-being (Harvard STRIPED, Academy for Eating Disorders, Deloitte Access Economics, 2020). Furthermore, eating disorders are the second deadliest mental illness after opioid abuse. With that, we strongly recommend every person considered for a GLP-1 prescription is screened for disordered eating and eating disorders.
Less than 15% of medical students receive any education on eating disorders in their doctoral training. It is imperative that healthcare providers learn about, and screen for, disordered eating and eating disorders, which could be a contraindication for the use of these drugs.
Individuals, and guardians of children and teens, should be aware of the risks when taking these drugs for weight loss. All mass media discourse on these drugs operates under the mistaken assumption that weight loss inevitably and, in all cases, leads to better health. This is simply not true. Furthermore, weight-based approaches to health exacerbate weight stigma, a correlate of adverse health and well-being (Tylka et al., 2014). As such, there are considerable ethical considerations of promoting treatment that may be damaging. It’s important to recognize the probability of weight cycling and the evidence of long-term harm from weight-loss interventions, especially for those with a history of, or predisposition for, an eating disorder.
The long-term impact of GLP-1s on individuals who are taking it for off-label weight-loss have yet to be seen. However, recent research has shown that individuals without diabetes who take GLP-1s for weight loss have an increased risk of developing serious medical complications, including pancreatitis, gastroparesis, bowel obstructions, and gallbladder disease (Sodhi, et al., 2023; He, et al., 2022). Over time, many will not eat enough to fuel their body properly because of their desire to lose weight. Extreme restrictive eating can lead to serious complications including, but not limited to: bone loss, low heart rate, organ damage, hormone disruption, and neurological issues.
As the popularity of GLP-1s soars, the lack of consideration for the negative impact on disordered eating, and contribution to medical weight stigma and fatphobia will put lives in danger. We strongly urge healthcare providers and the community at-large to include eating disorders in this crucial conversation. We invite you to engage with CEDO members for support and to help reduce the potential for harm. For more information, including signs and symptoms of eating disorders, please contact one of the non-profit organizations listed below.
With regards,
Collaborative of Eating Disorders Organizations
Beyond Rules Recovery
Education and Insight on Eating Disorders: EDIN
International Federation of Eating Disorder Dietitians: IFEDD
About CEDO
The Collaborative of Eating Disorders Organizations (CEDO) is a partnership of mission-aligned non-profit organizations and allies dedicated to increasing awareness and resources at the global, national, regional and local level for people affected by eating disorders and disordered eating. For more information, please visit www.eatingdisorderscollaborative.org
References
Harvard STRIPED, Academy for Eating Disorders, Deloitte Access Economics (2020). Economic Costs of Eating Disorders. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/
He, Wang, Ping, et al. (2022). Association of Glucagon-Like Peptide-1 Receptor Agonist Use With Risk of Gallbladder and Biliary Diseases: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Intern Med, 182(5), 513-519.
Mann, T., et al. (2007). Medicare's search for effective obesity treatments: Diets are not the answer. American Psychologist, 62(3), 220–233.
Sodhi, Rezaeianzadeh, Kezouh, et al. (2023). Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss. JAMA, 330(18), 1795-1797.
Tylka et al. (2014). The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss. Journal of Obesity.
I’m surprised that so few medical students are taught about eating disorders. It is a crucial disease that some many people have. Why isn’t it a important subject in their training?
Another band aid for an ever increasing epidemic. If the systemic issues and inherent human factors are not directly addressed, the problem will continue. Remember fen-phen? Orlistat? If the magic wand existed…. yet it doesn’t.
Unless root causes are exposed, and we accept realistic, holistic attitudes and solutions (aka- NOT diet culture- it’s part of the problem), our struggle, and waistlines, will continue to grow
Thank you so much I saw the entire infomercial. I was flabbergasted as a clinician with over 30 years of experience this was truly a travesty.
Alina Gastesi-de Armas, LMHC