Medications like Ozempic, Wegovy and Zepbound are often framed as medical breakthroughs. And in many ways, they are.
“In my practice, I’m seeing firsthand how transformative these medications can be,” says Hackensack Meridian Health’s medical director of women’s health, Dr. Soma Mandal.
“Not only in terms of weight reduction, but also improvements in glycemic control, cardiovascular risk factors and what many patients describe as relief from constant ‘food noise.’”
That term – “food noise” – comes up repeatedly. Patients describe less mental chatter around eating, a shift that can feel as significant as the physical changes themselves.
The clinical data backs up the impact. Trials show average weight loss of roughly 5–18 per cent, depending on the drug and dosage. And new global guidance supports the use of these medications as part of long-term therapy for obesity in certain patients.
But the story doesn’t end with individual health outcomes.
Because as these medications move from the doctor’s office into everyday conversation and onto social feeds, they’re doing something harder to measure: reshaping our collective idea of what’s “normal.”
A tool or a turning point?
For Dr. Mandal, the key is context. She admits doctors have actually been part of the problem.
“For years, obesity was treated as ‘eat less, move more,’” she observes. “Now we understand it’s a chronic disease with hormonal, genetic and environmental aspects.”
In that sense, GLP-1 medications aren’t shortcuts, but tools. And for many patients, especially midlife women navigating menopause-related shifts, Dr. Mandal asserts they can be life-changing.
But they’re not without trade-offs. Gastrointestinal side effects like nausea and constipation are common, particularly early on, and long-term adherence can be affected by cost, access and tolerability.
Importantly, Dr. Mandal is clear about intent: “The goal is not to make women smaller at any cost. It’s to make them metabolically healthier, stronger and more functional.”
That distinction matters, especially right now.
The return of ‘skinny culture’
While GLP-1s are rooted in medicine, they’re emerging into a society already primed to fixate on bodies.
“I feel like ‘skinny culture’ never really left,” says University of Colorado Anschutz (UCA) assistant professor, psychiatry, Emily Hemendinger. “It’s just the type of body our culture’s fixated on.”
What’s different now, she says, is the intensity and the accessibility.
“We’re bombarded from every direction – social media, celebrities, commercials. And now you can be prescribed these medications, or even get them online. It’s harder to escape.”
That saturation has consequences.
Eating disorders have among the highest mortality rates of any mental illness. A large review found more deaths across eating disorders, with anorexia particularly associated with a significantly increased risk of death.
Hemendinger, who’s also the university’s OCD Program clinical director, worries this moment could deepen existing vulnerabilities.
“We’ll likely see more people in therapy, more burden on the healthcare system,” she believes. “People constantly striving to fit a certain look.”
Trying to find the balance
The tension lies in what GLP-1s represent.
On one hand, they can improve serious health conditions, from diabetes to cardiovascular risk. On the other, they exist within a system that often equates thinness with worth at a time when, Hemedinger warns, body ideals, health messaging and disordered behaviours are tightly intertwined.
While GLP-1 medications can be appropriate in some cases, she sees patients both prescribed these drugs and accessing them online without oversight. In some cases, she says, they can reinforce and worsen eating disorder pathology by intensifying restrictive behaviours or disrupting hunger cues.
“They need to be prescribed with so much nuance. I’ve seen them really help people with substance abuse disorders … but it’s hard to work with someone active in their eating disorder while taking medication that disrupts their natural hunger cues,” Hemedinger notes, adding that many on GLP1s are more likely to have a history of feeling guilty about eating or have a disordered relationship with food.
Where does that leave us?
GLP-1 medications are neither miracle cures nor moral failures. They are, as Dr. Mandal puts it, tools – powerful ones – that can improve lives when used appropriately.
But they’re arriving in a cultural moment that complicates their meaning. In a world that still tells women to be smaller, quieter and more “acceptable,” GLP-1 medications are provoking real conversation – and concern – about their impacts beyond better health.
So, the challenge now isn’t just how we use these medications but how we understand what they’re doing to us, both as individuals and as a collective society – and that part of the story is still being written.
Emma Caplan-Fisher
