Provider Perspectives: Unpacking Trends in Ozempic Use & Abuse in Individuals with Eating Disorders with Winter Groeschl

In an effort to better understand the current landscape of Ozempic uses & abuses, we caught up with Winter Groeschl, LPC. Winter is a Licensed Professional Counselor who passionately supports individuals that may be struggling with mental health challenges including eating disorders. Here is what Winter has to say about the issue of GLP1 use in individuals with disordered eating:

What trends have you observed in the misuse of medications like Ozempic and semaglutide among your clients with eating disorders?

Since Ozempic was released to support Diabetes to its ‘approval’ to be used for weight loss in 2022, I has seen a huge trend then in individuals navigating the desperate waters of starting this medication, wanting to start this medication to support weight loss, improve body image, stabilize blood sugar, you name it we are seeing it.

The heart breaking piece is navigating medical professionals, doctors/psychiatrists/endocrinologists etc. prescribe these medications to individuals with disordered eating/eating disorders without screening at all for potential eating disorders. Because individuals are going to medical providers for support, they trust these suggestions and start the medications which further pushes individuals away from their interoception and trust of their own body. Taking these medications despite potential side effects that impact over 30/35% of people, nausea, slowed gastric emptying, vomiting, diarrhea, constipation, and in some users increase in suicidal ideation etc.

I also ask us to think about who is observing and assessing malnutrition as it is shared that people taking ozempic can lose “15 percent of their body weight” which is MALNUTRITION. Spooky!

The segment on Oprah sharing about her journey with Ozempic skimmed over the potential side effects and risks and highlighted this as being a ‘cure for obesity’ which is incredibly harmful and not accurate. The projection of this drug being the cure for ‘weight loss’ is highly problematic and continuing to perpetuate weight stigma.

There was also a case study in a recent training I did on GLP-1 medications and eating disorders that explored an individual who was navigating an active eating disorder and was given Ozempic and was taking a higher dose that prescribed as part of the eating disorder behaviors, which is something we need to be aware of as well, the potential to abuse this medication that is already prescribed at potentially not safe doses for weight loss purposes.

Source: Ozempic for Weight Loss: Side Effects and Safety| U.S. News (usnews.com)

How do you think diet culture is influencing the misuse of these medications among individuals with eating disorders?

Diet culture absolutely impacts the misuse of these medications (that for some could be helpful, but not for all) when an eating disorder is also in the picture. The way the medication has swarmed social media, tiktok, instagram, celebrity culture, media etc. again projects that it is easily accessible and a ‘quick fix’ with little data longitudinally on how this medication could impact bodies long term.

The symptoms and risks that we see with eating disorders go hand in hand with the symptoms and risks of Ozempic which further complicates potential recovery efforts.

What are the most concerning health risks you associate with the misuse of these medications in individuals who already struggle with disordered eating?

Lack of ‘food noise’ is such a popping term I have seen everywhere. I recognize and honor that dealing with food noise is exhausting, especially with those struggling with disordered eating. My fear is that if we just take away the food noise with medication, we are not actually getting to the root of the issue/the relationship with food and body image that continues to go unaddressed.

“How has restriction (mental, physical, psychological) impacted and increased ‘food noise?’” she asks. “How has diet culture and unaddressed internalized weight shame/stigma contributed to continued ‘food noise?’ How do we navigate the difference between needed & normal hunger and ‘food noise?’”

Weight stigma, fat phobia, oppression, lack of informed medical and overall holistic care, food insecurity, rising cost of living, etc. all impact someone’s connection with themselves. without addressing all the systems at play that support disordered eating/eating disorders, we cannot heal by placing a bandaid on a gaping wound.

Concerning health risks I have seen associated with GLP-1s include: gastroparesis and blockages in the colon/intestines requiring hospitalizations, severe vomiting, gerd/acid reflux, dehydration, muscle wasting, and lack of absorption/delayed absorption of integral psychiatric medications like anti depressants, antipsychotics, ADHD medications etc.

Source: A Pharmacist’s Guide to Counseling Patients on a Once-Weekly GLP-1 RA Treatment for Type 2 Diabetes (pharmacytimes.com)

How do you approach conversations with clients who may be misusing these medications, especially when they are resistant to stopping?

With SOOOOO much compassion and openness and curiosity. I have to check my own white, able bodied privilege first and foremost as a provider and continue to do my own work in unpacking my bias. Ultimately, it is not my job as a therapist to convince or argue that a client should stop or not take a GLP-1 medication. I approach them with a lens of bodily autonomy and agency first and foremost as well as bringing in a critical thinking lens to explore the good, bad, and ugly information about these medications. I also highly encourage that my clients meet with a dietitian specialized in eating disorders to address and assess for malnutrition if they do start this medication and continue to address weight stigma and weight shaming that they have potentially been a victim of their entire life.

We explore the risks and concerns out there. Approach using a harm reduction lens and continue to explore if there is openness to stop or not take the medication with client, assessing stage of change. Gentleness gentleness gentleness 🙂

What changes would you like to see in how healthcare providers prescribe and monitor the use of weight-loss medications, particularly in clients with a history of eating disorders?

Oh gosh, where do I start? My hope for the healthcare providers who prescribe and monitor GLP-1s would be to thoroughly assess risk and appropriateness of these medications, be willing to coordinate with a client’s entire team to get a full picture of the journey of that client if the client is open/willing/ROI signed etc.

Reflect on their thoughts/relationship with BMI and how harming BMI is, be willing to explore other indicators and data points of true health and not just weight. Holistically observing a human in their entirety instead of making assumptions about them and their health promoting behaviors based on their body/weight.

Have informed consent conversations outlining major risks of these medications as well as ensuring we are assessing for complications/malnutrition etc.

How & when can these medications be used safely & supportively (RE: without further compromising a patient/client’s health or recovery)

I am not really sure when using a GLP-1 medication JUST for weight loss would be indicated for a client with a hx of an eating disorder personally. It is so tricky and introducing a medication that mimics so much of an eating disorder can be so disorienting/debilitating.

While I do see the efficacy in treating diabetes, as Ozempic was created for initially, the explosion of new ‘weight loss’ medications on the market as well as now compounds of these medications that have not even been deemed safe for human use is deeply concerning and continues to require us as eating disorder professionals to be diligent in checking in with out clients and using a critical thinking, compassionate lens in addressing. I also urge us as professionals to be willing to offer our help in aiding clients in advocating for themselves in their medical professional offices as often times, their voices are not heard or they are fearful to do so. Practicing how to do so, coordinating care with healthcare professionals also is a way we can continue to advocate and support our clients.

IF clients are going to use these medications and have a hx of disordered eating/eating disorders, I highly encourage them to have a full multidisciplinary team around them to assist and monitor them that is trained in EDs. I also bring awareness and attention to the other indicators of health that have NOTHING to do with weight/BMI and support them in connecting to their values in life IF they do decide they are going to take these medications.

Winter’s Bio

Winter is a Licensed Professional Counselor passionate in supporting souls that may be struggling with mental health challenges including eating disorders, disordered eating, substance use, trauma, anxiety, depression, life transitions etc. You name it, all are welcome here.

In a world full of change and challenges, having a safe space to go to for support is Winter’s top priority as a human and therapist.

Winter pulls from different therapeutic modalities including ACT, Polyvagal theory, CBT, DBT, and compassion focused therapy. Winter has practiced at all levels of care within Arizona’s mental health care system and is grateful for the experience she has absorbed from every level she has worked within.

Winter is an LGBTQIA affirming therapist supporting all walks of life and all ages in their beautiful journey to find what overall wellness looks like for them. Winter is HAES informed and weight neutral in her approach, celebrating all bodies as every body is a good body!

Written by Hayley Schiek, founder of Cosana Coaching. You can learn more about Hayley Schiek and Cosana Coaching HERE.