GLP-1 Medications for Weight Loss: Is Informed Consent Possible Without an Understanding of Weight Stigma?

Body autonomy is a central tenet of weight-inclusive healthcare. Under most circumstances, people get to exercise their right to make decisions about their own bodies, including the decision to pursue intentional weight loss with a GLP-1 medication.

Informed consent is what makes that autonomy meaningful in a medical setting. It requires clear information about a treatment’s potential benefits, side effects, risks, and alternatives. It also requires the ability to provide consent free from coercion, shame, or pressure.

Consenting to weight-loss treatment with GLP-1 medications is therefore complicated within a culture and medical model that repeatedly tells people in larger bodies that they are unhealthy, unattractive, irresponsible, and in need of change. When becoming smaller is treated as an unquestioned medical and societal good, how can we ensure that a desire for weight loss on the part of both the individual and medical provider is not driven by the powerful pressures to pursue it?

Internalized weight bias can affect informed consent

People in larger bodies often experience discrimination and many come to believe that this mistreatment is somehow their fault. This is known as internalized weight bias. A 2017 survey of 3,504 U.S. adults found that internalized weight bias is common across genders and body sizes.[i] 

In healthcare settings, people of size often receive unsolicited weight-loss advice, struggle to access appropriately sized medical equipment, or have symptoms dismissed or attributed to weight without adequate medical investigation. As a result, many delay or avoid medical care because they expect to be judged, dismissed, or told to lose weight rather than receive treatment for the concern that brought them in. A 2018 survey of 313 women found that higher BMI was associated with both internalized and externalized stigma, which in turn predicted body-related shame and health care stress, leading to delayed or avoided care.[ii]

Weight stigma extends far beyond the doctor’s office, shaping how people in larger bodies are perceived and treated throughout society. In a peer-reviewed study involving 1,506 participants, people of size were rated as less evolved and less fully human than thinner people.[iii] This broad social acceptance of weight stigma can be seen in employment, education, public spaces, relationships, media, clothing access, and everyday interactions.

In a society where weight stigma is pervasive, a prescription promising a smaller body may feel like more than another medical option. It may seem like an opportunity to escape shame, judgment, exclusion, and discrimination. People may come to believe that becoming thinner is their best, or only path to improved health, acceptance, respect, and medical care. But when these internal and external pressures are present, we must ask whether people are being given the freedom and context needed to make a truly informed choice. 

External weight bias can lead to minimized risks and obscured alternatives

Weight bias not only influences one’s desire for weight loss treatment. It also affects how healthcare professionals present and evaluate the risks, side effects, and alternatives to GLP-1 medications. In 2023, a large U.S. study of resident physicians found high levels of explicit weight bias, with many participants agreeing with openly anti-fat statements. The findings are consistent with earlier research showing that weight bias is common in medical training and may be socially accepted within some clinical environments. As a result, higher-weight patients face a meaningful risk of receiving care from physicians who hold negative assumptions about their bodies.[iv]

GLP-1 medications can cause nausea, vomiting, diarrhea, constipation, abdominal pain, fatigue, dizziness, and indigestion. Labels also warn about pancreatitis, gallbladder disease, kidney injury associated with dehydration, severe gastrointestinal reactions, increased heart rate, and complications during anesthesia or deep sedation. Reduced appetite may make it difficult for some people to eat enough or meet their nutritional needs. Weight loss can also include the loss of muscle and other lean tissue, not only body fat. Treatment may affect a person’s energy, ability to enjoy food, social experiences, emotional well-being, and overall quality of life.

These side effects may be minimized or reframed as acceptable because weight loss is so highly valued within our culture and medical system. Nausea may be treated as evidence that the medication is working. Difficulty eating may be celebrated as freedom from hunger. Rapid weight loss may receive praise even when a person feels weak, dehydrated, preoccupied with food, or unable to nourish themselves adequately. Eating very little or losing weight rapidly, which might cause alarm in a thin person, may be viewed as successful treatment in a larger person. When becoming smaller is treated as the ultimate goal, it becomes easier to overlook the physical and emotional cost of getting there.

Meaningful informed consent requires providers to understand their own biases about the correlation between body size and health, so they can provide patients with weight-neutral treatment options rather than presenting weight loss with a GLP-1 as the obvious or best treatment option.

Informed consent requires an understanding of bias

Some will decide that a GLP-1 medication for intentional weight loss is right for them. Others will not. Both choices deserve respect. However, people deserve the freedom to say yes or no to GLP-1 medications without being told, directly or indirectly, that a smaller body is their only path to health, dignity, acceptance, or a full life. They deserve to understand their own biases, as well as those of their medical providers, when determining their best course of treatment. Support from a Health at Every Size®–aligned therapist can help people explore if weight stigma and internalized beliefs about body size are shaping their treatment options. The goal is not to influence the decision in either direction, but to help each person make a choice that is genuinely their own.

[i] Puhl, R. M., Himmelstein, M. S., & Quinn, D. M. (2017). Internalizing weight stigma: Prevalence and sociodemographic considerations in US adults. Obesity, 26(1), 167–175.

[ii] Mensinger, J. L., Tylka, T. L., & Calamari, M. E. (2018). Mechanisms underlying weight status and healthcare avoidance in women: A study of weight stigma, body-related shame and guilt, and healthcare stress. Body Image, 25, 139–147.

[iii] Kersbergen, I., & Robinson, E. (2019). Blatant dehumanization of people with obesity. Obesity, 27(6), 1005–1012.

[iv] Philip, S. R., Fields, S. A., Van Ryn, M., & Phelan, S. M. (2023). Comparisons of explicit weight bias across common clinical specialties of US resident physicians. Journal of General Internal Medicine, 39(4), 511–518.