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. 1

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. 2

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. 3 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. 4

POSSIBLE SIDE EFFECTS: 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.

1 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.

2 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.

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

4 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. https://doi.org/10.1007/s11606-023-08433-8