Reflection
Ozempic and Eating Disorders: Why the Weight-Loss Drugs Miss What's Really Wrong
Ozempic can make a body smaller. What it cannot do is answer the question the eating was asking.
More and more of the people who contact me now mention Ozempic, or one of the other weight-loss injections. Some are curious; a few have even stepped away from therapy because the weight is coming off and it feels, for a while, as though the problem is solved. After years of working with eating disorders, I want to say plainly what I see.
What the drug does - and what an eating disorder actually is
Ozempic and the drugs like it work by making you feel fuller for longer, and less hungry. For someone whose difficulty is genuinely appetite, that can help. But an eating disorder was never about hunger. People with an eating disorder do not eat because they are hungry; they carry on eating long after they are full. The eating is doing something else entirely. So a drug that reduces hunger is aimed at a problem these people do not have, and it misses the mechanism that actually drives them.
Let me be equally direct about the other side: I am not against these medications. For someone who is genuinely, dangerously obese and needs to lose a great deal of weight quickly for their health, they can be the right tool. My point is narrower, and important: for an eating disorder, they treat the wrong thing.
Rearranging the chairs on the Titanic
Here is what I most often see. Someone has been using food to manage their emotion - to numb it, to get through the day - and now, on the medication, they can’t use food in that way any more. But the emotion has not gone anywhere. The need it was meeting is still there. So the person simply reaches for another tool: they start vaping, or drinking, or something else, to do the job the food was doing.
Clinicians call this symptom substitution, and with these medications I now see it constantly. The weight comes off and everyone is pleased, but underneath, nothing has changed. It is rearranging the chairs on the Titanic. You have removed the symptom and left the cause completely untouched.
Does Ozempic work for binge eating?
This is the question I am asked most often, so let me answer it through what binge eating really is. Binge eating means consuming a huge quantity of food in one sitting, in a very short space of time - some people take in five to ten thousand calories at once. And the purpose is not enjoyment or hunger. It is to numb emotion: to flood the system so completely that whatever is being felt is drowned out for a while. A drug that dampens hunger does not touch that purpose - which is why the urge so often survives the injection, or migrates elsewhere.
Why the chewing works
There is a mechanism underneath this that is worth understanding. Almost every human being carries some anxiety, and anxiety is a kind of fear - a diffuse dread that something, somewhere in the future, is going to go wrong. Now watch what eating does. The simple act of putting food in the mouth and chewing brings a person firmly into the present moment. And in that moment of chewing, they are not in the feared future - so, briefly, the anxiety lifts. Then they swallow. The present-moment relief is gone, the guilt arrives, the future-dread comes flooding back - and so they need to eat again. That is the loop. It is not greed. It is a person using the only anchor to the present they have found.
Everything to do with food - and nothing to do with food
This is why I define an eating disorder the way I do: a complex psychological disorder focused around food. I will say it twice, because it matters - a complex psychological disorder focused around food. Everything to do with food, and nothing to do with food.
The diets, the weight, the calories, the shape - that is the tip of the iceberg, the part above the water. People will try every extreme diet imaginable to get the weight off, and it never holds, because the real problem is the nine-tenths beneath the surface: a problem of the self, of emotion, of relationships, sometimes a psychiatric problem. That is what has to be addressed. A weight-loss drug, like a diet, works only on the tip of the iceberg. It cannot reach the part that is actually holding the whole thing up.
The order of the work: emotion first, food second
There is a second reason the “just fix the diet” approach fails, and it is about sequence. When the emotional work is done properly, the bingeing stops - the food is no longer needed to manage feeling. But that is not always the end of it. I have worked with people who, after long and real therapeutic work, no longer binge at all and yet remain fairly obese, because at every meal they still reach for the wrong food: two sausage rolls in the morning, where a bowl of porridge would do.
So there is practical work to do as well - but you cannot start there. Treat the emotional root first, so the food loses its job; only then does the dietary work become possible and worth doing. Emotion first, food second. In the other order, you are back to dieting the tip of the iceberg.
The third reason people take it: youth
There is a motive underneath much of the Ozempic wave that is neither obesity nor an eating disorder, and it deserves naming. Most people were not fat when they were young. The weight arrived the way it arrives for nearly everyone, gradually, through the decades, with the children and the desk and the dinners, until one day the body in the mirror is simply an older body. And that is what many people are really trying to lose: not the kilos, but the years. The fat has come to stand for age itself, and the injection promises the return of the young body, the one without fat, the one from before.
Seen this way, Ozempic is not only a medical treatment. It is the newest sacrament of the church of self-hatred I have written about elsewhere, a chemical answer to the fear of ageing, sold into a culture that has already decided an old body is a failed one. And this is why the disappointment is so common. The weight goes, and the years, of course, do not. You are lighter, and still fifty. What was being medicated was not the body at all, but the refusal of time, and no drug touches that. The real work, there, is the one this whole culture avoids: making peace with a body that is allowed to have age in it.
The honest conclusion
Ozempic can make a body smaller. What it cannot do is tell you what the food was for, what feeling it was managing, and what the person will do now that it’s gone. For genuine obesity, it has its place. For an eating disorder, the work underneath still has to be done, and until it is, the weight - or the vaping, or whatever comes next - is only the problem wearing a different coat. That underlying work very often means processing the trauma beneath the eating.
An eating disorder is a serious illness, in women and in men - and men, in my experience, often arrive at this work years later than they should, having been told for too long that this is not a man’s illness. If you recognise yourself or someone you love in this, the underlying work is exactly what this practice is for: read more on male eating disorders and what a male eating disorder really is, or arrange a consultation.
On eating disorders in men specifically, see Men Who Heal, Dr Jacquet’s dedicated men’s practice.
In the Gulf, where obesity rates are among the highest in the world: eating disorders and obesity help for Kuwait, online from London.
What the appetite was doing for you: Emotional Eating, the Hunger of the Soul.
