GLP-1s, Exercise and Disordered Eating: When Losing Weight Stops Being the Whole Story
I want to start this one with a confession. When weight loss injections started taking off, I felt a knot in my stomach. Not because I think every person using them is doing something wrong, but because I kept asking myself one question: what happens when they come off?
I’ve lived with anorexia and exercise addiction. I’ve run at national level and lost that identity overnight. I know what it feels like when your relationship with food and movement becomes something that runs you, rather than something you run. So when I started seeing people go too far with appetite-suppressing medication, and then pair it with intense exercise and growing worries about their body, it felt like a perfect storm.
On a recent episode of the JenUp podcast, I sat down with Stephanie Van Shaik, a licensed mental health counsellor and founder of State of Balance Mental Health Counseling Services in the US. Stephanie is a certified dialectical behaviour therapist (DBT) and certified integrative mental health practitioner, specialising in eating disorder recovery, body image, trauma and perfectionism. She works with clients across the full range of eating disorders, including binge eating disorder, bulimia, anorexia and ARFID.
What follows is the heart of that conversation: what Stephanie is seeing in her clinic, why GLP-1s can complicate a person’s relationship with food and exercise, the signs worth noticing in yourself, and the reflective questions I wish someone had asked me years ago.
What is GLP-1 medication, and why are eating disorder professionals concerned?
GLP-1 medications began in the treatment of diabetes. Today they are widely used for weight loss, and as Stephanie put it, they’ve “come on the scene hard.”
Her concern isn’t the medication itself. It’s that, because it is so widely prescribed and easy to access, some people who would benefit more from support for disordered eating are going straight to the injection instead.
“When you are doing something to physically change yourself without addressing the mental health side of things, and what might be perpetuating these behaviours, unfortunately we’re not actually dealing with the issues.” — Stephanie Van Shaik
Stephanie compared it to gastric bypass surgery, where, in her experience, patients usually needed mental health clearance before going ahead. With GLP-1s, she’s seeing far more people willing to start treatment, including some for whom it may not be the healthiest choice.
The “food noise” problem
One of the big selling points of GLP-1s is that they quieten “food noise”: the constant thoughts about food that many people struggle with.
I’ll be honest: I find that term frustrating. It isn’t a scientific term. And from everything I’ve seen in my work, a lot of that noise comes from dieting and under-eating in the first place. When your body isn’t getting enough, of course it keeps reminding you about food. That’s what it’s designed to do.
Stephanie’s point was that muting the noise isn’t the same as resolving it.
“Once you are no longer on the GLP-1s, which ultimately is going to be the goal at some point, that all comes back. If you’re not dealing with the underlying things that fuelled the behaviours in the first place, then as soon as that’s taken away, we’re left with all the emotions and the thoughts that made your relationship with food difficult.”
Why GLP-1s and exercise can be a difficult mix
This is the part that worries me most as a personal trainer.
If you want to build or keep muscle (and muscle matters, especially while losing weight), you need to eat enough to fuel it. You have to eat to build that tissue, and you have to keep eating to sustain it. But when a medication is turning down your appetite, your body’s hunger signals stop doing their job.
Stephanie described it brilliantly:
“Food is fuel. Imagine if we just removed the fuel gauge from our cars. How are we going to know our car needs fuel? What ultimately happens is you’re left stranded on the side of the road thinking, ‘Oh gosh, what do I do now?'”
So people may be under-fuelling for the exercise they’re doing, without realising it. And when they eventually come off the medication, they’re faced with the opposite challenge: learning to eat more, to recognise hunger again, and to trust their body’s signals. That can feel completely alien, and frightening.
Intuitive eating isn’t always the first step
Stephanie made a point I think gets missed a lot. Intuitive eating, eating when you’re hungry and stopping when you’re full, is a lovely goal. But for someone with a disordered relationship with food, it usually isn’t the starting point.
“We have to regulate our bodies more before we can feel trusting of our bodies, both mentally and physically.”
GLP-1s make that harder. If you’re exercising on the medication, you may need to eat more than you physically want to, which teaches your brain to override fullness cues. That then becomes something to unpick later, once you come off.
The support gap: who is helping people learn to eat again?
Here in the UK, my understanding is that if you’re prescribed the medication through the NHS, you may be offered a support programme covering things like nutrition. If you’ve bought it privately, which many people have, you’re often left to seek out your own help. [Fact-check: NHS support/programme entitlement and any time limits on prescribing before publishing.]
Stephanie said that in the US it depends heavily on the individual doctor or clinic. Some recommend a full team; others hand over the prescription and leave people to get on with it. She’s met clients who were told almost nothing about how to eat, about hydration, or about protein.
And honestly, I don’t think a single nutrition session fixes this. What people need is mentoring through the process of learning to eat again: rebuilding hunger and fullness cues, managing the anxiety when hunger comes back, and working through the fear of weight gain that can trap people in a loop. That needs long-term attention.
What a good support team looks like
If there’s one thing Stephanie wanted listeners to take away, it was this:
“Get a treatment team if you can. We can use the GLP-1 as a tool while the noise is lessened a little. Then let’s figure out the other tools, so when you come off it you’re equipped to deal with it — nutritionally, mentally and physically.”
Ideally, that team includes:
- the prescribing clinician, who oversees the medication
- a therapist experienced in eating disorders, to work on the thoughts and beliefs driving the behaviours
- a nutrition professional, to make sure you’re properly nourished
- where movement is part of the picture, a trainer who understands disordered eating, so exercise supports recovery rather than feeding the problem
Signs your relationship with food or exercise may have become unhealthy
If something in this blog is resonating, Stephanie suggested starting by being honest with yourself, looking back as well as at the present.
Look back: why did you start?
- What led you to go on a GLP-1?
- What were your beliefs about it?
- What were you hoping it would resolve?
Notice what’s happening now
Some red flags:
- extreme anxiety about stopping the medication
- thoughts like “Once I come off, I’ll gain all the weight back,” “No one will like me,” or “I’ll have to go on another diet”
- using exercise to compensate for what you’ve eaten
- feeling intensely guilty or anxious if you don’t exercise
When neurodiversity is part of the picture
I wanted to raise this because it’s personal to me. I was diagnosed with ADHD two years ago, and looking back, the hyperfocus, the all-or-nothing drive and the perfectionism poured fuel on my eating disorder and my running. I can only imagine how that might combine with the results someone sees on a weight loss drug.
My story: when running was my whole identity
In my early twenties, I ran at national level. It was my life: my training, my focus, who I was. Then I got ill, picked up too many injuries, and couldn’t go back to it.
I lost it so suddenly. And with it, I lost my sense of who I was. A depression followed, and it was really tough.
Stephanie said she sees this a lot with runners. Being part of a sport can be wonderful: the community, the sense of belonging. But when an eating disorder is involved and something changes (an injury, or a treatment team saying you need to step back), it doesn’t just disrupt your training. It disrupts your identity.
“It’s diversity in who we are. If one thing goes by the wayside, and anything could change in an instant, then what? If we have other things that also make up who we are, it’s not such an identity shock.”
That’s what I’ve had to work hard on. I still love sport, but now I do lots of different things, and I try to remember that who I am as a person is enough. I don’t need to be defined by one thing. I’m in a really good place now, and that’s exactly why I’m so passionate about helping others find their way through it.
RED-S and losing your period: please get it checked
During my running years, I had RED-S (Relative Energy Deficiency in Sport). Put simply, my body didn’t have enough energy available for what I was asking of it. I lost my period, and so did others in my group. Nobody talked about it. Nobody checked in.
If there’s one piece of advice I give everyone, it’s this: if you lose your period, get it checked out straight away. I wish I had. I ended up with a significant hormonal imbalance that took many years to bring back into balance.
Stephanie agreed, describing a missing period as one of the first ways the body says, “Something’s wrong. Please tend to me.” It’s not just about fertility. A regular cycle matters for bone health, and Stephanie has known people in their twenties diagnosed with osteopenia, or sometimes osteoporosis, after years without a period. [Fact-check: if you’d like to add the link between oestrogen and cardiovascular health that we touched on in the episode, it should be sourced before publishing.]
We also both raised a concern about the pill being offered as the first fix. It may give you a monthly bleed, but as Stephanie said, that doesn’t resolve what’s underneath, and it can take away the marker that tells you when your body is recovering. If this is you, it’s worth having a fuller conversation with your GP or a specialist about the options.
Questions to ask yourself about your relationship with exercise
Before we recorded, I put together some reflective questions. They’re the ones I wish someone had asked me years ago. Be honest with yourself as you read them.
1. When and why do I exercise?
Exercise is there for your mental health and for fun. It isn’t there to burn off calories. Being honest about the reason is the first step.
2. How do I feel if I miss a workout?
If the answer is a lot of anxiety or guilt, Stephanie called that “a big red flag” and something worth getting help for.
3. Am I exercising because I enjoy it, or because I feel I have to?
This is my favourite. If you genuinely love it and feel great afterwards (and you’re medically cleared), wonderful. But if the thought is “If I don’t do this, I can’t have dinner later,” or “I’ll have to double up tomorrow,” or “I’m lazy,” that’s compensation, and it’s a warning sign.
4. What emotions am I trying to manage through exercise?
This one is close to my heart. I used exercise to escape my emotions. Yes, exercise is good for stress and anxiety. I tell my clients that as a personal trainer. But I took it way too far.
Stephanie’s practice is called State of Balance, and as she said, almost all her answers come back to balance:
“It could be a way to try to outrun your body image issues. A way to say, ‘I’m not feeling anything else, I’m just going to run, run, run,’ ignoring your emotions, which ultimately will catch up with you.”
5. Do I allow myself to rest without feeling guilty?
As a former athlete, I really struggled with rest. The ADHD drove the intensity, and the eating disorder told me rest wasn’t productive. But athletes need rest to perform.
Stephanie put it beautifully: rest is necessary. It isn’t optional, and it isn’t a reward you have to earn. If thoughts like “I’m lazy” or “Everyone else is doing more than me and getting ahead” come up when you rest, those are red flags too.
6. Does exercise leave me energised, or completely exhausted?
Even if you’re physically tired, movement should leave you feeling a bit better, with something left in the tank for the rest of your day.
I used to push myself to the max every single session. Nothing left. It came from a perfectionist, high-achieving place: if I hadn’t completely emptied myself, it wasn’t good enough. And when you’re doing that all the time, you’re not recovering properly or refuelling after your sessions. It took me years to work on that, because I had to work on the perfectionism driving it.
Training should challenge you, especially strength training. Everyone has the odd session where they overdo it. But more often than not, we’re aiming for that nuanced middle ground between all and nothing.
Ready to rebuild a healthier relationship with food and exercise? Book a free 15-minute consultation with me. We’ll talk about where you are now, what you’d like to feel, and whether working together is the right fit. My one-to-one support is fully online, tailored to you and your stage of recovery, and there’s no package commitment.