By now, you must have heard of Ozempic, Wegovy and other weight-loss medication brands that have been helping thousands of people meet their weight-loss goals quickly and with minimal effort. Given that sustainable weight-loss efforts have robbed us of so much indispensable time and money, shedding the pounds and keeping them off via weekly injection sounds like a dream come true. Is there a catch?
One of the hailed benefits of semaglutide (the generic name for these medications) has been the silencing of “food noise,” an evolving term referring to preoccupation with food. Of course, preoccupation with anything often results when we judge or seek to manipulate the very thing we are preoccupied with. When our broader culture is fixated on body size and shape, we don’t always recognize the influence of this preoccupation on our personal lives. We’re born with natural intuitive hunger and satiety cues, but for whatever reason and often at an early age, we—or our peers, parents and media—begin to criticize and question them.
As we disconnect from our intuitive process, critical and repetitive impressions influence our relationship with food and can lead to food noise. If such noise happens to be negative towards oneself, we can find ourselves seeking reasons to help dictate what we should and shouldn’t eat, how much, and when, all while ignoring the body’s signals until we can’t hear them anymore.
Instead of listening from within, semaglutide has the potential to help people feel safe in the world and yet, internally, we may not be reclaiming our innate cues, which communicate how to best nourish our bodies and, more importantly, our minds. It’s easier to pathologize hunger, and we now have the medication to mute it. Imagine: a life without food noise.
Is it all it’s cracked up to be?
No one actually knows. We worry about the false sense of control over our eating that semaglutide provides, as it can mask serious underlying issues related to food, such as disordered eating, metabolic irregularities, obsession, mania, over-exertion and social deficits. It might also help with these while someone is in treatment and under the care of a therapist who understands the complexities of how a relationship with food coincides with the unique ecosystem that exists between body and mind.
Nevertheless, the disruption of natural appetite and eating rhythms can increase the risk of depression and mood disorders. Moreover, semaglutide dependence is a serious concern. Weight loss seems to last only as long as the medication is in the body, so patients are tempted to take the medication perpetually rather than face the prospect of rapid weight regain once they stop.
But the prolonged use of semaglutide can lead to serious negative medical consequences, the worst of which may not yet be known. For now, chronic suppression of gastric motility, for example, could increase the risk of severe gastroparesis or bowel obstruction, and the alteration of bile flow due to rapid weight loss or changes in diet can escalate the risk of developing gallstones or other biliary diseases. Over time, suppression of hunger may impact muscle mass and physical health due to inadequate nutrition.
There are some patients for whom semaglutide may be an important part of their treatment plan, especially those with underlying medical conditions. But what about those of us who just want to lose weight and feel safe from the idea of having to worry about how food affects our emotions and thoughts? What is it about being human that makes us all want to short-circuit our basic needs?
We connect with our Creator, ourselves and our communities in a multitude of ways,all of which we consider holy: mitzvot, prayer, tzedaka, learning, chesed, Shabbat, and—you guessed it—food. We need to be careful. Shutting down our body’s communication system doesn’t just risk malnutrition, decreased energy and other GI-related complications. It isolates the mind from the body, leading to self-alienation in ways we’re only just beginning to see. I can’t imagine that Ozempic is going to cure deficits in social, executive and interpersonal functioning—and food certainly impacts all of these.
Of course, it’s always OK to make your own decision, but before you do, consider consulting with an eating disorder clinician to better understand your circumstances and whether this route is the right one for you.
Brian Pollack, LCSW, CEDS-S is an adjunct professor at Yeshiva University, Certified Eating Disorder Specialist and owner of Hilltop Behavioral Health. His work encompasses advocacy, national keynote presentations, and continued education surrounding the treatment and prevention of eating disorders.
