“Changing behaviour is hard, taking a pill is easy” – Professor Steve Joordens

2024 has only just begun, but some people are already saying that Ozempic is the drug of the year. The drug has (literally) been on the world’s mouths: and it isn’t something only used by celebrities or influencers. This antidiabetic (and other similar drugs, called agonists) were in huge demand after it was realized that they helped – a lot – in the process of losing weight. To give you just a little idea, this type of drug has been prescribed around 40 million times in the United States and in 2023 sales of Ozempic recorded an impressive 53% increase. And this raises several questions: what is behind this quest, often without regard for means or consequences, for weight loss and the “perfect body”? Has losing weight ceased to be an often difficult and painful process and become within anyone’s reach? Will we no longer need to diet? Is this the end of the sin of greediness?

We don’t have a crystal ball, but the answer to these questions will most likely be “no”: firstly, because it has been proven that the effects of these drugs only last as long as they are taken. This means that as soon as you stop, your appetite returns… and you gain weight. We also know that eating less is not necessarily synonymous with eating well, nutritionally speaking, and that a thin body is not, by definition, a healthy body.

Even so, some people only think about the pros and ignore the cons, with only one goal in mind: to lose weight. And when this is the case, could there be some kind of underlying psychological issue? Is the decision to lose weight increasingly influenced by society and less by the question of health and a better quality of life? Are we constantly looking for external validation? And what impact does all this have on our mental health?
These were some of the questions we asked Steve Joordens, Professor of Psychology at the University of Toronto Scarborough, in this edition of our newspaper.

Milénio Stadium: Apart from health problems, what other factors could be behind the desire to lose weight – and often without looking at the consequences? The search for the perfect body?
Prof Steve Joordens: Humans are highly social creatures and between the period where we leave our traditional families and have our own, we are very motivated to form social connections with new people, people who may become important friends or partners throughout our life. Humans also are attracted to “beauty” and thus we all know that our attempts to meet others will be easier if those others find us physically attractive. Unfortunately our concept of “beauty” is often formed by things like movies, social media, and other media sources that often push an extreme and sometimes unhealthy notion … that is an “underweight” or “overstrong” sense of what it means to be beautiful and often humans want to reach those standards even though they are not truly healthy states.

MS: Can we say that the need to lose weight is often more related to mental health issues than physical problems?
PSJ: Loneliness and isolation are at pandemic levels, and they are leading many to feel anxious or depressed. Being lonely isn’t really a mental health issue any more than being hungry is. It is our bodies telling us we need something. In the case of loneliness, the need is for social connection. The desire to lose weight is, at least in part, more of a means to an end than an end itself. So I would say it is a reaction to a psychological need, but I wouldn’t call it a mental health problem. The mental health problems are what are experienced when the need for social connection is not met.

MS: Some psychiatrists in the United States are prescribing drugs originally intended to treat Type II Diabetes to counteract the weight gain that often accompanies almost all antipsychotics and some drugs used to treat depression and anxiety. How do you look at this whole situation?
PSJ: Psychologists generally approach these challenges by promoting behavioural change, whereas psychiatrists often prescribe pills. Medications always seem to provide a “quick fix” and so many people want just that. But every drug has the intended effect, but also has a host of side effects. Moreover, even the intended effect tends to decrease over time (habituation). So often the “quick fix” does not last, and gives rise to other issues driven by the side effects. It is seldom the case that any drug provides a superior path to a solution as compared to behavioural change. But of course changing behaviour is hard, taking a pill is easy.

MS: There is a proven tendency for women to seek more radical solutions to achieve their ideal weight. Is there anything that can explain this, psychologically speaking? Low self-esteem? Pressure from society?
PSJ: I alluded to the media pushing our images of beauty, and ultimately forming them. For men, these images tend to involve strength, and while a young man might find these concepts of beauty hard to reach, the attempt to reach them is not really a bad thing as it typically involves healthy ways of being (e.g., working out regularly). For women however, the images are often of women who weigh less than the normal range, often much less, less than is healthy. These images do not just affect women, they also form partner’s goals. As a result, women may be chasing an unhealthy weight that can only be obtained through extreme behaviours like rationing food, or purging.

MS: Between medication, intermittent fasting, hypnotic gastric bands, drinking saline instead of eating… When we get to this point, can we say that there is a mental health problem that runs throughout our society, which manifests itself in this obstinate search for weight loss diets?
PSJ: Again, I wouldn’t categorize this as a mental health problem, well at least until it presents as some form of anorexia or other recognized condition. Rather, the push to be light reflects a societal force that continually reinforces unhealthy ways of being, that people cannot help but internalize and strive for.

Inês Barbosa/MS