It’s no surprise, then, that some people who undergo bariatric surgery experience a resurgence of a preexisting eating disorder, or develop a new one. Frequent vomiting, never knowing what foods will upset your stomach, and feeling pressure to maintain a post-surgical weight—”you can create an eating disorder that way,” Du Briel says.
But semaglutide and tirzepatide promise to fulfill an even stranger fantasy: eliminating appetite itself. While a drug like Mounjaro works on numerous fronts—including preventing the body from storing fat and “browning” existing adipose tissue—it’s the feeling of being untethered from desire that seems to fascinate patients and physicians alike. People for whom the drug works often say, “I forget to eat,” says Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital’s Weight Center.
If doctors really believe that obesity is the greater of any two evils, then this approach makes sense. When it comes to bariatric surgery, for example, a review of the medical literature suggests it is, on balance, associated with a reduction in all-cause mortality—or death of any cause*—*compared to patients with high BMIs who don’t go under the knife (although such studies are profoundly limited, as they often do not control for social factors, like income or education). Many hope that semaglutide and tirzepatide will one day prove just as vitalizing.
But eating disorders kill too. In many contexts, sustained hunger is considered a travesty. And desire—for food, or anything else—is a great way to know you’re alive. “It’s wild to me that we see no appetite as a positive thing,” says Shira Rosenbluth, an eating disorder therapist who works with people of all sizes. Anna Toonk agrees: “I realized that there are worse things than being fat,” she said told The Cut last fall. “The worst thing you can be is wanting to barf all the time.”
Ultimately, the proliferation of drugs like Mounjaro means medicine is not only in the business of dictating “normal” weights (a thing it still hasn’t quite figured out), but “normal” appetites. What was once an intuitive process, in which your body tells you what it needs, became a dictate under diet culture: You tell your body what it can have. Now medicine promises a radical reset: With the right drug, your body will hunger for nothing at all.
Weight loss technology can’t be stopped entirely—nor should it be. Everyone has the right to choose what they want to do with their bodies. But informed consent is built on information, and we may not have enough. Mounjaro was fast-tracked by the FDA based on studies designed to observe weight loss over just 72 weeks, a small fraction of the time real patients will be on the drug. At the very least, patients should be informed that in the first years after a drug hits the marketthey are participants in an ongoing experiment.
As biomedicine’s war on obesity continues, people must work harder to combat anti-fat bias—not on a technicality, but as part of the expansive vision of justice fat activists began articulating more than 50 years ago. For semaglutide, tirzepatide, bariatric surgery, and their ilk are neither miracles nor cures. There have always been fat people, and there always will be, whether they are “non-responders” to treatment, refuseniks, or languishing on the waitlist. Notably, even those who experience dramatic weight loss after surgery or on injectables may still be overweight or obese, depending on where they started.
Perhaps most importantly, the American weight loss discourse must move away from a reflexive scientism, which has enabled biomedicine to subject the entirety of human experience to its single-minded scrutiny. Weight, like almost every aspect of embodiment, is not an exclusively biological phenomenon or a clear-cut medical “problem” to solve. It is shaped by countless factors, like power distribution in society, personal psychology, and that most frightening of forces: the desire for more.
If you or a loved one is struggling with an eating disorder, the National Eating Disorders Association Helpline is available at (800) 931-2237.