GLP-1s, body image and disordered eating: the conversation we need to be having

For many women, the relationship with food and body image did not suddenly become complicated in midlife.

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It may have started in adolescence, with dieting, weighing, comparing bodies, avoiding certain foods or believing that being smaller would somehow make life easier. Over time, those behaviours can become so normalised that they no longer look particularly unusual, even when food, weight and body size are taking up a significant amount of mental space.

Then midlife arrives.

Your body begins to change, perhaps quite quickly. Hormones shift, fat distribution changes, muscle becomes harder to maintain and the body you have known for years may suddenly feel unfamiliar.

At the same time, GLP-1 medications such as Wegovy and Mounjaro have made substantial weight loss possible for many more people.

For some, these medications can bring important health benefits and a genuine sense of relief around appetite and food, but they have also arrived into a culture where many women were already carrying decades of body dissatisfaction and complicated food relationships.

Midlife can already be a vulnerable time for food and body image

The menopausal transition brings together a number of things that can affect how a woman feels about her body.

There are the physiological changes, including changes in body composition and fat distribution, but also menopausal symptoms, sleep disruption, mood changes, stress and the broader emotional adjustments that often accompany this stage of life.

Research suggests that this may also be a vulnerable period for disordered eating.

A 2024 systematic review looked at ten studies examining eating behaviours during the menopausal transition. The findings were mixed and most of the research was cross sectional, so we need to be cautious about drawing firm conclusions, but there were signals that binge eating may be more common during perimenopause while restrictive eating behaviours may be more common after menopause. Studies looking specifically at menopausal symptoms also found strong associations between greater symptom burden and disordered eating.

The researchers were clear that much more work is needed, but I think the findings matter because eating disorders and disordered eating are still often thought of as problems affecting younger women.

They are not, and this is something we see regularly in our clients here at Urban Wellness. For some women, midlife may bring the return of patterns they thought they had left behind, while for others it can be the point at which a difficult relationship with food that has existed for decades becomes much more apparent. And many will never have had a formal eating disorder diagnosis at all.

Disordered eating does not always look dramatic

When people hear the words “eating disorder”, they often imagine somebody who is visibly underweight or very obviously unwell, and yet the reality can often look very different.

A woman can live in a larger body and still restrict food heavily. She can spend decades moving between diets, skipping meals, avoiding entire food groups, binge eating, compensating after eating, weighing herself repeatedly or judging her worth by whether her weight has gone up or down.

She may not recognise any of this as disordered because it has been part of her life for so long that, to her, it simply feels normal.

This is one reason the conversation around GLP-1 medications needs to go beyond whether somebody meets a weight or metabolic threshold for treatment, because we also need to understand the relationship they already have with food and their body before appetite is significantly reduced.

What happens when restriction suddenly becomes easier?

One of the main effects of GLP-1 medications is reduced appetite. For someone who has previously felt overwhelmed by hunger, cravings or food preoccupation, that can be enormously helpful, but for somebody with a history of restrictive eating or an eating disorder, the same effect can potentially interact with very different thought patterns.

Eating very little may suddenly feel effortless and skipping meals may become easier.

A reduced appetite can make restriction feel medically legitimised rather than concerning.

And rapid weight loss can bring enormous positive reinforcement from other people, even when the way someone is eating is becoming increasingly restrictive. Emerging research is beginning to raise exactly these questions.

A 2026 scoping review examining GLP-1 medications and eating disorders found only nine empirical studies, which tells us immediately how limited the evidence still is. Some early findings suggest these medications may have potential benefits for people with binge eating or loss of control eating, particularly in certain clinical populations, but there is far less evidence about restrictive eating disorders, body image concerns and the psychological effects of these drugs in vulnerable groups.

A separate 2026 paper focusing on emerging clinical risks in the GLP-1 era highlighted the possibility that the same mechanisms which reduce appetite and food preoccupation could, in susceptible people, reinforce restrictive eating, avoidance of regular meals, compulsive weight control or relapse of a previous eating disorder.

That does not mean GLP-1 medications cause eating disorders, because the evidence simply is not there to say that, but it does mean we should be careful not to assume that appetite suppression is psychologically neutral for everyone.

Losing weight does not automatically resolve body image

There is an understandable assumption that if somebody is unhappy with their body because of their weight, losing weight will improve how they feel about themselves.

Sometimes it does, but body image is rarely that straightforward.

A 2025 study looking at interest in GLP-1 medications found that participants who were more interested in taking them also tended to report greater weight concerns, body shame, body surveillance and disordered eating behaviours, alongside lower body appreciation and body neutrality. The participants were mostly young adults, so the findings cannot simply be applied to midlife women, and the study showed association rather than causation.

Even so, it raises an important question.

If someone has spent thirty years believing that a smaller body will finally make her feel acceptable, confident or comfortable in herself, what happens when she reaches a smaller size?

Sometimes there may be genuine relief and greater body confidence.

For others, the goalposts move.

A little more weight needs to come off.

One part of the body still does not look right.

There is increasing anxiety about regaining weight.

The number on the scales begins to matter even more.

The body has changed, but the relationship with it has not necessarily changed at all.

GLP-1s have entered an already weight focused culture

A 2026 paper in Body Image argued that although the biomedical effects of GLP-1 medications are being studied extensively, their psychological and sociocultural effects remain comparatively under researched. The authors specifically highlighted questions around body image, weight stigma, media representation and the possibility that appearance becomes increasingly tied to self worth as these medications become more visible.

This feels particularly relevant for midlife women.

Many have grown up through decades of diet culture and are now reaching menopause at a time when substantial weight loss has become more visible and more achievable.

A nationally representative survey of almost 5,900 adults in Great Britain found that use of and interest in GLP-1 medications for weight loss were particularly common among women and people in midlife.

So the cultural reference point may be changing very quickly.

If more people around you are becoming smaller, whether that is friends, colleagues, celebrities or people you follow online, a body that previously felt fairly ordinary may begin to feel unusually large by comparison.

We do not yet know what the long-term psychological consequences of that shift will be, but it would be naive to assume there will be none.

This is not an argument against GLP-1 medications

There are people for whom these medications can be genuinely transformative. Someone who has struggled with binge eating or loss of control eating may experience a dramatic reduction in food preoccupation and find that enormously freeing. Emerging research is exploring whether GLP-1 medications could have a therapeutic role in binge eating disorder or loss of control eating, although the evidence is still limited.

For someone living with obesity or significant metabolic risk, the physiological benefits may also be substantial. The point is not that appetite suppression or weight loss are inherently problematic, but it is that the same medication can interact very differently with two people depending on the relationship they already have with food and their body.

Someone whose eating has largely been guided by hunger, enjoyment and routine may experience appetite reduction very differently from someone who has spent decades trying not to eat.

That previous relationship with food and body image can shape how someone experiences both the appetite suppression and the weight loss that follow.

Previous eating disorder history matters too

A previous eating disorder does not necessarily disappear simply because someone has been well for many years.

Old patterns can become quieter, but certain situations can reactivate them, particularly periods of body change, dieting or significant weight loss.

This is one reason clinicians and researchers are increasingly calling for better eating disorder screening and psychological monitoring around GLP-1 prescribing. Current literature highlights that many prescribing pathways still do not routinely assess eating disorder history or distinguish between medically appropriate appetite reduction and emerging restrictive pathology.

That distinction can sometimes be subtle.

• A person may say she is simply “not hungry anymore”, but is she still eating enough to nourish herself?

• Is weight loss slowing naturally being experienced as disappointing or frightening?

• Does she feel comfortable increasing food intake when her body needs more?

• Is she increasingly anxious about particular foods?

• Has weighing become more frequent?

• Would she feel able to stop the medication if medically advised to do so?

• Is losing weight improving her quality of life, or is weight becoming an even bigger part of how she judges herself?

These are not questions designed to pathologise normal weight loss or make people frightened of using medication. They are questions that help us understand the wider picture.

What about women without a diagnosed eating disorder?

This may actually be the much larger group. There are many women who have never met the diagnostic criteria for an eating disorder but whose relationship with food and weight has been difficult for most of their lives.

Perhaps they started dieting at 14.

They have spent thirty years thinking of foods as good or bad.

They feel guilty after eating certain things.

They routinely eat less before a social event or holiday.

They have repeatedly lost and regained weight.

They dislike being photographed.

They promise themselves they will start again on Monday.

None of this may ever have been diagnosed as an eating disorder, yet it can still have an enormous effect on emotional wellbeing and the relationship someone has with their body.

For that woman, a medication that suddenly makes eating less much easier may feel like the answer she has been searching for for decades. And it may genuinely help, but it is important that the wider food story is still understood rather than assuming that because appetite has quietened, the relationship underneath it has automatically healed.

A healthy body is about more than how small it is

This is perhaps where the GLP-1 conversation and the wider midlife conversation come together. Health is not defined by a particular dress size, and living in a larger body does not automatically mean someone is unhealthy.

Equally, body acceptance does not require us to ignore metabolic health, cardiovascular risk, blood glucose or the physical consequences of carrying significant excess adiposity.

Both extremes miss the complexity.

For some women, reducing weight may bring significant physiological benefits. For others, the healthiest body may be larger than the one they have spent years trying to achieve, particularly if maintaining a smaller body comes at the cost of restriction, anxiety, repeated weight cycling or an increasingly difficult relationship with food.

The goal should be a healthy body for you, one that supports both physiological health and emotional wellbeing rather than asking one to come at the expense of the other.

Perhaps the question needs to change

Instead of simply asking whether GLP-1 medications work for weight loss, perhaps we also need to ask what they are doing to someone's relationship with food and their body.

• Has food become quieter in a way that feels freeing, or has eating become increasingly restrictive?

• Is weight loss improving health and quality of life, or is the number on the scales becoming even more important?

• Does someone feel better in her body, or simply more frightened of becoming larger again?

• And if there was already a difficult relationship with food before the medication, what support is being offered for that alongside the prescription?

GLP-1 medications can absolutely be part of a person's health plan, but for anyone with a long history of dieting, body dissatisfaction, disordered eating or a previous eating disorder, the conversation needs to be bigger than appetite and weight alone.

Changing the body is not the same thing as changing the relationship you have with it.