Creating A Mindset Shift Regarding GLP-1 Medication
This is part two of my deeper dive into weight-centric thinking and GLP-1 use. This article looks at the connection between weight and diabetes stigma and weight-centric approaches.
When people ask me why I am weight-inclusive, they often assume that I don’t believe in GLP-1 medication. This is problematic for many reasons, and when I started to put pen to paper, I realized I was writing something of a novel rather than a newsletter.
I broke the original article into two parts, and in part two, I wanted to dive into weight stigma and how this is hindering diabetes care.
Then, I was hired to research disordered eating in diabetes, and that opened another aspect of GLP-1 medication, which I hope I can effectively unpack in Part 3 of this series.
If you missed part one → De-centering Weight for GLP-1 RA Users
One of the biggest problems with weight-centric thinking is the all-or-nothing mentality that surrounds it. This “Good/Bad” approach to health, nutrition, and self-care loses nuance and perpetuates the myth of a one-size-fits-all approach. It also creates a false dichotomy.
Weight-Centric Thinking Creates False Dichotomies in GLP-1 Care
Self-worth is tied to weight
Treatment success becomes about personal value rather than health outcomes
Weight regain feels like personal failure rather than a biological response
Impact on GLP-1 care: Patients feel they’ve “failed” at using GLP-1s if weight loss isn’t dramatic or sustained. They may hide weight regain from providers, discontinue medication out of shame, or develop unhealthy relationships with the medication. (Let’s put a pin in this point for Part 3)
Weight loss is viewed as the necessary (and primary) indication of health
Other improvements (energy, mobility, stable blood sugar) are devalued
People with minimal weight loss feel treatment “didn’t work” even if they feel better
Impact on GLP-1 care: A patient whose blood sugar has stabilized, whose joint pain has decreased, and whose energy has improved may feel the medication “isn’t working” because they’ve “only” lost 10 pounds instead of 50. Practitioners may discontinue effective medication because weight loss is modest.
Body acceptance and weight loss are treated as binary opposites
Creates guilt and confusion for people who accept their bodies AND experience weight change
Implies you must choose between self-acceptance and medical treatment
Both are actually threads in the larger knot of weight and health stigma
Impact on GLP-1 care: Patients feel conflicted about using GLP-1s, fearing it means they’ve “given up” on body acceptance. Conversely, patients committed to body acceptance may avoid beneficial medical treatment because it might cause weight loss.
To reduce weight stigma, a weight-inclusive approach de-centers weight change, treating it as neither good nor bad. It regards changes in weight as a normal part of the human experience and is morally neutral.
Weight-Centric Thinking Causes Direct Harm in GLP-1 Care
Promoting weight loss and focusing on weight as a primary health indicator has measurable negative consequences. Research shows that about half of US adults have been targets of weight-based teasing, unfair treatment, or discrimination, and up to 69% of women with higher weight report experiencing bias from healthcare providers. Weight stigma results in physiological stress, emotional distress (including depression, low self-esteem, and body dissatisfaction), and patients experiencing weight bias often avoid seeking medical treatment.
Impact on GLP-1 care:
Patients may avoid seeking GLP-1 treatment for legitimate medical needs (diabetes, cardiovascular disease) because they fear weight-related judgment
When GLP-1s are framed as “weight loss drugs,” the stigma intensifies (patients are “taking the easy way out”)
Patients may experience internalized shame about needing medication, viewing it as a personal failure
Healthcare discussions focus on weight rather than on the health concerns that led to treatment
Weight stigma is also linked to increased calorie consumption, lower physical activity, and disordered eating. When clinicians promote weight loss, they may unintentionally set patients up for lifelong weight cycling patterns, and weight cycling is linked to metabolic and cardiovascular disease risk factors.
Impact on GLP-1 care:
The appetite suppression from GLP-1s can mask or enable restrictive eating patterns
Patients may use GLP-1s to support chronic undereating, leading to muscle loss and nutritional deficiencies
When patients discontinue GLP-1s and weight returns, they experience the metabolic harm of weight cycling
The shame of weight regain may lead to disordered eating behaviors (extreme restriction, purging, excessive exercise)
Research has established clear links between dieting and eating disorders. Early dieting, depression, and body image distortion predict extreme weight loss behaviors. Early depression and dieting are associated with binge eating in young adulthood, and weight stigma has documented links to dieting patterns, disordered eating behaviors, and increased stress.
Impact on GLP-1 care:
GLP-1s prescribed primarily for weight loss (rather than medical indication) may increase the risk of eating disorders
The medication can mask restrictive eating disorders, especially in people with higher body weights, where eating disorders often go undetected
Patients with perfectionistic or obsessive-compulsive traits may misuse GLP-1s as “a form of control.”
The body image concerns and disordered eating that often drive interest in GLP-1s for weight loss are not addressed by the medication itself
The harm is measurable: When healthcare focuses on weight in GLP-1 care, patients may:
Avoid beneficial treatment due to stigma
Develop disordered eating patterns enabled by appetite suppression
Experience shame and self-blame when weight plateaus or returns
Miss the actual health benefits because attention is focused on the scale
Discontinue effective medication because weight loss is deemed insufficient
Connecting Weight-Centric Thinking to Stigma
Understanding why weight-centric thinking is problematic helps us see how it connects to larger systems of stigma. Both weight-centric thinking and stigma operate by:
Oversimplifying complex biological and social systems
Blaming individuals for systemic problems
Treating weight (or health status) as a measure of personal worth
Focusing on weight creates and supports weight stigma. This is why weight-inclusive approaches specifically decenter weight to stop perpetuating stigma.
Untangling the Knot of Weight and Health Stigma
Stigma isn’t something you fix or solve. It is a knot that we untangle. The threads of stigma come from many places, and they’re woven together in complex ways.
Stigma is the false belief that blames an individual for a systemic problem.
Examples:
Weight stigma blames higher-weight people for their size
Fails to see how biology, society, and institutions create barriers for people
Ignores: genetics, food systems, built environment, healthcare access, weight cycling from dieting
Diabetes stigma blames people with diabetes for having diabetes
Fails to see how biology, society, and institutions create barriers for people with diabetes
Ignores: genetics, autoimmune factors (Type 1), food insecurity, healthcare access, systemic inflammation
Why can’t individuals solve systemic stigma?
Stigma exists at the societal and institutional level
Individual weight loss doesn’t change how society treats higher-weight people
Individual A1C improvements don’t change how society views diabetes
The system maintains and recreates the same barriers.
When an individual wishes to untangle the knots caused by stigma:
There isn’t a single approach or a “right” way to do this
Seeking relief from stigma is understandable
It isn’t a contradiction to want body acceptance AND want relief from stigma’s effects
It’s a normal human response to an oppressive system
The key is understanding: When an individual loses weight or lowers their A1C, it doesn’t reduce or improve weight or diabetes stigma. It may provide individual relief from some stigma-related effects, but the system remains unchanged.
A weight-inclusive position decenters weight (not health) as the primary concern. It does this intentionally to dismantle weight stigma.
Summary of Key Points
Weight-inclusive thinking:
Understands weight as an outcome of complex biological systems
Focuses on behaviors, functional capacity, and metabolic health
Reduces harm by decreasing stigma though advocay
Focuses on and supports sustainable health behaviors
Is supported by evidence (improves psychological health without worsening physical health)
Looks for and works to reduce systemic beliefs that promote weight stigma
For GLP-1 care: Understanding these frameworks helps practitioners support patients using these medications without perpetuating weight stigma. This means attending to the multiple mechanisms by which GLP-1s work, supporting sustainable behaviors, and measuring success through functional improvements rather than relying on scale-based metrics.