Originally designed to treat diabetes, GLP-1 analogs are now prescribed as weight loss medications. But is this a good idea and should parents allow their kids to try this if they want to lose weight? Can these drugs increase the rates of eating disorders among young people?

Diet pills have been around for decades and historically have been pulled from the market after noting serious side effects. So, what do patients — and parents — need to know about weight loss medications? Dr. Anna B. Tanner, Vice President of Child and Adolescent Medicine for Accanto Health, shares her findings on whether these medications are safe and whether they can lead to eating disorders.

Dr. Anna B. Tanner

Dr. Anna B. Tanner (she/her) is Vice President of Child and Adolescent Medicine for Accanto Health, the parent company of Veritas Collaborative, The Emily Program, and Gather Behavioral Health. In this role, she has the opportunity to help younger patients access treatment with age-appropriate medical care. She works with child and adolescent medical sites across The Emily Program and Veritas Collaborative brands and also enjoys providing direct care to patients at Veritas’ Atlanta facility.

Dr. Tanner is driven to provide research-based medicine to young people and is passionate about preventing the long-term effects of eating disorders in children and adolescents. Medical complications in eating disorders are often treated through an age-neutral lens, yet children and adolescents have unique medical complications related to growth and development.

Dr. Tanner is a board-certified pediatrician who has specialized in the care of adolescent patients, in particular patients with eating disorders, for almost 25 years. Dr. Tanner completed medical school and residency at Vanderbilt University and then remained there to serve on the Pediatrics faculty in the Division of Young Adult and Adolescent Medicine.

Dr. Tanner has been very involved in advocacy and education efforts and serves on national and international committees for eating disorders education. She speaks frequently across the United States on the medical complications of eating disorders, especially as they affect children and young adolescents, and contributed a book chapter on that topic in the 4th edition of Dr. Philip S. Mehler’s “Eating Disorders: A Comprehensive Guide to Medical Care and Complications.”

Dr. Tanner currently serves as an Adjunct Assistant Professor of Pediatrics for Emory University School of Medicine and Morehouse School of Medicine. She is co-chair of the Academy of Eating Disorders (AED) Medical Care Standards Committee and a member of the International Association of Eating Disorders Professionals (IAEDP) Curriculum Committee. Dr. Tanner is a Fellow in the Society for Adolescent Health and Medicine (SAHM), a Certified Eating Disorder Specialist and a Certified Eating Disorders Supervisor. She has been named by Atlanta magazine as a “Top Doctor” every year from 2013 to 2023 and named by Castle Connelly as an Exceptional Woman in Medicine and one of America’s Most Honored Doctors.

Gabe Howard

Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.

To book Gabe for your next event or learn more about him, please visit gabehoward.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to the show, everyone. I am your host Gabe Howard, and calling in today we have Dr. Anna B. Tanner. Dr. Tanner is vice president of child and adolescent medicine for Accanto Health. She is a board-certified pediatrician who has specialized in the care of complicated adolescent patients, in particular patients with eating disorders for almost 25 years. Dr. Tanner, welcome to the podcast.

Dr. Anna B. Tanner: Thank you so much for having me, Gabe. I’m excited to be here today.

Gabe Howard: Let’s jump right in, because many people see weight loss drugs as a solution to the obesity epidemic facing our young people today. And in fact, many people see weight loss drugs as a solution to obesity, period. However, as a pediatrician, you feel that weight loss drugs just existing may do more harm than good.

Dr. Anna B. Tanner: Well, gosh, there’s so many components to that, Gabe, that I think we could discuss today. In general, this new move towards medications for weight loss has put a lot of focus on weight. And that in and of itself really lends itself to a lot of discussions about weight stigma in health care and medical providers and the lay public assessing health based purely on weight or BMI. And that is a really important thing that we should discuss, because weight in and of itself is not an indicator of health. And those of us in the field of eating disorders probably see this more than anyone. You can have good health at a range of body shapes and sizes. And so, I think it’s a really important to discuss that this focus on weight loss drugs and focus on weight is really taking us away from focusing on an individualized approach to health.

Gabe Howard: When you say that weight is not the end all, be all. This is not the messaging that I received growing up. I was very much told that this is the ratio that you’re supposed to be in. And if you’re outside of the ratio, you’re a little bit overweight, a lot overweight, obese, morbidly obese or dead man walking. It was weight was all we heard. Now I’m a middle-aged man and this does seem to be lightening up, for lack of a better word. I hear younger people talk today about body image and body shaming, and I think these are all good things. But even when I when I start to engage in like a real solid discussion, it’s still like, well, we still want to be pretty. I mean, it’s we don’t

Dr. Anna B. Tanner: Yeah.

Gabe Howard: Want to body shame, but we still know who is pretty and who is handsome and who is conventionally attractive. But we’re not body shaming anymore. And I’m like, but it just it seems like different words for the exact same thing. We know what we want to look like, we know what number we want on the scale. And if we don’t hit it, we just use different words to complain about it. Is that what you’re seeing in your practice?

Dr. Anna B. Tanner: So that’s such a really well phrased way to set this up, this conversation, because you’re exactly right. For young persons in today’s society, there is an exceptional drive to look a certain way and meet certain expectations. There’s a big social media factor there. But this is also something to your point that’s existed forever in society. And we know that the promotion of body dissatisfaction is as a major contributing factor to the development of eating disorders. And in fact, many years back, in a policy statement from the American Academy of Pediatrics, in their policy statement on the prevention of obesity and eating disorders, we stated that we should not promote body dissatisfaction. So, this idea that we have a society that may promote body dissatisfaction and this drive for even our youngest children to want to look a different way is really a very big problem that we need to continue to address and help our young people with and help adults with. If you’re if you start with that early in life and you’ve never addressed it, it’s not going to automatically go away when you’re grown up, no matter what other successes you have

Gabe Howard: There is so much I want to say on this topic because I want to be transparent. I’m vain. I want to look pretty. I buy the expensive clothes; I get my suit tailored. If now that I’m approaching 50, I’m like, I don’t want dad bod, right? I want to be a zaddy. I don’t know what a zaddy is, but it’s spoken about very favorably. But at the same time, I know my own struggles with weight and body image. I, I had binge eating disorder. I used to weigh 550 pounds and now I weigh 230. So, I’ve really struggled with my weight. And I do believe a large portion of my weight struggles were for health issues. I couldn’t walk from the parking lot into a building without needing a rest or losing my breath, and that’s clearly unhealthy. But I also want to be fully transparent that the big impetus for Gabe wanting to lose weight was that I wanted women to find me attractive. I wanted to date I, I, I mean, sincerely, I can’t phrase it any differently than that. And I think a lot of young people, they really do want to be attractive. And I’m not certain that’s a bad thing, unless, of course, it leaves you out. I know this is a long and cumbersome question, but I got to imagine as a pediatrician who are treating pre-teens and teenagers and even young adults, when they look at you and say, hey, look, I want to be conventionally attractive. I want to look like social media, it must be hard for you to say, well, the important thing is that you’re healthy and that you have good cholesterol.

Dr. Anna B. Tanner: Yeah. Well, first off, talking to adolescents about anything is always fraught with the fact that nothing because you’re a grown up. We’ll just establish that as our baseline. But I think it’s a really good point, right? So, it is very common to have thoughts of wanting to look different and to have thoughts of that that will help them achieve X, Y or Z in their life. So that’s a really fair thing to say, Gabe. But in addition, we know that thoughts of that become preoccupying, when persons become preoccupied, a large percent of their time and energy on their weight, their shape, their body size, the food that they’re eating, planning for that, that is when concerns that are very common in our society cross over into eating disordered thoughts and may lead to eating disordered behaviors. And I think they have to know how prevalent eating disorders are. They affect 1 in 10 Americans in the course of their lifetime. And so, this this movement from a concern which might be quite normal in our society and happens a lot into disordered thoughts that drive disordered behaviors that can lead to very significant long term irreversible medical complications or even death. It’s really important for persons listening to this to understand that that change can happen. And so, the concern around this conversation about diet medicines is if we start talking about it more, if we start promoting ways to lose weight, if we start focusing more on weight and weight loss, will this pre preoccupation force more persons into this pattern of preoccupied thoughts and lead to more behaviors and lead to more full-blown eating disorders?

Gabe Howard: It seems like medical providers are very focused on weight. How does that focus contribute to the development of an eating disorder?

Dr. Anna B. Tanner: Weight stigma amongst medical providers is very prevalent. It’s probably deeply instilled in medical culture, not for every single medical provider, but it’s there in medical culture. And it may pervade for many providers every aspect of what they’ve been trained in and how they approach all illnesses. Unfortunately, we know many patients have had experiences where they go to a medical provider for something like a sore throat and they come out with a lecture about what they should be eating and how much they should be exercising. And they may never have even had any attention paid to their sore throat. And we know that this kind of weight stigma in medicine is very hard on persons. It’s a form of discrimination. It leads to stress and it also leads to persons avoiding care because they don’t want to be back in this situation.

Gabe Howard: Diet pills were just sort of becoming a thing when I was a teenager and in my young adult years and I was excited about it. I remember them coming out now, the early diet pills, and I’m sort of making air quotes and I don’t know why, but they were basically caffeine pills that you bought over the counter. But

Dr. Anna B. Tanner: Yeah.

Gabe Howard: But then medicines came out, very popular ones that are now off the market because they caused a lot of damage. They were they were.

Dr. Anna B. Tanner: They did.

Gabe Howard: Dangerous for people to take. But they’re like, well, but they’ve used them in Europe for years. And I remember that was the marketing, used them in Europe for years very safely. And then Americans started taking them and all of a sudden heart valve issues and other just, you know, being overweight has its own health complications. But this was a medical intervention. You needed surgery. People were, it was a bad, bad scene, is really what I’m saying. But yet the diet pill conversation is still. I sort of thought that would end it. I was like, oh, wow. You know, people who were overweight took these pills and then they needed heart surgery. Like that’s a pretty convincing reason not to take diet pills. But here we are. They’re still marketed both prescription and over-the-counter. People are still taking them and people still see them as magic.

Dr. Anna B. Tanner:Yeah.

Gabe Howard: I just don’t know they seem very, very dangerous to me. Please stay tuned after the break where Dr. Tanner will tell me if I am correct in that assessment and share tips for you parents who want to talk to your teenagers?

Sponsor Break

Gabe Howard: And we’re back with Accanto Health’s Dr. Anna B. Tanner talking about eating disorders and weight loss drugs. And right before the break I asked Dr. Tanner if diet pills were dangerous.

Dr. Anna B. Tanner: I mean, I think that you’re very wise to point out that historically we have had negative medical outcomes associated with the rollout of medicines that are new, that are become widely used. And then we find these adverse medical events that that can be quite serious.

Gabe Howard: So, they’re driven by this idea that if I take this pill, I’ll look and feel better.

Dr. Anna B. Tanner: So, we’re seeing increasing stories of persons who are seeking out these medicines purely for weight loss, and they have no medical concerns or medical diagnosis attached to the use of these medicines other than a desire to lose weight.

Gabe Howard: So just to really clarify, it means they’re just unhappy with their looks. They don’t have high cholesterol. They don’t have high blood pressure. They’re they don’t have heart conditions. They’re able to run a mile or exist in society and sit in movie theater seats and play with their friends and hang out. They’re just they look in the mirror and they think, I wish I was thinner, prescribe me a drug.

Dr. Anna B. Tanner: We are definitely hearing anecdotes that that is happening. And that, of course, is concerning. It’s also concerning, Gabe, if you think about it in the context of eating disorders, right? So, if you have someone who perhaps medically does not only not need to lose weight, but perhaps medically, Gabe, should not lose weight. So, to your point, you have someone who is in perfectly good health. They have totally normal labs. They have totally normal vital signs. They have totally normal hormone function. They’re as active as they want to be, and yet they want to lose weight because of that self-perception, that over concern about body shape, size and weight. They may actually make themselves ill by taking a diet medicine, a medicine to lose weight. And we know this from our experience with patients with eating disorders that lose weight by other means. And so, again, a concern of those of us in the eating disorders field is that patients who have may lose weight and may become medically unstable or have new medical concerns because of these medicines.

Gabe Howard: As I’m listening to you speak, I think, okay, the solution is obvious. Pediatricians and doctors should just not prescribe diet pills to people who are not candidates. It seems really, really easy. Is that happening? Are pediatricians like you saying, look, I’m sorry, no, you’re not a candidate and then they can’t get a hold of the drugs and therefore this problem is resolved. Right.

Dr. Anna B. Tanner: Yeah, I think it’s such a great question. Unfortunately, all the time, Gabe. I’m seeing patients after they’ve developed an eating disorder and that’s always hard. And honestly, I always tell parents and patients not to do the shoulda, woulda, coulda done game because if they have the genetic makeup to be prone to these eating disorders, they’re very unbidden. Like all other mental illnesses. There’s a lot of genetics, there are a lot of social and environmental factors that make them at risk. And so, I always try to not backtrack and say, if this hadn’t happened, then you wouldn’t be here today. And yet I do remain concerned around physicians bringing their own weight bias into these conversations, promoting weight loss or inadvertently promoting body dissatisfaction, leading to either the use of these medicines or self-directed dieting or other eating disorder behaviors. That’s always our biggest concern. And unfortunately, again, when they present to me, that’s already happened. I’m already seeing them once they developed an eating disorder. And so, my biggest point I would make to pediatricians and to parents is to really think about a very individualized approach to every single child. What is their health? Are they as active as they want to be? What are the family’s habits around eating and activity? And looking for very individualized solutions and not simplifying it down to just if your weight was this, then everything would be better because one, socially, developmentally, that’s not normally the case. And medically, we have a lot of evidence that it might perhaps not be the case.

Gabe Howard: Dr. Tanner, I imagine that I don’t have a lot of 15-year-olds listening to my podcast, but I know that I have a lot of parents who are listening to this podcast. When their teenagers, when their young adults want diet pills and you’re talking to both them as your patient and their parents. What advice do you have for their parents and how do they feel about these conversations when you’re talking to them? Are they gung-ho for the diet pill or are parents, did they have a more nuanced viewpoint? What are you seeing from the parents to help them make the decision for their teenagers?

Dr. Anna B. Tanner: So, Gabe, I love the opportunity to talk to parents. I’m very passionate about helping parents feel like they’re doing a great job. Parents know their kid better than anybody, better than any of us as pediatricians. They’ve known them technically since the day they got them. And so, they know them best. They know what their kids are worried about. They know what their kids are like at home. They know what their kids are doing for sleep and studying and activity. They know how they eat as a family. They know their family values. And so, one thing, Gabe, that you might have heard of is this change in the field of eating disorders towards family-based treatment for eating disorders. This idea that parents know their child better than anyone and you can apply those principles of fact not just to helping children and their parents in recovery from eating disorders, but also in conceptualizing, you know, good health when maybe the child or the family is a bit off track with habits that they might like to change, that might improve their health. And so, I think it’s really important to just validate that parents know their child best. They might be looking for a fast solution. Their child might want a fast solution. But as adults, we know that, you know, things in life, you know, aren’t easy and simple solutions don’t usually get you where you want to be. And so, this idea of collaborating with families, help them achieve their best health is a really important point. And I think that you’ll see in the future in medicine that we continue to move towards this more and less, you know, more away from an older approach in medicine, very authoritarian, where the pediatrician would say, do this and do that and come back and see me and everything will be better. So, I think it’s a really important point to validate that parents are the expert when it comes to their kid, and they might have a lot of pressure to find quick changes and they might even get pressured by the medical community. But at the end of the day, they know their child best.

Gabe Howard: And what conversations are you having with parents to help them make the decision? Do you start off with this is dangerous and it’s not in their best interest? You have a more nuanced view. In general, for the parents who are listening, who are trying to decide if they should broach this with their pediatrician, what foundational knowledge can you give them to have this conversation?

Dr. Anna B. Tanner: Well, I think first you have I think it’s very important when you’re evaluating any child and weight and shape concerns to do an evaluation for an eating disorder. And so, when parents have a concern, it hasn’t usually just happened overnight. And I think it’s really important to look at the big picture. Is this a long-term issue or is this something new? And if it’s a change, what other behaviors or the parents and parents noticing? Again, it’s very important to screen for eating disorders. At a Accanto Health. We know the earlier we intervene, the better outcomes we’re going to get. And I really want to direct these conversations, these concerns to making sure first that an eating disorder is not present. And again, kind of trying to jump to a simplified solution and more an individualized evaluation.

Gabe Howard: Dr. Tanner, before we leave, is there anything else that you would like to add to this conversation?

Dr. Anna B. Tanner: Okay. If I could give any advice to your audience from the perspective of a pediatrician who’s been seeing young persons with eating disorders for more than a couple decades, just a reminder that eating disorders are an unbidden mental illness. Families don’t cause them. Patients don’t ask to have them. We are very early in our understanding of the genetic risk and the other factors that lead to these developments of these of these illnesses. And we know that eating disorders can and do get better. I would not still be in this field after this long if I didn’t see patients get well all the time.

Gabe Howard: Dr. Tanner, thank you so much for being here. How can folks find a more information or learn more online?

Dr. Anna B. Tanner: So, as you know, I’m with the Accanto Health and we have a website that’s very easy to find. It’s just Accanto.com. It’s an Italian word, A C C A N T O. And our brands are Veritas Collaborative, Gather Behavioral Health and the Emily Program. And so, there’s a lot of information across our brand and website for anybody who’s listening to this that’s worried that they might have some eating disorder behaviors or they’re concerned about their body shape and weight, that’s always a great resource is our website.

Gabe Howard: Thank you so much, Dr. Tanner, and a big thank you to all of our listeners.My name is Gabe Howard and I’m an award-winning public speaker and I could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations.” You can get it on Amazon, but you can grab a signed copy with free podcast swag or learn more about me by heading over to my website gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the show. You don’t want to miss a thing and it is absolutely free. And hey, can you do me a favor? Recommend the show, bring it up in a support group, bring it up at work, bring it up on social media. Hell, send somebody a text because sharing the show is how we grow. I will see everybody next Thursday on Inside Mental Health.

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