GLP-1 Medications – A Fat Positive Informed Consent Model
Fat Positive Informed Consent for Glp-1 Medications – Continuing the Conversation
What Informed Consent Means… or Should Mean
In theory, informed consent means you’re given all the relevant information including risks, benefits, unknowns, alternatives, and the freedom to make a decision that aligns with your values. But in practice, especially when weight is involved, that process often gets distorted. Because, if you’ve spent years being told (explicitly or implicitly) that your body is a problem, that weight loss is the goal and that health is conditional on weight loss… is the choice really
free? And if so, at what cost?
Informed consent isn’t just a form you sign. In it’s truest form, it’s a process rooted in honesty, autonomy, and care. This is especially important in a culture where people in larger bodies are so often pressured, dismissed, or harmed in medical settings.
The Problem with Weight-Centric Framing
Most conversations about GLP-1s happen inside a weight-centric model of care. That means:
- Higher weight is treated as something that needs to be fixed
- Weight loss is assumed to be beneficial always
- Risks are often downplayed because the prescribed outcome (weight loss) is
seen as inherently worth it
I’ve heard countless variations of the same story: someone goes to a medical appointment seeking care, and weight loss is brought up right away—often before anything else is even considered.
What often isn’t shared:
- That long-term data on GLP-1s for weight loss is still evolving
- That weight cycling can have real health consequences
- That many health markers improve independent of weight loss
- That social factors including stress, access to healthcare and weight stigma have
an overwhelming impact on health
Without that context, it’s hard to call it informed consent.
Potential Harms of GLP-1s and What Often Gets Minimized
When people are told about risks, it’s often quick, clinical, and incomplete.
These medications can come with real, sometimes significant impacts:
- Ongoing nausea, vomiting, constipation, or diarrhea
- Loss of muscle mass which can affect long-term strength and metabolism
- Gallbladder issues and increased risk of gallstones
- Rare but serious complications like pancreatitis
- Under eating or nutritional gaps since hunger cues are suppressed
- And potentially more as we still don’t fully understand about long-term use at these doses
There’s also the piece that doesn’t get talked about enough: what happens after? Most people regain weight when they stop taking GLP-1s. That’s not failure, it’s biology. But the onus is put onto the individual when weight is regained which can be accompanied by shame, distress, and the very real impacts of weight stigma and cycling. That deserves to be part of the conversation upfront.
GLP-1s and Eating Disorders: An Important Conversation That’s Often Missing
GLP-1s work by dampening appetite and changing how hunger feels in the body. In a culture where disconnection from hunger is already normalized, even praised, that can be risky.
For people with a history of eating disorders, or long-term dieting, this can look like:
- Slipping back into restrictive patterns
- Feeling “rewarded” for eating less
- Losing touch with hunger and fullness cues
- Becoming more preoccupied with food, weight, or control
I’ve seen people describe it as “finally not thinking about food”. That could feel like freedom. However, it may be unhealthy suppression of natural biological cues. Katie Epstein-Candler wrote a great article on “Food Noise” if you’d like to take a deeper dive into that.
For folks navigating eating disorder recovery, these medications can be destabilizing in ways that aren’t always immediately obvious. And it’s highly troubling to see how rarely screening for eating disorders occurs before GLP-1 medication is prescribed.
If we’re not asking about someone’s relationship with food, their history, their mental health, then we’re missing a huge part of the picture.
What About the Benefits?
Exploring medication benefits is also part of informed consent, and equally important to making your decision. GLP-1 medications have benefits that are not about weight, and those can be named clearly and honestly.
Depending on the person and the context, these can include:
- Improved blood sugar regulation, especially for people with type 2 diabetes
- Reduced risk of certain cardiovascular events in some populations
- Changes in appetite regulation that may feel relieving for some people
- Potential reductions in inflammation markers
- Emerging research on benefits for conditions like PCOS, Metabolic Dysfunction-
- Associated Steatotic Liver Disease (MASLD-previously known as NAFLD), and
addiction medicine
For some people, these shifts can feel meaningful. They can improve quality of life in ways that aren’t about body size. Holding that truth doesn’t cancel out the risks, it just makes the conversation more complete.
Informed consent isn’t about steering someone toward or away from a choice. It’s about making sure they can see the whole picture.
Reclaiming Autonomy
You can invite a different kind of question. Not “How do we fix or change this body?” but “What is this person actually looking for?”
It makes room for:
- Exploring why someone is considering GLP-1s
- Naming the pressure (internal and external) that might be shaping that desire
- Supporting choices that feel grounded, not coerced
Because there’s a difference between choosing something and feeling like you have to. In a culture steeped in weight stigma, that line can get blurry. HAES and Anti-Diet Perspectives: Expanding What’s Possible
HAES and anti-diet frameworks remind us that health isn’t a number on a scale, and it isn’t something you earn by shrinking your body.
Informed consent, through this lens, includes knowing that:
- There are weight-neutral ways to support health
- Dieting/ restricting food intake and weight cycling can cause harm
- Movement, nourishment, rest, and connection matter
- Stigma itself is a health risk
- People deserve to know that weight loss is not the only path being offered, because
often, it’s presented as the only one.
Fat-Positive Care: Naming What’s Real
We can’t talk about consent without talking about power, specifically the position of power medical providers are in. Anti-fat bias is real in healthcare and it causes harm. It shapes what providers recommend, how seriously patients are taken, and what options are presented. To explore this concept more, take a look at this blog post on weight bias in healthcare written by our founder.
In the context of this implicit bias and imbalance of power, when a patient says “yes” to a medication in, it’s worth exploring what pressures were present in the room. Were they truly making this decision based on their personal values and wishes?
This difference with fat-positive care is that we don’t assume weight loss is the goal. It doesn’t treat certain bodies
as “problems”. And it doesn’t require people to change their bodies to receive respectful care. This shift in orientation changes the conditions under which consent happens.
But What if Weight Loss is the Goal?
There’s a common misconception that working with a fat-positive, weight-neutral, anti-diet provider means your desire for weight loss will be dismissed, judged, or rejected. That’s not what this work is about. Honoring your autonomy means honoring your goals, even when they include weight loss. Support doesn’t disappear. It becomes more thoughtful, more transparent, and more grounded in care.
Informed consent, in this context, is not about persuading you away from weight loss. It’s about expanding the conversation so your choices are truly yours.
This might look like:
- Exploring where the desire for weight loss is coming from (without judgment)
- Naming the very real pressures (medical, social, and cultural) that shape that
desire - Offering information about risks, benefits, and alternatives that may not have
been shared before - Making space for complexity, including ambivalence
Part of the exploration process may include conversations about weight stigma, bias, and the broader systems that influence how bodies are valued and treated. These conversations can be uncomfortable, especially when they touch on privilege or long-held beliefs. A trauma-informed, ethical provider will ask for your consent before going there and will respect your boundaries if you’re not ready.
You deserve to have the full picture, not just the parts that reinforce a single path. Your relationship with your body is lifelong, and it’s shaped by far more than individual choice. Our role is not to override your intuition, but to support it. To help you access information, context, and self-understanding so your decisions feel grounded rather than
pressured. Whether your answer is yes, no, or “I’m not sure yet,” you deserve care that stays with
you in that process.
What Ethical GLP-1 Conversations Could Look Like
Imagine a conversation where:
- Benefits and risks (physical and psychological) are clearly explained
- Eating disorder history is screened for and taken seriously
- Uncertainty is acknowledged and explored, not dismissed
- Alternatives are offered
- Saying “no” is just as supported as “yes”
No pressure, fear tactics or assumptions. Just information, context, and respect.
Resources for Deepening Understanding
If you want to explore these ideas more deeply, here are some resources:
- Weight and Healthcare Newsletter by Ragan Chastain
- Medical Students for Size Inclusivity (MSSI) “Glp-1 Agonist Informed Consent”
- The Body Trust® annual Glp-1 webinar
- Virgie Tovar and her work on Glp-1’s, fat liberation and diet culture
- “The Fat Doctor” Podcast-Dr Asher Larmie
- “Maintenance Phase” podcast episode on Ozempic
Closing Reflection
GLP-1 medications aren’t inherently good or bad. But the way they’re being talked about and prescribed matters. If people aren’t being told the full story including benefits, risks and unknowns. If eating disorders aren’t part of the conversation, if weight stigma is shaping the entire framework… then consent isn’t really informed. Everyone deserves care that honors their body, their autonomy, and their lived experience. We’re here to support your decision-making by asking thoughtful questions and offering additional perspectives you may not have considered. We hope you’ll let us help! Reach out here.
