GLP’1’s & Weight Management

There is no doubt that the development GLP’1’s has completely changed the landscape of weight loss and long-term weight management. Like Bariatric surgery these treatments can be life changing and life saving for many people. I am so relieved that people are finally being heard about experiencing distressing food noise, rebound weight gain, and diets failing them. 

These feelings were always real, but diet culture had made people feel they just had no will power and it was all their fault. We have now got some powerful and welcome tools available for people who have had long complex struggles with their health and weight. While weight loss on these medications for many people has resulted in some amazing health benefits, and science is showing that these medications have even broader health benefits than originally thought, my observations are that behavioural and emotional support are still an important part of the process. 

Emotional eating can still present itself and can quite often override the fact that physical hunger is absent. The foods people want to eat to self soothe are often not nutritious foods, which is totally ok sometimes, but when this pattern is repeated it risks confusing hunger and satiety signals which are already being affected by these medications. 

It is also important to discuss creating healthy coping mechanisms for distress other than eating. I worry about people wanting to never feel hunger and consequently keep increasing the dose of medication in the pursuit of more weight loss. Hunger itself is an important signal just like needing to breathe is an important signal to keep us alive. 

Ironically malnutrition on GLP’1’s is now a valid concern because people might be eating very little, especially if they are not having dietetic support. Life doesn’t stop because someone is actively losing weight. There are many external factors that still affect one’s world and experience. Trauma, grief, relationship issues, hormonal impacts such as PMOS, diabetes, perimenopause, menopause, sleep, inter personal and intrapersonal conflicts can all still coexist while taking GLP’1s or having bariatric surgery. 

Many people express fear of not being able to afford to stay on these medications for life and are anxious and understandably so about the regain of weight. Some have been told they can stay on the medication till they get to the weight they want and then must stop. Or they themselves have decided that is that is their intention to stop once they reach a certain weight, but no one has discussed with them the implications of stopping these medications. Some people must stop because the side effects are intolerable. 

This is extremely important because through absolutely no fault of their own, weight usually returns, as does food noise. Having a safe place to work through this as well as exploring strategies to minimise these outcomes is important. While some people are relieved to have been able to lose weight while on medication, some struggle with not recognising being in a different body or having a lot of loose skin which may be causing discomfort and will require surgery to remove. 

Then there is the impact on their intimate relationships around such significant body changes that might affect them or their partner in ways they never anticipated. We are also seeing these medications fuelling pre-existing eating disorders or facilitating the development of an eating disorder. 

These are just the some of the many reasons why psychological and emotional support is a significant part of the process of weight management even with the advent of these medications and surgery.