Warning: This article discusses binge eating, anorexia, and other types of eating disorders, which may be triggering for some people.
I KNOW THINGS have gotten bad when the pizza boxes begin stacking up. It’s like the tower of Domino’s boxes is calling out, “Hey, you’re doing it again!” In college, I hid the boxes in a compartment over my dorm closet. When I broke my foot after moving to Washington, D.C. in my mid-20s, I would hobble to the trash chute and hide them in that room. Now, living in New York in my early 30s, I fold the boxes and push them deep into the recycling bin so that my partner won’t see them.
For the first time in my life, I’ve been trying to consciously address this 20-year pattern with my therapist: stress that leads to exhaustion that then leads to eating whole pizzas and sometimes more, despite feeling full or even sick. The bloat and weight gain that stems from this adds another worry to the pile, because on top of whatever it was that causes me to eat, I’m now anxious about appearing fat and slobby. I’ve learned that by the time the pizza box tower begins to topple over, I’m in the throes of my binge-eating disorder.
As the Mayo Clinic defines it, binge-eating disorder is “a serious eating disorder in which you frequently consume unusually large amounts of food and feel unable to stop eating.” Over half a million men in the U.S. are affected by binge-eating disorder and, according to a Harvard study, approximately 6.6 million guys nationwide have experienced an eating disorder in the last year.
I didn’t always have the language to define that seemingly endless pattern—and it’s certainly not the language I’m always comfortable using. What’s more, I’m navigating this new diagnosis at a complicated juncture. In five months, I’m getting married, and vainly, I want to look great for it. We’re also in the midst of this cultural moment where weight-loss drugs (or anti-obesity drugs, whatever you want to call them) like Ozempic and Wegovy and Mounjaro are everywhere. As celebrities and other public figures subtly reveal their transformations, I’ve admittedly become interested in trying the drugs myself.
But taking any of these drugs means introducing something into my body that changes the way it works. What would that look like for someone like me who has an eating disorder? How will that impact my recovery? And ultimately, am I just putting a Band-Aid on my complex relationship with food?
Some of the most popular anti-obesity drugs out there right now are Ozempic, Wegovy, Mounjaro, and Zepbound. Ozempic (approved to treat Type 2 diabetes) and Wegovy (approved for chronic weight management) are made from the active ingredient semaglutide. Mounjaro (approved to treat Type 2 diabetes) and Zepbound (approved for chronic weight management) are made from the active ingredient tirzepatide.
Semaglutide works by activating the GLP-1 receptors in your body, which help control blood sugar levels and suppress appetite. Tirzepatide works similarly, though it targets both GLP-1 and GIP receptors, which means it can have an even greater effect on blood sugar levels and weight loss. The average cost for a one-month supply of these drugs is around $1,000 without insurance (you can only get covered if you meet certain BMI requirements and/or are diagnosed with Type 2 diabetes).
Anecdotal evidence has shown that the way these drugs interact with our brains can have profound effects on people with binge-eating disorder. While GLP-1 drugs primarily suppress the feeling of hunger and satiation, people have also reported experiencing less rumination and obsessive preoccupation about food. This means these drugs potentially have the ability to numb that “food chatter” that makes you want to eat, and eliminate those compulsive thoughts as well.
Food chatter is a frequent occurrence during one of my typical “pizza nights.” With binge-eating disorder, the reminder of that food is like an itch in my brain. I might eat, say, half a pizza and put the rest in the kitchen. I constantly think about the remaining slices. I think about when I’ll get to eat them…maybe in the morning for breakfast or maybe one before bed. I might even worry that someone else is going to eat them instead. It’s embarrassing and unnerving and, frankly, a pain in the ass.
If that early evidence holds true, those lingering thoughts would be silenced via medication, effectively turning off the nagging impulse to revisit the food. That’s only a salve for binge-eating disorder though, and silencing that food chatter also requires a more regimented, balanced eating schedule to help offset the fact that your body isn’t telling you to eat. In short, those positive effects come with some important homework when it comes to eating habits, and knowing your relationship with your eating disorder is key before taking these drugs.
“Any medication that becomes part of the public culture for body image manipulation could be high-risk [for triggering] anybody with an active eating disorder or even in recovery from an eating disorder,” explains Andrew Walen, licensed clinical social worker and Certified Eating Disorder Specialist. And while there is no hard and fast research on whether medications like this could cause an eating disorder, researchers have indicated that intensive monitoring for disordered eating habits in patients on these drugs is highly encouraged, especially for those with restrictive eating disorders like anorexia nervosa.
A common concern among experts is that people believe you can cycle on and off these drugs. This isn’t a situation where you hop on a drug like Wegovy until you hit your goal weight, then stop taking it. This is a long-term commitment meant for stabilizing conditions, whether that be obesity, Type 2 diabetes, or, potentially, binge-eating disorder. If you stop the injectables, you’re likely to regain two-thirds to three-quarters of the weight.
For people like me with an eating disorder, that rebound from coming off the drug could potentially send them into a panic, potentially derailing their recovery journey. That’s why the monitoring of these drugs and how they’re being used is so important, especially if they’re being used off-label (treatment of disordered eating would fall under that off-label category). According to Walen, people with eating disorders who take these drugs should ideally work with a doctor in tandem with a licensed therapist and a dietician for a full treatment program.
Still, the bigger issue that remains is the lack of research on men with disordered eating. Combine this with the lack of research on men and weight-loss drugs (not only do many studies have fewer male participants than women, but men are often less likely to report side effects), and we have more questions unanswered than answered when it comes to men with binge-eating disorders taking these drugs. This also expands to men with anorexia nervosa or atypical anorexia nervosa (when someone who has previously lost substantial weight continues to do so through unhealthy behavior), who may abuse the drug to help medically stymie the urge to eat.
When I asked experts what could happen to people with restrictive eating disorders like atypical anorexia nervosa or even someone participating in something as seemingly innocuous as extreme cutting and bulking, the concerns continued to mount. If someone with a restrictive eating disorder uses these drugs to lose weight too quickly, they can cause cardiovascular harm. Continuing to gain and lose weight quickly—also known as weight cycling—can also cause severe stress on the body and affect your health. Those who turn to these drugs to suppress appetite run the risk of extreme malnourishment.
“It’s important to fully understand the individualized and personalized history of each individual who’s considering using these medications,” says Jason Nagata, M.D., who specializes in body image and eating disorders in men. “There’s quite a wide range of eating disorders. Combining that individualized insight to a patient’s decision-making, along with their own understanding of their eating disorder, is key.”
By BMI standards, I qualify to take these drugs. Whether I’m going to follow my initial curiosity? The answer is no. After speaking to experts and reading the studies, I’ve come to realize that taking the weight off quickly without a proper understanding of my binge-eating disorder isn’t going to be the most beneficial decision for me. You need a good handle on your mental health and nutrition and physiology to maximize the effect of these drugs on binge-eating disorder. I’m not in the place yet. I don’t understand my triggers fully. I don’t have a regimented eating schedule, nor do I have a good grasp on how I should be eating for someone my size.
I want to be happy with the way I see my body. I want to find good ways to manage stress. And, frankly, I’d like to see more research on these drugs. So, in the meantime, I’ll stick with diet, exercise, and therapy. That wedding is still five months away, and while a quick fix would be nice, I’ve chosen the good ol’ high protein, low carb and sugar route. I journal the moments when my binge-eating is triggered. And, for now, the Domino’s app is removed from my phone.
This decision feels like the biggest win in my road to recovery so far. Men with eating disorders should feel confident in making an informed decision about what’s best for themselves. Though these disorders can feel all-encompassing, we’re the ones who know ourselves best. We have to be. Even if “knowing yourself” just means you don’t know enough to introduce one of these drugs into your life. The correct choice is the one that works best for you, with the best safeguards to protect your health. The rest is just part of the journey.
If you’re looking to speak with someone about eating disorder concerns for yourself or a loved one, contact the National Association of Anorexia Nervosa & Associated Disorders (ANAD) helpline at 1-888-375-7767, available for free and confidential support Monday through Friday from 9 a.m. to 9 p.m. CT.
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