In the age of Ozempic, body image has morphed. How do we learn to love our bodies?

On a special episode (first released on April 14, 2024) of The Excerpt podcast:

The mass media has pushed skinny on us for decades. And while doctors encourage healthy eating and lower body mass indexes, the body positivity movement supports the inclusion of all shapes and sizes, emphasizing loving the skin you’re in. But there are even more fractures in this conversation when it comes to the newest weight loss fad and object of desire: the drug Ozempic and its competitors like Wegovy and Mounjaro. There is also a dark side to this pursuit of perfection; namely, eating disorders and other health issues, both physical and emotional. Meredith Nisbet, the National Clinical Response Manager for the Eating Recovery Center, an eating disorder treatment center based in Denver, Colorado, joined The Excerpt to discuss the body image debate and how to navigate healthy ways to see ourselves.

Hit play on the player below to hear the podcast and follow along with the transcript beneath it. This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.

Podcasts: True crime, in-depth interviews and more USA TODAY podcasts right here

Dana Taylor:

Hello, and welcome to The Excerpt. I'm Dana Taylor. Today is Sunday, April 14, 2024.

Why is our relationship with our body so complicated? The mass media has pushed skinny on us for decades. While doctors encourage healthy eating and lower body mass indexes, the body positive movement supports the inclusion of all shapes and sizes, emphasizing loving the skin you're in.

But there are even more fractures in this conversation when it comes to the newest weight loss fad and object of desire, the drug Ozempic and its competitors like Wegovy and Mounjaro. There's also a dark side to this pursuit of perfection, namely eating disorders and other health issues, both physical and emotional. Here to dig into the body image debate is Meredith Nisbet, the National Clinical Response Manager for the Eating Recovery Center and Eating Disorder Treatment Center based in Denver, Colorado. Thanks for joining us, Meredith.

Meredith Nisbet:

Yeah, absolutely. Thanks for having me.

Dana Taylor:

A few years ago we saw a rise in body positive messaging recently coinciding with the rise of the use of drugs like Ozempic for weight loss. There were some body positive influencers who were shamed when they lost weight, costing them followers. What's going on here?

Meredith Nisbet:

There's so much complexity when it comes to social media that it's different for every person involved. But I think there's a lot of backlash for influencers who are using these GLP-1 drugs to lose weight because there is a financial gain for them in that. Many people feel that these body positive influencers have profited off of the plus size or the fat community over time throughout their careers.

Then on the opposite side of that, I think there are folks that are engaging in their body autonomy. They're engaging in making their own decisions about their bodies, and we don't have the information about their medical history. We don't know why they're taking the medications. We don't know if it's just for weight loss. We don't know if there's perhaps another medical concern happening there. We don't know what the conversation was with their doctor or their family when they decided to take this medication.

Dana Taylor:

Can you explain if you saw more outrage against those who've lost weight using drugs like Ozempic compared to those who'd lost weight naturally without using any type of weight loss drug?

Meredith Nisbet:

There does seem to be more outrage, and in my opinion, I think that this is tied to the risks that some of these medications carry. We don't really know the implications for folks with eating disorders, but we can predict based on what we know about physiology and mental health and the way that eating disorders develop and are maintained in the body and in the brain.

When we know that these medications mimic some of the symptoms of some eating disorders, it can be really concerning for folks who are in a body positive community who are trying to learn to accept themselves in their current body, who are maybe on an anti-diet journey and are pursuing values aligned with that. It can be really difficult to swallow that someone is taking a medication that mimics something that they've struggled with and maybe they're in recovery from, and that they may know the risks of the medication that we don't really know how it could affect someone who is in recovery from an eating disorder or who has an active eating disorder, or even just someone who is at risk genetically or environmentally from an eating disorder.

Dana Taylor:

It may be too soon to tell, but is it possible that a drug like Ozempic could help foster a better relationship for Americans and the food we eat? What's your thought there?

Meredith Nisbet:

Yeah. I think you hit the nail on the head. It's really too soon to know. I think we are very curious as a community of professionals of what is to come with using this medication to treat something like a true disorder of satiety. Someone who truly does not have fullness cues and really cannot regulate their body on their own. I think we don't really know what they could be helpful with, but we are concerned about the potential impacts for folks with eating disorders. We're not ruling out that they could be helpful for other things, but there's just no literature for us to really know right now.

Dana Taylor:

Clearly, the topic of body image is complicated. I want to circle back to something you brought up just moments ago. I want to talk about body neutrality and body autonomy. First, what's the role of body neutrality in fostering a healthy relationship with our bodies?

Meredith Nisbet:

I work with so many patients who really struggle with the idea of body positivity. When someone is struggling so hard with their body image, body positivity can feel like a 14,000-foot mountain standing right in front of them that they cannot climb no matter how hard they try. Body neutrality to me is a midpoint and a way to meet people where they are and say, "Hey, I don't need you to love your body. That may never be in the cards for you. We don't know, but what we do know is that your body needs to be taken care of." I liken it to when you buy a house, so you have to make sure you clean your gutters and you change your air filters. There are just things that we need to do to care for our bodies and to take care of the physical homes that we live in.

Dana Taylor:

And then how might body autonomy, particularly when we're discussing the use of a drug like Ozempic, help in that regard in terms of body image?

Meredith Nisbet:

I think body autonomy is super important in body image because for many people with mental health struggles, at some point in their lives, choice has been taken away from them. When someone has that choice removed from them of what it means to be in a good body or what it means to be in an attractive body or a healthy body, acknowledging their body autonomy to be as they are and to make the choices that they choose to make for themselves is really important. To give them back that power, to say, "You are the expert of your own body."

Dana Taylor:

Conversations about eating disorders were all the rage in the '80s. Unfortunately, those disorders have not gone away. Why is that? Are we making any progress here?

Meredith Nisbet:

Yes. We have made truly so much progress since the 1980s. We've been able to acknowledge new diagnoses like binge-eating disorder, which wasn't in the Diagnostic and Statistic Manual of Mental Health Diagnoses until recently. Binge-eating disorder is actually the most widespread eating disorder and is the least diagnosed. Some of the progress that we've made in terms of being able to name what people are struggling with, being able to know how to support them with things like emotion regulation, values, aligned care, body autonomy, things like that are really important and are really huge strides that the eating disorder community has made.

Dana Taylor:

Another term we're hearing more about today is disordered eating. How does that differ from eating disorders?

Meredith Nisbet:

Disordered eating is a pattern that we see really often. It's very socially acceptable. Typically these are folks who, if I compared them to my list of criteria in the DSM, they would not meet that criteria for whatever reason. They might not have been doing it long enough. They may not be doing it frequently enough. It may not be impacting their life as severely as it needs to be for it to meet that criteria for a diagnosis. It limits the way people live their lives, and often what I talk about with my patients is the way that their lives have shrunken with their eating disorders.

I'm not able to go to events if I don't know who cooks the food or if I didn't prepare my own food. I certainly can't go eat in a restaurant because I don't know what the content, the ingredients of this food is. I have to allocate X amount of time to work out every single day very rigidly in this way for this amount of time. I can't skip it no matter what, if I'm injured, if I'm sick. A lot of the rigidity that shrinks the lives of people with an eating disorder, people with disordered eating also experience that, just to a lesser degree.

Dana Taylor:

Oprah Winfrey recently hosted an hour-long special on the topic of body image called Shame, Blame and the Weight Loss Revolution. In it, she shared how her struggle with weight loss made her a topic of national ridicule. When it comes to body image, how do we get beyond the judgment of others?

Meredith Nisbet:

I did watch that special, and I have so much compassion for Oprah herself. She has certainly been through the wringer with regard to body image and with regard to being ridiculed simply for living in a larger body at different times in her life, and also for her success or failure in getting into a smaller body, maintaining a smaller body. So I have the utmost compassion for that experience from her.

Because we have this intense need for belonging, it makes sense that we feel so threatened when there's something about us that's not accepted by other people.

Something we start to work with people on in therapy is values-based living. What is important to you, and acknowledging that there's always going to be a part of you that wants the approval of other people, that wants the acceptance of other people, and how instead of changing your physical form, instead of changing your self to meet the acceptance of someone else, how can we find people who accept us as we are? How can we find community with people who understand us, who want to show up for us, who want to be with us in the way that we are right now? That's a large underpinning of that conversation is it's not your body that needs to change, it's not your appearance that needs to change, it's not your ability that needs to change. It's the environment that you're currently in, and so how do we make that better for you?

Dana Taylor:

We're speaking of Oprah, and this leads to another thorny topic. Who gets access to Ozempic and who doesn't? There's been a backlash against celebrities and wealthy people who can afford this drug. Is this a conversation we need to have?

Meredith Nisbet:

I think that when we're talking about GLP-1 medications for a medical concern and not for weight loss, I think that access is certainly a concern for folks who are using these medications for things like PCOS or type 2 diabetes. We have some limited research that these medications are supportive for specific people with specific medical concerns, and so of course, that is a conversation where access is really important.

I think when it comes to medication for weight loss, I would actually pivot that conversation from financial access to who is being prescribed this medication and who's not? If we're targeting folks in larger bodies regardless of eating disorder history, regardless of medical status, all of these things, to prescribe these medications, then we might actually have an overabundance of access. I think if we're talking about it from a financial perspective, of course, folks with higher financial means, celebrities, people in the media, those are folks who are going to have more access to these drugs because they could pay for them, they can get them as quickly as they need them. I do worry about the shortage that that could cause for folks who do need them for medical concerns. But I worry actually about the over-prescription of them, not the under availability.

Dana Taylor:

Finally, Meredith, what gets us on the path to thinking about our bodies in a healthy way? What do you want people to walk away with?

Meredith Nisbet:

I want people to know that you are worthy and you are valuable as you are currently. You do not need to be in a different body. You do not need to look a different way to be more worthy of whatever it is that you're pursuing; that relationship, that job, that degree, that friendship, whatever it is.

I would also encourage people to turn inward and to think about what matters to them and what is important to them, and what is going to lead them towards a life that is happy and fulfilling and where they are in community with people who want to be in community with them as they are.

I think those are some of the biggest takeaways that I wish I could tell anyone who's struggling with their body image is that I know it might feel like you have to change in order to be accepted, and the truth is your life might need to change, but that's not necessarily true for your body or your appearance, and that your life gets a lot bigger when you're able to think about your values and living a light, happy, fulfilled life rather than how many calories did I eat today?

Dana Taylor:

Meredith, thank you so much for being on The Excerpt.

Meredith Nisbet:

Absolutely. Thank you.

Dana Taylor:

Thanks to our senior producers, Shannon Rae Green and Bradley Glanzrock for their production assistance. Our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to podcasts@usatoday.com. Thanks for listening. I'm Dana Taylor. Taylor Wilson will be back tomorrow morning with another episode of The Excerpt.

This article originally appeared on USA TODAY: Body image has morphed. How do we learn to love our bodies?