When Appetite Returns: The Fear of Hunger, Body Image and Long-Term Consequences of Weight Loss Drugs

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When Appetite Returns

Speaker 2  0:00 

Jenny, hello and welcome back to the Jen up podcast. If you’re struggling with an eating disorder and feeling lost, you certainly come to the right place. Both myself and Becky stone are former sufferers of eating disorders, and we understand the challenges that you’re facing. So join us for inspiring, educational and relatable content, whether you’re seeking support, guidance or just someone who understands we are here for you. So today, we have Joanna Silva again on the podcast, so we’re delighted to have her again. She is the lead psychological therapist at the Orri Clinic in London. She is responsible for the development of psychological therapies at Team Orri Clinic, which is a specialist eating disorder treatment service. She has regularly been featured in The Daily Mail and the independent around her concerns on weight loss jobs. So I thought it’d be really important to have her on today. It’s a topic that both myself and Becky are passionate about, to speak about weight loss drugs, the side effects and advice for parents as well for any concerns on young people getting their hands on these weight loss drugs. So it’s great to have you on here to speak about this, and I think it’ll be good to kind of just start off the podcast with just like, you know what you’re seeing in clinic and kind of what’s going on, right?

Speaker 2  1:33 

Yeah. Well, thank you. Thank you very much for having me back. It’s really good to be here. So I think what we’re seeing in clinic is some people who have managed to get their hands on weight loss drugs, perhaps coming from a point of being a healthy weight or even underweight, they have found that they have lost a lot of weight. And some people kind of, by the time they get to us, realize that they’re they’re caught in a cycle that they need some help with. Some of these people had eating disorders beforehand, which maybe were dormant and are triggered. And a lot of fears, you know, fears about weight gain, fears about feeling full, fears about appetite returning, some fears that people have done real damage to their minds and bodies, and they don’t know how to get out of this situation. And I think, you know, what we’re seeing a lot of is that even for people who are not taking the drugs, currently, it feels to me like it’s kind of changed the discourse, you know, and it’s changed the images that we’re seeing and perhaps the way that some people feel that they’re meant to look it feels like there’s been a real shift or a real emphasis on this very, very slim ideal, and what that means and what people feel that they should be aspiring to.

Unknown Speaker  3:01 

Okay, that’s really scary to hear.

Speaker 3  3:05 

what I was just about to say the same that is really scary, because we’re losing our sort of, our normal of what we’re supposed to look like.

Speaker 2  3:16 

Yeah, I think it’s it. I think it is it difficult, and I think it’s there’s for people who are in larger bodies, there’s almost been a an increase in shame that almost, you know, an expectation. Why? You know, some of the people who are in larger bodies have said to me that they always feel judgment if they’re not taking the Japs, because now that there’s something out there, and almost a feeling that they should be taking it almost like a moral duty, that it’s, it’s not okay to be in a bigger body when there’s something that people feel that they should be taking,

Speaker 1  3:50 

Wow, okay, that’s in, that’s, I had no idea that People felt that way, like that’s, that’s that’s really upsetting actually, to hear that people actually feel that way and like there’s like, yeah, that’s crazy, yeah, yeah.

Speaker 2  4:11 

Obviously, you know, not all people, and it’s important not to generalize, but I think that, yeah, as I said, just the whole kind of culture and the whole norms and what to aspire to has, has changed, it feels like, and that’s, and that’s really scary,

Speaker 1  4:29 

Yeah, and that is, and you mentioned there about, like, anxiety, about appetite coming back, what’s so what’s happening there? Have you had clients who have come off it and they can’t deal with it and they’ve gone back on it again. Are they struggling to regulate their their appetite after they come off the drug? Like, what? What’s been going on there?

Speaker 2  4:47 

Like, yeah. So I think, you know, and I think with all things, it’s, it’s important not to be black and white. I think that there is a time and a place for the job, and it can be. Really helpful for some people. So I think it’s, you know, it’s very easy to become kind of diametrically it’s the best thing ever or the worst thing ever. And I, you know, I’m, I’m very balanced. I think we’ve got to take it on a case by case basis. But some of the people who I’ve seen have a not wanted to get off the jail because they have lost weight and perhaps feel really good about themselves. And you know that that’s really scary. There’s literally not wanting to get back on the or to get back and have that appetite back. You know, some people have really enjoyed the feeling of not being hungry. So I think, you know, we see some people who, even if it’s having real health, you know, really impacting their health, are still on the jab. Other people who I see, you know, want to, want to have come off the off the jabs, and are hungry, and because they haven’t been hungry for a long time, that can feel really, really scary, because if the signals have been shut off, what is it like when the signals come and that real lack of trust in their bodies and their appetites and the ability to eat intuitively? I think that’s become very, very hard. So if you know hunger is switched off, and you know seen as a bad thing, then coming back and feeling hunger, even if it’s in inverted commas, normal levels of hunger, that’s scary,

Speaker 1  6:30 

yeah, um, so I just feel like I want to say this, but that that’s kind of how I felt when I was recovering from anorexia. Like, yeah, um, you know, it was very difficult, it was very overwhelming. And that’s, that’s crazy that, well, it would be, it’s understandable that people feel that way and kind of but, you know, and it’s that’s been made from a drug, and it’s that’s very worrying, isn’t it? I don’t know what you think about that Becky, but it’s really

Speaker 3  7:05 

weird, because I was just thinking about that fear of feeling full, and those hungers like I always used to my little weddings. I want to eat a scabby dog. It’s like that starvation, like that, coming back alive again. My body’s telling me I’m hungry. That used to be really scary. He did settle. But I think the worst bit is getting past that,

Speaker 2  7:26 

yeah, and I think, you know, as as an eating disorder practitioner, I want people to be able to know when they’re hungry, you know, hunger is there for a reason, and not just to kind of shut it away and then not know what to do with it. So, you know, I think, I think that that can be very difficult to switch off those signals and then it come back. So I think it, yeah, as I said, I think it can become very, very, very tricky. Because, as we know, you know, eating is never just a case of hungry and eat when you stop. It’s much more complicated than that. And as I said, you know, for some people, it can be, you know what they need, but for some people, it’s really not, and it is. It’s scary to hear how people have managed to get their hands on it despite not meeting the guidelines.

Speaker 1  8:15 

Yeah. I mean, I mean, do you know how people are? Is it from, like, sort of online, sort of pharmacies or, I mean, I’m not sure.

Speaker 2  8:24 

So, yeah, I think you know that there are many, there are many different ways that people have got in a hold of it. Some, you know, some on in online sessions, you know, not face to face, as we know that there is a kind of black market out there. So it’s a scary place. And as I said, yeah, it can be very scary to navigate. And I think, as I said, I think you know, some people you know, have had history of an eating disorder, and it can almost reawaken it. Other people haven’t necessarily had an eating disorder, but being in that starvation can start an eating disorder. And I think, you know, I think the truth is that everyone is vulnerable to an eating disorder, you know, some more than others, but it, it needs to be really, really kind of used with great caution. This is a very strong thing, yeah.

Speaker 1  9:22 

And also, I know you said about it’s wanting people to stay on the drug long term because they’re scared of the hunger. Is it? Is I think you’re only allowed to be on the drug for two years? Is that right? Two years?

Speaker 2  9:35 

Um, I think that there’s certain there’s certain guidelines. And again, it’s very new, but a lot of the people that I’ve seen, and I want to be on it forever, and I think, you know, with with all new drugs, we’re dealing with a lot of unknowns.

Speaker 1  9:50 

Yeah, because we don’t yet know the long-term side effects of it yet, if someone were to stay on it long term or soil themselves a little long term, we don’t. There’s not enough studies yet. Is there to sort of say, what are the long-term side effects of that? Like, yeah, well, we’re dealing

Speaker 2  10:05 

with something which is, you know, very unknown. And I think with everything in medicine, we’ve always got to weigh up, you know, the risks and the benefits. You know, everything does have a risk. And for the people who it was designed for, you know, their risks of not taking it can be very high. So it may be really appropriate for them to be on it in a, you know, in a very controlled way. But I think, you know, even for the people who it was designed for, you know, just to be on it without the psychological support, I think it’s very difficult. I think it can be used, you know, for the people who it’s designed with as part of the holistic program.

Speaker 1  10:43 

Yeah, it does say on the there was guidelines that came out that you should be having, like, kind of seeking, you know, support for when you come off the drug to help, you know, get back into a normal eating routine, like regulate that and kind of say, it does say that now, yeah, that you need to seek out for that support. But it’s whether that, it’s whether people can afford that. I go, I mean, the price has gone up as well, isn’t it? So rated any anxieties with the price going up of you know, has, have you seen that at all causing any distress with people

Speaker 2  11:20 

in terms of, in terms of the price going up, yeah, I think again, it can add to that sense of fear. You know, especially those who are, yeah, it definitely can add to the fear and another factor. But I think, you know, for some people, the, I guess, the desire to be in a smaller body is so strong, and that is what’s, what’s scary, you know, the, you know, the the promises of, you know, if I’m slim, then my life will be better, is really, really strong, and it’s understandable that people want to kind of, you know, remove their distress, or remove the distress of others. That it, you know, it can seem like a solution, but I think it is more complicated than that. And as I said, Not, you know, not just thinking about the medical risks, but the psychological risks. Is, is on my mind,

Speaker 1  12:15 

yeah, because you get used to being in this smaller body, don’t you, and it’s the kind of body, sort of dysmorphia with that. And kind of, you know, that becoming the new norm, and kind of, you know, it’s, I can understand that that’s very stressful for someone. And, yeah, I mean, I don’t know if you want to say anything around that Becky, but just

Speaker 3  12:36 

thinking about the addiction to the smallness and that feeling like what it gives you, and like sort of the illusion of what their bodies look like, but actually how other people treat you as well. What is society being acceptable? Or because so many more people are on the drugs, and you get so much more compliments, you get seen, you get a lot more attention to it. So then what happens when you come off of it? Do you not get seen or in then it triggers all the underlying stuff that was already bubbling there in the first place. It’s never really been sort of touched like and therapeutically dipped into

Speaker 2  13:16 

that mall skin. Yeah, I think you know that. That’s the thing is, we know that eating disorders, while they look like they’re about food and weight, they’re not, they’re a way of managing feelings, and yet, the drug can certainly help with the weight loss, but it’s not going to help with those feelings, and that’s why it’s really important that that that is addressed.

Speaker 1  13:39 

Okay, that’s a really important point to get across for anyone listening to this, that you must address the you know, the underlying feelings that are going on as well. So and what about, you know, I know you said about there was an article of articles that you’ve put out in the Daily Mail, the independent about weight loss, drugs in young people. I think that it was actually on the news a couple of weeks ago. They said, how many cases you know young people? But now what’s, what’s your opinion on? Like, you know, sort of, you know, giving drugs to young these weight loss drugs to young people. Like, is there enough evidence for that?

Speaker 2  14:15 

Like, I mean, at the moment, they’re not licensed for young people, although there have been, you know, some cases, you know where they have been. You know, on a case by case basis, used, I think it’s very understandable as a parent to want to reduce your child’s distress. You know, if your child is being bullied or unhappy like it, it makes sense that you would do anything in the world to make them happier. However, that being said, you know, it is for me, such a worry. You know, as as children are growing up, you know, bodies do change. You know, during puberty, it is so normal to, you know, gain some weight, to grow. And essentially what this drug is doing. Doing is interfering with that. And like we were saying that this is something that we just don’t know. You know, we’re giving something we don’t know the long-term impact. So as I said, I think it’s very important, you know, never to be black and white, you know, to look at things on a case by case basis. You know, look at the risks, look at the benefits. But I think that, and I guess, you know, it’s very difficult for anyone growing up, but I think that the the message that these jabs are giving, especially to a child, is that, you know, losing weight may be the solution. And I would be very curious, you know, if a child, say a child was presenting in a bigger body to explore, you know, what is your relationship with food? You know, what is the relationship between your feelings and food? And to explore that in a really kind of gentle and kind way, would always be my preference.

Speaker 1  16:00 

Yeah, definitely, and yeah, I think what you said, it’s completely true.

Speaker 2  16:08 

And to give you know children, the message that their worth is not dependent on their weight. You know everyone, every child, every adult, is worth so much more than their weight. And I think, as I said, I think is a time when, you know, we want to help children to accept the changes of their bodies and and to get to know their bodies. You know that? I think that’s really, really important to to kind of start that relationship with your hunger. You know, when am I hungry? What kind of foods do I like? You know, what is my relationship with movement? All of that is, is part of, I guess, a child’s journey into adulthood, and this feels like a kind of a disruption of that.

Speaker 3  16:53 

And also something that just went through my mind is also parents looking at what they can do differently behind the scenes, what foods are they putting into like, are they doing nourishing food? Is there lots of like, bits and pieces? It’s all quick and grab food, because a lot of food is dopamine based now. So is there things within the household that can change instead of looking at the quick fix? Because even if you not that I agree with kids having the jabs at all. Even if they did have the jabs, the problem’s still going to be behind the scenes. Yeah, and the long-term sex can be so damaging.

Speaker 2  17:33 

So I think, yeah, I think there is, you know, a lot, a lot to explore. And you know, in terms of wanting to give children, if that, you know, injections. You know, has that come from, you know, the child’s view of their weight, or is it has this come from the parents view of the child’s body? So I think there’s a lot, you know, there’s a lot that we need to explore in terms of, I guess, you know, society’s view on being in a bigger body, parents view on being in a bigger body teacher’s view, but all of that needs to be really, really explored and examined and held with such compassion. You know, these are really, really complicated things that don’t have a black and white answer.

Unknown Speaker  18:17 

It’s scary, really scary. Yeah.

Speaker 1  18:22 

I just feel everything you’ve just said is kind of what, you know, what’s in the back of my mind, and kind of, you know, I just hope that you know, that we can, kind of, you know, having conversations like this and kind of will help to kind of spread awareness to young people, teachers, parents, to have these conversations. As you said, it’s got, you know, it should come from the child if they want to go on it, and if they don’t have that understanding, how, how, you know, are they educated? Do they have enough knowledge to make that decision? Probably not so. And actually, again, yeah. I mean, I think,

Speaker 2  18:56 

yeah, it’s very hard to kind of, you know, consent to something of the child, and especially to consent to something that we don’t know the long term implications. And as I said, you know, I think each time it’s important to do things you know, on a case by case basis, to not reach rush decisions, but to really, you know, to really, I think there is a lot, you know, it does feel, you know, a difficult time, but I think that there’s, you know, there’s a lot of challenging that we can do. And, you know, really, really thinking about, I guess, the messages that sometimes are passed down from generation to generation, about size and about health, that’s that can be really important work. You know, sometimes, you know, I’m of the view that most parents do the absolute best that they can with the knowledge that they’ve got. You know, sometimes we can, you know, parents can have had messages from grandparents about the importance of looking a certain way and all of these things that you you may not even realize. And I think there’s room for exploring, there’s room for challenging. So, you know, I don’t think all is. Lost. I think that there are, you know, enough voices out there who are who are able to challenge,

Speaker 1  20:07 

yeah, definitely. Like, even sometimes when the when I do the talks in schools and the talks of parents, it’s the language you’re using around food, like thoughts and beliefs about your own body image, like, how do you feel about your own body? How do you talk about your food and your own body in front of your child. It’s so important, like, because one common can really affect someone. So yeah, and

Speaker 2  20:27 

as I said, I think, you know, I can really understand that as a parent, not wanting to see your child distress, but I think it is also important for parents to have the skills to manage, you know, a child’s distress like it’s really, really hard. And as I said, it’s so tempting to want to take that away, but thinking about that, there are times, you know, especially as a child is growing up, that they’re not going to love their bodies every moment a day. But you know thinking about, How can parents manage that? You know, what role model can parents be in terms of thinking about how they you know how they treat their own body? You know what they say about it, what they don’t say about it? You know what? How are they eating all of that is really, really important. You know what messages are they giving them in terms of you are so much more than your body. You know you are of value regardless?

Speaker 1  21:20 

Yeah, I do. I completely agree. And I do think it’s a generational thing as well, because, like, in my, you know, in my, my mum and dad, like, you know, there was, I grew up in a very sort of traditional family. I was lucky. And there was no, we didn’t talk. There was no talk about that, and kind of, we all sat down together as a family. It was all very traditional, kind of, you know, just, I just, you know, minor X was caused by external sort of things, like my household, my home life was good. So I can’t imagine, for someone, you know, you know, who has issues at home or a family or something, how hard that is to kind of be around that. And just like how important it is to have that positive attitude towards food, spending meal times together, and, you know, and talking, as you said, about your body, in a positive way. So thank you for that,

Speaker 2  22:04 

yeah, or even in a neutral way, you know, even I think it’s really important to think about, you know, the function of bodies. Bodies are not just aesthetic objects, you know, thinking about, you know, not just you know, what? What does my body look like? What? What can my body do? What am I grateful for in terms of what my body has done today. So there’s, I think there’s a, you know, a lot of work that can be done that doesn’t involve, you know, unknown drugs.

Speaker 3  22:30 

Yeah. So finding something I do a lot in the therapeutic setting is finding, like, what they enjoy doing, like pulling away from anything to do with food, and what is their purpose? What is their drive? What do they enjoy doing? So then they’ve the whole focus isn’t just on dopamine successes with around food and body shape, is using those reward systems in a healthier way. So you’ve got that transition,

Speaker 2  22:57 

yeah, yeah. It’s a really kind of tricky and delicate time growing up full stop. So I think it’s, yeah, it’s really important to kind of hold that with kind of compassion and the complexity of it.

Speaker 1  23:13 

Yeah, great. No, I made it Becky. Is there anything that you want to ask before we sort of finish up here on the podcast.

Speaker 3  23:22 

I was just, I think it’s we wouldn’t come. The only thing that keeps sort of running through my mind is that we’re coming against challenging times. I think we are going to end up seeing more and more and more of this. And I think it’s about being aware of it, having the training, and it like the right wording, to be able to support the kids as well as the parents.

Speaker 2  23:43 

Yeah, and Ella said, I it’s something that I feel so passionately about. You know, people speaking up all you know, offering an alternative narrative, you know, educating the children on, you know, social media, on the images that we see. I think you know, more than ever. It’s important to to challenge, challenge, challenge, you know, challenge these ideals, challenge that. You know, thinness means that your success, all of that to, as I said, you know, to challenge the idea that there’s any moral worth in your body. So I think, yeah, more than ever, I kind of feel impassioned to, kind of to challenge it. And there are, you know, voices out there, and, you know, the as we all know, the earlier we intervene, the earlier we kind of have a different narrative, the better. I would much rather kind of go in and be talking to people before they get sucked into that.

Speaker 1  24:37 

Yeah, definitely early intervention all the way,

Speaker 2  24:41 

Yeah, definitely. Yeah.

Speaker 1  24:44 

I mean, thank you so much for coming on. And I hope any parents listening to this, they’ve taken them away from it and kind of and Thanks Jenny for so much for coming on. And if anyone’s sort of struggling with the needs, although they feel like they’ve they’ve got an addiction to a weight loss drug, what can you see them with it already? Clinic and direct them to your website. Do they go to your website or Yeah.

Speaker 2  25:04 

So we’ve got a really good website in terms of Orri we offer. So we’ve got outpatient services, and that’s 13 plus. We’ve got daycare, which is 16 plus, and we’ve got a really good online service, so even if people are not in London. And aside from that, you know, we have do a lot of free webinars, you know, reaching the public. We also kind of go into school, so there’s a lot of information there for people who want to learn a little bit more in all different shapes and sizes. In terms of the information, that is amazing.

Speaker 1  25:41 

That’s great. Thanks so much again for coming on. And it was great to have you here to kind of speak about this topic that we’re all you know, we’re concerned about it, but we’re also passionate about it, and it’s having these discussions to see how we can go forward with it. So thank you. Thank you for having me.

Speaker 3  25:59 

Thank you so much for listening to the JenUp podcast, please subscribe and share this podcast so others can benefit. You can find us on Facebook, Instagram, at @askjenup and on Jenny’s website, at www.Jenup.com. If you visit the website, you’ll find lots of resources available there. Please like, subscribe and share.

How to get help?

Jenny Tomei is a Nutritional Therapist and Eating Disorder coach. See all her credentials on her About Jen page and then should you need help then make contact with her today. Your road to recovery can start now!