SPEAKER_06 0:09

Good morning, Boulder County. It's Wednesday, July 8th. I'm your host, Chay Castle. And this is the Frequency. A weekly local podcast covering the news, events, and voices shaping the Boulder Valley. This podcast is supported by Boulder County locals and small businesses. Sponsor an episode and reach our growing audience of highly engaged listeners. Over 4,000 of you tuned in last month alone. Email boulderfrequency at gmail.com for pricing and details. Some weeks on the Frequency, we do only the headlines. For this episode, we're mixing things up. We're skipping the news entirely and getting straight to the main story. It's a tough one. So consider this your content warning. Today, we're talking with a doctor who specializes in treating eating disorders and with a recent CU Boulder grad who is in recovery for her own eating disorder. This conversation does include explanations of various eating disorders and their symptoms, and also deals frankly with the fallout of diet culture. That includes mention of death, disease, and long-term disability brought on by the use of GLP1s and America's excessive focus on being thin. If these issues are ones you struggle with, you might want to skip this episode. We'll be back Friday and next week with other topics.

SPEAKER_01 1:39

I'm Serena Williams. I'm Charles Barkley. And this is me on rope. 34 pounds down on GLP1. Join the more than 7 million adults like Michael who've taken a dump. What's the secret to pink health? Join micro with new micro-dose GLP1.

SPEAKER_06 2:03

If you've got an internet connection, a television, or even a radio, it's likely you've seen or heard an ad for the weight loss medications, broadly and generally known as GLP1s. They are everywhere. For most of us, their ubiquity is merely annoying. But for the roughly 10 to 25% of Coloradans with an active eating disorder or recovering from one, the constant barrage of ads promising weight loss can be more than a minor frustration.

SPEAKER_05 2:32

It's different than like a dieting fad that we've seen in the past. To me, I've never seen something so highly endorsed. I'm in my 20s and I love following social media and seeing celebrities. I think it's fascinating. But then there's also this, like, for me, like an underlying seeing the ads is just exhausting. Hi, I'm Olivia. I just graduated from CU Volder and I'm a Boulder local. I'm also, I guess, a graduate from Eating Recovery Center. I attended treatment when I was 19. So that was three years ago.

SPEAKER_06 3:10

Olivia is far from alone. Experts who treat eating disorders say they are seeing more patients who are relapsing after long periods in recovery. Sometimes the disease and its symptoms were showing up more strongly than before and resisting treatment that had worked in the past.

SPEAKER_07 3:27

In the world of eating disorders, we are seeing GLP1s become a major conversation. So we first started noticing about five years ago that we had a few patients who were presenting to treatment who had been in recovery from their eating disorder and had been prescribed a GLP1 receptor agonist for usually for a metabolic concern for type 2 diabetes or prediabetes or something like that. And in these cases that were coming across my desktop, they were seeking treatment for their eating disorder, which had recurred following taking GLP1 receptor agonists. And what we saw in those first few patients, where we started to wonder, is regardless of how their eating disorder had presented before, now they were presenting with very restricted eating, very low caloric intake, and a lot of compulsive thinking about food and calories, a lot of body dysmorphia. And even once they got into treatment and tried to do the things that had worked for them before, they were finding that it wasn't as successful. They were having a more difficult time letting go of those thought compulsions. We first had these few cases, and I remember talking with a colleague, and we were sort of, you know, thinking together, you know, we have to keep our eyes on this. This could be something. We're very unfortunate to be right that we've seen now a significant increase year over year of patients who are seeking care for their eating disorder, who are on these medications. I'm Dr. Elizabeth Wassinar. I am a child and adolescent and adult psychiatrist, and I trained in pediatrics. I'm also board certified in obesity medicine, and I work primarily in the field of eating disorders for about a decade. And I work with people who have really severe manifestations of the disease. I work at Eating Recovery Center and Pathlight Behavioral Health right here in Denver, Colorado.

SPEAKER_06 5:29

ERC PathLight offers on-site residential and outpatient treatment and support groups for children, adults, and loved ones of people with eating disorders. Before we go further, let's define what an eating disorder is. Most people who hear the term will think of two specific manifestations anorexia and bulimia, not eating enough or not keeping the food you do eat in your body. The binge purge cycle is what experts refer to as compensatory behavior. But those are just two forms eating disorders can take. And those behaviors are often part of other diagnoses. The most common eating disorder is actually binge eating disorder, eating compulsively without purging. Most people with binge eating disorder also go through periods of restriction, leading to malnutrition despite the size of their body. There can also be overemphasis on so-called clean eating, known as orthorexia, or compulsive exercise or movement, another form of compensatory behavior. These behaviors are often combined with obsessively thinking about what you eat or how much you work out, and a belief that certain foods or activities are right and good, while others are bad and wrong.

SPEAKER_05 6:42

When I was in my eating disorder, literally probably 80 to 90% of my thoughts were around food and exercise. You wake up and you think about, oh, what am I going to have today? Blah, blah, blah. And then at the end of the night, I at least was running through replaying everything that I ate that day. Did I work out enough? Did I feel like I did enough? Oh, I didn't. I'm going to go do this now. It was a constant, and it got to the point for me where I couldn't even really have a conversation about anything else.

SPEAKER_06 7:11

That level of dysfunction clearly qualifies as an eating disorder, but many people can identify with that type of moralizing when it comes to food and movement. It's that familiar feeling of guilt for eating a cheeseburger instead of a salad, or judging yourself for having ice cream after dinner, or skipping a workout to watch TV.

SPEAKER_07 7:31

A lot of times eating disorders are really associated with a lot of rigidity and like things need to be a certain way. It can be hard to recognize when someone has sort of crossed over that boundary into a place where it becomes more disordered or may actually be an eating disorder.

SPEAKER_06 7:49

Underlying all eating disorders is a sense that one's worthiness is tied to their choices around food and exercise, and more specifically, what their body looks like. That's why GLP1s can be so dangerous, Dr. Wassenar said. They reinforce the cultural standard that everyone can and should be thinner, no matter what. Boulder and Colorado are particularly vulnerable, given the area's culture of fitness, health, and wellness. Olivia said she experienced that firsthand while attending CU Boulder.

SPEAKER_05 8:19

The whole health culture in Boulder is really easy to like, you know, every place is has a healthier option or like the skinny side option. I would go to school. So I'm like, oh, I went for a five-mile hike this morning. And then I went to Flower Child. And like there's been moments for sure for myself where I feel bad about myself. Oh, am I not? You know, fitting in the culture of Boulder. Is there a disconnect with me? It's just kind of, yeah, it's inherent to the culture here.

SPEAKER_07 8:44

When people are in recovery from an eating disorder, we often recommend that they really focus on resting their body. That can be so hard. You know, every Saturday, people are getting out to the mountains, whether it's to ski or to hike or to do whatever, to be active. And if your prescription is actually to rest your body, that can make it really difficult. Being outside and being active is also such an active part of our social culture. So it's how people make friends and do things with others. And if you are not able to do that because of where you are in your own journey with your eating disorder, it can become very, very lonely. So I think that there's some unique challenges for individuals in the greater Denver Boulder area that can make it hard to recognize the disorder, but also to recover.

SPEAKER_06 9:36

Yeah. And I feel like harder to draw a straight line, but Colorado, we're really struggling with our mental health as a state and you're doing all these roadmaps and investments and things like that. And I'm like, well, this is a huge, huge part of that. Not a question in here, just a wish that people would recognize mental health is also health. And maybe feeling like crap about your body is really bad for you. So maybe we should do something about that.

SPEAKER_07 9:59

Eating disorders are very, very deadly. They are one of the most deadly mental illnesses. They sort of trade places for first place as most deadly illness with opiate use disorder, depending on how much prescribing we're doing for opiate use disorder. But eating disorders have traditionally been and continue to be one of the most deadly mental illnesses because of the intersection of the severe consequence of malnutrition. And eating disorders have a very high suicide rate, a very high rate of completed suicide, unlike opiate use disorder, which is catastrophic in its own right, but we don't have a medication for eating disorders. I don't have a pill that I can give people to mitigate that voice in their head, that eating disorder voice. And so they remain a catastrophic disease in and of itself and highly, highly fatal.

SPEAKER_06 10:54

Diet culture is deadly in another way. Stigmatizing fatness has real consequences for people with larger bodies.

SPEAKER_07 11:01

When we hold this belief that larger bodies are intrinsically unhealthy and smaller bodies are intrinsically healthy, what happens is that individuals who live in larger bodies avoid health care. When people are in larger bodies and they seek out health care, they are given advice related to their weight, regardless of what walked them in the door. And so what we see is that especially individuals who live in larger bodies, they avoid preventative health care. They avoid their sort of annual physicals, their well women exams. And so there are more likely to be manifestations of preventable diseases. We also see that individuals who live in larger bodies are more likely to have preventable causes of disease that are not adequately treated. So in one study where they looked at individuals who had got health care and died, individuals in larger bodies were 1.6 times more likely to die of a preventable cause. So we know that diet culture is absolutely toxic. It is killing people because of its impact on individuals' ability to get equitable health care in addition to precipitating and perpetuating eating disorders.

SPEAKER_06 12:27

Dr. Wassenar is also worried about the long-term side effects of GLP1 use. Weight loss will only last as long as someone is on the medication. Stop taking them, and the weight comes back. That sets people up for a lifetime of use. And there are no studies assessing long-term side effects across multiple decades. Dr. Wassenar has already seen patients with severe digestive issues, such as paralysis of the stomach and GI tract. Thousands of lawsuits have been filed against the makers of GLP1s for gastrointestinal disorders, and dozens more alleging serious complications of vision, including blindness.

SPEAKER_00 13:14

Right now, one in eight Americans is using a GLP one, and this is growing worldwide, too. I know. So I think we're we're on the precipice of blockbusters for both companies.

SPEAKER_06 13:28

Meanwhile, the world's biggest pharmaceutical companies are earning billions in market share as weight loss drugs become the best-selling medications across the globe. Regulation of weight loss drugs has been scant. The federal government continues to expand access. On July 1st, Medicare began an 18-month pilot program covering three of the most popular GLP1 brands. For patients who need the medication, it's a blessing. But for the culture as a whole, it represents further entrenchment of dangerous attitudes and practices that drive eating disorders and weight stigma.

SPEAKER_07 14:03

I think we have the makings of a real catastrophic situation on our hands, especially knowing that these medications are being prescribed now down to the age of 12. And I've seen younger. We have kids in elementary school who are taking these medications that just changing their body's ability to take in nutrition, but also reinforcing to them at that critically young and vulnerable age that their body needs to be a certain way for them to be acceptable to the world. Watching how people are taking these medications for cosmetic weight loss is such a slippery slope for diet culture, for weight neutrality, and for recognizing and appreciating body diversity and all of those things contribute to a culture that reinforces eating disorders.

SPEAKER_06 15:04

It's young people, Olivia thinks of when she is confronted with ads for GLP ones. Seeing and hearing them is frustrating and exhausting for her, but not dangerous. She does worry for others who aren't as far along in their healing.

SPEAKER_05 15:18

I've gotten to this point in my recovery now where I don't feel like these things impact me too much, but it does really worry me for younger girls and people who are in my spot. I know if this was all going down when I was pretty deep in my eating disorder, I would I don't know what would have happened. But I feel like it would have been solidifying for me that I was doing the right thing and what I in my behaviors and what I was doing. So it's hard to see because I know I'm in recovery, but I know a lot of people are impacted by it and believe now that that's healthy or what they should look like. And I know as someone who I guess has looked that way, that was not healthy for me. And obviously I wasn't using GLP ones, but appearance of it all seems very like they're glamorizing the eating disorder culture. And that's yeah.

SPEAKER_06 16:06

The reality of our culture, the decades-long striving for thinness, the relentless pressure of capitalism-fueled health care, the parade of ever thinner bodies across our screens and social media feeds. Amid all this dysfunction, what does recovery look like? Is it even possible to feel truly neutral about the things you eat and the way your body looks? Yes, Dr. Wassenar insists. It is.

SPEAKER_07 16:32

People get better from eating disorders and from disordered eating. And if you are sitting with that feeling of like, my life just isn't fitting together, like it just, I just can't quite get there. And there's always something more you have to do, and a new challenge you have to take on, and a new diet you have to do, a new way to eat. It will make things feel better. What I want to challenge you to do is to seek out help, ask for help, recognize that in and of itself, striving for something better all the time is a part of mental illness and can be a part of an eating disorder. And that there really is true peace on the other side of getting help for this. It can feel better. You can feel better, and recovery is absolutely possible.

SPEAKER_06 17:28

For Olivia, recovery comes with freedom, the freedom to make choices and the freedom from feeling guilt or shame about them, the freedom to try new things, and the freedom to rest, the freedom to show up fully in her life.

SPEAKER_05 17:42

There has become a different motivation behind things. For me, it was like, okay, I'm eating this food because I feel like I need to and I have to eat this way. And I think through treatment and beyond, I've reintroduced certain things into my diet. And now I feel pretty confident in that and just having a good balance in my life of letting myself, if I feel like it, I'm gonna do it. And if I don't feel like it, I'm not going to, and I'm not gonna be so hard on myself. You know, the biggest thing is just leaning into how I feel now versus how I felt then and knowing, okay, now I feel strong, I feel healthy, I feel like I can, you know, be there for the people that I love. And I wasn't able to when I was at that point.

SPEAKER_06 18:22

As for those pesky ads, ERC's public relations manager, Carla Potts, has some practical advice.

SPEAKER_04 18:30

Just start hitting that unlike, unfollow. Don't show me this. Curtail your feed so that you have things that are coming to you. But yeah, I always say there's a lot of power in the unlike, unfollow. I find this offensive. Go off and do that.

SPEAKER_06 18:52

Thank you to Carla, Olivia, and Dr. Wassenar from Eating Recovery Center Pathlight for speaking with me on this difficult subject. Listen to my full interviews with Olivia and Dr. Wassinar at patreon.com slash boulder frequency pod. If you or someone you know is struggling with any of the things we discussed today, find it free resources at EatingRecoveryCenter.com. We'll drop a more detailed link in our show notes. The Frequency's focus on health continues Friday with a trip to Colorado's largest superfund site, just up the road in Gilbin County. The Mountaineers Tyler Hickeman files the special report. Dr. Wassenar provided this week's one more thing. Before you go, here she is.

SPEAKER_07 19:42

Hope feels somewhat hard to come by. The thing that's giving me hope in spite of all of the uncertainty in the world and all of the craziness of the world is in the moments where you can still see that the world is beautiful, that nature is beautiful, that your friends love you, that you are loved, that you are sending love to the world. I think that those moments where you stop and take a breath and remind yourself that there is a big crazy world out there, but right here, in this moment, with my two feet on the ground and fresh air in my lungs, it's okay. I'm okay.