November is here, and that means the holiday season is upon us. I always feel ambivalent about this time of year. On the one hand, I do enjoy spending time with family and friends that I don’t see very often, and Thanksgiving foods are some of my favorites. On the other hand, seeing family and friends whom I haven’t seen in a while can be somewhat nerve-wracking. Even though Jonah and I are very firm in our HAES and fat-positive beliefs, many of our family members are entrenched in diet (or “health”) culture, so naturally there will sometimes be triggering conversations.
As we approach Thanksgiving, many of my patients are concerned about interacting with family members and friends who have started taking GLP-1s over the past year for weight loss. As I am sure you are aware, these medications have skyrocketed in popularity over the past few years, with seemingly everyone under the sun taking them. The pharmaceutical companies and the government are making these drugs more available and affordable than ever before. According to the Journal of the American Medical Association (JAMA), about 12% of American adults have tried a GLP-1 for weight loss, with 6% using them currently. Obviously, the drug is most widely prescribed to treat Type 2 diabetes, but JAMA also reports that of the people who are taking GLP-1s for weight loss, approximately 22% of people classified as “obese” or “overweight.” As of 2024, the US population is over 340 million people, so that means that about 20 million people in the US are currently using these medications.
Given this information, it is quite possible that one or more of your friends and family members will be currently taking GLP-1s when you see them for the holidays. Considering Thanksgiving is traditionally known for the abundance of highly palatable and “special” foods (in addition to being thankful to be with our loved ones), there is also likely to be some awkwardness and possibly even some very triggering conversations and food situations occurring. The main purpose of GLP-1s is to decrease the user’s appetite by greatly slowing down digestion. This means that most individuals who use these medications are either not hungry at all, or when they do eat, they feel fuller much faster, leading them to not eat much.
My patients who are not taking GLP-1s are concerned that they will feel “gluttonous” in comparison to their GLP-1-taking friends and family members. Some of my patients report feeling anxious to even eat “normally,” as it will be uncomfortable to watch their loved ones on these medications hardly eating at all. This anxiety makes sense to me. Since the beginning of humanity, food has been a way for us to connect with each other, to show love, to carry on traditions, and to nourish each other. In my opinion, it feels unnatural (and honestly sad) to try to enjoy a Thanksgiving meal with people who are unable or unwilling to eat.
Virgie Tovar, a fat activist who writes about fat acceptance, anti-fat bias, and diet culture, just recently published a newsletter piece on her Substack about getting invited to a “GLP-1-Friendly Thanksgiving,” which is both hilarious and terrifying at the same time. The invitation she received included a “menu” for the Thanksgiving party that included everything but traditional Thanksgiving fare, including “mini protein bombs,” “high-fiber dips with spinach and white beans,” and “anti-bloat snacks with oatmeal and probiotics.” It goes without saying that Virgie politely RSVP’d no to this invitation, and just the thought of a Thanksgiving centered around these diet culture foods gives me anxiety.
In addition to the food restriction and awkwardness that may occur, some of my patients are scared to see how much thinner their friends and family members have become since taking these medications. All of these patients believe in bodily autonomy and that everyone has the right to take these medications, but it doesn’t change the fact that when family members/friends lose a lot of weight intentionally, it can be jarring. We live in a fat-phobic society, and it feels like the anti-fat sentiment is lately at an all-time high. Existing in a larger body (and not pursuing weight loss or engaging in diet culture) can feel like a radical act. It is hard to spend time with friends/family who have made it clear that they don’t want to look like you anymore, that being in a larger body is something to be ashamed of and avoided at all costs, all under the guise of “health.” Of course, none of my patients would ever comment on anyone’s body or what they are eating (or not eating), but it doesn’t take away from the discomfort that can arise during these get-togethers.
So, what are we supposed to do about this? About eight years ago, I wrote a blog about surviving the holidays when your friends/family are stuck in diet culture. I still stand by everything I wrote in that blog, obviously, but I wanted to add to it because of the huge impact GLP-1s are having on all of us (not just those taking the medications). If you are having a hard time being around folks who are restricting/not eating/talking about weight loss, or demonizing foods, you can choose to not engage. That could look like pardoning yourself from the table and taking some space, changing the conversation to a different topic, or even talking to family members/friends ahead of time about your concerns. I hope that all of our readers can survive (and even enjoy) this holiday season amidst the GLP-1 craze. Happy holidays!