The medicine and the message: Unpacking the chatter around GLP-1s

Yvie: [00:00:00] This podcast is recorded and produced on the land of the Wurundjeri people of the Kulin nation. We pay our respects to their elders past and present, and extend that respect to all Aboriginal and Torres Strait Islander people who may be listening.

Welcome to another episode of Let’s Talk, a podcast from Butterfly Foundation. I’m your host, Yvie Jones, and today we’re talking about what everyone’s talking about right now, but is rarely discussed with the nuance or care that it deserves. We’re talking about GLP-1 medications—the drugs originally developed for diabetes that are now being widely used for weight loss.

These medications are changing bodies quickly, but they’re also raising complex questions about medical ethics, identity, body image, eating [00:01:00] disorders, and who’s benefiting from this medical breakthrough. Joining me today are two experts who bring both professional insight and personal experience to this conversation.

Chevese Turner is a long-time advocate in the body liberation space with firsthand experience using GLP-1 medications for diabetes, while also navigating their recovery from an eating disorder. Kathryn McKay is the program director and senior lecturer in bioethics at University of Sydney, whose work includes a focus on body image, health, gender, and the cultural forces that shape how we understand wellness and work.

Together we’ll unpack how these drugs intersect with diet culture, capitalism, medical gatekeeping, and social belonging, and why the hype around rapid weight loss can come at a real psychological and physical [00:02:00] cost. Most importantly, we’ll be talking about what support, safeguards and honest conversations are needed, especially as these medications become more accessible and more visible in everyday life.

Chevese: So to start us off, why now and why so fast? What made the culture so primed for GLP-1s? What happened to body positivity, body acceptance, body neutrality and all of that? I don’t think it’s a one size fits all situation. I do feel that there were pockets of people—in which I refer to it as body liberation—who have done their work, learning and unlearning, and it’s strong within those of us who have done that work. I think it’s one of those things that once you really, really, truly [00:03:00] embrace it, it’s very difficult to let go of, at least not 100%. And I think that the body positivity world was always very fragile. I feel that some people just really worked hard to make themselves believe that they were, you know, positive about their changing bodies or a body that they didn’t necessarily like from the beginning.

And I also think that there have been cultural shifts. I am going to be a little political here. There have been big cultural shifts over the last, probably 10-ish, 20 years or so, that this sort of conservative ideal of what women are supposed to look like has re-emerged. And along with [00:04:00] that, the thin ideal has really become again necessary for many women to fit into what is becoming more and more of an oppressive society for women once again.

Yvie: Just on that, what do you think as far as that cultural shift that’s happened recently? Can you give me some examples of that? Because I know what I’m thinking. I just want to get expert opinion here.

Chevese: In the United States over the last 10 years, we’ve had a lot of turmoil in both our political setting and in our culture. And it has skewed conservative. And I’ve noticed, and so have many people who really pay attention to culture that I read—hair has become long again for women. More [00:05:00] make-up, and lots of contouring has become more expected. Clothing is, again, very fitted and tailored. The rise of the Kardashians, right? There is this ideal that we see over time in our history in more conservative times where women are expected to be and look a certain way. So I think that’s part of it, at least here in the United States, and I’ve seen it in other parts of the world that I’ve visited as well.

But I think there are probably other reasons—always capitalism. People make a lot of money when women spend a lot of money on hair and make-up and, you know, now GLP-1s and yeah, other weight loss interventions. And I think that these medications have just [00:06:00] brought something that those of us who have been fat—and I use the descriptor of fat for myself—

Yvie: I believe that for many women especially, but also men and those who are non-binary, you know, this has brought something that they didn’t think was possible. And now it’s possible.

Chevese: Yes. And Kathryn, same question to you.

Kathryn: Yeah, I guess I would just build on what Chevese has said so far because I agree with pretty much all of it. I think that we never really experienced that much of a shift, broadly speaking, in terms of body acceptance and the broadening of beauty ideals and standards. And I think that the kind of valorisation of thinness [00:07:00] was critiqued a bit and we saw some runway changes. We saw some changes to what was considered acceptable or healthy in these kinds of magazines that have obviously a huge influence on people, on culture.

But you know, you mentioned the Kardashians—even there, they were promoting a very unrealistic beauty standard because that beauty ideal requires a lot of money and it actually requires a lot of intervention. Those aren’t natural. So there was never really, I don’t think, a form of true body acceptance. There was just an acceptance of different ways of making a more beautiful body. And I think that the kind of surgical intervention side, or the non-surgical intervention side, has always really been there in the background, been a part of that.

And I wanted to pick up on what Chevese has also said about the kind of conservatism, because I think we see something really interesting happening right now where there’s definitely a move towards more kind of drag influence, more make-up, more intervention. But there’s on the other hand, this move towards clean girl aesthetic, trad wifery, [00:08:00] and yeah, in either of those cases, actually bodies are still thin, sculpted, not too muscly and not too flabby. So there’s not too much softness, but there’s also not too much hardness and it’s all—like, it’s interesting just how regulated that is across a whole variety of different ways of expressing yourself in our culture.

Yvie: Now that urge to be an off-the-rack size, it’s just never really gone away.

Chevese: So true. So sad, but so true.

Yvie: So what’s being medicalised? Are we treating disease or treating deviation from an aesthetic ideal? Where’s the line and who gets to draw it? Chevese?

Chevese: This is complicated for me because I actually take a GLP-1 for diabetes, and the women in my family, especially—there are generations of women in [00:09:00] my family who have diabetes, and I was born with PCOS, and so I knew that at some point I would be diabetic. And I have always been interested in trying to, you know, just keep myself as healthy as possible given that diagnosis. And so when I first went on a GLP-1, which was one of the first that no one’s ever heard of, it was called Bydureon, and I’ve been on two or three over the last six or seven years since I was diagnosed.

And so I landed finally on Mounjaro. And for the first time I started to experience appetite [00:10:00] suppression and I prepared for it. I was very worried about it because I had binge eating disorder and atypical anorexia, and I was very concerned. And so I set timers every day to remind myself to eat, including my snacks. You know, I kind of had to go back to the beginning of eating disorder recovery and make sure that I was getting enough nutrition. And it has been difficult, honestly. And the drug really, really does a good job maintaining my A1C. They’re really good drugs for this and it has helped in other, you know, liver enzymes, all kinds of things.

So I’m grateful for it for that reason. I know that if I hadn’t had as much recovery as I have, and even for some people having this amount of recovery would be extremely difficult because of that appetite suppression. I also have [00:11:00] people around me that I’ve told, you know, including my therapist, if I seem to be dropping a lot of weight, we need to do some sort of intervention. And I have lost a little bit of weight. I don’t know how much. I don’t get on a scale. I can tell from my clothing, and I just really try to not focus on that because I know it’ll quickly spin me back. So in my story alone, I see it as an important medical intervention for me, and it also can threaten my recovery. That will not be worth it at that point. I will come off.

My mother had a similar situation. She had to be taken off of it. She lost 80 pounds almost overnight and really went—at age 78—had a recurrence of her anorexia, and last summer was just terrible. We were [00:12:00] worried we were going to lose her, and I was very upset with her doctor for putting her on it because I knew her recovery was not strong.

So those are two examples, and I think that I worked in pharma at one point in my life and I know what it is like to sit in those meetings and hear about a drug and just all of the different ways that it can be marketed. So this is about both, and we shouldn’t kid ourselves.

Yvie: And Kathryn, you seem to know a lot of what Chevese is talking about. What do you think?

Kathryn: I thought about this question a lot actually, getting the list in advance, and I thought, what is being medicalised here? [00:13:00] I think it’s a really complicated question actually, because I think Chevese has just given a really excellent firsthand account of how useful these drugs are for people who are trying to control diabetes.

And for a couple decades now, there’s been broad social moral panic over having more larger bodies in our society. So because it’s also so effective at curbing appetite, curbing thoughts, the kind of preoccupied thoughts around food, like all those kinds of things, it’s helping people. It’s helping GPs to control or help their patients control obesity.

Now, I’m really sceptical about all of this. What’s being medicalised? I’m not even sure that I still know the answer to this. It’s not particularly in the interest of anyone [00:14:00] except for big pharma. It is to a certain extent, right? And I think Chevese has just given us that example. It is to people who have diabetes. It is to people who are really facing some serious health problems as a result of their weight, because we have to acknowledge that happens too.

But who’s really benefiting from this is big pharma by creating a completely new category of chronic patients. And what they really want is long-term users of any of their drugs. These long-term users generate so much income. So the side of this that really strikes me as most ethically fraught is just the fact that like overnight, a whole new patient class was created. People who are going to be on these drugs potentially for—or, you know, we don’t know how long yet, but it seems like—I know a few people who are on them as well, and the advice they’re getting from their GPs is that this is long-term treatment. You’re now on this perhaps for the rest of your life.

And I mean, that’s just a licence to print money for big pharma. They just hear that and they, you know, rub their hands together because that’s exactly what they’re aiming for. So, yeah, and you know, when you think about it from that perspective, if I step into [00:15:00] that big pharma place, it doesn’t matter whether it’s for health or for aesthetics or whatever. All that matters is that people are on it and that they’re on it for a long time, and that they’re on it with as few side effects as possible because they want people to not quit, but they want them to stay. They want them to stay on there.

So, yeah, I don’t know. It’s not a great answer to the question. What’s being medicalised? It’s sort of all things wrapping up our preoccupation with aesthetics, with some concerns around health and lifestyle and all of that.

Yvie: Can I just ask a question? This is just out of my own personal curiosity. You’re talking about the side effects and you know, obviously they don’t want side effects, you know, so you do stay on these drugs or all drugs as long as possible. Is this the kind of medication that they’re constantly [00:16:00] updating? Or is this like a breakthrough medication and this is it? It’s like, well, we can’t get better than this. Or, you know, you’ve got these backgrounds—is all medication like that? Like do they just keep trying to get better and better and is this one of them, Chevese?

Chevese: It’s definitely one of them. I know that Eli Lilly bought another pharma company that was working to produce a drug that would stop the muscle wasting that happens with GLP-1s. And I know that the newest generation that Eli Lilly is launching—it is Mounjaro, which has two different modes of action, and then they’re adding a third, which is a molecule that will speed up your metabolism.

And so the thought is that if you have the GLP-1 that’s, you know, the agonist that is lessening your want to eat and it is helping—the [00:17:00] second molecule helps with some of the side effects, nausea and that sort of thing. And then you have a molecule that ramps up your metabolism, you’re going to lose more weight. So that is the idea.

And you know, every drug company—every drug is patented, and when those patents run out, they often add molecules or change molecules so that there is a new patent issued. So the drug has a longer life. So that way they have you hooked into buying the drug and not getting generics for a much longer time.

Kathryn: The other thing that they’re doing at the moment is trying to create more accessible versions, so pills instead of having injections. And part of the idea behind that I think is also to be able to get a wider range of people—[00:18:00] make it slightly more affordable because even if it’s less costly, more people taking it will still mean more profit.

So yeah, in addition to what Chevese’s saying, and I think they are always trying to prevent people from stopping because I think at the moment quite a few people, like one in seven will stop taking their GLP-1 drug in the first year. And it’s because of the real side effects that some people experience, like terrible nausea or other kind of gastrointestinal effects, and they’re just bad enough that it’s not worth it. And you know, there are other reasons too that might not be worth it, like Chevese said earlier. So trying to, you know, that’s not what they want. They don’t want people to—

Chevese: No.

Yvie: So, okay, so Chevese, what happens to identity and belonging when bodies change rapidly?

Chevese: Yeah, that’s a really good question. I’ll be very interested to hear what Kathryn has to say, but it’s been interesting being a part of the fat acceptance community and seeing in all directions [00:19:00] people losing their communities. So people who were part of the fat acceptance community who have taken these drugs—they don’t feel like they belong anymore in that community for reasons that I understand, because I’ve seen things happen online and they may still be fat even after taking the drug for weight loss. You know, they’re still fat.

And then there are the people who—I have somebody in my family that believes that anybody that takes these drugs for weight loss, you know, that they are wrong, that they should do it the old-fashioned way. But she gets very upset when she hears about people taking it because—and she has an eating disorder—but you know, they should be restricting and exercising, not taking the drug.

You just see all the comment section of any, you know, post about it and you see the comment section from diabetics [00:20:00] accusing overweight people of stealing this drug from people who really need it. There is that. And so it’s complicated and yet the drug helps some people fit in to what is socially more acceptable in a thinner body.

The number one place where these drugs are prescribed apparently is the Upper West Side of New York City. It has the highest number of prescriptions and we know from the type of people that live in that area, these are all not people who would be considered in any way larger-bodied, overweight, obese. These are people that are using it to become more thin.

Yvie: Kathryn, what do you think?

Kathryn: Yeah, I think that’s completely true. I think there are a lot of people—[00:21:00] yeah, it’s so fascinating to hear that it’s in the Upper—I mean, I’m not surprised to hear that. I think even here in Australia, a lot of people who would not be maybe considered fat are taking them to lose weight. What they want is to lose 12 kilos before they go to a wedding. But they love the result and they end up being on it forever because if you stop taking it, you’ll regain that weight even faster.

So it’s a really fascinating thing and so fraught, and I think there’s real questions there about gatekeeping in the medical community and whether or not they should be doing a better job. I wouldn’t normally say that about the medical community, but I think there are some important questions to ask about gaining access to these when it is such a big life-changing thing that you’re about to do. And in terms of, you know, how does that change people’s sense of community and things like that, I think Chevese speaks to this better than I can, but I think that one thing that happens—well, I guess there’s kind of two sides to it.

When people [00:22:00] find themselves in a thinner body, it can be really socially rewarding. You get a lot of positive feedback from society about that, and sometimes that can feel good and sometimes that can feel kind of bad because it can kind of make you feel worse about how you were before. It also comes along with a lot of potentially unwanted attention from people, and that can be from, you know, the opposite sex or people you’re attracted to, but you’re not used to having so much full-blown objectification or attention. But it can also be, you know, that can also be really great too.

And I think that it’s really down to the individual and it’s really down to the instance of it, how people feel kind of on a day-to-day basis in this really—in this new body. And having to, in many cases, purchase a new wardrobe and having a way to present yourself, I think the things that I’ve read about it really seem to split two ways, and some people experience that as very empowering and some people experience it as really quite confronting and a [00:23:00] little scary and, you know, more than they bargained for.

Chevese: Yeah. And can I add to that, that I think it is common—I certainly experienced during my weight cycling career that the first year or so of becoming thinner, you really have this honeymoon period where you feel great and everybody is noticing and you kind of feel on top of the world, at least I did. And then things start to become real and all of the problems that you thought were going to be solved by weight loss actually aren’t, you know? Relationships still have issues.

It is just such a honeymoon thing. And it’s so interesting to me when people are taking these drugs or they have weight loss surgery, how they just cannot say enough good things about it. I mean, there are people that [00:24:00] don’t feel that way definitely, but it is such a honeymoon period and that’s what gets sold back to us—that you’re going to feel great. You’re going to have smaller sized jeans. Everybody’s going to love you. So it’s really an interesting phenomenon and I see it happening amongst many of my friends.

Yvie: And you see Hollywood just disappearing. All those individuals talking about it as if it’s just so wonderful and it’s made their lives so wonderful.

Chevese: That’s so true.

Yvie: I think we all know the answer to the next question. Why are GLP-1s overwhelmingly marketed to and used by women? Kathryn, we’ll start with you. I think we all, like I said, we all know the answers to these things, and we’ve already touched on them already, but please, yeah.

Kathryn: I mean, there’s something that Chevese mentioned earlier that I think is really important here, which is just that women spend so much money in the health and wellness [00:25:00] industry. They’re the key market for all things health and wellness. And when you see online influencers and you see all the attached related marketing phenomena that are going on there, it’s so very aimed toward and driven by women. It’s a lot of women-to-women marketing in that space and the kind of aspirational lifestyle thing being marketed as well.

So I think that it’s no surprise that women are a key market for this because of all of the decades of messaging around controlling the size of your body and attractiveness and health. You know, health gets marched out as the kind of biggest, best reason. But in my view, being physically active is far better for your health than weight loss. Like weight loss isn’t meaningless, but becoming more physically active, even if you don’t lose weight, is far better for a person in terms of their real health.

So weight loss, I always, you know, when people talk about it in terms of health, I think, no, this is really just beauty, but you don’t want to just say that it’s beauty. [00:26:00] Of course when it comes to beauty, women are—women are the key market. They’re not the only market, but they’re the key market.

And I think the other thing too that I wanted to pick up on, and related to what Chevese said, is I think men and men-identifying people are under different kinds of aesthetic ideals and different kind of aesthetic pressures. And something that’s super relevant here is how much muscle you lose on GLP-1s. So I think a BMJ study found that it was 39% of weight loss was represented by actually losing lean muscle. Now that is absolutely astounding and it’s really bad for you.

Yvie: Really dangerously bad, isn’t it?

Kathryn: And actually, it’s really bad for women.

Yvie: Yes.

Kathryn: It’s really, really bad for women’s health to lose that much muscle. Your muscle affects your bone density. [00:27:00] Women are already more vulnerable to having lower bone density because of our hormones. So that’s a whole pile of problems. But for men, the aims I think—like the kind of social aesthetic ideal—is definitely more towards having defined muscle, more lean muscle. So this wouldn’t be marketed in the same kind of beauty or aesthetic way.

Yvie: That’s interesting what Chevese was saying about Eli Lilly then, you know, coming up with something that would stop that from happening.

Kathryn: If they can stop the—bring the men in then couldn’t we?

Yvie: Then it’s going to be a game changer for marketing it to that.

Kathryn: Yeah, it’ll—

Chevese: And the muscle loss [00:28:00] is, you know, we’re talking about eating disorders as well. Sarcopenia, which is muscle loss, is a key feature of anorexia nervosa and atypical anorexia. So, you know, there are some common denominators happening here.

Yvie: And what about young women, young girls seeing all of this as well? You know, seeing their mums, aunties, teachers taking it. It’s just another pressure, isn’t it?

Chevese: It is. It is. But it’s interesting because I grew up watching my mum and my gran cycle through diet after diet. The one they were on the most was Weight Watchers. And sometimes I have a hard time thinking like, how different is this? This is different. This is different because it’s a pharmaceutical intervention as we were talking about. It’s chronic, it’s this long-term thing. But as a girl, are you seeing something different? I’m not really sure. I don’t know. I would need to actually talk to some girls and find out what they think.

Yvie: Yeah. Actually, it’s [00:29:00] an interesting point that we haven’t, I guess, really, you know, started to study yet what it’s doing to younger girls or even if they’re seeing it, the actual taking of it. Whether that’s even being shown or, you know, because with diets, especially, I know the same as you two growing up watching mum on Weight Watchers, it was funny, like, you know, your mum would have a different meal, but often, you know, when—

Chevese: Time to intervene with little chubby teenage girl here, let’s get you on it. You know, the whole family can eat it kind of thing. This is a different type of discipline. I don’t know what other word to say.

Yvie: So for people with eating disorders, what are the specific risks and benefits of GLP-1s? Chevese?

Chevese: Well, I think, you know, we’ve outlined the risks [00:30:00] to some extent already. There is the muscle loss, which can affect the main primary muscle in our body, which is the heart, and there are gastro issues. There are just issues about losing weight too quickly and everything that comes with that. There is the risk of an eating disorder developing or re-emerging, or has never been diagnosed, and so it worsens.

And I know we’re going to talk about binge eating disorder, and I have some really—I don’t know if they’re different views than what I thought the questions sort of insinuated, but I happen to think that this drug can cause a lot of harm for everybody with any type of eating disorder, not just—and we say restrictive eating disorders, but all eating disorders are restrictive. Binge eating disorder is a very restrictive eating disorder, so that’s one of my pet peeves in the field that we [00:31:00] leave binge eating disorder out of that because people are larger-bodied and it’s just not true.

Yvie: Same as atypical anorexia, is that correct, Chevese? People with a larger body who still can have anorexia. Is that right?

Chevese: Absolutely. I had both binge eating disorder and atypical anorexia, which by the way is just anorexia.

Yvie: Yeah. Same result.

Chevese: Well, same. It’s all the same. Yeah.

Kathryn: I think that’s actually a really useful clarification because I think something that folks in—speaking very generally, folks out in the kind of broader, broader social world—don’t perhaps fully appreciate the amount of overlap between disordered eating and people with bigger bodies. [00:32:00] There’s a huge overlap. And a lot of people who experience weight cycling will tend to become larger over time and they’re still suffering from disordered eating, like of whatever kind. And I think, yeah, I just think we have this assumption that a person with an eating disorder will be thin and that’s the only way that that will appear. And that’s just simply not true.

Yvie: Simply not true.

Kathryn: No.

Chevese: Binge eating disorder makes up the largest number of people with an eating disorder and every body size is included in that bucket of people.

Kathryn: And I think that this kind of GLP-1 phenomenon—there are a few things that I think are almost like socially sanctioned ways of having an eating disorder. And this is one of them. Like, I don’t want to say this to sort of offend anyone, but sometimes I had the same feeling about things like being vegan or being on a paleo diet. And I think this is really restrictive [00:33:00] eating or being like a raw vegan, or any combination of these—you have made it so difficult to find food that will fit into this diet.

And again, it’s all under the banner of health. It’s like, well, a raw vegan diet is the healthiest one you can have. Activated almonds are the healthiest snack you can have. But I think there’s different forms of having disordered eating right out there in the public that are even a part of, you know, wellness influencers’ public profile. And that’s a fascinating phenomenon to me.

We don’t label it as eating disorder, and it wouldn’t really count as that if you just looked at something like the DSM. But it’s very clearly what, you know, Chevese was just saying it’s restrictive. It’s control. It’s a whole number of things. It’s going to involve a lot of thinking, a lot of planning, and it’s just somehow become socially acceptable.

Yvie: Okay. So we’ve kind of talked about the side effects and things like that, but we don’t really know about the long-term side effects. As you were saying, Chevese, you were one of the very first to go on [00:34:00] this drug for diabetes. Did you say eight years ago? So is that all that it’s really been around?

Chevese: Well, I think they actually have been around a lot longer than that.

Yvie: A lot longer. How long have they been around?

Chevese: I can’t remember the exact amount of time, but they had been around for some time when I began taking a GLP-1. But they just weren’t powered the way they are now. The molecules were different. They didn’t have as many side effects, but they also didn’t have weight loss. And those drugs really have gone by the wayside. They’re just for health. So come on, they had to really work at it to get the weight loss in there as well.

Yvie: God, they must have patted themselves on the back when they found that.

Chevese: Well, I’m sure a lot of people got a lot of big bonuses, lot of bonuses, a lot of nice gold watches coming their way.

Yvie: Mm-hmm. So what about long-term effects? [00:35:00] When will we know them, if at all?

Chevese: Well, long term we will, but what’s long term in the medical field?

Yvie: Yeah.

Chevese: Well, I think we’re already seeing—for instance, I saw a study that showed that people that were above the age 70 who were taking them were more likely to have congestive heart failure or to have CHF side effects or go from, you know, cardiomyopathy into CHF more quickly and have more recurrence of it. So we’re seeing that, we’re seeing blindness, we’re seeing, you know, of course the muscle loss. There is also the lack of joy aspect. Many people are having their emotions blunted. I thankfully have not experienced that, but I’m not on a super high dose.

Yvie: Just jumping in quickly. For those who didn’t know, CHF is congestive heart failure.

Chevese: Now I’ve just [00:36:00] read about the depression that people are expressing to their doctors.

Yvie: Right?

Chevese: Well, and you think about it, if it’s dulling some of the pleasure parts of our brain, then that pre-frontal cortex, then it’s not just food, it’s everything. So that’s an issue. And I think the people that I’m truly worried about are kids because there’s no drug that doesn’t change your body. We know on a cellular level, these drugs change your body and we don’t know if that’s a good thing or not. We don’t know what it’s going to change long term. So I think that this is just a total—just a guess from a non-professional—I think that we’ll start to really see what some of the longer-term impacts will be within the next 10 years.

Yvie: And just a question, I’m not sure if either of you know, or even if it’s different in our countries, what’s the age allowance that you’re allowed to take this drug?

Chevese: Here in the States, I think it’s seven.

Yvie: Well, I think that’s what the—the AP [00:37:00] guidelines. I’ve actually just done a quick search, and I believe the GLP-1 injectables are available for adolescents age 12 and up, but it can be up to the physician’s discretion in some countries, including the US and Australia potentially.

Kathryn: What I was thinking while Chevese was talking is that, yeah, I think the range of health effects that we’re seeing as a result of GLP-1s—so far, there’s not so much evidence for some of them. There’s more evidence for others, and that evidence base will just grow as more people are on them for longer. So we’ll learn more. But certainly some of those issues you might think are worth it in a trade-off if [00:38:00] yeah, you’re on the GLP-1 either for control of diabetes or because of health-related—of your weight.

And so, you know, some of the evidence around optic neuropathy, it needs more research. But you know, you might think, well, if I have uncontrolled diabetes, my eyes are at risk anyway. So what do I want to trade off? Yeah. And the same thing with, you know, heart health. If you’re experiencing sort of heart health impacts of weight, you might think, well, either way my heart might be at risk.

But I think those are things we have to decide as adults. I think those are things we have to decide at an age in life when that kind of risk analysis makes sense. I don’t think it makes sense when you are a teenager or even in your twenties. You know, I don’t know. I’m not an expert on diabetes. I don’t know if there’s a benefit to going on one of these drugs earlier in life for that reason, or if there are [00:39:00] alternatives if you’re a kid or if you’re a teenager.

But I think that, you know, with the clear evidence about muscle loss, the evidence about some organ impacts, you kind of think to yourself, well, this isn’t just a straightforward like, yeah, this is great. At the same time, as we were talking about earlier, pharmaceutical companies will continue to try to improve these, which is if there is any kind of silver lining, that would be it—that they’ll be seeking to reduce these kinds of impacts. And that will obviously, you know, five or 10 years from now, I would expect that they’ve done a much better job with some of those.

Yvie: And Chevese, you were saying like when patents run out, that’s when, you know, we can get generic versions of—or how long is a patent for a GLP-1, do you know?

Chevese: Usually it’s about 17 years and that begins at when it goes into humans. So, you know, it goes from animals into humans, and then it goes through phase one, two—[00:40:00] there’s two phases of phase three, and then phase four is post-marketing. But at the end of phase three is when it goes to—you know, here in the US it’s the FDA for approval, and then however many years is left.

I think we have to look at the role that weight stigma plays here. My mother, as a young mother when I was four or five and she was already worried about my weight—I could see her at age seven or eight taking me to a doctor because my paediatrician at that time was telling my mother, you know, don’t let her eat these things and don’t let her gain any more weight. She’ll get taller in a couple of years and then she’ll be kind of normal.

So I have no doubt that my paediatrician and my mother together would’ve decided that this was good for me, and that’s what we see happening. Parents get really [00:41:00] distressed about their children’s weight in middle childhood because that’s when kids start to broaden and gain weight. And then in puberty, they really become taller, most of them. And so then it all sort of evens out. But those are the ages when physicians and parents really start to become worried and then they immediately go to interventions that may actually harm the child in the long run or, at a minimum, they send them down a weight cycling road.

Kathryn: Yeah. Like the kids absorb that dialogue. Even if nothing’s diagnosed or nothing’s prescribed, kids absorb the anxiety from their parents and their grandparents and—

Yvie: Totally. And just to have that medical expert, they are to the lay person [00:42:00] everything. Your doctor—end of. If they say it, it’s gospel, just, you know, just so many people. So if your doctor, GP, paediatrician is saying to your parent, you know, you’ve got an 8-year-old obese child here and we are going to have medical intervention, of course, you would feel like the worst possible parent to go against that.

Chevese: I didn’t, and I didn’t.

Yvie: You didn’t feel like the worst possible parent, but were you the lay person?

Chevese: I was the lay person.

Yvie: You were. So you didn’t have all this information kind of already—research yourself or anything? You just—

Chevese: Well, I had some of it because I was in recovery, but my second—my youngest son had ARFID.

Yvie: What’s ARFID, sorry?

Chevese: ARFID is avoidant restrictive food intake disorder. It’s essentially when a child has a very limited number of foods that they’ll eat, and they have a lot of—some have gag reflexes, some have [00:43:00] texture issues, all that sort of thing. So I knew enough at that point that something was going on with him and we got him some help, and he’s done beautifully. But in middle childhood, he did then start to gain some weight and his paediatrician wanted to sit down and talk to me about it and what are we going to do about this?

And I said, we’re not going to do anything about it. And I forbid him to talk about it to my child. And my child is now a tall, strapping young man who is just a normal guy. You know, he has none of these issues.

Yvie: No doubt.

Chevese: Yeah. And we strongly believe it’s because we just let him alone. Yeah. We didn’t do some sort of intervention that set him down a road that was not helpful.

Yvie: Yes. I guess what I’m trying to say is that in your person, there was maybe a bit less lay person, right? I don’t look at physicians as God. They are [00:44:00] people that I—and I’m so thankful for them. I’m very thankful for the medical community and at the same time, I know my body best. I have body trust and we’re going to consult together. This isn’t a top-down type of relationship and I think more and more people are understanding that these days.

Yeah, I totally agree. Okay, we’ve run way over time, so I’m just going to ask for both of you, I guess personally and professionally, yes or no to this kind of drug, Chevese?

Chevese: Well, for actual medical diagnoses of diabetes, if you and your doctor together decide that it’s a good idea for you—yes. With the caveat that if you have a history of an eating disorder, no. Or you don’t have a team around you to make [00:45:00] sure that you stay safe. Absolutely not.

But for everyone else, I’m a person that thinks in nuances a lot, and I understand that people have autonomy. I just wish our public health professionals did a better job of understanding the implications of pharmaceuticals on populations and really took that into consideration when making policies and how drugs are paid for and who gets what, all of that. So, you know, if someone feels like they really need to or want to lose weight, I’m not going to [00:46:00] stand in their way and say, oh no, you can’t do that. But I want people to be screened for eating disorders and I want them to be given the actual information and I know that’s not happening.

Yvie: Yeah. Great. Great answer. Kathryn, what do you think?

Kathryn: I think my answer would just really build on that because I think that as we’ve been discussing, for some people, there are clear clinical benefits and similarly, I believe in people’s agency and supporting it. And I think that this is very complicated and I’m not about to say to someone, you ought not to desire to fit in better to this highly normative, judgemental society that we live in. People need to feel good about themselves, and I think that what Chevese said about these drugs being accompanied by really good psychosocial support is absolutely key.

If they’re being prescribed primarily for weight loss, there has to be some kind of accompanying support. [00:47:00] Because even for people who’ve never had a diagnosis of an eating disorder, it’s just right there, it’s just like adjacent to having a GLP-1 drug. So I think that that would be absolutely key.

And the kind of looming thing about saying something like that is that even in Australia, and I’m Canadian—in Canada, where you have universal healthcare, the mental health side of that is radically underfunded. So how about we start by providing some better mental healthcare across the board? Maybe that would even help with some of these body issues that people face, peer pressure, alienation, online, all of those things.

Yvie: Reasons for wanting to take it.

Kathryn: Yes. Reasons for wanting to take it to which this would be an additive thing that people could pursue if they really sort of wanted to. But yeah, like Chevese said, I mean, I think it’s a yes with caveats and I think it’s [00:48:00] something that there’s so much hype around it, we really need to dial down the hype and dial up a little bit more of the common sense and the care for people just generally and, you know, do a better job of keeping an eye on what’s really happening with these in the kind of middle and long term.

Yvie: Well said. Thank you both so much for your time and coming on and your just words of wisdom, expertise, but with so much care. Thank you for the—I can see in both of you how much care you have for this particular sector and it’s really wonderful, you know, being a person of that community, talking to two people who—I like that. So thank you very much.

Chevese: Thank you.

Kathryn: It was a pleasure to be on this podcast.

Yvie: A huge thank you again to Kathryn and Chevese for sharing their knowledge and experience on this very important topic. If you are concerned about an eating disorder for yourself or someone you care about, please [00:49:00] reach out to the Butterfly National Helpline at 1800 33 4673. That’s 1-800-ED-HOPE for a free confidential conversation with one of our specialist counsellors. Alternatively, you can chat online by visiting butterfly.org.au and following the prompts at the top of the page.

To find out more about today’s episode, check out the helpful links in the show notes and on the Butterfly website. Just head to butterfly.org.au/podcast and click through to this episode.

Let’s Talk is produced for Butterfly Foundation by Yvie Jones and Sam Blacker from The Podcast Butler with the support of the Wurundjeri Education Foundation. Our executive producer is Camilla Beckett, with support from Melissa Wilton and Kate.