Weight loss drugs affecting eating disorders

[Runnersandtoms]

Just wondering if there is any evidence around weight loss drugs contributing to eating disorders.

I know someone (not well but I've moved in similar circles to her for many years) who, up until a year or two ago was perhaps what you might call on the large side, definitely not obese, maybe size 16-18 at most and carried it well, always wearing lovely clothes and looked attractive, with slightly larger than average boobs. Pretty face with a nice shape.

She has been on weight loss drugs for a while and is now what I would describe as skeletal. She looks like an anorexic, you can see the bones at the top of her chest, her legs are like two sticks, her boobs have practically disappeared and her face looks gaunt. But apparently she's still taking the drugs. Surely this is enabling unhealthy and dangerous weight loss?

Someone who doesn't need to lose weight still thinks they need to lose more weight, isn't that a definition of an eating disorder/body dysmorphia? Surely this is a sign that weight loss drugs need closer controls?

What is her current weight, height and BMI?

I've no idea. As I've said she is merely an acquaintance who I observe is now extremely thin, and yet is still taking weight loss drugs. I am reliably told this by a mutual friend who is also concerned that she has lost too much weight.

I think that as with anything there are people who will abuse the medication. I also think that our perception of health weight is really really off.

i am on WLI (Mounjaro), I have just hit the healthy BMI range after losing 4 stone. I can see my collarbones for the first time ever. I have another stone and a half to lose to get into the middle of the healthy BMI range, could lose another 2 and a half stone and be at the bottom end if it and have had a few comments about having “lost enough now”. I’m starting to be able to wear size 12 clothes, though mainly in size 14, so not super skinny, not even close and under my clothes I have lots of fat still accumulated on my belly.

I’m tall and whenever anyone found out I was wearing size 22/24 clothing they’d be surprised, whenever anyone gifted me clothes they would buy size 16/18. I don’t think anyone would have guessed that at points in my life my weight was as high as 21 stone. We just seem completely unable to accurately see size.

you think this acquaintance is skeletal and unhealthily thin, but it’s possible that she’s actually the right weight for her height and within the healthy range.

I'm on the jabs. People are starting to call me skinny, but that's just wrong - I'm still obese (BMI > 35)

I'm certain that I'll be hearing rumblings by the time I'm down to normal weight, just because it's going to be such a dramatic change.

on the large side, definitely not obese, maybe size 16-18 at most

And this is part of the problem. Obese is often size 16-18. Not Amberlynn Reid/my 600lb life sized. You have no idea what her BMI was and at that size she probably was obese. These medications are licenced for long term use/maintenance so the fact that she's still taking it doesn't necessarily mean she's trying to lose more but she may be aiming to maintain (which is much harder to do when you have been obese, hence staying on the medication)

You say she's skeletal but as you don't seem a good judge of what a healthy weight looks like I would reserve judgement unless I knew what she actually weighs 🤷🏼‍♀️

I agree. I was size 16/18 when I started MJ and obese. Now I’m size 16 top and I can squeeze into 16 bottoms but they don’t really fit yet and I’ve just moved from obese to over weight.

There supposed to be life long drugs. You don’t stop taking them.

As you do not know her weight you do not know that she is in fact underweight (BMI <18), it’s you and your mutual friends opinion.

Most women are obese at a size 16-18.

A registered pharmacy will not prescribe to a BMI <18. If she is BMI <18 and has got the medication, she’s got it fraudulently and that’s her problem.

I’ve had comments that I’m getting ‘too thin’. My BMI is 26, still overweight.

Do you suffer from an eating disorder? If you do, this may be distorting your reality of what is or isn’t a healthy weight.

Lastly, I’m not sure why you are so concerned with what someone you don’t even know very well is doing with their life.

What’s the root of this concern? Would you like the jabs but you can’t get them? Was she the fat one and now she’s slim - is that getting to you?

Lots to unpack here.

My GP thinks injectables could be a ticking time-bomb for EDs. I've been told I cannot use them, despite being obese with a BMI of 31, because the bulimia I had as a teen/early 20s has now manifested as non-purging bulimia as an adult. I honestly thought I was just a binge eater because I didn't purge, but it turns out there are separate behaviours that categorise non-purging bulimia over BED and they include compensatory behaviours after a binge cycle, such as excessive dieting/exercise, fasting, using stimulants etc. In short, the kind of yo-yoing lots of women experience. I'm now receiving treatment. So, if I took injectables, I'd almost certainly lapse back into bingeing once I stopped, which could be so dangerous and put huge strain on my heart and digestive system.

So it could be that this person had anorexia as a teen and has lapsed into that feeling of wanting to be ultra thin again and is taking it too far. Or maybe not and she's fine, but we as a society have just lost sight of what a normal body should look like. I know I have.

But why would that potential risk be more harmful than being obese and binging without purging @SuperTrooper14?

I know a few with lifelong eating disorders who have lied to get the injections and now have kidney problems, they were both around size 14s after getting to healthier weights for years and since the injections are very slim now. Not skeletal but the nature of the injections and their health histories has meant they have very quickly developed kidney pain.
These drugs are so tempting and damaging for people with eating disorders, seeing lots of people suddenly lose weight and having something that makes it easy to have that control.

Well, of course, those behaviours have huge risk too, which is why I am now undergoing treatment. But I know injectables are not the answer for me and my GP's point is that we are not going to know the long-term harm they cause people with ED until they stop taking them.

They're not just tempting – they feel like the Holy Grail! The idea of not having any food noise makes me want to weep. But I know, after consulting my GP, I just cannot risk the possibility that I could fall headlong back into bingeing if I came off them and there isn't enough research yet into the issue of stopping.

Katie Price have you seen her!

I agree that more research should be done around injectables and eating disorders but I also agree that what we consider skinny/normal/overweight has changed a lot over the years.
BMI can be misleading but most women in a dress size 16/18 are probably overweight.
I think injectables are helping a lot of people to get to a healthier weight although there is some abuse - especially by ‘celebrities’.
Going forward I would like to see more research into why we are generally bigger than a few decades ago. I think UPF has a lot to answer for and if we can prevent the food noise through an achievable way of eating ie more wholesome then injectables would be less needed.
However, I firmly believe that food processors are about profit not nourishment the same as housing developers are about profit not meeting a need for accommodation.
Yes a business needs to be profitable but it seems the masses are supporting a minority of wealthy people to remain wealthy at a cost to health and lifestyle.
Sorry for going off topic.

Interesting you say “definitely not obese” - I was “obese” in November at a size 14. I’m now being complemented on how skinny I am when I’m still “over weight”. I’m on the jabs and they monitor your weight. I seem to have plateaued before getting into healthy range so need to do a bit of a push.

If they were both size 14s then likely they didn’t lie. I was 14 but also bmi was 30 and within range to be prescribed.

ALL women at size 16/18 are overweight and almost certainly obese.

I was a size 14-16 and now down to a size 10-12. I’ve had so many comments that I wasn’t overweight or obese to start with. That I didn’t look big. But the fact was I was that big.
I’ve now stopped the jabs but wearing 10-12 sized clothes and now people are saying stop now you’re too thin you’re wasting away. I feel so much better for losing the weight. I would have continued at a maintenance dose if I could have afforded it. I think we have all lost what a healthy weight actually is. And would think most people in size 14-16 are overweight and bordering obese.

They are both tallish and definitely had to lie, they told me how they did it. They didn’t look overweight and one was into the gym and building muscle, now doesn’t have the energy to go.
One has stopped injecting since she was hospitalised as she was collapsing with kidney pain, the other is still on them and getting tinier all the time, so worried about her but she seems so “happy” as she feels she has the control she always wanted

Glad you are not risking it!

As a society, we have definitely lost sight of what is a healthy size. It's totally normal to see collarbones. Because of my physical bone structure, when I'm a healthy weight, I have (gently) protruding hip bones and visible ribs. But I've also got a very cuddly arse, a wide back etc. I'm just never going to be tiny.

When I'm overweight my collarbones disappear, I get a rounded stomach and fat around my ribs.

There are definitely people on the WLI who take them beyond then they should stop, or don't do the exercise required to maintain muscle mass. But I do think we need to rethink what a healthy weight looks like.

She's probably internalised all the online comments about how size 10/12/14/16 or 9/10/11/12 stone is obviously fat/obese, that we've all lost sight of what a healthy weight is, of size 8 posters calling themselves chubby with huge breasts/fat tummy/flabby bits and, combined with potentially some additional weight and width caused by loose skin, and an internal narriative of words such as gorging and troughing (both very common on MN), she's been primed to believe that she's still not slim enough.