Things My Clients Are Saying: Is Everyone on a GLP-1?
Smaller Bodies, Bigger Questions: What Are We Actually Celebrating?
“Ninety percent of my friends are on a GLP-1.”
My client sits across from me in the oversized blue velvet chair in my office. My special client chair. Her legs are tucked underneath her. She has adjusted the throw pillows just so.
We’ve been working together for three months. She originally reached out to me through my website contact page saying: I am a 46-year-old perimenopausal woman with a recent diagnosis of Hashimoto's. I have body image problems and my mind never shuts up about food.
My client comes in every three to four weeks. We are monitoring symptoms, lab results, tolerance to dietary changes, and other indicators of well-being.
Like many women with Hashimoto’s, she came to me having been given recommendations to avoid entire food groups and take numerous supplements.
In my experience, conversations about Hashimoto’s can quickly become entangled with diet culture, with restrictive food rules and weight loss often taking center stage. I want my clients to have access to individualized, evidence-informed care that supports their health without unnecessarily narrowing their world of food.
Her health questions are unfolding during perimenopause, another life stage that our culture seems determined to treat as a problem to solve.
My client wants to care for her health without making weight loss the primary goal. Meanwhile, it seems like everyone around her is doing just that. Many of her friends are taking GLP-1 medications for weight loss. She feels like the only one not trying it. The peer pressure from friends (targeted ads, the entertainment industry, and even her medical providers) is significant.
She has worked hard to develop a respectful and peaceful relationship with her body. She has lived long enough to know that the pursuit of weight loss comes at a cost (emotionally, physically, financially, etc.). However, she isn't immune to cultural messaging. A part of her even feels jealous of her friends' weight loss. She wonders what it would be like to have that experience herself. She sees her friends receiving praise and positive attention, and she notices what looks like a growing confidence.
But something doesn’t seem quite right.
Girls’ Weekend: Girls Gone Mild
My client describes a whirlwind weekend in a popular East Coast city: museums, concerts, sightseeing, and the excitement of exploring a new place with friends.
Except something unexpected happened.
Her friends, who are taking GLP-1s, don't seem to think much about eating. Their appetites are dulled, and food doesn't naturally enter the itinerary. But, there is another “dullness” at play. Her friends, formerly adventurous and curious, seem muted.
My client, in an effort to support her autoimmune disorder, needs to eat regularly to care for herself and sustain her energy.
Her body needs nourishment. Her muscles need energy. Her brain needs fuel. Her digestive system needs support. Her body needs dietary fat, protein, carbohydrates, fiber, vitamins, minerals, and enough overall food to function.
And instead of feeling comfortable tending to those needs, she feels embarrassed. Almost like a burden.
She covertly eats granola bars in the hotel bathroom, afraid her friend will hear the wrapper being peeled open. She hides the trash under a wad of toilet paper in the bin.
The protein shake she brought for the return flight home? She hastily mixes it and chugs it in three gulps during a trip to the hotel lobby under the guise of getting more towels.
She's hiding her food. She's hiding the evidence that she's eaten. She experiences the ordinary act of caring for herself into something secretive and shameful.
The thing is, my client knows her friends want her to be nourished. They aren't telling her not to eat. They say all the right things: “People come in all shapes and sizes!” and “To each their own!”
But then there are comments like, “Let's just split a salad,” and, “How could you be hungry? We just shared a single sushi roll six hours ago!”
And their bodies seem to be shrinking right before her eyes.
They used to swap clothes on these weekend getaways. Now my client feels like the odd one out. They used to talk about books, hobbies, relationships, and all the other things that make up a life. Now the conversation keeps returning to weight and shape.
She's also noticing something that gives her pause.
What happens when the pursuit of being smaller starts taking up so much space that there's less room for everything else?
Diet Culture's Cannon: Convincing Us That Smaller Means Healthier
My client returned from the trip feeling like an inconvenience for wanting to eat regularly, while her friends' diminished appetites seemed to raise few questions.
And that's what I keep coming back to: the contrast between what we celebrate and what we question.
We have become so accustomed to treating weight loss as evidence of success that we can overlook other important questions:
Is someone getting enough food and a range of nutrients to support their body and overall well-being?
Do they have the energy to participate in their own life?
Are they experiencing pleasure, connection, curiosity, and spontaneity?
Can they respond to their body's needs without shame?
Is their pursuit of health expanding their life or narrowing it?
Weight alone cannot answer these questions. Neither can a medication prescription, a clothing size, or a before-and-after photo.
GLP-1 medications have legitimate medical uses and can be beneficial for some people. What concerns me is the culture surrounding them.
A culture already obsessed with thinness can turn a medical tool into another vehicle for the message that smaller is always better. When weight loss is celebrated without much curiosity about the rest of someone's experience, we risk confusing a change in body size with a comprehensive picture of health.
And when appetite suppression becomes normalized, the person who still needs to eat can start to feel like the one doing something wrong.
When Deprivation Gets Mistaken for Discipline
My client's body was asking for something ordinary and necessary. She was trying to respond. Yet in the company of friends who weren't feeling hungry, her own need began to feel like the problem.
Diet culture teaches us to see eating as something to minimize, hunger as something to overcome, and needing food as a potential failure of discipline or restraint.
When those beliefs collide with appetite-suppressing medications, the pressure to eat less can become even more normalized.
And suddenly, the person who remembers to eat can feel like the odd one out.
What if the problem isn't that you need to stop for food?
What if the problem is that we've created a culture in which feeding yourself can feel embarrassing?
Rewriting Midlife Health
Midlife can bring real questions about energy, changing bodies, symptoms, strength, bone health, metabolic health, and how to feel well in the body you inhabit. Those questions deserve thoughtful, individualized care.
But the cultural conversation often offers a much simpler answer: lose weight.
My client is trying to take another path. She wants to care for her health without making shrinking her body the central measure of success.
That's not giving up on health. It's asking a more expansive question about what health actually means.
There's something I notice when I work with people recovering from restrictive eating disorders. After a prolonged period of inadequate nourishment, when their bodies and brains finally receive enough food to support them, something can begin to shift.
I see more energy, more engagement, more spontaneity. There's room for curiosity, connection, and the ordinary pleasures of being alive. Sometimes friends and family tell me their loved one is “back.”
I don't mean that nourishment makes every difficulty disappear. Recovery is complex, and people experience it differently. But I've seen how adequate nourishment can restore capacity for life in ways that extend far beyond physical measurements.
It's this quality of life that my client values and wants to protect as she navigates Hashimoto's thyroiditis and perimenopause.
She wants to care for her health. She wants to feel well in her body. She also wants to be present for her life.
And weight loss for the sake of weight loss alone? That's a remarkably narrow definition of what it means to live well.
We deserve a more expansive dfinition.
A Few Questions Worth Sitting With
Have you ever felt embarrassed for needing to eat when others weren't hungry?
Have you caught yourself equating someone's weight loss with improved health, without knowing anything else about their experience?
What would change if we celebrated people for being more present in their lives, rather than simply taking up less space in them?
You may feel conflicted reading this. In my experience, it's entirely possible to both envy someone's weight loss and question the culture that makes us envy it. It’s a double bind, for sure.
You can want to care for your health without pursuing weight loss. You can respect another person's medical choices without making those choices your own. And you can opt out of making weight loss, body shape, or clothing size the price of belonging, dignity, and respect.
Because the goal isn't simply to become smaller.
It's to imagine yourself nourished. To have the capacity to participate in your life. To make room for pleasure, connection, curiosity, and even a little wildness.
What if we stopped asking only whether our bodies are getting smaller and started asking whether our lives are getting bigger?
Curious what nutrition counseling looks like when weight loss isn't the goal?
For anyone navigating Hashimoto's thyroiditis, perimenopause, fatigue, or concerns about their relationship with food, nutrition care with On the Brink Nutrition addresses real medical needs without defaulting to restriction or weight loss.
[Read more about my approach to nutrition counseling for Hashimoto's and explore an example treatment plan.]