The popularity around weight loss drugs like Ozempic is worrying eating disorder experts, who say the conversation risks making recovery harder and could put others at risk of developing disorders.
"My fear is that there is now a belief that anyone can and should achieve a certain body shape and size with the help of these medications, so there's going to be an even greater drive towards a certain body type," said Tracy Richmond, director of the eating disorder program at Boston Children's Hospital.
Medications like Ozempic and Mounjaro were originally developed and FDA approved to treat people with Type 2 diabetes. But they also lead to weight loss, and many doctors also prescribe them off-label to patients with obesity. They're medically necessary for people with Type 2 diabetes, and the associated weight loss can also have health benefits for some people who are overweight or obese.
Now, celebrities and public figures are either taking or are rumored to take these drugs, as are others who aren't overweight but who have the means to pay for a prescription out of pocket. Telehealth startups are advertising the drugs to anyone who wants to lose weight with little medical oversight, according to reporting from the Wall Street Journal.
"You see celebrities shrinking," Richmond said. "It points out that there is a desire for smaller and smaller body size. Even in people who are 'normal' sized, there's still a drive to do something as extreme as taking these medications."
That's a risky environment for people with eating disorders -- some of whom are also seeking out the drugs themselves, said Dr. Kim Dennis, a psychiatrist specializing in eating disorders and co-founder and CEO of SunCloud Health.
"It's just another new tool in the toolbox for self-destruction for people who have eating disorders," she said.
Dennis said she's seeing that most from people who don't fit the stereotype of a person with an eating disorder, including "folks in larger bodies."
That could include people with atypical anorexia, a diagnosis where someone has all of the symptoms of anorexia but is not underweight, or people with binge eating disorder, Dennis said. A doctor might prescribe them Ozempic or a similar drug because they have a higher BMI, with the assumption that using the drug to lose weight would make that person healthier.
"That's for sure not the case if the person has an eating disorder," she said.
Experts also worry that people who take these drugs without a medical need and do see weight loss could go on to develop an eating disorder. People who lose a significant amount of weight often become fixated on body size and food and can develop eating disorders, Richmond said.
"We don't know what that's like with a medication like Ozempic, but I wouldn't expect it to be very different," she said.
The drugs don't cause permanent changes -- people can gain weight back if they stop taking it, research shows. Richmond said she'd be concerned about how people might react when the effects plateau or if they're no longer taking the drug.
"You could see a drive for higher doses or more restrictive eating," she said.
Overall, the conversation around the drugs risks reversing progress on the idea that there can be health at every size, Richmond said.
For some people, weight loss can help lower diabetes risk or lower blood pressure. But other people at higher weight might not have any health problems. Someone's weight does not in and of itself give any information about any diseases they might have, she said.
"Weight alone is not a health issue," Richmond said. "Weight is a health issue when it's tied to adverse outcomes -- and for some people it is, and some it isn't."
But the focus of the conversation around Ozempic and similar drugs is on the weight loss aspects, not improved health, Dennis said.
"It makes my work a lot harder," she said. "It reinforces all of these ideas about the thin ideal that are so deeply embedded in culture and the medical establishment and are not founded in truth, or reality, or science."
If you or someone you know is battling an eating disorder, contact the National Eating Disorders Association (NEDA) at 1-800-931-2237 or NationalEatingDisorders.org.