Cassie Hayward: This podcast was made on the lands of the Wurundjeri people,
Cassie Hayward: the Woi Wurrung and the Bunurong. We'd like to pay
Cassie Hayward: respects to their elders, past and present, and emerging.
Nick Haslam: From the Melbourne School of Psychological Sciences at the University
Nick Haslam: of Melbourne, this is PsychTalks.
Nick Haslam: Welcome back to a new season of PsychTalks. I'm Nick
Nick Haslam: Haslam and I'm joined as always by my co-host, Cassie Hayward.
Cassie Hayward: Hi Nick, great to be back in 2025.
Cassie Hayward: And for anyone new, we're here to explore the latest
Cassie Hayward: research in psychology and neuroscience with our brilliant experts at
Cassie Hayward: the University of Melbourne School of Psychological Sciences. We break
Cassie Hayward: down the science behind how our mind works and what
Cassie Hayward: these insights might mean for you at home.
Nick Haslam: That's right. And this season of psych talks is set
Nick Haslam: to be a cracker. We'll be getting our teeth into
Nick Haslam: some really fascinating research, like how
Nick Haslam: self-compassion could ease the pathway through menopause. And why misinformation
Nick Haslam: has spread so rapidly online, just to name a few.
Cassie Hayward: I can't wait. Now, today we're talking about Ozempic and
Cassie Hayward: other GLP-1 receptor agonists, drugs that have become hugely popular
Cassie Hayward: for weight loss. But there's a lot more to the
Cassie Hayward: story than just numbers on a scale, especially when it
Cassie Hayward: comes to their interactions with disorders like binge eating. Our
Cassie Hayward: colleague and guest, Dr Trevor Steward, is investigating what these
Cassie Hayward: medications do to the brain, not just our bodies.
Nick Haslam: Welcome to PsychTalks, Trevor.
Trevor Steward: Thanks for having me.
Cassie Hayward: It's a fascinating area, Trevor, but could you start by
Cassie Hayward: telling us a little bit about your background and your
Cassie Hayward: research interests and how you've ended up studying Ozempic?
Trevor Steward: Yeah, sure, Cassie. So, my background is in psychology. I
Trevor Steward: did my undergraduate degree in the United States and then
Trevor Steward: now
Trevor Steward: Afterwards moved to Spain to specialise in neuroscience and during
Trevor Steward: my PhD I was embedded in an eating disorders unit
Trevor Steward: in a public hospital and it was there that I
Trevor Steward: really saw firsthand the burden of eating disorders and how
Trevor Steward: much they can impact people's both physical and psychological well-being
Trevor Steward: as well as their caregivers.
Trevor Steward: And what really struck me was that there weren't any brain-
Trevor Steward: based interventions available for these disorders. You know, anorexia nervosa
Trevor Steward: is a perfect example. I recently went to a conference
Trevor Steward: and there was a professor there who got into psychiatry
Trevor Steward: and eating disorders, and he said in 1970, there wasn't
Trevor Steward: a single approved medication for anorexia nervosa.
Trevor Steward: And there still isn't a single approved medication for anorexia nervosa.
Trevor Steward: So that just really makes it evident that we need
Trevor Steward: to understand these disorders more in depth. Then I moved
Trevor Steward: to the University of Melbourne in 2019 and that's where
Trevor Steward: I sort of expanded my research program. But then just
Trevor Steward: in the past two years, much like everyone in in society,
Trevor Steward: we've really been awed by the emergence of these new
Trevor Steward: medications called GLP-1 receptor agonists.
Trevor Steward: Uh, for example, Ozempic, and these medications are absolute game
Trevor Steward: changer in the in the realm of treating obesity. And
Trevor Steward: then with more people using these, we started to get
Trevor Steward: more anecdotal evidence around other psychological effects that they're having
Trevor Steward: that are related to eating behaviours and eating disorders. And
Trevor Steward: so that's where I want to step in and try
Trevor Steward: to understand what's going on on a neurobiological level.
Nick Haslam: So you talked about Ozempic - can you give us a
Nick Haslam: quick definition of what kind of drug it is, what
Nick Haslam: other drugs are in that class, and what they've mostly
Nick Haslam: been used for before they became revolutionary in this area
Nick Haslam: of weight?
Trevor Steward: Yeah, for sure. So when we talk about drugs like Ozempic,
Trevor Steward: we're actually talking about a broader class of medication known
Trevor Steward: as GLP-1
Trevor Steward: receptor agonists. Now, GLP-1 stands for glucagon-like peptide-1. Don't worry,
Trevor Steward: you don't have to remember that. Which is a naturally
Trevor Steward: occurring hormone in the body involved in the regulation of
Trevor Steward: blood sugars. Now, after we eat, GLP-1 helps us to
Trevor Steward: stimulate the secretion of insulin, which lowers our blood glucose,
Trevor Steward: while then also, um, you know, helping to regulate our appetite.
Trevor Steward: Now, what we can do with these medications is basically
Trevor Steward: mimic the effects of this naturally occurring hormone, which will
Trevor Steward: then slow, for example, our gastric emptying, our digestion, that
Trevor Steward: makes us feel fuller for longer. And it also um
Trevor Steward: does other things in terms of metabolic health and uh
Trevor Steward: regulating insulin levels. Now, Ozempic is the most famous of
Trevor Steward: these types of medications, but its generic name is actually semaglutide.
Trevor Steward: Um, there's some several other ones out on the market
Trevor Steward: now that you might have heard of, for example, Mounjaro
Trevor Steward: or Zepbound, and all of these compounds are quite similar
Trevor Steward: in the sense that they mimic this GLP-1 hormone. Now, historically,
Trevor Steward: these medications were used to treat type 2 diabetes and
Trevor Steward: what they found was that these individuals who are using
Trevor Steward: these GLP-1 medications to regulate their diabetes were also losing weight.
Trevor Steward: And then someone came up with a genius idea of saying, oh,
Trevor Steward: what would happen if we really upped the dose of
Trevor Steward: these medications in people with obesity? Would they also lose weight?
Trevor Steward: And that's when we started to see the emergence of
Trevor Steward: these compounds. And there have been some very large clinical
Trevor Steward: trials for people with obesity that have found that it
Trevor Steward: can help people to lose weight, um, at levels that
Trevor Steward: you can't really ever see with other types of interventions. Um,
Trevor Steward: apart from that, it's also there's now emerging clinical trials
Trevor Steward: that have found that it's effective for conditions like sleep
Trevor Steward: apnoea or for fatty liver disease, and so we're only
Trevor Steward: um at the tip of the iceberg in terms of
Trevor Steward: what is indicated uses could be.
Cassie Hayward: As you say, there's been this huge buzz about what
Cassie Hayward: these drugs can do from a weight loss perspective.
Cassie Hayward: But that's not entirely your focus, is it? You're looking
Cassie Hayward: at what they might also be doing to the brain.
Cassie Hayward: Can you tell us a little bit about what you're
Cassie Hayward: doing there?
Trevor Steward: Yeah, exactly. And so, um, our, uh, study is going
Trevor Steward: to be examining the effects of tirzepatide, which is also
Trevor Steward: known as Mounjaro or Zepbound, in adults with binge eating disorder.
Trevor Steward: Binge eating disorder is a very serious eating disorder. It's
Trevor Steward: the most prevalent eating disorder. Um, there's more people living
Trevor Steward: with eating disorder than bulimia nervosa or anorexia nervosa combined.
Trevor Steward: And binge eating disorder is characterised by the presence of
Trevor Steward: binge eating episodes, which are characterised by people eating large
Trevor Steward: amounts of food for a short amount of time, often
Trevor Steward: accompanied by feelings of loss of control, guilt, shame, and
Trevor Steward: they really get locked into this really
Trevor Steward: Um, difficult, entrenched cycle that impacts your quality of life
Trevor Steward: and impacts their health and makes it very difficult for
Trevor Steward: them to maintain a positive wellbeing. Whereas bulimia nervosa does
Trevor Steward: have bingeing episodes, but it's also characterised by the presence
Trevor Steward: of compensatory behaviours. So that could be, for example, someone
Trevor Steward: self-inducing vomiting or, you know, exercising to excess to try
Trevor Steward: to compensate for the previous binge eating episode.
Trevor Steward: And what we're interested in this study is to try
Trevor Steward: to understand how tirzepatide
Trevor Steward: impacts the brain processes linked to some of these core
Trevor Steward: eating disorder symptoms such as compulsions to eat, impulsivity around food,
Trevor Steward: or what you as often um heard of in social media,
Trevor Steward: food noise, which is these intrusive thoughts around food where people,
Trevor Steward: for example, can't get this idea out of their head
Trevor Steward: of how they're planning to binge eat.
Trevor Steward: Or a certain type of food that they would like
Trevor Steward: to eat. Now, there's a lot of anecdotal evidence around
Trevor Steward: drugs like Ozempic or tirzepatide, being able to lower the
Trevor Steward: volume of these intrusive thoughts around food. However, on a
Trevor Steward: neurobiological level, we just don't understand how this is occurring
Trevor Steward: and why this is happening. There are GLP-1 receptor, um,
Trevor Steward: GLP-1 receptors located throughout the brain.
Trevor Steward: But it's not really clear why uh a drug that's
Trevor Steward: targeting the gut would have such a huge impact on
Trevor Steward: these brain processes. And so we're really interested in trying
Trevor Steward: to interrogate that further.
Nick Haslam: It is a bit surprising, as you said, I mean,
Nick Haslam: if the drug is primarily slowing the gastric processing or whatever, Uh, emptying,
Nick Haslam: is that what you, what you said? Uh, how does that,
Nick Haslam: how does that, um, have any effect whatsoever on attention
Nick Haslam: you pay to certain thoughts or any of the other
Nick Haslam: processes involved in binge eating disorder?
Trevor Steward: No, that's a great question, Nick. And so we're stipulating
Trevor Steward: this is mainly based off of animal research because we
Trevor Steward: really don't have that much evidence in humans yet around
Trevor Steward: us that by um lowering or slowing down the gastric
Trevor Steward: emptying process, you are impacting food reward pathways. And so
Trevor Steward: For example, dopamine is probably the most well known neurotransmitter
Trevor Steward: out there. It's very much linked to motivation to find rewards.
Trevor Steward: And so if you are able to slow down the
Trevor Steward: emptying of someone's stomach and say, OK, now you don't
Trevor Steward: need to find that reward. That reward isn't as salient
Trevor Steward: for you anymore. Or if, if you even did find
Trevor Steward: that reward, you wouldn't get as much pleasure from it
Trevor Steward: as you would have previously. That's going to lead to
Trevor Steward: neurobiological changes that extend beyond the gut. It's going to
Trevor Steward: mean that these cues
Trevor Steward: around food are no longer as salient as they used
Trevor Steward: to be, or even the predictions that you make within
Trevor Steward: your mind about whether this, um, food will give you pleasure,
Trevor Steward: will start to be diminished. And so that really offers
Trevor Steward: a lot of hope for people with binge eating disorder
Trevor Steward: because it's breaking that cycle of like, oh, if I
Trevor Steward: want to find relief from the stressors of everyday life,
Trevor Steward: or I find myself entrenched in this pattern where as
Trevor Steward: soon as I come home, I start eating one thing,
Trevor Steward: which then leads to me eating everything in the kitchen.
Trevor Steward: That's essentially pumping the brakes on that because it's saying, oh,
Trevor Steward: this medication is telling me that, maybe that's not gonna
Trevor Steward: work for me this time.
Nick Haslam: If it's changing pathways, or if it's in some way,
Nick Haslam: you know, breaking patterns in the way you say.
Nick Haslam: Does that imply that potentially after a course of treatment
Nick Haslam: with the drug, the problem might be fixed as it were,
Nick Haslam: or does it imply that instead you have to continue
Nick Haslam: to use indefinitely?
Trevor Steward: Yeah, and so there's a lot of unknowns around that,
Trevor Steward: and that's something that we are particularly cautious around for
Trevor Steward: this study because studies in
Trevor Steward: individuals with obesity have found that when individuals stop taking
Trevor Steward: these medications that most often it's accompanied by weight regain,
Trevor Steward: not necessarily to the same level that they had before,
Trevor Steward: they began using the drug, but they do go back
Trevor Steward: to or the weight is gained again.
Trevor Steward: And also anecdotal evidence has shown that individuals who stopped
Trevor Steward: taking the drug also report the re-emergence of, you know,
Trevor Steward: intrusive thoughts around food or compulsions to eat and cravings.
Trevor Steward: And what I'm really concerned about in this population is
Trevor Steward: we're talking about people here with this severe psychiatric disorder
Trevor Steward: and often they will report that starting to take these medications,
Trevor Steward: opens up a lot of mental space for them. They
Trevor Steward: feel as if they're, you know, much freer than they
Trevor Steward: had been before or
Trevor Steward: ever in their lives around the relationship with food. But
Trevor Steward: what would happen if they were to suddenly stop taking
Trevor Steward: this medication? Would these intrusive thoughts come back with a vengeance?
Trevor Steward: Would they, for example, feel as if they had failed?
Trevor Steward: And so we have to have a lot of care
Trevor Steward: when we're dealing with this population and this medication. So
Trevor Steward: that's why for this study we're using a multidisciplinary team
Trevor Steward: involving psychiatrists, endocrinologists, and importantly, clinical psychologists that will be
Trevor Steward: delivering CBT in conjunction with the tirzepatide.
Nick Haslam: So, obviously, it's early days and you haven't got all
Nick Haslam: your findings yet, but is it your sense that you
Nick Haslam: can't simply give someone a prescription and expect it to
Nick Haslam: be beneficial overall for binge eating disorder, you'd need to
Nick Haslam: have adjunct treatments as well?
Trevor Steward: I would advocate for that position. I don't think the
Trevor Steward: evidence is there to say that tirzepatide alone or any
Trevor Steward: other GLP1 receptor agonist alone is enough to treat, uh,
Trevor Steward: an eating disorder or binge eating disorder specifically. And it's
Trevor Steward: also important to remember that psychiatric disorders
Trevor Steward: rarely exist in isolation. They're often accompanied by comorbid, um,
Trevor Steward: for example, anxiety disorders or depressive disorders. And so, yes,
Trevor Steward: this medication may prove to be effective at treating some
Trevor Steward: of the core symptoms of binge eating disorder or reducing
Trevor Steward: the frequency of bingeing episodes, but that doesn't mean that
Trevor Steward: it's gonna necessarily help the patient to deal with, for example,
Trevor Steward: the underlying trauma that caused them to use binge eating
Trevor Steward: episodes as a form of coping.
Trevor Steward: Or for example, if it will then lead to, OK,
Trevor Steward: less mental space is being dedicated to seeking out food
Trevor Steward: or that type of reward, but then now they're gonna
Trevor Steward: be spending more time thinking about, you know, for example,
Trevor Steward: entrenched negative thought patterns or anxious thought patterns. And so
Trevor Steward: that's why I think from a duty of care perspective,
Trevor Steward: we need to accompany it with CBT, which we know
Trevor Steward: is effective for some individuals with binge eating disorder.
Nick Haslam: So by CBT, Trevor, you mean cognitive behaviour therapy.
Trevor Steward: That's right.
Cassie Hayward: So just on that, you mentioned the food noise issue,
Cassie Hayward: and you see that a lot on social media, just anecdotally,
Cassie Hayward: people talking about these drugs, just dialling down that noise.
Cassie Hayward: And you mentioned that with obesity and binge eating disorder.
Cassie Hayward: Are you saying that there's not clinical evidence that that
Cassie Hayward: that's actually happening, or we just don't know the pathways
Cassie Hayward: by which that food noise dials up and down?
Trevor Steward: Yeah, that's a great question. So the, the situation is
Trevor Steward: that the evidence is lacking. Um, most of these randomised
Trevor Steward: control trials weren't specifically looking at intrusive thoughts around food.
Trevor Steward: Their main primary outcome measure was weight loss, changes in BMI,
Trevor Steward: and some of them maybe they had a questionnaire around
Trevor Steward: food cravings pre-post, 6 months later after taking it, but
Trevor Steward: they're not really
Trevor Steward: getting into the granular details of how food cravings are
Trevor Steward: being modified, and when it's happening to these participants, or
Trevor Steward: even their food choices. And so for our city, what
Trevor Steward: we'll be using is something called ecological momentary assessment or EMA,
Trevor Steward: which essentially uses prompts on participants' mobile phones to ask
Trevor Steward: them throughout the day how they're feeling from a mood
Trevor Steward: and affect point of view.
Trevor Steward: Some of their core binge eating behaviours and also how
Trevor Steward: they're feeling around food cravings because I'm really interested in
Trevor Steward: trying to understand the dynamics, the temporal dynamics of what
Trevor Steward: happens first is it the food cravings that happen and then
Trevor Steward: that go down and then the bingeing episodes that disappear
Trevor Steward: or is it the other way around, or are the
Trevor Steward: folks that respond best, the ones that lose the cravings
Trevor Steward: right away and we don't really have that richness in
Trevor Steward: the data yet at all. But I'm also concerned around
Trevor Steward: the way that food noise is being used in social
Trevor Steward: media because
Trevor Steward: there's a lot of evidence demonstrating that people that with
Trevor Steward: an eating disorder
Trevor Steward: Suffer from problems with interoception. When I say interoception, it
Trevor Steward: means that someone's ability to perceive internal bodily states, and
Trevor Steward: that could be, for example, feelings of fullness, uh, you know,
Trevor Steward: feelings of hunger, or even simple things like, you know, um,
Trevor Steward: being able to count one's heart, heart rate or, you know,
Trevor Steward: sensitivity to touch. And we don't understand whether or not
Trevor Steward: these medications are gonna impact those interoceptive pathways as well.
Trevor Steward: We have evidence
Trevor Steward: showing that there's a risk of people with obesity taking
Trevor Steward: these medications, often skipping meals or eating very little because
Trevor Steward: they don't feel hunger. And these GLP-1 medications are maybe
Trevor Steward: working too well if weight loss is your primary objective,
Trevor Steward: which we, I really want to reiterate, isn't the primary
Trevor Steward: objective in this population. Our our interest is understanding how
Trevor Steward: it impacts the brain and how it impacts binge eating behaviours,
Trevor Steward: not necessarily weight.
Trevor Steward: And when we're talking about a population that's so used
Trevor Steward: to this, you know, restrictive and then binge eating cycle
Trevor Steward: that's been probably defining a lot of their adult life,
Trevor Steward: we have to be extremely cautious around whether or not
Trevor Steward: this medication is hijacking those interoceptive pathways and not allowing
Trevor Steward: them to eat in a healthy way.
Cassie Hayward: And the food noise, as you say, there's a lot
Cassie Hayward: of anecdotal stuff on, on TikTok, recognising that's not the
Cassie Hayward: most scientific kind of way of gathering data, but I
Cassie Hayward: was looking at some TikToks in preparation for this. And
Cassie Hayward: the way people talk about food noise being turned off
Cassie Hayward: with these medications is just fascinating and
Cassie Hayward: I was listening to one woman from Australia, and she
Cassie Hayward: said she started taking Ozempic, and she said, Is this
Cassie Hayward: how normal people live every day? She said, she had
Cassie Hayward: no idea how much of her brain power was being
Cassie Hayward: taken up with, you know, and it wasn't binge eating,
Cassie Hayward: it was, it was mild obesity, but she was saying,
Cassie Hayward: I was constantly thinking about, well, should I eat this?
Cassie Hayward: And if I eat this, what do I have to
Cassie Hayward: do and what exercise will I do to counteract it?
Cassie Hayward: And she said, once she started taking this, that just
Cassie Hayward: simply went away, which is fascinating from a kind of
Cassie Hayward: brain function point of view.
Cassie Hayward: But as you say, with your binge eating disorder, um, clients, uh, population,
Cassie Hayward: if that then goes away and
Cassie Hayward: The trauma that might be underlying the binge eating disorder
Cassie Hayward: then takes over. How do you balance that kind of,
Cassie Hayward: maybe the food noise goes away, but is it worse
Cassie Hayward: then to have the trauma take up more space?
Trevor Steward: Yeah, that's a really good question. And what you described
Trevor Steward: there from the TikTok evidence, uh, is actually very commonly
Trevor Steward: reported in, in just based on, you know, my interactions
Trevor Steward: with endocrinologists and GPs and what their uh patients are
Trevor Steward: telling them.
Trevor Steward: And I think when you imagine someone with binge eating disorder,
Trevor Steward: imagine that dialled up to 11, you know, they're basically
Trevor Steward: constantly thinking about, OK, well, when I finish this activity,
Trevor Steward: I'm gonna go home and I want to binge or
Trevor Steward: this is gonna be my way of managing the situation
Trevor Steward: and
Trevor Steward: they want relief from that. I remember just seeing firsthand
Trevor Steward: when I was working in the disorders unit, how much,
Trevor Steward: how debilitating these intrusive thoughts were. It wasn't just around
Trevor Steward: the food itself, it was the actual act of binge
Trevor Steward: eating and just being able to carry out those motions
Trevor Steward: of eating to find that relief. And so if we
Trevor Steward: can open up that mental space for them by giving
Trevor Steward: them this this medication, our hope is that it will
Trevor Steward: then allow them to engage in a more effective way
Trevor Steward: with therapy.
Trevor Steward: Because often a big part of CBT is, for example,
Trevor Steward: identifying triggers, restructuring negative thought patterns, but if you've gone
Trevor Steward: through multiple courses of CBT and you're finding like, oh,
Trevor Steward: this still isn't helping me stop this compulsive behaviour.
Trevor Steward: Maybe it's time to find something else that can sort of,
Trevor Steward: you know, tip the scales a little bit and allow
Trevor Steward: that intrusiveness to go down and then to be able
Trevor Steward: to face the other issues going on around it. I
Trevor Steward: think the same goes as well in terms of other
Trevor Steward: things like meal planning, or for example, one thing that
Trevor Steward: I'm particularly concerned about around is
Trevor Steward: with this population is, most people with binge eating disorder
Trevor Steward: do have obesity. They're going to be somewhere between 70
Trevor Steward: and 80%. And so I'm concerned that these individuals, most
Trevor Steward: likely based on the evidence we have, will begin to
Trevor Steward: lose weight over the course of the study because it's
Trevor Steward: going on for 24 weeks. And they're going to start
Trevor Steward: to receive messages from society, from their peers, from colleagues
Trevor Steward: around their body shape. And this is going to start
Trevor Steward: to internalise, you know,
Trevor Steward: fat biases, you know, internalise the stigma that they may
Trevor Steward: have around their body, and how will they deal with
Trevor Steward: that when on the one hand they're feeling fantastic because
Trevor Steward: they have all this mental space that's been opened up
Trevor Steward: with the food noise, you know, going away and being
Trevor Steward: able to have a better and healthier relationship with food.
Trevor Steward: But then also being reminded of, oh, people did used
Trevor Steward: to perceive me in this way and now they're making
Trevor Steward: these comments around my body. And so that's why going
Trevor Steward: back to your previous question, I think it's so important
Trevor Steward: to accompany this with CBT or with some sort of
Trevor Steward: psychological counselling because they're going to be facing a whole
Trevor Steward: slew of new problems as they begin taking this medication.
Cassie Hayward: And, as we talked about, may have to keep taking it.
Trevor Steward: Yes, exactly, and that's something that we're, it's probably the
Trevor Steward: thorniest ethical issue that we're dealing with in the study
Trevor Steward: is we're gonna, you know, be in direct contact with
Trevor Steward: all of our participants, GPs and explain to them, OK,
Trevor Steward: they're participating in the study, receiving tirzepatide over the course
Trevor Steward: of 6 months, and then as the study begins to
Trevor Steward: wind down.
Trevor Steward: Being in contact with their GPs and saying, OK, do
Trevor Steward: you want to continue to take this? And if so,
Trevor Steward: this is the dosing that they've been using. Um, is
Trevor Steward: there a possibility of a maintenance dose? Where, what would
Trevor Steward: be the best option for their patient? Um, and then
Trevor Steward: that also opens up a whole can of worms around
Trevor Steward: the economics of this
Cassie Hayward: Because it's not cheap, right?
Trevor Steward: Exactly, um, and it hasn't Been, you know, um, I'm sorry,
Trevor Steward: what you call it in Australia?
Trevor Steward: It hasn't been exactly, it hasn't been approved yet by
Trevor Steward: the PBS for obesity, um, let alone for binge eating disorder,
Trevor Steward: and so there's a lot of, you know, issues around
Trevor Steward: access that we need to be cognizant of.
Nick Haslam: What do you hope will come of your own research? What, what, uh,
Nick Haslam: will be the fruits of, uh, your labours?
Trevor Steward: Yeah, I think one of the first things that I
Trevor Steward: want to study, um, or understand from my study is
Trevor Steward: what's occurring on a neurobiological level with these medications. Um,
Trevor Steward: why is it having these effects on, you know, intrusive
Trevor Steward: thoughts around food, food craving, or even taste perception, that's
Trevor Steward: something that we didn't have a chance to get into
Trevor Steward: very much now, but there are, there's a lot of
Trevor Steward: anecdotal evidence of individuals taking these medications
Trevor Steward: who suddenly find that they're not drawn to complex carbs
Trevor Steward: or highly processed foods and they're going straight to the
Trevor Steward: vegetable aisle and they don't when they've never done that
Trevor Steward: in their entire lives and we don't really understand why
Trevor Steward: that's happening.
Cassie Hayward: And not drinking.
Trevor Steward: And not drinking. That's another example of, not drinking, not smoking,
Trevor Steward: other compulsive behaviours. And so I'd be really interested in understanding, OK,
Trevor Steward: why is it that this
Trevor Steward: medication that mimics a hormone in the gut is causing
Trevor Steward: all these other effects on the brain, and specifically what
Trevor Steward: circuits and pathways are being impacted by that. And so
Trevor Steward: that's something more in the short term. And then after that,
Trevor Steward: I would like to get a more nuanced picture of
Trevor Steward: what I was describing before and being able to really
Trevor Steward: track on a very detailed level, the course of treatment
Trevor Steward: and understanding, OK, at what time point do the intrusive
Trevor Steward: thoughts stop, at what dose were these individuals taking these medications?
Trevor Steward: That will then give us some
Trevor Steward: indications around, OK, whether these treatments are fit for purpose,
Trevor Steward: for example, for people that don't have obesity, but that
Trevor Steward: have binge eating disorder. We really can't gauge that now
Trevor Steward: because in our study, we'll only be recruiting participants with
Trevor Steward: both obesity and binge eating disorder. But I hope that
Trevor Steward: that level of detail will allow us to do that.
Trevor Steward: And then the third and the biggest goals are eventually
Trevor Steward: to be able to run a large scale randomised control
Trevor Steward: trial where you know, you have half the participants receiving
Trevor Steward: the treatment, the other half not receiving the the treatment
Trevor Steward: and being able to really gauge whether or not this
Trevor Steward: is effective for binge eating disorder. Now that's a really, uh,
Trevor Steward: you know, big ask and so now I can pass
Trevor Steward: a hat around and take donations and try to get
Trevor Steward: some money for that.
Cassie Hayward: Trevor, it's such fascinating research in terms of the clinical
Cassie Hayward: uses of these drugs. One thing we're certainly seeing is
Cassie Hayward: that people who wouldn't at all qualify as obese are
Cassie Hayward: using these drugs just to get kind of super skinny.
Cassie Hayward: We're seeing that kind of return to super skinny people
Cassie Hayward: on red carpets. I know this isn't your area of research,
Cassie Hayward: but do you think these medications
Cassie Hayward: have some unintended consequences of just bringing us back to a,
Cassie Hayward: you know, we talked about the importance of society, expectations
Cassie Hayward: and fat stigma and those sorts of issues. I think when,
Cassie Hayward: when we see celebrities going back to, you know, late 90s,
Cassie Hayward: early 00s levels of skinniness, is there a danger that
Cassie Hayward: that just feeds that cycle of skinny being the, the,
Cassie Hayward: the way to go?
Trevor Steward: Absolutely. And that's something that I'm quite concerned of, especially
Trevor Steward: with this population that I
Trevor Steward: I spend a lot of time interacting with and setting
Trevor Steward: because they are receiving these really harmful messages on a
Trevor Steward: constant basis, especially with social media, and it's quite disheartening
Trevor Steward: when you, you know, look up Ozempic on TikTok or
Trevor Steward: Instagram or any of these things. The images you see
Trevor Steward: are all based around body image and, uh, really putting
Trevor Steward: that thin ideal on a pedestal and it's difficult to
Trevor Steward: then
Trevor Steward: have conversations around these medications that focus on the well-being
Trevor Steward: of patients, their health, their mental health, because we know
Trevor Steward: that they're going to probably start receiving comments from their,
Trevor Steward: you know, friends and family around these medications specifically about
Trevor Steward: their body image. And so I think it's something that
Trevor Steward: we need to try to shift the dialogue to more
Trevor Steward: of the potential benefits of this in terms of health.
Trevor Steward: But then also be aware that these can, you know,
Trevor Steward: throw more fuel on the fire in terms of fat
Trevor Steward: biases and stigma that these patients are living with.
Nick Haslam: So Trevor, for someone who's listening and thinking about taking
Nick Haslam: a Ozempic or a similar medication, either for eating disorder
Nick Haslam: or just for weight loss, what would you recommend they
Nick Haslam: consider first?
Trevor Steward: Yeah, so I think the first thing is you need
Trevor Steward: to speak about this with your doctor. Um, I would
Trevor Steward: really discourage people from trying to obtain these medications through
Trevor Steward: online pharmacies and compounding pharmacies, which, you know, is, uh,
Trevor Steward: readily available option nowadays, unfortunately, it's quite
Trevor Steward: dangerous sometimes because you don't necessarily know what you're going
Trevor Steward: to get, if it's gonna really be GLP-1 receptor agonists
Trevor Steward: that you think you're ordering. And then when you're having
Trevor Steward: that conversation with your GP or medical professional, um, be
Trevor Steward: very transparent about any sort of eating disorder symptoms that
Trevor Steward: you might be experiencing. Even if you say, oh, I
Trevor Steward: don't have any eating disorder, you might have other preoccupations
Trevor Steward: around your body image, or maybe you have a history
Trevor Steward: of engaging in something like purging behaviours and
Trevor Steward: Your doctor might not necessarily ask that question unless you
Trevor Steward: prompt it. And so I would really recommend going to
Trevor Steward: that appointment prepared, knowing that they might be willing to
Trevor Steward: give you the medication without necessarily asking all the questions
Trevor Steward: of you that are necessary to make sure it's the
Trevor Steward: safest decision. And also being aware of the fact that
Trevor Steward: that if you do start taking this, it's a possibility
Trevor Steward: that you might need to start taking it for a
Trevor Steward: long time. What impacts would that have for you in
Trevor Steward: terms of economic impacts or family planning, things like that.
Nick Haslam: Uh, it's just such fascinating work, Trevor. What's one final
Nick Haslam: takeaway or piece of advice you'd like to leave our
Nick Haslam: listeners with?
Trevor Steward: Yeah, well, I, if I could leave, um, our listeners
Trevor Steward: with one thing, I'd just say, uh, be mindful with
Trevor Steward: the words that you use around body image and weight.
Trevor Steward: You never really truly know what someone else is dealing
Trevor Steward: with and even, um, you know, casual remarks can cause harm.
Trevor Steward: And y'know, if you are someone that's living with an
Trevor Steward: eating disorder, I, um,
Trevor Steward: I can understand that it's so frustrating having to go
Trevor Steward: through different courses of treatment, having to navigate the healthcare system,
Trevor Steward: and just feeling as if nothing's working. And so I
Trevor Steward: really really want to encourage someone if they are living
Trevor Steward: with eating disorder or they're caring for someone with an
Trevor Steward: eating disorder, not to lose hope around that. Um, for example,
Trevor Steward: Eating Disorders Victoria has some wonderful peer support groups that
Trevor Steward: you can look up online if you are living with
Trevor Steward: these types of eating disorders and not sure what to do.
Trevor Steward: And then on another point, I think it's really worth reiterating,
Trevor Steward: and this is something that I try to emphasise to
Trevor Steward: patients that I'm speaking to is that, be critical of
Trevor Steward: what you are engaging with on social media. It's hard
Trevor Steward: because it's almost like a knee jerk reaction. I find
Trevor Steward: myself doing this where the second you take out your phone,
Trevor Steward: you're consuming content and you don't necessarily know why just
Trevor Steward: sort of passively getting into your psyche.
Trevor Steward: But I just really wanted to emphasise, you don't need
Trevor Steward: a stranger on the internet telling you how to live
Trevor Steward: your life in terms of body image ideals or what
Trevor Steward: medications to take. So I think that's something that I
Trevor Steward: really want to encourage people like, OK, well, question what
Trevor Steward: advice you're getting is really thinking whether or not they
Trevor Steward: have your best interests in mind.
Trevor Steward: And then last point, which I realised this isn't one,
Trevor Steward: this is like more like 4 or 5 is um.
Trevor Steward: It's important to remember that these medications and the use
Trevor Steward: of these medications and mental health care, it's a political issue,
Trevor Steward: let's not beat around the bush. Right now, there's very
Trevor Steward: strong evidence linking obesity and binge eating to socioeconomic status
Trevor Steward: and you know, for example, food deprivation or living in food,
Trevor Steward: food deserts. And what's really troubling is that this these
Trevor Steward: medications are so expensive that down the line we might
Trevor Steward: be in a situation where only people from privileged backgrounds
Trevor Steward: are going to be really able to access them. And
Trevor Steward: so we need to
Trevor Steward: make sure that we're engaging politically within the space to,
Trevor Steward: you know, are we endorsing calls to actually believe in,
Trevor Steward: you know, a humane health system that, you know, allows
Trevor Steward: people to access these.
Cassie Hayward: Oh, it's fascinating. Thank you for joining us, Trevor. I
Cassie Hayward: think it's just, there's so many things in there that
Cassie Hayward: we could have spent another hour talking about, but, um, yeah,
Cassie Hayward: fascinating research and good luck with your future research.
Trevor Steward: Right, thanks, Cassie. Thanks, Nick.
Cassie Hayward: You've been listening to Psych Talks with me, Cassie Hayward,
Cassie Hayward: and Nick Haslam. A big thank you to our guest today,
Cassie Hayward: Dr Trevor Steward.
Nick Haslam: This episode was produced by Carly Godden with production assistance
Nick Haslam: from Mairead Murray and Gemma Papprill. Our sound engineer was
Nick Haslam: Jack Palmer. Thanks
Cassie Hayward: for tuning into PsychTalks, and we'll see you again in
Cassie Hayward: two weeks. Bye for now.