Doctors are reporting a rush of patients asking for SEMAGLUTIDE which promises rapid weight-loss. Even psychotherapists working with obesity are asking us about the value of these medications to “kick-start” weight-loss for their patients.
At the National Centre for Eating Disorders we have views about weight-loss medications and we are not provoked into a knee-jerk response. Some people call them “anti-obesity” drugs. Because this term risks causing stigma, let’s for now call these latest drugs “metabolic medications.”
The Risks of Weight Loss
Using tips and tricks learned at slimming clubs or in the media, anyone trying to lose weight on their own, is exposed to a host of dangerous mental and physical risks. Fat is not just “stuff” – it is a metabolic engine that is controlled by many different systems and that is well-defended. People who want weight loss (as is their right) need a thorough assessment, tracing the course of their weight over the lifespan with a sympathetic and knowledgeable therapist who also looks at the family and other aspects of their lifestyle. We need to learn about their relationship with food, to see if there is an eating disorder present. This is because weight-loss never cures an eating disorder and weight-loss efforts can make things worse. For an explanation of why weight-loss efforts can cause and worsen an eating disorder like binge eating or bulimia, another blog is needed.
It is helpful to our readers to point out that not all people in larger bodies have an eating disorder. About 1 in 2 people who seek help for their weight issues have some form of eating disorder; that means many people in larger bodies do not have an eating disorder. Maybe they just like…. ummm (how do I say this) “fat-promoting” foods or they might have genes that make them gain weight more easily. We are not all the same. Nonetheless, people have agency and they have the right to choose how they want to live. They are misled to be told that there is no link between body fat, diet and disease.
The metabolic meds like Semaglutide are not designed to make people feel happier because of how they LOOK. Let’s be honest – looking different is a motivation for many people seeking weight loss. They will say, Oh I want to be healthier or fitter, but what they really mean is, I want to approve of myself when I look in the mirror. The metabolic meds are designed to make people healthier. The question is, do they? Metabolic meds change aspects of metabolism and some drugs can improve cardiometabolic health. To give my readers, clients and professional therapists a balanced view, let’s look at the pros and cons of Semaglutide
Benefits of Semaglutide
Semaglutide is a drug that affects a hormone called GLP-1 that is part of what we call the “incretin pathway”. This slows gastric emptying, making people feel fuller for longer and it affects some of the many hormones in the brain that control appetite. It is a drug that causes fast weight-loss and some people discover that their blood sugar profile improves, they may stop being diabetic.
As long as the drug is taken, Semaglutide also affects weigh-regain mechanisms in the brain. Alongside fat loss, the level of inflammation in the body improves. Very few people understand what “inflammation” means and how it relates to obesity. Inflammation is responsible for a great deal of illness including cancer. Inflammation can also be caused by stress, so for sure, stress and weight stigma can also make you ill.
A great many people think that taking a drug or having surgery to lose weight is cheating. This is unkind, because obesity is a complex metabolic condition that is affected by many things; some of which are out of our control. Each single person is affected differently by genes, our living environment, our personal biome, our early eating patterns, even the behaviour of our mothers when we were in the womb. Now we know that going on a calorie-controlled diet is ineffective and potentially dangerous. But we cannot shrug our shoulders and just tell people that there is nothing we can do and more controversially, that people “should” welcome obesity into their lives.
Even while being sensitive to stigma, I do not remove hope or healing. If, for example, you have insulin resistance or diabetes Type 2, a metabolic drug will level your metabolic playing field and give you a better chance of widening your choices. What can be wrong with that?
The cons of Semaglutide
Metabolic meds do not change a person’s relationship with food, including the ways in which food is used as a fix or a way to regulate feelings. Most of us eat to manage our moods some of the time and some people do more comfort eating than others. Emotional eating is not just “in the mind” – some of us more than others are “wired” to need more pleasure from food. How can I best explain this? – well – it is possible to develop faulty wiring because of long-standing eating patterns. Binge eaters, for example, usually develop resistance, deep in the brain, to the normal signals of pleasure when they have eaten something that they like. Now is not the time for me to explain how we can put this right; but putting it right does NOT involve taking a metabolic drug.
Semaglutide can have a lot of unpleasant side effects like nausea and vomiting. More worryingly, as soon as you stop taking it, the weight piles back on. People wanting weight loss assume that losing weight is enough to make them able to keep it off. In over 99% of cases, weight is not only regained but it is exceeded. The drug can make you end up fatter than you were before and this gives rise to shame and worry. So, I would not do anything that makes a vulnerable client feel worse. My final concern is that we don’t know the long-term effects of manipulating pancreatic hormones. The drug industry is littered with the history of very adverse and sometimes fatal consequences.
So, when one of our therapists tell me that their client wants to take Semaglutide for a weight-loss fix, I tell them “NO”- do not go there for now.
I am on the side of happiness and wellbeing. If there was a weight-loss drug that could be taken safely for life, that would help people look and feel better (in their mind anyhow) I would be all for it. I don’t believe in “cheating thinking”, because we are all born with different bodies and different challenges when it comes to what we choose to eat and how our body deals with it.
At The National Centre for Eating Disorders, we do a deep, holistic assessment, to learn more about a person and their relationship with food before we make judgements. Clients in treatment for an eating disorder are discouraged from trying to lose weight and we attend to their body image, their feelings, their mindset, self-esteem and ability to self-care. We do not assault our patients with tyrannical views about how they “should” eat, what they “should” weigh or how they “should” feel about their body size. If they are desperate and craving a metabolic drug, we give them the facts as we know them.
If you or someone you know is considering Semaglutide, or bariatric surgery, please don’t take action before having an assessment with a properly trained therapist. This therapist will want to learn everything about your relationship with food and how it has gone astray. Email us at admin@ncfed or call 0845 838 2040.