The Dark Side of GLP-1s No One Is Talking About
Karen Martel didn't just grow up adjacent to diet culture — she grew up inside it. Her mother ran a weight loss center. Butter was referred to as Vaseline. Popcorn was treated as the enemy. By her teenage years, Karen was deep in an eating disorder that shaped her relationship with food, her body, and her sense of self for decades. That's a front row seat most of us never sat in, and in this episode, she doesn't hold back about what it cost her.
But this episode isn't simply a look back. It's a challenge to the present. Body positivity was supposed to be the turning point — the cultural moment where women finally stepped off the scale and stopped letting a number define their worth. And for a while, it looked like it was working. Then something shifted. Somewhere in the last two years, the pendulum started swinging back. Karen has a theory about why, and it involves the very tools that have been celebrated as a breakthrough in women's health: GLP-1 medications and peptides.
This conversation goes places most discussions about semaglutide and weight-loss injections don't. It asks what happens when a medication designed to quiet food noise becomes another vehicle for old, disordered thinking. It examines where the line sits between healing and harm. And it raises an uncomfortable question about the doctors prescribing these medications — what they're checking for, and what they're missing entirely.
What We Discuss in This Episode
- How growing up in a household centered on food restriction and diet culture shapes body image and eating behavior for decades
- The uncomfortable overlap between old-school dieting mentality and today's biohacking and peptide culture
- What it actually looks like when GLP-1 use crosses from a genuine health tool into disordered eating behavior
- Why so many midlife women are afraid to admit they still count calories or obsess over the number on the scale
- The real conversation around microdosing and maintenance dosing — and why escalating to more is not always the answer
- What doctors are missing when they prescribe peptides or GLP-1 medications without a follow-up program or psychological screening
- The connection between hormone imbalance, HRT timing, and whether a woman even needs a weight-loss medication in the first place
- Why shame is the wrong response to someone using these tools — and what a more useful response actually looks like
- The long-term physical risks of GLP-1 use that are being underreported: bone density loss and the risk of malnourishment
- Who these tools are genuinely helpful for, and who may be better served by a different approach first
When Diet Culture Gets a New Prescription
The cultural story around food and women's bodies has always been complicated. But Karen's experience makes clear that when dieting is not just ambient culture but your literal home environment — when your mother's professional identity is built around weight loss — the psychological imprint runs deep.
Eating disorders are not simply a matter of willpower or vanity. They are adaptive responses to environments where the body's worth is treated as conditional on its size. When restriction is modeled as normal, the developing brain absorbs that as truth. And that truth does not simply update itself when the person grows up and is told, intellectually, that diet culture is harmful.
Karen is candid that she still catches herself in old patterns. That self-awareness is not a sign of failure — it reflects how deeply ingrained these neural pathways become. It also makes her particularly well-positioned to recognize those same patterns when they appear in new packaging.
The packaging, right now, looks like a weekly injection and a wellness hashtag.
GLP-1 medications like semaglutide were developed to treat type 2 diabetes and have demonstrated meaningful effects on weight and metabolic markers. For some women — particularly those dealing with significant insulin resistance or obesity-related health risks — they represent a genuine clinical advance. The concern Karen raises is not with the medications themselves. It is with the cultural context in which they are being prescribed, marketed, and discussed.
When a medication is positioned primarily as a way to get smaller, when before-and-after photos drive its social media presence, and when the success metric is the number on a scale rather than metabolic health or quality of life — the tool has been embedded into the same framework that diet culture always operated in. It just has a more sophisticated vocabulary.
The Blind Spot in the Prescriber's Office
Karen identifies what she describes as one of the biggest gaps in the current conversation: what happens — or more precisely, what doesn't happen — in the prescriber's office before a GLP-1 or peptide is written.
Screening for eating disorder history is not standard practice in most telehealth platforms offering GLP-1 prescriptions. Psychological readiness, relationship with food, and history of restriction are not typically part of the intake process. A woman with a thirty-year history of disordered eating can often access these medications as easily as a woman with no such history.
That is a problem. Not because women with eating disorder histories cannot or should not have access to these tools — but because using them without support, without context, and without a clinical framework that takes that history into account creates a meaningful risk that the medication will be absorbed into existing disordered patterns rather than replacing them.
Karen also raises the question of follow-up. Many women receive an initial prescription and a refill system, with little to no follow-up programming around nutrition, behavior, or psychological health. The medication suppresses appetite. What it does not do is address the underlying beliefs and behaviors around food that, without intervention, are likely to reassert themselves the moment the medication is discontinued — or to quietly run alongside it in ways the prescriber never sees.
Hormones Before Peptides — Why Timing Matters
One of the most practically useful points in this episode is Karen's argument that many women who believe they need a GLP-1 or weight-loss peptide may actually be experiencing the effects of untreated hormonal imbalance.
Estrogen loss during perimenopause and menopause has direct effects on insulin sensitivity, fat distribution, and metabolic rate. Progesterone decline affects sleep, mood, and cortisol regulation — all of which influence body composition and eating behavior. Testosterone loss affects muscle mass and energy, which in turn affects how the body uses and stores fuel.
A woman who addresses these hormonal deficits through well-timed, appropriately dosed hormone replacement therapy may find that what looked like a weight-loss medication problem is actually a hormone problem. The metabolic disruption resolves, the weight picture shifts, and the peptide question may look very different — or may not be necessary at all.
This is not an argument against peptides. It is an argument for sequencing care thoughtfully. Karen's position is that HRT optimization should be part of the conversation before weight-loss medications are introduced, particularly for women in midlife whose symptoms are likely to be at least partly hormonally driven.
Microdosing, Maintenance, and Why More Isn't Always Better
The GLP-1 conversation in mainstream wellness culture has trended toward more: higher doses, longer duration, faster results. Karen pushes back on this framing.
Microdosing — using a fraction of the clinical dose — is a legitimate approach for some women, particularly those who are sensitive to the medication's side effects or who are using it as a short-term metabolic reset rather than a long-term management strategy. Maintenance dosing, similarly, may look very different from the induction phase, and for many women a much lower dose sustains the benefits without the risks that come with sustained use at higher levels.
The risk of staying at high doses long-term without a deliberate tapering or maintenance strategy includes the very things that are not prominently featured in GLP-1 marketing: muscle loss, bone density reduction, and a caloric intake so low that adequate nutrition becomes genuinely difficult to maintain. These are not hypothetical concerns. They are increasingly documented clinical observations, and Karen argues they deserve more prominent placement in the conversation women are having about these medications.
Listen to the whole episode HERE on Apple Podcasts
Common Questions About GLP-1s, Peptides, and Disordered Eating
Can GLP-1 medications trigger or worsen an eating disorder?
GLP-1 medications suppress appetite, which may sound straightforwardly positive. For women with a history of restrictive eating disorders, however, appetite suppression can interact with existing patterns in ways that intensify restriction rather than normalize eating. A woman who was already undereating before the medication may find the medication makes it easier to eat even less — and may experience that as progress rather than a warning sign. Anyone with an active or historical eating disorder should discuss this with a clinician who specializes in both metabolic health and eating disorder treatment before beginning a GLP-1 program.
What does disordered GLP-1 use actually look like?
Disordered use is less about the medication itself and more about the motivation and behavior surrounding it. Signs that use may have crossed into disordered territory include: using the medication primarily to restrict intake as much as possible rather than to eat comfortably at a moderate deficit; measuring success only by scale weight rather than energy, strength, or health markers; feeling significant anxiety or guilt on days when appetite is higher; and resisting discontinuing or tapering the medication even when a clinician recommends it. These patterns deserve attention and ideally professional support, not shame.
Should women with eating disorder histories avoid peptides entirely?
Not necessarily — but they should not access these medications without disclosure and appropriate support. Karen's position is not that women with complicated food histories are disqualified from these tools. It is that the standard prescribing model, which does not screen for this history, is not adequate for this population. A woman who is transparent with her provider, who has access to psychological support alongside her medical care, and who is monitoring the right markers — not just weight — may be able to use these medications safely and beneficially.
What are the long-term risks of GLP-1 use that deserve more attention?
Bone density loss is an underreported concern, particularly for women already at elevated risk due to estrogen decline in menopause. [SOURCE NEEDED] The mechanism is partly related to the significant caloric reduction that often accompanies GLP-1 use: if caloric intake drops dramatically, adequate calcium, vitamin D, and protein intake become difficult to sustain, which compounds the existing risk from hormonal changes. Muscle loss — sarcopenia — is a related concern. For midlife women, losing muscle mass has compounding effects on metabolism, bone protection, and physical resilience. Resistance training and adequate protein intake are not optional add-ons to a GLP-1 program; they are, Karen argues, essential parts of using these medications responsibly.
Why do so many women feel ashamed to admit they still obsess over their weight?
Body positivity created a valuable cultural shift, but it also, for some women, created a new layer of shame: the shame of not having transcended diet culture. Admitting that you still count calories, still feel distress when the scale goes up, or still want to lose weight can feel like a failure of consciousness in a space that told you those thoughts were supposed to be behind you. Karen's point is that shame does not resolve disordered thinking — it drives it underground, where it continues to operate without support or intervention. Naming the experience honestly is the beginning of being able to address it, not a moral failure.
How do hormones affect food obsession and body image during perimenopause?
Estrogen has direct effects on mood, serotonin regulation, and the brain's relationship to reward and appetite. As estrogen fluctuates and declines during perimenopause, many women experience increased anxiety, irritability, sleep disruption, and — relevant here — a heightened preoccupation with body image and food. This is not purely psychological. It has a physiological basis. Addressing the hormonal component may meaningfully reduce the intensity of these preoccupations for some women, making it worth exploring before concluding that the problem is purely behavioral.
What should a prescriber actually assess before writing a GLP-1 prescription?
At minimum: metabolic and hormonal baseline (including thyroid, insulin, and sex hormones), eating behavior history and any disordered eating patterns, current dietary intake and adequacy, weight history and relationship with weight, and psychological readiness. Karen's broader point is that prescribing a GLP-1 without a follow-up program — one that includes nutrition support, behavioral guidance, and regular check-ins — leaves women without the scaffolding they need to use the medication in a way that produces lasting, healthy results.
Is the body positivity movement declining, and why?
Karen observes that what looked like a genuine cultural shift toward accepting diverse bodies appears, in some spaces, to be reversing. She attributes this partly to the mainstreaming of GLP-1 medications, which have introduced a newly accessible and socially legitimized path to significant weight loss. When weight loss becomes easy to discuss as a medical intervention rather than a personal choice, some of the social pressure that body positivity had begun to dismantle re-enters through a different door — with a clinical vocabulary that makes it harder to challenge.
About Karen Martel
Karen Martel is a Certified Hormone Specialist, Transformational Nutrition Coach, and weight loss expert based in Canada. As the host of The Hormone Solution Podcast, she has spent years helping women in perimenopause and menopause understand the hormonal drivers of their symptoms — and pushing back on a medical culture she believes too often dismisses what midlife women are experiencing. Her work integrates hormone optimization, metabolic health, and an increasingly frank conversation about the psychological dimensions of weight loss and body image in midlife.