With eating disorders, holidays and GLP-1s increase challenges

Bridget is a longtime member of the 12-step group. Over time, holiday cookies, desserts and big meals are no longer destabilizing — something that seemed impossible early in her journey — but that’s come with lots of meetings, counseling and family support.

For James, another FA member, the holidays required an exorbitant amount of time figuring out when he’d be able to binge on holiday leftovers.

“During this time of year, I would actually not eat much because there were people around, and I had so much anxiety around my body, but then I’d eat a lot of [leftovers] the rest of the day,” he said.

National data, such as a 2021 survey from the National Alliance on Mental Illness, backs the common sentiment that the holiday season can inflame symptoms and triggers for those struggling with mental illness, including eating disorders.

“It’s the food but also the loneliness or the grief, or there could be other things going on that make it a hard time of year for folks,” said Marcella Cox, founder of Redwood City-based Kindful Body, which offers eating disorder treatment. “People commenting on their bodies can also be really activating.”

Successful, long-term recovery typically hinges on structure and predictability. Wendy Sterling, a dietitian specializing in eating disorders, said she advises her patients to continue the same meal prep and timing as any other day.

“We start talking about managing nutrition during the holiday season way in advance, and then sometimes we’re managing how it went even after the fact,” Sterling said. “I really recommend that for all of the holidays, people stick to their regular schedule — breakfast, lunch and a snack. We have a lot of people who are stressed about binging or overeating during the holiday season and so we do a cope-ahead plan around what would you need to do to feel more grounded at the table, more present.”

Cox said she’s noticed more middle-aged women developing eating disorders in her Peninsula-based practice, something that also bears out in national data. Dr. Lauren Hartman, a Bay Area-based doctor who works primarily with teens and young adults, said she’s noticed increasing frequent symptoms for boys — especially in the form of trying to gain muscle mass — however, their symptoms aren’t always initially perceived as a disorder.

“We’re seeing such a rise in boys with eating disorders,” Hartman said. “Creatine and protein powder are impacting them quite a bit. We’re seeing this phenomenon of ‘bigorexia,’ which is the building of muscles and feeling a lot of distress over not having them.”

Kristen — who began dieting at 8 years old and eventually led to bulimia — said she is mindful about her relationship with food, not just for herself but also to model to her own teenage sons.

“They’re for sure watching us all the time,” she said. “I let them eat whatever, but I can see that they’re thinking about what they’re eating.”

A 2023 report from FAIR Health noted that eating disorder-related medical claims have increased by about 65% between 2018-22 nationwide. San Mateo County’s Behavioral Health and Recovery Services, the county’s Medi-Cal plan that covers conditions such as substance abuse and eating disorders, treats an average of about 140 eating disorder clients per year, with higher levels of care costing around $109,000 per client, according to recent data from the county — though that does not include those covered with private insurance. Access to long-term treatment for low-income county residents has also been historically difficult to secure. This year is the first time that many of the providers that treat eating disorders in the county agreed to get Medicaid certified, since historically the reimbursement rates have been too low.

GLP-1 meds

Many experts, including Dr. Hartman and Cox, are also wary about the impact of glucagonlike peptide-1 receptor agonists — commonly known as GLP-1 medications, such as Ozempic, Wegovy and Zepbound — for those who are struggling with or recovering from eating disorders. The medications have taken off in the last few years for weight loss. Between 2020-23, the number of U.S. adolescents and young adults that were dispensed the medication increased from 8,722 to 60,567, a nearly 600% increase, according to a study from the Journal of the American Medical Association. The sudden popularity of a new weight-loss medication isn’t a unique phenomenon, however, Cox said the rise of GLP-1s feels unique.

“It does feel different, partly because of the accessibility of it, and it seems that the medical community … seems to be embracing the GLP-1,” Cox said. “They can be very dangerous if you’re recovering from an eating disorder, reigniting old behaviors … they might be getting praise for how their body looks and that can reactivate the thought of ‘I’m more accepted and loved when I’m smaller.’”

For those with eating disorders, it’s “never as superficial as someone just wanting to lose weight,” Cox said.

Hartman said the lack of long-term studies on the impact of GLP-1s for weight loss, particularly on adolescents, is especially concerning given the critical development stage they’re in, she said. And it can send confusing messages to those who have looked up to adults, including celebrities or loved ones, who championed body acceptance and positivity.

“It plays into the narrative that all body sizes aren’t OK,” Hartman said. “It’s a confusing message to people that are starting to feel like you have some acceptance of the body you’re born in and then seeing that the people who you’ve looked up to are changing their body. It’s hard, especially for a vulnerable adolescent.”

Hartman said she’s found that prescribers often don’t properly screen for such mental health conditions, and there are also a lot of information silos between the weight loss and eating disorder communities.

Temptations

In addition to the tempting promises of GLP-1 medications, the ubiquity of delivery services like DoorDash and increased isolation among some demographics has helped perpetuate a dangerous cocktail of mental health struggles and unhealthy eating patterns.

“I used to have a lot of temptation stopping at drive-thrus, but now you can be home and nobody sees you and nobody knows who you are,” Kristen said.

All three members — Kristen, Bridget and James — said they haven’t found a substitute for the support they receive from FA, which includes sponsors and group meetings, even on holidays.

“The more time we have in the program and learn how to deal with our feelings and what’s really going on under the surface, it’s not a problem anymore,” Kristen said. “At the beginning, when I would go to a restaurant and see everything, it would be hard, but now it’s not.”

For more information or a list of additional meetings throughout the U.S. and the world, (781) 932-6300, or locally call (650) 537-0066, or visit foodaddicts.org.