GLP-1 agonists promise weight loss, but what about the consequences of perpetuating the thin ideal?

June 7, 2024June 8, 2024 ~ Green Apple Dietitian ~ Leave a comment

Over the last few years, the medical landscape has turned completely upside-down. With all the recent hype around GLP-1 agonists, we don’t need any more proof the world’s gone mad.

Semaglutides are effective for significant weight loss and may have other health benefits. Many great resources explain their effectiveness, so I won’t discuss them here. The main thing to know is they slow down the stomach’s digestion and curb appetite, which can result in weight loss. However, some people lose their appetite completely and stop eating. This is where I have a problem.

Losing your appetite is a serious side effect that can lead to severe consequences

Significant weight loss in a short amount of time puts patients on the fast track to malnutrition. Fat cells don’t go away, they shrink. Unintended loss of lean muscle mass diminishes strength, stamina, and resting metabolic rate.
Dehydration and constipation are major side effects of weight loss that need immediate attention.
Gastroparesis which is claimed to be a rare side-effect of GLP-1 should be assessed by a health practitioner.
Significant weight loss and meal restriction are associated with depression, anxiety, and disordered eating.

No one is immune to the pressures of the ideal body weight

I’m not pretending that I understand another person’s struggle with weight or health issues. As a female living in the US, I’d be lying if I said I never experienced negative thoughts like feeling bad about my body size, being unhappy about what I see in the mirror, or feeling guilty after eating certain foods. Conducting medical nutrition therapy sessions over the years has fine-tuned my ability to pick up on the hatred of fat in our society, and how people sell themselves short because of their body size. Let me tell you it’s no picnic to inform patients I don’t specialize in weight loss. The conversation often comes to an incredibly uncomfortable abrupt end. It’s an emotional hot button that’s impossible not to push.

The psychological perspective is always ignored

We all know there are consequences for our actions. The likelihood of maintaining a healthy weight decreases If you are clinically depressed and anxious. There’s no doubt in my mind that mental health issues affect normal eating patterns. So, chances are your weight will go up or it will go down. No matter the direction it won’t be healthy or sustainable if you don’t find a way to deal with reoccurring issues in your life that are holding you back. A healthy mind usually follows a healthy body. Usually. If someone spends most of their time dieting, there’s no way they feel good about themselves. That’s where the focus should be, not on body weight.

What adds to this is when well-intentioned friends, loved ones, and health practitioners validate a person’s bad feelings about themselves and comment on their weight. If you’re somebody who comments on other people’s weight stop it. It’s not helpful and you’re not earning points by doing it. It was once said that if shaming worked everyone would lose weight. Well, it doesn’t. So, knock it off. If people in larger bodies bother you, maybe you should find out why that is.

Are GLP-1 agonists the cure for obesity?

I don’t believe obesity is a disease the way social media preaches it. It’s way too complicated for medication to “make it go away.” As I see it the medical profession continues to ask people in larger bodies to sacrifice way more than thin people to be healthy. As much as it’s proclaimed that side effects are not the norm for most people, it isn’t comforting to those who’ve taken the drug and experienced gastroparesis gotten so bad they couldn’t get through the day without vomiting to the point of severe dehydration. For them, the “rare side-effects” have made a huge impact on their lives. Either way, it’s a lot to expect from folks when there are so many other factors that cause ill health other than obesity.

It’s too early to know what the long-term efficacy will be

If you don’t have an eating disorder, there’s reason to believe you could develop one while taking semaglutides. Medically induced appetite suppression still leaves us with many questions. But what we do know is that severely restricting dietary intake and losing a significant amount of weight messes with the brain and creates an unhealthy obsession with food.

If you’re considering semaglutides for weight loss, you still need to make major lifestyle changes. It’s not a magic pill. You are still responsible for the outcome. An adequate diet and exercise will be necessary to get results. Don’t do it alone. There are plenty of great dietitians out there. Remember no one can predict how your weight will trend within your lifetime. You might need to take the drug for the rest of your life. With the recent shortages, you might not be able to take it the way it’s prescribed. Most importantly, think about how you might feel if your weight doesn’t trend the way you want it to. Semaglutides won’t do much for your mental health.

Increase your awareness by being a devil’s advocate

For every practitioner prescribing this drug, there’s a pharmaceutical company with an inexhaustible marketing budget earning record profits. Semaglutides are already in a nice comfortable space within the diet culture which has welcomed them with open arms. You can be sure there are plenty of weight loss companies vying for the extra dollars by adding them as a weight loss option.

As a consumer, you have the choice to take the wait-and-see approach. Dig your heels in. Don’t let the catchy jingle on the commercials or the celebrity weight loss stories give you false hope. Learn about every side-effect and don’t be afraid to ask the tough questions. In the grand scheme of things, you are the strongest advocate for your health and well-being. No one knows more about what you need than you do.

DISCLAIMER: The Green Apple Dietitian blog provides nutrition information for education only and is not intended to offer medical advice or cure any health conditions. The content should NEVER be used as a substitute for medical advice, diagnosis, or treatment of any health condition or problem. Any questions regarding your diet and health should be addressed to your specific healthcare providers. Never disregard professional medical advice or delay seeking it because of something you have read on this blog.

Green Apple Dietitian makes no warranties expressed or implied regarding the accuracy, completeness, timeliness, comparative or controversial nature, or usefulness of any information posted or shared on this blog. Green Apple Dietitian does not assume any risk whatsoever for your use of any information contained herein that was posted or shared on this blog in the past, present, or future. By accessing this blog, you agree that neither Green Apple Dietitian nor any other party is to be held liable or otherwise responsible for any decision made, or any action taken or not taken, due to your use of any information presented on this blog website.

How diabetes nutrition education “inadvertently” encourages disordered eating

July 4, 2023 ~ Green Apple Dietitian ~ 1 Comment

Over 10 years ago, my mom was diagnosed with diabetes. She was referred to a diabetes educator who taught her about foods that affect blood glucose levels and those that don’t. The educator recommended a carbohydrate intake of 45 grams of carbs for meals and 15 grams of carbs for snacks. She didn’t keep up with carb counting but always ate a wide variety of foods, and is one of the healthiest eaters I’ve ever known.

Last year after my mom’s second knee surgery, she lost a noticeable amount of weight. It made sense the weight loss was the result of healing and her dedication to physical therapy. However, during a follow-up procedure, the anesthesiologist reviewed her chart and noticed her blood glucose was consistently above 200. After a 6-month checkup, her A1C was 9.5. When she was first diagnosed, excessive weight loss was a symptom of hyperglycemia and her recent weight change signaled high blood glucose once again.

Weight loss is not a reliable measure of good health. Rapid and significant weight loss can indicate an underlying issue. If eating habits and medication haven’t changed, it’s crucial to consult a healthcare practitioner for an evaluation.

My mom’s doctor, again, referred her to a diabetes educator. She received the same carb-counting education as before, including the proverbial cut-a-banana-in-half speech. Bananas sold in stores are usually larger than what’s recommended on diabetes exchange lists. Patients are encouraged to eat one half and save the other for later. From a behavioral health perspective, how the patient interprets this advice is important. Do they see it as increasing food variety, or an opportunity to consume fewer calories?

If the diabetes educator is unaware a patient is struggling with an eating disorder, the advice may encourage food restriction. If this patient is encouraged to eat half a banana, this validates disordered thinking, “Eat less food so you don’t gain weight.” The eating disorder doesn’t care about diabetes or the patient’s health, only the fear of weight gain. Without screening for and addressing disordered eating, diabetes care is like a band-aid that comes off in the water.

Diabetes educators teach patients about foods that raise blood glucose. The goal of this education is to improve their diet, so it trends within a healthy range. But unfortunately, traditional carb-counting diets put food into distinct categories like eating disorder thought patterns. In simplistic terms, the carb-counting diet has 2 major lists of foods. 1. Foods that don’t affect blood glucose. 2. Foods that affect blood glucose. 3. The eating disorder will see them as good and bad foods while sifting through them to find safe foods that won’t cause weight gain. The result is usually less food intake while raising the risk of malnutrition.

Eating disorders aside, carb-counting diets are not easy to follow, especially when preferred foods are not available. Science proves behavior change is difficult. Not everyone will adapt well to a new diet as people tend to move toward what’s expedient. When feeling stressed, some patients might stop seeking treatment altogether or seek unproven alternative care treatments that can make diabetes worse.

After her appointment, what my mom said later that day is something I hear all too often in my practice, “I don’t know what to eat.” While revisiting the education booklet at home she said, “I’ve forgotten about the carbs. I should get back to that.” Yet she was confused about the difference between a carbohydrate and a protein. Her desire to change perceived incorrect eating behavior insinuated by the diet was evident. She also wasn’t happy with the idea she couldn’t have her oatmeal for breakfast when it was suggested she try to eat something different in the morning.

In my mom’s case, carb-counting education disrupted her healthy relationship with food by causing her to second-guess her choice to eat a banana and oatmeal. Later, she began giving away foods she loved because she believed she could no longer eat them.

As a dietitian specializing in disordered eating, I’ve observed how a carb-counting diet can overwhelm some folks more than it can help. It encourages perfectionistic dieting behaviors that are difficult to follow in real-world situations. The diet requires the patient to learn a lot of information in a short amount of time. There are numerous ways a patient can misconstrue what they’ve learned at first. For example, a newbie to carb counting may decide to “avoid” instead of “balance,” and take an all-or-nothing approach. Then the language becomes, “I can’t eat that, it has too many carbs,” which sounds just like a punishment for bad behavior.

Screening for disordered eating behaviors can help practitioners become aware of treatments that may do more harm than good. Diabetes educators should create an environment that’s all food inclusive while encouraging patients to consume healthy fruits and vegetables as nature intended. The longer I’m a dietitian the more it seems like this diet inadvertently blames the patient for their diabetes instead of giving them the help they need to better manage it.

When Good Intentions Trigger Disordered Eating Behaviors. Who is at risk?

May 7, 2022 ~ Green Apple Dietitian ~ Leave a comment

Last week my mom showed me a brochure that came in the mail a while back. The message on it was about foods that are better for your health versus foods that are not. It appeared to be written as a healthy eating piece to educate the public.

It seemed the audience they are trying to reach are folks who don’t eat too many fruits and vegetables every day. It might also include people who usually eat frozen meals at home or dine out at fast-food establishments.

On one side of the page, it says “Discover food secrets. At least one will surprise you.” Below it has an infographic about different fruits and vegetables and their health benefits—the superstars. When I first read it, the tone concerned me. The wording takes on an all-or-nothing approach.

Then I flipped the brochure over to the other side and saw the words, “We name names!” Below that heading, the body copy delves into food examples from a popular frozen food company and fast-food restaurants. Calorie amounts, sodium, sugar, and fat grams are listed for each food and beverage. The punitive tone was enough to make me, a practicing RD, cringe with guilt after seeing my favorite ice cream as one of the examples. It was called, “Extreme ice cream.” The paragraph goes on to describe how ice cream squeezes large amounts of calories and sugar into fat cells. Whatever that means. I don’t know about you, but when I want to enjoy dessert, that’s not something I want to think about. I certainly don’t want to feel guilty about my decision to enjoy ice cream, ever!

The brochure was created by a non-profit organization working for public interests. I do not doubt the good intentions. I visited the website and observed recipe books, magazines and newsletters. It’s very professional and appears creditable. They’re part of another larger organization that’s been around for a while. But I’m not going to divulge who they are. Bashing others who are working hard for the benefit of the public isn’t my goal. But I want to tell anyone who will listen, who doesn’t already know, that there are folks out there that won’t take this information the way it might be intended. After reading it, I see the potential for these words to be triggering for those who don’t feel good in their own body and are dealing with more than just a desire to eat healthier.

With the recent rise in disorder eating diagnoses, my experience with patients suffering from eating disorders compels me to give constructive criticism. These individuals often have negative thinking patterns which can lead to extremely unhealthy eating behaviors. Traditionally it was thought to be usually white females suffering from anorexia or bulimia, but people coming from every age, race, gender identity and sexual orientation represent a growing portion of individuals who are getting diagnosed with eating disorders. If you’re not too familiar with disordered eating, it’s more troublesome than you think. Taking the approach “just eat what I tell you and you’ll be fine” while pushing personal nutrition beliefs onto someone with an eating disorder can be more harmful than helpful.

When I was in college, this area of dietetics didn’t get enough attention. Students taking classes in nutrition don’t learn enough about disordered eating unless they had a specific interest in it. I remember eating disorders were only discussed during a lecture in one of my clinical nutrition courses. Later I learned some of my fellow students were engaging in unhealthy eating habits.

Human nutrition is a science that also deals with human behavior. Like it or not. To maintain discussions that put food into good or bad categories leaves out the fact that for some individuals it will stir up strong feelings of guilt and shame. Others can get stuck and become confused about what to eat. It’s these negative thought patterns that can raise an individual’s risk of engaging in disordered eating patterns. Over time this can lead to poor health outcomes that have nothing to do with the food they eat.

Orthorexia at the very basic is healthy eating thoughts and behaviors that go awry, which can cause serious malnutrition. A person suffering from orthorexia will choose not to eat at all when they believe they are limited to foods perceived to be unhealthy. It can be personal. But feeling bad about oneself while believing they are eating the wrong foods is not acceptable. No one should ever starve themselves just because a certain kind of food is on a naughty list.

The brochure goes on to say there are better alternatives. I agree! But not from a food choice standpoint. A better alternative is to teach nutrition gently, without blame or punishment. Foods should be described as they are. Some foods are high in protein, while others are high in sugar. That’s it. Food is just an inanimate object. That piece of chocolate cake is innocent after all. It can’t think or make decisions. It just sits on a plate. We as humans are the ones that bring all the emotion and judgment to it. We bring our appetites and our opinions to the table every day.

Public health should be more inclusive with more safe places for individuals to talk about disordered eating without shame or guilt. Places where people feel comfortable enough to ask for the help they need. Only truthful discussions will bring this illness out of the shadow and into the light. Believe it or not, chances are higher these days, that we all will run into somebody silently struggling with an eating disorder stemming from a self-loathing standpoint. You don’t know how much they might hate themselves or the body they live in. It could be the stranger on the street waiting for an Uber, or someone you know and work with every day that seems a little down recently. It could be even someone that lives under your roof that you love dearly. No one ever really knows all the chapters in someone else’s story.

If you or someone you know is struggling with an eating disorder click to talk, text, or chat: NEDA (nationaleatingdisorders.org)

Green Apple Dietitian makes no warranties expressed or implied regarding the accuracy, completeness, timeliness, comparative or controversial nature, or usefulness of any information posted or shared on this blog. Green Apple Dietitian does not assume any risk whatsoever for your use of any information contained herein that was posted or shared on this blog in the past, present, or future. By accessing this blog, you agree that neither Green Apple Dietitian nor any other party, to be held liable or otherwise responsible for any decision made, or any action taken or not taken, due to your use of any information presented on this blog website.