Ozemporexia

The subtle "disease" that shadows successful GLP-1 use.

This piece discusses several Eating Disorders. Eating Disorder Hope has free resources of places to contact for all types of EDs. Ozemporexia is not one of those. Those tools still need to be developed. If you feel you have Ozemporexia, please contact your prescribing physician and an Eating Disorder Therapist immediately. Or go to the nearest Emergency Room for help. You are not alone.

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As a few of us on GLP-1s spent time together and got to trust each other, we began whispering about a secret desire to keep losing weight, even after getting to our goal weights. At first I was shocked! I thought I was the only one. Not hardly.

I branched out and started listening in on different forums… not social media… and began hearing/reading the same thing happening. Over and over, I read whispering confessions of how it feels to be thin. Finally, thin. And how powerful that feeling is.

But, was it just the being thin part? I explored even deeper.

From Whence We Came

After a lifetime of being fat, socially abused, physically edged out, and emotionally tattered, then losing weight, only to regain again and again, so many of us, including those of us on GLP-1 medications, were crushed by so much pain and disappointment. That cycle of abuse quickly embedded itself into becoming a part of us. Part of our mental makeup. All of this hate and anger towards fat people altered our thinking so dramatically, that all we could do was repeat the weight loss/weight gain pattern we had learned, many of us, when we were children.

The experiences between others and ourselves… and ourselves alone… took on an umbrella term: Shame.

Only someone who has “been on every diet” understands the shrugging non-expectation of these new medications so many of us are now taking. I have been on over 50 documented diets and diet programs since I was nine years old. That was when the pediatrician put me on speed because I was “too fat” - his words. I saw those words in my military medical records before they were purged. Back then, they didn’t even use the (still derogatory term) “obese” to describe a person. Or a child.

Then we began hearing about movie stars losing gobs of weight on Ozempic and rolled our eyes at their vanity. Now we roll our eyes at their privilege to be able to pay for the medications.

“Well, they might work for them, but what about real people who don’t have a chef, a personal trainer, and oodles of time to focus on weight loss?”

We thought we were left out of this new weight loss magic.

When Health Became the Focus

For us peons, we weren’t allowed to want the medications to lose weight. Then (and still!), we are supposed to suffer to lose weight. Heck, we’ve given in to every hedonistic pleasure our whole lives through gluttonous eating, right? Now it’s time to ante up and show how much we really want to lose weight. Denial. Pain. And accepting that the only acceptable way we were allowed to succeed with losing weight was by flaggelating ourselves with the thin people’s (and doctors’!) rules.

Even though the GLP-1s were created to help diabetics, that reality was all but ignored, hiding in weight loss’ shadow.

Once the health benefits, even beyond sending us diabetics into remission, began being reported about in studies and on the news, suddenly the world of GLP-1s opened up.

“I need it for my health. I’m not on it to lose weight,” we preemptively defended our use of the medications. I’m chuckling writing this as I did this in the beginning, too. Using “health” as a shield (and diversion) from why we might really be on the medication.

I was dying, literally, when I was put on Trulicity (dulaglutide) in Spring 2022. I weighed 405 lbs. at 5’1” tall. I had no idea it was a GLP-1 and, in hindsight, am very glad I did not. Between the time I went on Trulicity and switched to Mounjaro in September 2023, I lost 141 lbs. The Trulicity package insert says a person might lose 3-5 lbs. I know the main reason I lost so much weight was because I quit eating Uber Eats and began heaving my behemoth body around, not because of the Trulicity.

Hesitation & Hope

With every new diet, we’re filled with adrenalin that “This time will be different! This time, it will work.” The old adage, “Hope springs eternal!” abounds. Hundreds of times, we were disappointed. More accurately, we thought we disappointed ourselves. The truth, though, was the diet… diet mentality… failed us.

I didn’t have many people to look to for inspiration at that time. Very few were public on YouTube about it. I know TikTok was more active, but I wasn’t there, so didn’t know. I fumbled my way along, writing about my excursion in my quiet Health at Any Cost blog (that I am slowly migrating over here). Here we are, almost four years later and people are still fumbling along because there still is no accepted strategy for how to use the medications to the best of their abilities.

The one thing we have figured out is, as long as we stay on the medications, the weight looks like it will not come back. We have become hopeful that this is the truth. It is a heady feeling. For many, many people like myself, the great amount of possible weight loss could never have been dreamt of before. We knew too many people like myself who had had the gold standard Roux-en-Y Gastric Bypass and either lost very little or lost a lot and regained more years later. That second one was me.

But with the Obesity Management Medications (OMMs) like Mounjaro, Zepbound, tirzepatide, Ozempic, Wegovy, and semaglutide, a new reality was born. We might actually get to walk through this world in a body that no one stares at, that doctor’s don’t tsk tsk tsk at, and that what we see in the mirror doesn’t make us sigh… or cry. In our wildest dreams, we could not have foreseen that the weight would not pile back on the moment we stopped white knuckling whatever program or diet we were trying “this time.” Never before have we experienced such true “control” over our food intake and, for many, our energy expenditure, either.

How Do We Obtain a “Goal Weight?”

A goal in this OMMs world is nebulous. We’re told we can’t rely on the BMI chart because it is antiquated. But we still do. Lots of folks choose to use the Weight Watcher’s goal weight chart, which is the BMI chart. (Too many of us spent wayyyy too much money going to Weight Watchers our whole lives.) Googling “Ideal weight for 5’1” female” gives me a range from 100 to 135 lbs. That’s a wide range. There is the SMART method (Specific, Measurable, Achievable, Relevant, Timebound) of deciding a goal. Plenty let their doctors decide. One way they might choose to do this is with Waist to Height Ratio, Waist to Hip Ratio, or one of the Ideal Body Weight formulas. The Hamwi, Devine, Robinson, and Broca are four such formulas. They all choose a baseline weight and add a certain number of pounds per inch or centimeter of height.

And what of the scale? Why does our culture put so much focus on a piece of metal with springs inside that was only invented for individual use 120 years ago? And all it measures is the gravitational pull towards the earth! Because it is an easy metric to tell someone. It’s much easier to spit out one number than it is to demonstrate and explain lab results. Before lab tests were regularly done, doctors measured people’s health status only with the BMI chart. That simplicity of measurement has become an obsessive focus for many of us who are on GLP-1s. Surely has been for most of us who have ever needed or wanted to lose weight.

I’m showing some scales from the 60s and 70s.

But this ad beats it all. Look at the scale that says, “Hey, Fatso.” Can you imagine getting on that every morning? Especially if someone bought it for you. Talk about scale intimidation! I wrote what the first two lines of the ad says in the caption.

“Bath Scales that make light of avoirdupois. They give you the grim news with a grin. “

Scale-Obsession When on GLP-1s

It is well known that many people are scale-obsessed. It often starts in childhood when having to be weighed in PE class in front of everyone. How mortifying when you are the 90 lb. fat kid when everyone else weighs under 70 lbs. (My reality.) I wouldn’t doubt if most people in the United States are married to the scale.

But when we start taking our OMMs, the scale takes on a dual personality; that of a saint… or a reflection of a sinner. Of course, that is not the truth at all, but try telling someone that who’s paying hundreds of dollars a month and the scale just doesn’t move as fast as their Internet friend’s scale does. A scale that doesn’t move, or God forbid, dares to go up while on GLP-1s is screaming “Incompetent! Glutton! You can’t even get this right!” (It would be good to annihilate that voice!)

But ohhhhh, when the scale goes down. It’s incredible watching those numbers falling that first month, then trickling downward. My mind thinks of a leaky faucet, drip-drops that bring joy with each chiming ping into the abyss.

The Publix Scale! 252 lbs. The first time I fit on it because the highest it went was 300 lbs. I'd lost 153 lbs. & was ecstatic! / 231 lbs. / 125 lbs.

As the numbers fall, our clothes get looser, our faces thin, people start noticing our changes. One of the odd experiences when our bodies begin changing shape is when people who do not know us are kinder to us. People smile at us now, whereas before, they would have looked away. When we fit into theater seats, don’t need to have the seat belt extender on a plane, when our bellies aren’t smashed into the steering wheel anymore… these are all wonderful feelings that we hope, will never go away again. If we ever wondered if the medications were going to work, that worry all but vanishes.

Oh, the Power of Weight Loss!

We begin to feel powerful. There is no stopping this descending weight and ascending joy. For the first time in our lives, we feel we might actually make it to our goal. And maybe, just maybe, even stay there. I still think it takes time to come to terms that this could be the permanent solution to a life-long problem. But when it hits, it can hit hard.

I’ll speak about my own experience, but know there are others who feel the same. Others I know, and many I do not.

As I said, I started at 405 lbs. It took from April 2022 until my 64th birthday, March 29, 2025, before I was in maintenance at 125 lbs. I initially thought I would land at 150 lbs. and did that in early October, 2024, but I kept going down. I never counted calories, but ate Lean Cuisines and Healthy Choice (not sponsored by them), so had an idea of what my base calories were for the day. I supplemented with chicken, protein shakes, fruit, yogurt, things like that, so was eating a healthy amount of calories for someone so short. Apparently, I am small-boned whereas my entire life I thought I was workhorse-size. I ate about 1200 calories a day. I didn’t change that, so my weight kept going down. I also had no goal weight, but when my calories-in matched my calorie needs, my weight settled at 125 lbs.

And it felt gooooood. A few times, I dropped down to 121 and that felt even more fun. I so wanted to see how far down I could go and still walk miles a day. I really wanted to keep going down. I mean, the charts say 100 lbs. was the low of my healthy weight. Maybe I could see what that felt like. Only because I have two cancers, did I make myself not lower my calories. My oncologist even told me to gain 10 lbs. I cried. It distressed me to think about gaining weight. Would I stop at 135 lbs? Or would it keep going up? If I lost control, what would I do? I wanted to go down further, but she told me we had to watch my weight carefully because if I started losing without trying, it was a sign one of the cancers was picking up speed.

She said if I kept losing weight, she would take me off the Mounjaro. I felt like I’d had a bullwhip across my back. That was as much of a threat as telling me I had to comply or one of my kids was going to suffer for it.

Reluctantly, I regained five pounds. I just couldn’t gain five more. I’m hovering at 130 lbs. I wince when I stand on the scale each day, seeing it at or above 130 lbs. The one day I hit 137 lbs., I cried to my GLP-1 friends.

And I got a new therapist.

I had never been diagnosed with an eating disorder, though I have, retroactively, been told I had (have?) OSFED - Other Specified Feeding or Eating Disorder. Mine took this shape:

• Continuous hyperphagia/grazing, but never hiding or feeling shame with binges.

• Eating in secret, even when I was alone - hiding food even when I lived by myself.

• Eating throughout the night.

• The continuously massive volume distinguished it from typical Binge Eating Disorder.

Claude AI helped me count the calories I was eating pre-GLP-1s by examining my Uber Eats orders and my Instacart orders before GLP-1s and after them. Before, Trulicity and Mounjaro, I was eating between 8000-10,000 calories a day. I’m horrified, and flabbergasted I could eat so much.

I’ve been in therapy since I was 18 years old and there has not been one session… not one… that we did not discuss my eating or size. My behaviors were so extreme and different than what was considered an eating disorder back then, which is why I was never diagnosed until recently.

So it’s easy to see why losing weight and keeping it off… being able to eat only 1200 calories a day and still walk miles and miles, have tons of energy… how this could be addictive.

Watching “Ozemporexia” Come Alive

My dear GLP-1 friend Mindy Mikami coined the word “Ozemporexia.” It began as a discussion between a group of us who confessed our desires to see how low we could go before being forced to stop… either by our providers or by our energy levels. I wish I could convey what a high it is to be in control of one’s eating after a lifetime of not having any control at all. How all of us white-knuckled diets, lost sometimes hundreds of pounds, only to put them back on again. The never-ending cycle we thought we would die within. I even had the damn RNY Gastric Bypass and didn’t have any control, gaining it all back and more! How could this not be exhilarating?

As I write this, I can feel myself getting a sort of high, thinking how cool it would be to restrict more calories to see how low I could go. Only that threat of being taken off the medications keeps me from doing it. I don’t know what would keep others from doing it besides therapy or becoming weak. And I’m not sure becoming weak would be anything some would even pay attention to.

A person online that I have met, but don’t know well, recently said her BMI was under 23, but she wanted to lose “just 5 more lbs.” Her doctor threatened to take her off the medications, too, if she did that. She was as distraught as I was about having the meds taken away. Is this going to be a winning strategy for this new eating disorder? That our provider will remove our “drug of choice” if we continue on this “I want to lose just a teensy bit more. Then I will stop” cycle? What of those who have telehealth providers? What if they can’t visually see or get labs on someone and the prescriptions keep coming? Who will “save” them from themselves?

Psychiatrists, Psychologists, Therapists, Health Care Providers… and Parents… Beware!

This is a secret so far that has not been spoken about openly. We’ve only whispered these feelings to each other. It’s really important that you watch your OMMs patients carefully. And your GLP-1-taking children as well. I have not been in treatment for an Eating Disorder, but I imagine there are clever and subtle ways to discover how people are feeling about their weight and their actions around food. Restricting is obviously there, but it comes from a medication, not from mind-games with oneself. Talk to each other. Learn new strategies to work with us. Not everyone has had a diagnosis of their pre-OMMs diet or life, so it might take digging into the past before being able to confront the present and future.

One thing to know, it seems most, if not all of us, easily tell about our past eating behaviors. Even if they were subconscious before, these medications have pulled the veil from what we had been doing, so finding a key to helping now might be in those behaviors.

I honestly believe this is going to be an Eating Disorder of a different magnitude. It will be a mix of past and present behaviors, mindsets, thrills, desires… and the continuing hunger for complete control. Something we have never had in our lives before.

Please tell me in the comments what you think about this new phenomenon. Tell me if you have seen this before, especially if you are a mental health provider. I think we need to open up this discussion NOW.