GLP-1 Medications, Cravings, and Body Autonomy
As someone who works closely with individuals navigating mental health conditions, addiction, and eating disorders, I believe there is an important conversation surrounding GLP-1 medications that cannot be ignored. These medications have the potential to fundamentally change how we approach cravings, compulsive behaviors, and addiction—and they also raise complex ethical and psychological questions. How do we support individuals in a medically responsible and compassionate way while honoring principles of body autonomy, self-acceptance, and mental health in the context of medications that are clinically indicated for weight loss? More specifically, can medications that reduce cravings and compulsive eating behaviors coexist with the principles of body positivity and Health At Every Size® (HAES®)? This should not be a side conversation—it needs to be central to how these therapies are discussed and prescribed.
Weight Stigma and Fat Phobia in Healthcare
How often are you weighed at the time you go to the doctor’s office for any form of care? An earache? Allergies? A rash? Well, we have to weigh you. What single part of your healthcare that day is knowledge of your weight informing? In many routine visits, very little. Your ear infection medication is not weight-based, nor is your allergy or rash treatment dependent on your weight. While weight can be clinically relevant in some settings, it is often collected reflexively even when unrelated to the presenting concern. What does this number inform and why are we evaluated in this manner? We are weighed more often than a doctor ever listens to our heart, holds our hand, or looks at us deeply in the eye.
Would it surprise you to know that your weight is obtained partly for the purpose of financial reimbursement? Well, it does. Could you have received the appropriate medical care for these conditions without being weighed? Yup. Does being weighed each time further propagate fat phobia and weight stigma? Definitely. Is it medically ethical to weigh someone at every medical visit if this is the case? Highly questionable.
Does Body Weight Affect Health Outcomes?
Literature points to yes, but this is true for both those who carry excess weight and those who are underweight. Meta-analyses show relationships between obesity and cardiovascular disease, diabetes, dementia, risk of certain cancers, and all-cause mortality. Being underweight also puts one at increased risk of dementia and all-cause mortality, as well as fractures.
The relationship between weight and these conditions is complex and mediated by a variety of factors. The conversation is further broadened by large studies that have shown that there can be metabolically healthy obesity – in which there is an absence of elevated blood pressure, blood sugar, and low-density lipoprotein (LDL) cholesterol – in which there is not an increased risk of stroke, myocardial infarction, and all-cause mortality versus non-obese individuals.
So why are we so biased against bodies that come in different shapes and sizes, especially larger ones?
What Is the Health At Every Size® (HAES®) Movement?
Health At Every Size® (HAES®) is a body-positive, weight-neutral approach to health that emerged in the early 21st century with the publication of a book which carries the same name. But the movement pre-dates that and has roots in other body-positivity movements, beginning in the 1960s. A central principle of HAES is that people can pursue health and well-being at a wide range of body sizes. Advocates argue that an excessive focus on weight in healthcare can contribute to weight stigma, mental health challenges, and poorer health outcomes, particularly for individuals who struggle to maintain what is considered a “normal” weight. Importantly, many proponents of HAES also emphasize individualized care, informed consent, and respect for body autonomy.
How GLP-1 Medications Changed the Weight Loss Conversation
GLP-1 medications like Ozempic, Wegovy, and Mounjaro really are the first medications that make substantial weight loss (approximately 15-21%) achievable and have rapidly gained popularity for this reason. Anyone who has ever investigated this medication category is likely bombarded by advertisements from influencers and the massive amount of telehealth companies prescribing compounded, lower cost versions of the drugs for this use. As of late 2025, approximately 12% of American adults were taking these medications, despite many of them paying out of pocket for the cost of these drugs. Thirty-four percent of individuals who have ever used a GLP-1 drug have taken the medication for weight loss.
So how, one may ask, do GLP-1 drugs even remotely fit into the conversation about body positivity?
The Physical and Mental Health Effects of Binge Eating
From a medical perspective, binge eating episodes are defined in the DSM-5 as periods in which 3 of the following exist: 1) eating much more rapidly than normal, 2) eating until uncomfortably full, 3) eating large amounts when not physically hungry, 4) eating alone because of embarrassment, and 5) feeling disgusted, depressed, or guilty afterward. There are clear physiological consequences of binge eating including digestive symptoms such as gas, bloating, or abdominal pain; blood sugar spikes; and sleep disruption; and over time, it is possible that type 2 diabetes, dyslipidemia, and cardiovascular disease may develop.
The psychological impacts of binge eating are possibly more impactful, especially acutely. Within the 5 criterion, the latter 2 directly shed light on this. Binge eating can have a huge psychological impact – so much that individuals who struggle with it often speak of having a hangover the next day and beyond. Blood sugar spikes and crashes undoubtedly contribute, but the shame and disgust one often experiences with their behavior and themselves can be immense.
In individuals who meet the criteria for binge eating disorder (BED), which is a repeated pattern of psychologically distressing binge eating episodes at least once weekly for 3 months without purging behavior, there also is a substantial increase in suicidal behaviors and suicidal ideation, often not even associated with body mass index (BMI). To one unfamiliar with these disorders the number may be shocking: risk of suicidal ideation was more than 6 times higher in the BED cohort while suicide attempts were more than 9 times higher. Compensatory behaviors such as fasting, exercise, vomiting, or laxative use after binge eating episodes are not uncommon; each with their own unique risk profile when abused.
If a medication existed that helped reduce food noise, binge eating behaviors, and their psychological consequences, would it be in opposition with HAES?
Can GLP-1 Medications Reduce Binge Eating and Food Noise?
GLP-1 medications may align with—not oppose—certain HAES principles when viewed through the lens of craving reduction, psychological suffering, and body autonomy. Data about the impact of GLP-1 medications on binge eating behavior does exist, with 5 studies evaluating the drug category in individuals with binge eating disorder as of November 2024. GLP-1 receptor agonists modulate appetite, reward sensitivity, and self-regulation – reducing food noise and the consumption of food (and other substances such as alcohol as well). Researchers increasingly believe these medications may influence dopaminergic reward pathways involved in compulsive behaviors and craving reinforcement loops (what we might think of as “food noise”). Should we be surprised that binge eating scores in this population were significantly improved across these studies?
Beyond binge eating, psychiatric safety signals of GLP-1s were found to be positive from a meta-analysis of 31 long-duration randomized clinical trials. In fact, across 6 studies, mostly in individuals with type 2 diabetes, a small but statistically significant antidepressant effect was found. Although these medications are not without controversy, including concerns about gastrointestinal side effects, access inequities, and the possibility of reinforcing societal pressure surrounding thinness and body image, they definitely beg consideration for someone struggling with binge eating disorder and mentally plagued by food noise.
Body Autonomy, GLP-1 Medications, and the Right to Pursue Weight Loss
Not everyone living in a larger body experiences binge eating, and not everyone who struggles with binge eating is overweight or obese. Still, the growing conversation around GLP-1 medications, weight loss, body image, and cravings raises important questions within the broader HAES framework.
For many people, the desire to lose weight is not about meeting societal expectations — it may be about feeling more comfortable, confident, and at ease in their own body. For others, weight loss may reflect a desire to reduce physical discomfort, improve mobility, lessen binge eating behaviors, or quiet persistent food noise and cravings. From a body autonomy perspective, individuals should have the right to make informed decisions about their health and appearance without shame or judgment. This includes the choice to use GLP-1 medications for weight loss if that aligns with their personal goals and well-being.
Body autonomy ultimately extends beyond body positivity: it supports the idea that people deserve respect and agency over their own bodies, whether they choose to pursue weight loss, maintain their current body size, or reject weight-focused goals altogether, without shame, stigma, or outside judgement.
The conversation surrounding GLP-1 medications will undoubtedly remain complex and evolving. These medications intersect with discussions about mental health, eating behaviors, body image, cravings, and personal autonomy. For some individuals, they may help reduce compulsive eating behaviors and psychological distress, which adds an important layer of nuance to conversations about weight loss, body positivity, and healthcare ethics.
Written by Dr. Carrie Decker, who has proudly refused to be weighed at every medical visit (with the exception of when anesthesia is necessary) for nearly 20 years.