Weight Loss Injectables- What I’ve Observed So Far
Weight loss medications are nothing new. I’m old enough to remember Fenn-phen and HerbaLife. What is new is people with hella clout like Oprah promoting these meds on prime time TV. What’s new is having fat influencers being targeted by the pharmaceutical companies and watching drastic weight loss happen before our eyes all day every day. What’s new is this trend coming after a few years of burgeoning body acceptance and awareness of fat liberation.
I’m hoping this will cycle back to body acceptance, but for now these weight loss injectables are here. And they’re making a giant impact on the lives of fat people especially.
The medications I want to primarily talk about are the injectables ozempic, wegovy, and mounjaro. There are great resources going over the details of what these medications do, how long they’ve been around, and what they’re traditionally used for. I encourage you to check out Ragen Chastain’s work on this and the Maintenance Phase episode on it. Kate Manne also wrote a great article on the Oprah special which you can read here. For the purposes of what I want to talk about today, just know this: these medications can work really well for folks with diabetes (and note I do not mean pre-diabetes). While the meds have been around for awhile, there are not long term studies on the effects they have on folks that do not have diabetes. And, they come with hefty side effects.
Like most clinicians in my field, I’ve already experienced clients taking and stopping these meds. I want to share my observations of this in case you’re feeling tempted to try them. I’m all about body autonomy, so use them if you think that’s what’s best for you. But know what you’re getting into!
The side effects can be intense. Every client I’ve had that’s taken these meds has had vomiting, nausea, and diarrhea. Each time they take a dose, they spend the next day very sick. When they eat and what they eat becomes tenuous because they are more likely to vomit from things like drinking coffee without eating first or eating dinner too late. I’ve seen clients have to miss work, cancel social engagements, and feel worried about dating because they can’t be sure they can stay out of the bathroom.
These meds have the potential for aggravating existing eating disorders. Because of these side effects, it becomes easier to skip meals or eat much less than you usually would. This is why people wanting to lose weight find it so appealing- it sort of forces your body to diet. I’ve seen clients who have eating disorders get clinically worse. This could lead to malnutrition, osteopenia and bone loss issues, as well as a number of negative health effects. And yes, this applies to folks in larger bodies!
From what I’ve seen, weight gain happens pretty immediately upon stopping the medication. I mention this not because weight gain is a bad thing, but because many people are using these meds specifically for weight loss purposes. From what I’ve heard, in order to maintain the weight loss, you’d have to expect to stay on the medication indefinitely. And even then, there’s no guarantee since there have not been many studies on this especially for folks not using the medication for insulin management. (Again, check out the work of Ragen Chastain who is much more scientific than I am).
Losing weight does not make you happier, solve your problems, or make you love yourself. Let’s just make this really clear.
There are often shortages of the medication, so using it solely for weight loss disrupts access for the folks who use it for insulin regulation. Some people are pointing to manufacturing issues, but certainly more people than ever have been using these meds and everyone I’ve known who has used them has had issues refilling due to shortages.
The wide spread promotion of these meds hurts fat people, no matter what. Every fat client I have has talked to me about this. Doctors are pushing the medications more, even for clients without any insulin management issues. Influencers are using them, and advertising their dramatic weight loss. What used to be comforting fat fashion accounts, where clients could see other people with bodies like theirs, are now weight loss ads. Sometimes previously fat influencers are getting real aggressive about it (some of you may know who I mean…) and are insulting those still committed to accepting their fat bodies. Everywhere we look there is talk of these medications, and there is a general sense in society of there’s no more “excuses” for being fat- now we have injections for that. Fat people are feeling more unsafe, experiencing more weight bias, and have fewer spaces to organize that are free from weight loss talk.
Weight loss does not stop weight stigma. It’s been clear that diet companies and pharmaceuticals have learned the language of the body acceptance movement. We hear them call out diet culture while directly promoting calorie restriction (Noom is a horribly perfect example of this). And now we have these companies talk about weight stigma. I don’t recommend you watch it, but in Oprah’s weight loss special, she talks about weight stigma/bias. However, we don’t end weight stigma by making people skinny. The logic of this breaks my brain, and I just have to scream at how utterly ridiculous this is!!!
I get fired up about this topic because I love fat people. Because I’m fat. Because my loved ones are fat. My clients are fat. And I don’t want people harmed because we’ve bought into some made up nonsense about what weight means and signifies.
These are my observations from a small sample size. I share this because not everyone is being honest about the side effects and the realities of the medications. Not everyone will experience what my clients have experienced.
As I said, I’m all about body autonomy and I believe there are some people with insulin related illnesses that these medications can really help. However, that’s not what is being promoted by people like Oprah, god bless her. If you do want to pursue taking these meds, consult with your physician of course and utilize the services of a weight neutral or anti-diet dietician as well. They can help mitigate side effects and help make sure you are still eating enough while taking them.
I respect that living in this world as a fat person is really damn hard- I mean, I live it every day so I get it! The solution isn’t to make our bodies smaller. The solution is to reduce medical anti-fatness, to create spaces that accommodate a wide array of bodies and abilities, to abolish the BMI and medical gate keeping, to increase clothing inclusivity, and so on and so on. When I talk to clients about why they want to shrink, these are the things that come up. They want to live more comfortably in a world that is biased against them. What we’re being served as a solution is individual- potentially harm yourself to make yourself as small as possible. The real solutions are way bigger than that.
