Diet culture’s marketing tactics and the consequences of using meds for weight loss

Last month, drugmaker Eli Lilly took a stand against using its two antidiabetic medications, Mounjaro and Zepbound, for cosmetic weight loss. In a public letter, the company emphatically said, in part, “Mounjaro and Zepbound are indicated for the treatment of serious diseases; they are not approved for — and should not be used for — cosmetic weight loss.”

For those of us who work with eating disorders, it’s no surprise that this needs to be stated. The surprise is they chose to speak up, given the increasing popularity of GLP-1 agonists, which are medications that help lower one’s blood sugar level and promote weight loss.

The latest diet and exercise fads clog our social media feeds, fueling the perpetual idea that losing weight is the ideal. And just when we think we’ve navigated our way through some of the noise, new destructive trends find their way into our “For You” pages or viral diets.

A 2023 report found that TikTok pushes harmful eating disorders and self-harm content to teens every 39 seconds. The Center for Countering Digital Hate’s report says that harmful content includes information about eating disorders, self-harm, and sexual assault. It is not uncommon to find GLP-1 agonists among these “trends” promising happiness, health and self-acceptance on the other side of a prescription.

As someone who treats and cares for individuals with eating disorders, I have serious concerns about the way this messaging affects vulnerable populations. The advertisements for GLP-1 agonists are hidden in glossy social media photos and videos of people achieving seemingly effortless weight loss. This is dangerous territory for social media users who are suffering from or at risk of developing eating disorders or disordered eating. The reality is bodies of all sizes and shapes can be healthy. The idea that you must change your body to achieve health or happiness is an insidious and harmful idea that continues to make billions for drugmakers and diet companies worldwide.

GLP-1 receptor agonists, at their core, are medications developed for the treatment of Type 2 diabetes. Many people are prescribed these medications for legitimate medical concerns and can benefit from these medications. Despite messages from manufacturers and escalating concerns, there are some who are prescribing GLP-1 agonists for cosmetic weight loss, the Associated Press reported.

Some offer prescriptions for these medications with seemingly minimal medical oversight of the risk or long-term consequences. They do not see the fallout of prescribing to vulnerable individuals or the risk to patients who are harmed by diet culture, weight stigma and unrealistic body ideals that may impact the development of severe eating disorders.

I am especially concerned when these medications are being prescribed for adolescent patients. Many who prescribe these medications have minimal awareness of the long-term implications of dieting and malnutrition on the adolescent brain. GLP-1 agonists decrease food intake and can create a state of malnutrition. Adolescent brains are extremely vulnerable to nutritional deprivation and malnutrition, and the use of these medications could trigger disordered eating.

The biggest unknown factor, especially with adolescents, is how long-term use of these medications will truly affect their bodies. In our treatment centers, we see the effects of social media and ads like these on adolescents. Negative social media messages coupled with easy online access strongly influence adolescents to seek out these medications. And while access to these drugs is restricted by prescription, there is mounting concern about their increased availability online.

We have already begun to see the impact on the eating-disorders community, as more patients are experiencing a relapse to disordered eating after using these medications. I suspect this trend will continue as these medications are prescribed for weight loss. Those of us in the eating-disorders field are concerned and actively monitoring this situation as it unfolds.

Each year, approximately 10,200 people die as a direct result of an eating disorder. That’s one person every 52 minutes. We know eating disorders are complex neurobiological diseases and, as a field, we want prevention and treatment options so that no one needs to live with or die from an eating disorder. We challenge our diet culture that idealizes thinness above health, happiness and above wholeness, and the use of GLP-1 agonists as a part of diet culture.