Can GLP-1 medications trigger or worsen eating disorders?

Yes, GLP-1 medications can trigger or worsen eating disorders in vulnerable individuals, and eating disorder specialists are raising significant concerns about the lack of screening and monitoring currently in place. GLP-1 medications work by altering appetite signaling in the brain, which can suppress hunger and fullness cues. For someone already struggling with an eating disorder, this pharmacological suppression of internal hunger signals makes it far more difficult to meet basic nutritional needs, potentially escalating restriction, malnutrition, and other disordered behaviors.

Clinical reports from eating disorder practitioners indicate that some individuals in active recovery have experienced rapid relapse after beginning GLP-1 medications, sometimes after years of stable recovery. Additionally, the social reinforcement that accompanies weight loss, including compliments, improved treatment in medical settings, and easier access to clothing and public spaces, can make it extremely difficult for a person in recovery to hold the internal gains they have worked to build. The conditional acceptance that comes with a smaller body can itself be destabilizing.

A further complication is that many people are using GLP-1 medications off-label or without disclosing their use to their eating disorder provider, making clinical monitoring nearly impossible. This is partly because the broader cultural celebration of GLP-1 use creates shame or pressure to conform, even for those for whom the medication is clearly harmful. Eating disorder specialists report seeing clinical situations more dangerous than anything encountered before the widespread availability of these medications.

For health professionals, the most important immediate action is to stop defaulting to congratulations when a client is losing weight and to instead ask open, curious questions about their lived experience: what has the weight change meant for them, how their relationship to food has shifted, and whether they feel they are meeting their basic nutritional needs. Practitioners who work with general populations should be aware that eating disorder behaviors exist on a spectrum, that formal screening tools are limited, and that GLP-1 medications are being prescribed without systematic evaluation of eating disorder history or risk.

Transcript 

[00:00:00] Stephanie: Welcome to the podcast, Marcie.

Marci Evans: Thanks so much for having me, Stephanie. I’ve really been looking forward to this conversation that we’re gonna have today.

Stephanie: And it’s a very important conversation, the other side of GLP-1, body image and eating disorder. But first, I would like you to introduce yourself because you have a long, very powerful background.

[00:01:00] Marci Evans: I probably introduce myself a bit differently than how an official bio is written out. My name is Marci. I use she/her pronouns. I am really energized by these types of conversations, so I appreciate the invitation. I am a registered dietitian. I have been practicing eating disorders care since really the very beginning of my career and have been, I think, a bit unique in that while I had a kind of traditional dietetic training, weight-centric training, very early on was introduced to the concepts of intuitive eating and actually found myself down a rabbit hole of weight inclusivity and body acceptance.

And so I didn’t have to ever do kind of a big pivot in my career. I was really fortunate, I think, in many ways to have that pretty close to my foundation and my start. I often make the joke that I’m a one-trick pony. I do many different things, but I have a singular trick, which is eating disorders work, and I appreciate you probably have listeners who come from the lived experience of recovering from an eating disorder or maybe eating disorder professionals.

[00:02:00] But I also hope the conversation we have today feels inclusive of people who maybe don’t identify with that diagnosis. Maybe they have a history of disordered eating or just kind of wrestling and inundated with diet culture.

I am a clinician still. I have a clinical practice, and I feel that at my heart of hearts, I am a clinician. I love, love, love the work that I get to do with my clients. I’m also a clinical supervisor, which I also love. I’m also an educator. I teach graduate courses at Simmons University, teaching nutrition counseling for eating disorders.

[00:03:00] And then the other main thing that I do is clinical education. So for the past decade, I’ve developed online courses to help other clinicians and colleagues feel capable and excited about doing this kind of work. And after five years of intense work, I have completed a manuscript with my beloved coauthor, Lisa Pearl. We just submitted a book manuscript, which is expected to be out late fall 2026.

Stephanie: And I’m gonna say for the audience, I’ve taken some of Marci’s courses, and she has a brand called Body Image Healer. That’s how I came to know her. So we’re gonna focus our interview on body image and eating disorder in this new era of GLP-1. I’m gonna just launch us with a very general question.

You’ve spent your career working at the intersection of body image and eating disorder. What are your thoughts? What was your reaction? How are you thinking about GLP-1 right now?

[00:04:00] Marci Evans: We are in the midst of a major cultural shift. It is really a pretty profound moment that I think in some ways is a repeat of past moments, and in some ways different than past moments, that I think is a really intense time for people, where being able to access weight loss in a way that feels easier and within reach in a way that it hasn’t for many people, and I think it feels like intense pressure for a lot of people.

[00:05:00] That’s certainly what I hear from many of my clients, that there is, because of the accessibility, because of the prevalence of GLP-1 use, because of the marketing, because of the intense social media, there is an incredible pressure that is surrounding them that is different than, say, bariatric surgery when bariatric surgery was on the rise maybe fifteen years ago or so.

So it’s a really particular time where we have the medication intersecting with capacities with social media and marketing. Honestly, I feel a lot of tremendous compassion that we are all sort of thrust into a moment that we don’t really know how to make sense of and sort of how to manage it all.

Stephanie: And that’s why this conversation is really important. I’m gonna focus our conversation on body image. [00:06:00] The cultural narrative that people are being fed is that losing weight will improve their health, which we’re not gonna focus so much on in this interview, but will also make them feel better about their body, will, quote-unquote, “heal their body image.” What does this message and assumption get wrong as a person who has this expertise in body image? Does weight loss improve body image?

Marci Evans: I think that any time there’s a singular narrative, it can become problematic because one of the things that I love about clinical work is that I get to be in the individual experience. And so any time we’re assuming that something will be true for everybody, it’s not going to be true for a lot of people, and it may be true for some people.

[00:07:00] Now, as you well know, and as you’ve talked about extensively in your work, that neurobiologically, we are wired to want acceptance. That is built into our neurobiology. And so it is reasonable that some people do experience weight loss and feel significantly different about themselves, feel better about themselves.

And a large part of that is the social affirmation that comes along with that weight loss. And that is a true experience. People are trained in our culture to comment on appearance, to comment on size, and to have a values-based judgment that smaller is better. And so that is very real and alive for people. But I think it often is more complex, at least in my conversations with my individual clients.

[00:08:00] I’m thinking about one client in particular who decided to go on a GLP-1 as a result of a medical condition that she has. She’s actually very strongly in recovery from an eating disorder. She did a tremendous amount of work around her own food and body image relationship for about a decade, the two of us worked together. She decided to go on a GLP-1. It has changed her body, and in some ways that has felt really positive for her, and that’s been actually quite complicated.

But alongside that has been a pretty profound grief, a grief of the reality that she didn’t really see a problem with her body before, but she realized that the world saw a problem with her body, and that as a young child, her parents saw a problem with her body. And so the reality that she is really confronting, appreciating that she doesn’t really know, will her body remain this size?

[00:09:00] Will her body get bigger again? And will she be treated differently? Will the acceptance be conditional? And so there is this real tenuous relationship to all of the positive feedback that she’s getting from other people, and that certain things are made easier for her. Clothing shopping is easier. She’s having an easier time navigating public spaces, how she’s being treated at the doctor’s office. Like, those are real things for her. And for her, it’s actually been, in certain ways, deeply upsetting because she sees in such a clear juxtaposition of the ways in which, for actually a lifetime of forty years, how she had been treated previously.

And she’s really, to her credit, able to locate the problem not actually within her body, but within the sociocultural norms, the systems, the biases that are held outside of her. And so my work with her has been such a great experience for me going through this process with her.

[00:10:00] I have another client who started a GLP-1. He has lived his entire life in what we would call a super fat body, and has actually gone on a GLP-1 for some medical reasons, some desires to lose weight, and he’s not losing weight on this medication. And so what does that mean for him as somebody who can see many ways in which his life might be different or made easier if his body were different?

I just think it’s a complicated place for many people when the notion is it is accessible, it is something you can purchase, it is something that you can access, and now seemingly everybody can have the body that they want. And of course, we know that it is far more complicated than that, and it’s simply not true. It’s not everybody’s experience.

[00:11:00] And then, which I’m sure we’ll get to today, the reality for some people who do decide to go on this medication for body changes and for whom it’s incredibly detrimental in terms of their relationship with food, in terms of having an eating disorder, getting thrust into severe malnutrition, severe eating disorder behavior symptoms escalating, and for whom these medications would actually be clearly contraindicated.

And so it is, in my clinical experience, a pretty complex array of feelings, reactions, thought processing, grief, all of that.

Stephanie: I think it demonstrates the complexity of body image. Body image for the general population is what we look at in the mirror, and it holds so much more complexity than what we think it is. So if you had to describe what body image is, how would you describe it? [00:12:00]

Marci Evans: That’s a great question, Stephanie, and I like that you’re asking it. It’s one of the things that I do when I’m working with clients and when I’m sitting with supervisees or I’m running a training, and you know this because you’ve taken my training, is that that’s often the place that I begin in dialogue because, sure, we have academic definitions. We have definitions that are utilized in research. But I think the most important thing when I’m sitting down with someone, and that I would actually encourage your listeners to think about is, well, what does body image mean to you?

I think body image is really multifaceted, and I think that what it means for me as somebody who is very conscious of having this conversation with you, my lived experience of having a body has been extremely privileged.

[00:13:00] As somebody who is straight-sized, who has lived with a degree of health, being somebody who is cisgender, a white, female-presenting person. And so my own narrative and experience of body image being, of course, complicated because I’m a human, but in many ways made less complicated because I live in a privileged body.

And so the way I think about what body image is, really what I think about is what’s the story inside of me and the lived experience inside of me of what it’s been like to have a body? We have the technical definition of the image in our mind of what my body looks like to other people. But I think that it is layered on with our thoughts and our stories and our narrative, our emotional experience, our felt sensory experience in our body. But I think more than anything, it’s a cumulative lived experience of what it’s been like for me to have a body.

[00:14:00] And in fact, when I really get in with my clients and we are doing body image work, we often go back and I invite a narrative of let’s just allow you to talk about what it’s been like for you to have a body. And what they’re often surprised by is that thought loops that they live with day in and day out are often connected to experiences that they had when they were quite young and that they’re carrying with them.

I think the amazing thing about body image in all its complexity is that if you had asked me six months ago or ask me six months from now, I’d probably give you a different answer, which I think is endlessly interesting.

Stephanie: And the answer would also be different understanding the context of GLP-1 right now, and will continue to be evolving and changing. [00:15:00] Preparing for the interview, I was looking specifically at research on body image and GLP-1, and there’s only one observational study. That’s it.

Marci Evans: Thanks for sharing that with me. I have not looked at that study. I’m interested to know that there is a singular study. I’m interested in who’s done the study, and I’ll have to take a look at it.

Stephanie: Yeah, it’s a small study, and it was done from a body image researcher, which I think outlines a problem, right? As we discussed in the interview we did earlier with Louise, GLP-1 right now is marketed for weight loss, and that’s where the capitalist system will make money out of it, but it’s not being researched. We’ll talk about body image and also eating disorder and the consequence of GLP-1 on body image. When I share with you that there’s only one study and we’re not looking at it, what are your thoughts on that?

[00:16:00] Marci Evans: I’m just not the least bit surprised. I think that one of the things that I’m confronted with on a daily basis is that I am so interested in my clients’ internal experience, sort of the consequences of their relationship to food. What we would see on the outside — how a person is presenting, how they’re living, how they’re eating, how they’re behaving — and I’m really interested in knowing what is the impact on the inside. And that is often not the priority of researchers. It’s certainly not the priority of researchers who are primarily focused on a singular target, which is success is measured in weight loss.

[00:17:00] We see this also overlapping in eating disorders research. It’s not just in the, quote-unquote, obesity literature that there is a narrow focus on did the scale go down, and if the scale went down, then it’s considered successful. But it’s often not measured alongside things like psychological experience, emotional experience, sense of self, sense of self-esteem, impact on depression, anxiety, let alone eating disorder behaviors.

And I think that some of these things are really difficult to capture in all of their nuance. A person might say, “Well, I’m less anxious. I’m less socially anxious because I’m feeling better in my body, and I’m being complimented.” And also, when I’m in there with my clients and we’re talking about it, it’s a little bit more layered than that. What if I lose the capacity to have this kind of restraint?

[00:18:00] What if I’m not able to maintain my prescription for this medication? I’m actually eating in a way that doesn’t feel sustainable, but the benefits right now feel worth it to me. And so I’m often thinking about, well, what are the stated upsides now? What are the downsides in the short term, but what will this also mean for this person in the longer term?

And that level of nuance and conversation is just not conducive to a randomized control trial, and so our research is quite limited in that way. And of course, if you had this conversation with Louise, there’s a particular agenda and who that agenda is being fueled by and who the narrative benefits.

[00:19:00] And so there’s a real limitation to relying solely on published research, and I’m always asking the questions of published research. What questions weren’t being asked? Who designed the study? What’s being measured? What’s not being measured? And it’s one of the reasons why I love being a clinician, because I actually get to get into all of that richness with the people that I’m sitting with.

Stephanie: And for me, it’s also opening the space for us as practitioners to bring that forward to people that we work with — that currently the side effects on body image, on mental health, on eating behavior are not being measured or explored, and there are consequences. We need to bring that conversation to people who are thinking about GLP-1 or making the decision, because that conversation would not be held in traditional medical counseling.

Marci Evans: Right. Absolutely. Yeah. That’s exactly right.

[00:20:00] Stephanie: Let’s talk about eating disorders, because in my research for this interview, I was like, “Okay, so there’s only one study on body image. Let’s look at the field of eating disorders,” and it’s the same pattern again. There’s one study that was primarily focused on binge eating disorder, which was suggesting that GLP-1 were beneficial for binge eating disorder. Now, I’m not an eating disorder specialist, but I do know that there is a line of thinking in eating disorder treatment that weight loss is a solution to eating disorders. Where is your mind, your thoughts, your observations on that aspect of eating disorders and GLP-1?

Marci Evans: Yeah. This is such a complicated topic in many ways. And one of the things that I want to name as we’re talking about this is that there can be almost two different conversations that we’re holding, you and I, simultaneously. There’s the conversation of how we think about this as a clinician, how I think about it clinically, [00:21:00] what my orientation is, what my ethics are, how I read the research, all of those things.

And there is a related but slightly different experience, which is what it is like when I’m sitting across from somebody and I am in relationship. And I often strive to really watch my own agenda, particularly around the experience of body image as somebody who does not live my day-to-day in a larger body, right?

And so I am a very, very strident believer in body autonomy, but I also believe that body autonomy needs to be, if somebody is seeing me as a clinician, accompanied by ethical transparency of my understanding of where we’re at in the research, where we’re at in our understanding of GLP-1 medications, what we’re seeing in the short term, what we don’t know in the long [00:22:00] term, so that my clients can really make thoughtful and self-reflective decisions about what they believe is gonna be best for their bodies.

And while I might have a particular belief system, I ultimately want to honor the fact that I know that my clients are incredibly smart. They are asking really important questions, and while I can offer my perspective, my opinion, my clinical understanding, we might arrive at differences of opinion, and that means I can still respect them as thoughtful, wonderful, multifaceted people.

[00:23:00] Now, I believe actually very firmly that trying to engage in intentional weight loss while trying to simultaneously recover from an eating disorder is not a way that I practice clinically. I think it seems like an almost impossible needle to thread. I don’t quite understand how one is trying to suppress their body size while they’re trying to work towards making peace with food, fully recovering, nourishing their bodies in a way that is in alignment with health-promoting body acceptance.

And I really respect that there are people who believe that is something they can do. There are clinicians who believe that that is something they can provide, and so I do try [00:24:00] to be very, very clear from the outset if that is something a person is wanting from me, we’re just not gonna be a match. I just don’t know how to arrange that in my mind. It’s not something that makes sense to me.

Now, what I will say is that I do believe that there is incredible variability in how a person’s physiology responds to a GLP-1 medication. And is it possible for someone to be on a GLP-1 medication and be absolutely engaged in their eating disorder recovery? I do. I have seen it. I’ve witnessed it. I’ve been a part of that clinical care. But it is incredibly complicated because by nature of the medication, which alters appetite signaling, the question becomes, [00:25:00] do they have access to hunger and fullness cues? And if they don’t have access to hunger and fullness cues, are they able to eat in the absence of hunger adequate nutrition that is sufficient to fuel their brains, sufficient to fuel their body, sufficient to fuel their recovery?

Now, if a person with an active eating disorder is having a hard enough time doing that work with the presence of hunger and fullness cues, it’s really going to be quite difficult to be doing that in the absence of an internal physiological drive to be eating.

[00:26:00] However, I do want to say that I have also seen that there are individuals who have baseline metabolic dysregulation on a GLP-1 who actually feel better access and greater clarity around their hunger and fullness. And so I try not to have a blanket statement of GLP-1s are always, always bad, or they’re always harmful, or they’re always going to put somebody into a more disordered state because that actually hasn’t been my clinical experience.

However, what I will say in the eating disorders realm is that we are seeing more extreme behaviors, more harm than ever before in a way that feels deeply frightening to me. It feels really scary. We have clients who are feeling unable to talk with their providers about their GLP-1 use, and so they’re going underground using GLP-1s off-label, not getting it from their providers, using it for months, being incredibly symptomatic in their eating disorder, having pretty profound medical consequences, very dangerous behaviors, and it’s not being addressed.

[00:27:00] And then it’s being condoned and marketed and celebrated in every other aspect of their life. As weight-inclusive providers, we have always felt that we’ve been going upstream, going up the cultural stream. I’ve certainly been going against the normative stream in the realm of dietetics. And it’s like the rapids have just gotten bigger. How do we even have a hope of helping clients for whom a GLP-1 is going to be exceedingly dangerous, exceedingly harmful, and how do we make a case for that when the messaging elsewhere is so, so strong?

[00:28:00] And I’ll add on, I don’t know what you’re seeing in your clinical practice, but I have people who don’t want to go on a GLP-1, who are feeling pressured or who are feeling it’s everywhere, and they’re like, “I’ve been working on my recovery for years, and now I feel even more pressure to kind of go headlong into my eating disorder with a medication, and I don’t want to. That’s not the life I want for myself. That’s not the life I’ve been building.” And so, going back to what we’ve been saying, there is not a singular experience.

Stephanie: Okay, I have so many questions. What you’re describing as an eating disorder where GLP-1 can be extremely harmful, I think is also what we’re seeing in cultural social media, where we’re seeing certain stars presenting a very emaciated body and signs of malnourishment. [00:29:00] And I think that’s a great example of how GLP-1 can be a tool to actually severely harm people, and we know that eating disorders are the deadliest mental health condition. They’re being given a tool that gives them the ammunition to deploy their eating disorder to the extreme.

Marci Evans: That’s exactly right.

Stephanie: Are you seeing that in clinical practice as well?

Marci Evans: I’m absolutely seeing that in clinical practice. My colleagues are seeing that in clinical practice. There are incredibly dangerous clinical situations that we have never seen before. Really, really complicated, dangerous situations because of these medications, and that is not something the larger public is all that concerned about.

[00:30:00] I think the larger medical world, it’s just not a high level of concern. I think eating disorders are thought of as being so rare, so our sort of countering with “We are seeing incredibly dangerous practices. This is harmful. This is deadly. This is enabling. This is giving the tool of anorexia to people,” and I don’t think that the larger medical establishment, certainly not the larger social media industrial complex, cares at all.

And so that is something we are really up against. It feels as if we’re sort of hollering from the rooftops like this house is on fire, and people are kind of giving it a shoulder shrug.

Stephanie: And there’s no screening requirement. Like there’s no screening requirement being prescribed GLP-1. I think that’s what we need to go after — screening people before prescribing. Would you agree with that?

[00:31:00] Marci Evans: I totally and completely agree. I mean, absolutely, I can join you on that soapbox. It’s frightening to me that a medication that by design alters in the brain the appetite signaling is thought of as solely a positive without any sort of inkling of concern. There is no screening, but not only that, Stephanie, it’s not screened and it’s not monitored. It’s also given out when people aren’t even going to the doctor for it.

[00:32:00] A patient might come to their doctor and bring some medical concern. They haven’t said “I’m looking to lose weight” or “I’m looking for a GLP-1,” and so they’re going in, and then almost willy-nilly, the prescriber says, “Well, how about a GLP-1?”

I have a colleague who has some blood sugar dysregulation, is dropping into hypoglycemia. We’re not talking about somebody who’s pre-diabetic, we’re not talking about someone who’s diabetic or has PCOS, anything for whom we would think a GLP-1 makes clinical sense. The provider said, “Maybe a GLP-1.” Now gratefully, this is a clinician who works in this space and says, “Why in the world would you be prescribing me a GLP-1? What is your clinical rationale for that?” She didn’t have one. So it is frightening [00:33:00] the fact that we have no screening, no follow-up, no monitoring, and a frenzy almost for which the medications are being offered and prescribed as if it is a panacea for anything that a person might be seeing a doctor for.

Marci Evans: And the stories I’m hearing are almost unbelievable.

Stephanie: And you’re seeing that in your practice, and for those of you who may not work in eating disorders, you’re seeing it in the world of stars and social media. It’s a reflection of what is being seen in the eating disorder treatment field.

Marci Evans: Oh, that’s exactly right. [00:34:00] The number of clients who talk about the ways in which they feel so activated by what is being seen with GLP-1 use among the stars who are using it for extreme presentations of weight suppression, malnutrition — it’s like handing a green light. Why would I not join? And I can appreciate the fact that it feels incredibly activating for many people who are trying their hardest to stay focused on eating disorder recovery when it feels like everything around them in such a profound way is giving a completely different message.

Stephanie: And it’s being pedestaled and it’s being recognized. Are you seeing in clinical practice a difference between those that are on GLP-1 from a medical perspective versus those that are intentionally engaging for weight loss?

[00:35:00] Marci Evans: I think that I have a selective sample size, to put it that way. To be fair, I have the profound privilege of working with individuals for typically very long periods of time. So I don’t have the most typical clinical practice. I have folks that I have been working with in their relationship to food, their relationship to body from a weight-inclusive lens for many years.

And so for individuals who I’ve been working with who’ve chosen to go on a GLP-1 medication for a variety of reasons, there is a certain sort of compass that they have inside of themselves that says, “Marci, I want to sustain my eating disorder recovery. I don’t want this medication to eradicate the years and years of work that I have built up, the trust that I have built inside of myself, the self-respect that I have, the way in which I want to nurture and take care of my body.”

[00:36:00] So I have absolutely witnessed individuals who are choosing to use this medication and who are using it really in the service of their wellbeing. And I supervise a lot of clinicians who are seeing individuals who have been actively working on their recovery decide to go on a GLP-1 medication. They want to lose weight because a surgery is being withheld, and they haven’t been granted the surgery. And then they find themselves down a rabbit hole of rapid weight loss, of resurgence of their eating disorder, of being thrust back into anorexia, of extreme malnutrition.

[00:37:00] And for certain people, because people respond to this medication differently, it happens incredibly rapidly. And so there are people for whom they’ve been in their recovery for many years, maybe they’ve even been solid in their recovery, they have very understandable reasons to want to access weight loss, reasons for which I do not hold any judgment around, and then they find themselves back in the throes of their eating disorder. But it’s also giving them access to social praise, to medical care, to being treated differently in different spaces. So it’s incredibly complex for the individual.

Stephanie: And I’ll add to this, we’re also just at the beginning of this, right? So people who are potentially seeing medical benefits will most likely not be on GLP-1 for the rest [00:38:00] of their lives, because of financial insurance issues, because of medical side effects. So we don’t know what the other side of it is.

Marci Evans: No. Right. And that is what I try to hold in the room with my clients, with my supervisees. Can we hold that we are in the unknown and we’re going to continue to step into the unknown, which is why I want the individuals that I work with to know that I actually believe that it’s my job to be a support and a guardrail for their recovery and to be holding the red flag when I’m highly concerned, you know, holding the yellow flag when I’m seeing something that’s concerning before it becomes red.

[00:39:00] I’m really asking in detail what’s happening in their relationship to their body, what’s happening in relationship to food, really getting into the detail there so we can be watching out for whether we’re getting concerned. And I’ve had to have some kind of difficult conversations with certain clients to say, “How is it gonna feel for you if you are losing weight and I’m not cheering alongside of you? That I’m not your weight loss coach, that I’m not celebrating with you.” And I understand how that could be difficult because it’s something that feels perhaps for them celebratory.

[00:40:00] And I’ve had to talk about why that is. Because the reality is, for many people, I may be working with someone who’s losing weight now, and what happens down the line if they decide to go off the medication, if they can’t afford the medication, if insurance has withdrawn the medication? And what we do know is the most likely outcome is that they will regain the weight, and I want them to know that I will be alongside them then.

And that the way that I’m feeling about them and feeling about their body size is not something that is going to wax and wane, but that I am most curious about what it means for them. How does it impact their own sense of self? And I think that that can be difficult, but I think there’s also, for many of my clients, a tremendous sense of relief and safety that they know that the way that I see them, the way that I understand them as people, goes beyond the visual.

But I appreciate that is not how the world treats them. That is very different than how they step out and experience the world when they leave my office.

[00:41:00] Stephanie: And you’re creating safety for them no matter what the outcome is, that you will always be there with them, and I think that’s the safety that the world cannot give them. So if I think of the practitioner listening, perhaps not necessarily an eating disorder specialist, but a dietitian, a coach, a nurse practitioner, somebody that helps support, counsel, treats general population, what would be your recommendation? And I know this is an entire course, but in a nutshell.

Marci Evans: I actually think it’s quite simple, which is my hope would be that any clinician out there, provider, whatever setting you’re in, is to not project celebration and success onto weight loss, and can you inquire rather than assume that, “Yay, we’re losing weight.”

[00:42:00] Well, if losing weight is happening because a person is taking a medication and they’re no longer eating, or they’re not eating well, or they’re actually abusing their bodies, we don’t want to accidentally join them in that. And so even just coming from a place of inquiry and curiosity — what has it been like for you in your relationship to your body since your body has changed? How are you feeling about yourself? Are you feeling differently about yourself? Are your interactions changing? How is it in relationship to other people? — so that they have the room to have a nuanced experience, because most people are having a nuanced experience.

And I think that there is often, especially in medical settings, comments that are made without malintent. I think that these are social norms that have been built where there’s an automatic celebration or a congratulations or a compliment. But I think if a provider can actually be curious about what is happening for this person, what is their experience, how are they doing on a medication, what does the weight change mean to them, [00:43:00] and center the client’s experience rather than default to praise and compliments, I think that that would go a very, very long way.

Stephanie: Well, I think that’s something — outside of the dietetic world, when I talk about general population practitioners, I don’t think there’s understanding of what disordered eating is. There’s a lack of screening. So they are perhaps advising, recommending, and counseling without understanding the full spectrum of the individual in front of them because they’re not trained in it. More screening tools would be my recommendation. And yes, there is a difference between eating disorder and disordered eating, but they still need to be brought into the conversation to the decision of GLP-1 and what the long-term impact will be.

[00:44:00] Marci Evans: Yeah, I think even bringing that into the room. In clinical settings, screening tools can be used. I think that a lot of the screening tools can be quite limited when we’re having conversations about eating disorders because people think eating disorder — and many people, even people who might actually meet criteria for an eating disorder, that doesn’t sound right to them, or it just seems too extreme.

And so even having a couple of questions that aren’t necessarily from an official screening tool: can you imagine if a medical provider said, “Hey, you know, you started on a GLP-1. They significantly alter appetite. Are you able to eat just basic nutrition needs? Are you eating regularly? Are you able to have three meals a day at a minimum? Do you feel you’re taking care of yourself? [00:45:00] We’re worried about, particularly with aging, muscle loss, loss of bone health.” Paying attention and really demonstrating that you actually care more about a more complex picture of health than just the number on the scale — I think even that would be a pretty profound signal to individuals going to see their provider.

Stephanie: Broadening the conversation. That was my intent with this series, was giving the other narrative of what we need to be thinking about and careful about — broadening the conversation with the people we are working with beyond weight loss. What else do we need to consider? What else do we need to think about that you’re not hearing in mainstream media, so we can have a true informed consent?

Marci Evans: That’s right. Yep, that’s exactly right. [00:46:00] When an individual is eating so little that it’s translating to rapid weight loss, of course, as a nutrition provider, I am thinking about all of the hidden consequences, the ways in which that does impact lean body mass over time, skeletal health over time, hormone health over time, the ways in which appetite across the board sometimes becomes suppressed just in terms of desire and sexual appetite, social connection, feeling alive in the world.

And so being curious about all of those different pieces rather than just the scale. And I think that’s the beauty of being a weight-neutral, weight-inclusive provider — we are always seeking to see the full picture beyond what’s solely happening on the scale.

Stephanie: Yeah, we’re seeing people beyond the physical body. I always say, [00:47:00] you are more than a physical body. You’re an emotional, mental, spiritual being, and that’s where we’re gonna bring the conversation, because for years you’ve only been treated as a physical body.

Marci Evans: That’s right.

Stephanie: That conversation, medically and counseling-wise, is never talked about. You go to your physician and they will never talk about mental, emotional, and spiritual wellbeing. We need to have that conversation with our clients and patients, and to me, that’s us.

Marci Evans: Yeah. It’s one of the many reasons I love my job. I think that primary care providers, at least here in the United States, are in a very difficult position in that they are required to see very high volume of patients in a very short period of time. [00:48:00] They’re tasked with responding often to a number of different challenges and issues that a person has, and they’re meant to sort of resolve those issues pretty quickly. So I really feel for the constraints that our primary care providers are operating under.

And it’s actually why I feel so fortunate that I am able to have a full 50 minutes with my clients, typically weekly over long periods of time, where a client can get their lab results back and have a one-sentence response from their physician, and then we spend an hour unpacking it all, and what does it mean for them in their lives and in their relationships and all of the facets of what makes them a person — their spiritual life, [00:49:00] their emotional life, their psychological life, their embodied physical life — because we are these complicated multidimensional people.

Stephanie: Yeah. I ask this question to every interviewee, so I’m gonna ask it to you. Based on your career, you’ve dedicated your career to helping people with their relationship to food and body. When you look at what we do know of GLP-1 right now and where we can project where it’s going, where do you see our niche, the weight-neutral health field, going in three to five years from now, long term?

[00:50:00] Marci Evans: The short answer is I’m not sure I know where we’re headed, and what I really, really do believe is that our work is still so necessary because we are going to have people for whom they don’t want to go on a GLP-1, and they’re navigating the fact that they’re making that choice that maybe feels unpopular, and so they’re navigating that. I absolutely have clients like that in my practice.

We’re also gonna have people who choose to be on a GLP-1, and they with all of their heart and soul and all of their being want to be in a committed, authentic eating disorder recovery. And we’re gonna be able to work with those individuals in all of the nuanced ways that we do.

[00:51:00] Marci Evans: We’re also going to have folks for whom they go on a GLP-1, and it is the worst possible medication for them to be on, and it has really severe untold consequences, and we’re going to be on the other side of that. We’re going to be on the other side of the people for whom there’s been pretty catastrophic damage.

And so I see so many ways in which this is not going to be the end of weight-inclusive care. I think that it has just made our work all the more complicated because it’s added an additional element of unpredictability, of accessibility to something that can be incredibly harmful for many individuals.

[00:52:00] And one thing I feel quite strongly about is that as providers, we have to be prepared to become more comfortable with being in dissonance with clients, of being in dialectic, of being with profound ambivalence, and being able to settle into that and welcome that into the room. Also with internal clarity, an internal compass, an internal sense of what feels like work that I’m on board with versus what feels like work that is just not aligned with my own ethics.

And so I think that there’s gonna be a real continued internal reckoning and an internal need to get more and more clear within inside of ourselves.

Stephanie: I love that. Like, to make our own decision internally as practitioners first, while holding nuance. [00:53:00] And for me, I’ll add one thing — having much more deeper and more complex conversations than just what we are unfortunately trained for at a baseline. Because a group of people will go on this medication and think of it as “That’s finally the solution.” And then we know what is most likely to happen — they’ll come back to say, “Well, that didn’t work again.”

Marci Evans: It didn’t work and/or it created some problems that I didn’t anticipate. I ended up having this medical complication that I didn’t know was a possibility. [00:54:00] We’re gonna be on the other side of what is a person’s unique experience, and I really strongly agree that we have to, inside of ourselves, be open, be skillful enough, and be ready to lean into that kind of complexity with compassion and non-judgment, but also with clarity.

Stephanie: Yeah. And we need to demand more research, obviously. We need to look at mental health research, eating disorder research, body image research. We do know that financially there’s no appetite for that in the traditional research field. I think if we want to do some activism, we need to demand for more research that will broaden the outlook.

[00:55:00] Marci Evans: That’s exactly right. Talk about holding this dialectic — we need to demand it while at the same time appreciating that we have always done our work with a real deficit in research and data. Many people are not so interested because it’s not rooted in capitalism, so there isn’t money to be gained.

Stephanie: Anything else you would like to share? How can people work with you? Where can people find you?

Marci Evans: Thank you so much for this conversation, Stephanie. I love that you’re doing this series. I think it’s phenomenal and really necessary. The easiest way for people to find me is on my website, which is marcird.com. I’ll sure you’ll link it in the show notes.

[00:56:00] And I am on social media. The place I’m the most, although not even super consistently, is Instagram. And if folks want to hear from me in a more nuanced way, I would suggest that they join my newsletter, which they can do on my website, and I promise not to spam you. I’m actually quite conservative in terms of the number of emails I send out. I do have a number of free resources on my website, both for clinicians and for individuals that might be helpful for folks. And I have a number of offerings coming out this fall.

I’m having a new offering on the impact on weight-inclusive clinicians holding space for this work around GLP-1s and the impact it’s having on providers. I’m also having a new course coming out on digestive disorders and eating disorders, so I’m relaunching that. It’s fully updated. And then, as I mentioned, my book comes out this November, so folks will see that. It’s a textbook geared towards clinicians who do eating disorders work.

Stephanie: Thank you, Marci, for having shared one hour of your time with me and the listener, and we’ll put all the links in the show notes for you.

Marci Evans: Thanks again.