475-Beyond GLP-1: Body Image Healing & Eating Disorder In The Era Of GLP-1 With 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.

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, you know, bariatric surgery when bariatric surgery was on the rise maybe, you know, 15 years ago or so.

So it's a really particular time where we have the medication intersecting with capacities with social media and marketing.

So, uh, honestly, I feel a lot of just tremendous compassion-That we are all sort of thrust into a moment that I think not...

We don't really know how to make sense of it and sort of how to manage it all.

And that's why this conversation is really important, because we're learning as we go.

And I'm gonna focus our conversation on body image, and I'm gonna open with this question.

The cultural narrative that people are being, uh, fed is that losing weight will improve their health, which we're not gonna focus so much in this interview, but will also make them feel better about their body, will, quote-unquote, "heal their body image." What does this message assumption get wrong as a person who has this expertise in body image? Does weight loss improve body image?

You know, I think that any time there's a singular narrative, it, it can become problematic because, I mean, 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.

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, not to say the, the sole determinant of this, but a large part of that is the social affirmation that comes along with that weight loss, right? 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 dis- judgment, right? That smaller is better.

And so that is very real and alive for people.

But I think that it often is more complex, at least in my conversations with my individual clients, with my individual supervisees, right? So I'm thinking about one client in particular who, we won't get into the details of her experience, but 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.