Ottawa Morning6:35Global eating disorders
One of the things Cheryl Rasband learned during her recovery from anorexia was that she shouldn’t actively try to lose weight. That’s why she was a little taken aback when the psychiatrist suggested that she might want to try Ozempić.
“I want to give him the benefit of the doubt because I have expressed concerns about my weight. However, he knows my history,” she said.
The 40-year-old nurse and mother who lives in Utah County, Utah, has struggled with an eating disorder since she was 16 and said her weight has been up and down ever since.
When she was at her lowest point she had to be hospitalized and even temporarily lost custody of her children as a result, she said.
Now, after undergoing extensive treatment, Rasband said she feels much better mentally, even though, she says, she is technically overweight. Body mass index. (BMI is a measurement some doctors use to determine a healthy weight, although it has been questioned as an indicator of health.)
“I feel like I’m healthier, more functional, more everything at this weight compared to when I’m at a lower weight and when I’m in and out of treatment and suicidal myself.”
People who work in the treatment of eating disorders in Canada say what Rasband experienced is happening in this country, and are raising the alarm that their patients are being prescribed weight-loss drugs without proper screening or counseling.
Risks for people with eating disorders
Anita Federici, assistant professor of clinical psychology at York University, has noticed this trend.
“My big concern is the movement I’m seeing where doctors are prescribing drugs like Ozempic to people with eating disorders and giving them the false education that they’re front-line treatments for things like binge eating disorder or bulimia nervosa, which they absolutely are not,” he said. Federici, who has a doctorate in psychology and is also a member of the Academy of Eating Disorders.
While there is no data to show how many of the 3.5 million Ozempic prescriptions written in Canada last year went to people with a history of eating disorders, Federici said a number of her patients are on Ozempic, and she is concerned, not just about their mental health. well-being, but also their physical health.
Of particular concern are patients who have what is sometimes called “atypical anorexia,” she said, because even though they may have a BMI that puts them in the overweight or obese category, they are actually starving a lot of the time and are at risk of becoming malnourished if they use a weight-loss drug.
“You are medically compromised.” And now there is a danger that a person with, unspecified, atypical anorexia or binge eating disorder will enter the doctor’s office and be prescribed Ozempic more and more often,” said Federici.
‘starvation under medical supervision’
This is something that also concerns clinical psychologist Jennifer Mills.
She is a professor studying eating disorders in the Department of Psychology at the University of York.
Mills said that a drug like Ozempiz can even cause an eating disorder in someone “who is predisposed to that kind of reaction” and that patients should be closely monitored during what is “almost like a physician-supervised fasting.”
She said there have been some documented cases of people who have had weight-loss surgery or taken weight-loss drugs, where it has caused an “anorexia nervosa-like reaction.”
“Sometimes when people lose a lot of weight, they can develop a distorted sense of what their bodies look like. It’s almost as if their brain has a hard time catching up with the physical weight loss, and maybe an exaggerated fear of regaining the weight or not being thin enough,” said Mills, who is a doctor of psychology.
One issue, she said, is that doctors and psychologists don’t always agree on the best approach to weight loss.
For example, Mills says she believes people can be healthy at any size and encourages her clients to adopt that perspective as well.
“That’s what I preach to my patients, and yet it runs counter to this kind of buzz and hysteria about a drug that really makes weight loss easier.”
For some, a ‘valuable’ medicine
But for doctors of diabetes patients, weight loss may be a desired byproduct of using Ozempic.
“We have an obesity epidemic. That’s why we have a diabetes epidemic,” said Dr. Stuart Harris.
He is a professor in the Department of Family Medicine at Western University School of Medicine and Dentistry and Medical Director of the Primary Care Diabetes Support Program at St. Joseph’s Health Care in London, Ont.
“From a purely clinical perspective of diabetes[Ozempic]is a very valuable remedy in our toolbox.”
And, he said, Ozempic can even be safely prescribed to someone with an eating disorder if proper precautions are taken.
“If I know someone has a history of binge eating or mental health issues, I’m going to be much more judicious and careful about whether I even start this treatment option, how I do it, or how I follow up with them,” Harris said.
“I’m very selective and careful with all the people I give this therapy to, but especially with people I’m concerned about where there may be more adverse outcomes associated with eating disorders in humans.”
He said he doesn’t want to point fingers, but he knows not every doctor does that.
“You [can] just walk into a health promotion clinic that sells diets and other lifestyles and things and they just give you a prescription without knowing who you are or what your clinical history is. “Then I think that’s where people get into trouble,” he said.
CBC Radio columnists6:31 amBe positive and Ozempić
Sad and scared
Cheryl Rasband said she still isn’t sure if she will try Ozempic as her psychiatrist suggested.
While she’s much happier living without an eating disorder, she’s not sure it won’t come back with the pressure she feels to take weight loss medication.
“It’s so sad that it catches me after all these things my eating disorder has done, and brings it back.”
She also fears that she is not the only one struggling with this difficult decision.
“If it’s questioning me and all these other people who are like me questioning what their values are and what their priorities are for this publicly pushed weight loss drug, I feel scared for the general population.”
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