The false perception that individuals with weight problems don’t have consuming problems is among the most dangerous misconceptions in weight problems care. In actuality, people with weight problems are at a excessive danger for consuming problems.
The intersection of weight problems, psychological well being, and disordered consuming is advanced. As GLP-1 receptor agonists (like semaglutide and tirzepatide) turn out to be extra broadly used for weight administration, the danger of exacerbating consuming problems have to be addressed. Weight problems is not only a metabolic concern—it’s a deeply interwoven bodily and psychological well being situation that calls for a holistic, multi-disciplinary response.
The prevalence of consuming problems
Many nonetheless affiliate consuming problems solely with thinness, linking them to situations like anorexia nervosa. Nevertheless, consuming problems are additionally extremely prevalent in people with weight problems and sometimes go unnoticed.
Binge Consuming Dysfunction (BED) is the commonest, affecting 1-3% of the final inhabitants, and will be as excessive as 47% of these in search of weight reduction remedy in clinics or bariatric packages. Individuals with weight problems and comorbid binge consuming usually search weight reduction therapies reasonably than therapies for consuming problems. Night time Consuming Syndrome (NES) is estimated to have an effect on ~2% of the inhabitants with 2.5-2.8 occasions increased prevalence in women and men with weight problems, respectively, and sometimes overlapping with BED. Equally, as much as 55% of sufferers in search of bariatric surgical procedure have reported some signs of NES. There’s a want for extra knowledge on the co-occurrence of Bulimia Nervosa (BN) and weight problems.
Moreover, many people with weight problems expertise Different Specified Feeding and Consuming Issues (OSFED), that are disordered consuming patterns that won’t match neatly into BED or BN standards however nonetheless considerably affect an individual’s well being. An instance is Atypical Anorexia Nervosa (AAN). Many individuals mistakenly imagine that as a result of anorexia nervosa entails excessive restriction of meals consumption, an individual can’t have the dysfunction whereas additionally experiencing weight problems, however that is merely not true. AAN entails people who meet all standards for anorexia nervosa, and exhibit an intense concern of weight achieve resulting in harmful behaviors like restriction, fasting, extreme train, purging, and utilizing laxatives, diuretics, or slimming capsules. Though proof is restricted, it’s potential that the mechanism of GLP-1 might exacerbate or contribute to the event of ED pathology. The prolonged fullness from GLP-1s might unintentionally reinforce dangerous beliefs about skipping meals, undereating, or ignoring starvation indicators.
Regardless of these excessive prevalence charges, consuming problems in people with weight problems usually go undiagnosed as a result of weight stigma and outdated assumptions, highlighting the necessity for larger consciousness and extra complete screening in weight problems care.
The risks of overlooking consuming problems in weight problems remedy
Moderately than receiving concern for doubtlessly dangerous behaviors, people with weight problems are ceaselessly praised for weight reduction, even when it outcomes from excessive restriction or disordered consuming. This will delay correct prognosis, reinforce harmful patterns, and make restoration tougher. Compounding this concern, many widespread weight problems therapies—reminiscent of aggressive weight reduction packages, restrictive diets, and even sure medicines—can unintentionally exacerbate consuming problems. With out cautious behavioral oversight, sufferers might develop an unhealthy fixation on weight reduction, growing the danger of compulsive meals restriction, malnutrition, and metabolic hurt.
Past the bodily penalties, a slim concentrate on weight alone fails to deal with the deeper psychological drivers of disordered consuming. Many people scuffling with weight problems flip to meals as a coping mechanism for trauma, anxiousness, or despair. When weight problems care doesn’t combine psychological well being assist, it overlooks a essential part of long-term success, making it more durable for people to interrupt free from dangerous consuming cycles. Additional, supporting people who must shed weight for medical causes whereas additionally managing an consuming dysfunction requires a multi-disciplinary, patient-centered method that integrates each psychological and bodily well being care.
GLP-1 remedy is highly effective however carries potential dangers
GLP-1 receptor agonists have revolutionized weight problems remedy by decreasing urge for food, enhancing metabolic well being, and supporting sustained weight reduction. Nevertheless, they’ll exacerbate disordered consuming patterns when not rigorously managed. Given the excessive prevalence of consuming problems in people with weight problems, it’s essential to know how these medicines might intensify present dangers or create new issues.
GLP-1s suppress urge for food by slowing gastric emptying, making it simpler for people to skip meals or eat considerably much less. Whereas this may be useful for weight administration, it could additionally reinforce restrictive consuming behaviors, particularly in these with a historical past of anorexia, orthorexia, or different restrictive problems. The lack of pure starvation cues can disconnect people from intuitive consuming, resulting in insufficient vitamin and malnutrition. When caloric consumption turns into dangerously low, the physique enters a catabolic state, breaking down muscle for power, which might have long-term metabolic penalties.
Extreme lean physique mass loss is a significant concern with fast weight discount, as it could actually result in fatigue, weak point, and slowed metabolism. That is significantly regarding for these with disordered consuming histories, as they could see muscle loss as an indication of “success” reasonably than a critical well being danger. With out ample protein consumption and resistance coaching, lean mass loss will be vital, doubtlessly creating long-term dangers.
For some, the psychological affect of GLP-1 remedy extends past the bodily adjustments. Sufferers might turn out to be hyper-focused on sustaining weight reduction, creating an unhealthy concern of consuming or regaining weight. This anxiousness can result in elevated meals avoidance, social withdrawal, and a deepening cycle of disordered consuming. Others might develop psychologically depending on the treatment, fearing that with out it, they are going to lose management over their consuming habits. This reliance could make transitioning off GLP-1s troublesome, usually triggering binge-restrict cycles or different compensatory behaviors.
The answer: a multi-disciplinary, behavioral-integrated method
It’s important to combine complete behavioral and dietary assist alongside GLP-1s to make sure secure, efficient, and sustainable weight problems remedy. A multidisciplinary care staff is essential, together with:
- Behavioral well being specialists to watch for rising disordered consuming behaviors, physique picture issues, and psychological misery.
- Registered dietitians with experience in each weight problems and consuming problems to make sure dietary adequacy, forestall extreme lean mass loss, and promote a wholesome relationship with meals. Dietitians additionally assess for indicators of malnutrition, metabolic adaptation, and psychological unwanted effects.
- Licensed well being coaches to supply strength-based train steering to protect lean mass and assist metabolic well being with out triggering compulsive train behaviors.
Backside line
Weight problems and consuming problems will not be mutually unique—they’re usually intertwined. Weight reduction ought to by no means come at the price of metabolic, psychological, or emotional well being. The rise of GLP-1 therapies presents each a chance and a danger. When used responsibly, they’ll assist sustainable weight administration, however with out correct oversight, they’ll additionally exacerbate disordered consuming tendencies.
A multi-disciplinary, patient-centered method is paramount to make sure that weight problems therapies, together with GLP-1s, promote long-term well-being reasonably than reinforcing cycles of restriction and disordered consuming. The objective shouldn’t simply be weight reduction however sustainable well being and a optimistic relationship with meals and physique.
About Gretchen Zimmermann
Gretchen is a registered dietitian, board-certified weight problems and weight administration specialist, licensed diabetes care and schooling specialist, and Vice President of Medical Technique for Vida Well being, a digital, personalised weight problems care supplier. Her expertise main the event and progress of key medical verticals and cardiometabolic packages informs her experience in evidence-based drugs and medical interventions. She is especially within the intersection of bodily and psychological well being. Gretchen holds a BS from Kansas State College and an MBA from William & Mary.
