This podcast was made on the lands of the Wurundjeri people, the Woi Wurrung and the Bunurong. We'd like to pay respects to their elders, past and present, and emerging.

This podcast was made on the lands of the Wurundjeri people, the Woi Wurrung and the Bunurong. We'd like to pay respects to their elders, past and present, and emerging.

From the Melbourne School of Psychological Sciences at the University of Melbourne, this is PsychTalks.

From the Melbourne School of Psychological Sciences at the University of Melbourne, this is PsychTalks.

Welcome back to a new season of PsychTalks. I'm Nick Haslam and I'm joined as always by my co-host, Cassie Hayward.

Welcome back to a new season of PsychTalks. I'm Nick Haslam and I'm joined as always by my co-host, Cassie Hayward.

Hi Nick, great to be back in 2025.

Hi Nick, great to be back in 2025.

And for anyone new, we're here to explore the latest research in psychology and neuroscience with our brilliant experts at the University of Melbourne School of Psychological Sciences. We break down the science behind how our mind works and what these insights might mean for you at home.

And for anyone new, we're here to explore the latest research in psychology and neuroscience with our brilliant experts at the University of Melbourne School of Psychological Sciences. We break down the science behind how our mind works and what these insights might mean for you at home.

That's right. And this season of psych talks is set to be a cracker. We'll be getting our teeth into some really fascinating research, like how

That's right. And this season of psych talks is set to be a cracker. We'll be getting our teeth into some really fascinating research, like how

self-compassion could ease the pathway through menopause. And why misinformation has spread so rapidly online, just to name a few.

self-compassion could ease the pathway through menopause. And why misinformation has spread so rapidly online, just to name a few.

I can't wait. Now, today we're talking about Ozempic and other GLP-1 receptor agonists, drugs that have become hugely popular for weight loss. But there's a lot more to the story than just numbers on a scale, especially when it comes to their interactions with disorders like binge eating. Our colleague and guest, Dr Trevor Steward, is investigating what these medications do to the brain, not just our bodies.

I can't wait. Now, today we're talking about Ozempic and other GLP-1 receptor agonists, drugs that have become hugely popular for weight loss. But there's a lot more to the story than just numbers on a scale, especially when it comes to their interactions with disorders like binge eating. Our colleague and guest, Dr Trevor Steward, is investigating what these medications do to the brain, not just our bodies.

Welcome to PsychTalks, Trevor.

Welcome to PsychTalks, Trevor.

Thanks for having me.

Thanks for having me.

It's a fascinating area, Trevor, but could you start by telling us a little bit about your background and your research interests and how you've ended up studying Ozempic?

It's a fascinating area, Trevor, but could you start by telling us a little bit about your background and your research interests and how you've ended up studying Ozempic?

Yeah, sure, Cassie. So, my background is in psychology. I did my undergraduate degree in the United States and then now

Yeah, sure, Cassie. So, my background is in psychology. I did my undergraduate degree in the United States and then now

Afterwards moved to Spain to specialise in neuroscience and during my PhD I was embedded in an eating disorders unit in a public hospital and it was there that I really saw firsthand the burden of eating disorders and how much they can impact people's both physical and psychological well-being as well as their caregivers.

Afterwards moved to Spain to specialise in neuroscience and during my PhD I was embedded in an eating disorders unit in a public hospital and it was there that I really saw firsthand the burden of eating disorders and how much they can impact people's both physical and psychological well-being as well as their caregivers.

And what really struck me was that there weren't any brain- based interventions available for these disorders. You know, anorexia nervosa is a perfect example. I recently went to a conference and there was a professor there who got into psychiatry and eating disorders, and he said in 1970, there wasn't a single approved medication for anorexia nervosa.

And what really struck me was that there weren't any brain- based interventions available for these disorders. You know, anorexia nervosa is a perfect example. I recently went to a conference and there was a professor there who got into psychiatry and eating disorders, and he said in 1970, there wasn't a single approved medication for anorexia nervosa.

And there still isn't a single approved medication for anorexia nervosa. So that just really makes it evident that we need to understand these disorders more in depth. Then I moved to the University of Melbourne in 2019 and that's where I sort of expanded my research program. But then just in the past two years, much like everyone in in society, we've really been awed by the emergence of these new medications called GLP-1 receptor agonists.

And there still isn't a single approved medication for anorexia nervosa. So that just really makes it evident that we need to understand these disorders more in depth. Then I moved to the University of Melbourne in 2019 and that's where I sort of expanded my research program. But then just in the past two years, much like everyone in in society, we've really been awed by the emergence of these new medications called GLP-1 receptor agonists.

Uh, for example, Ozempic, and these medications are absolute game changer in the in the realm of treating obesity. And then with more people using these, we started to get more anecdotal evidence around other psychological effects that they're having that are related to eating behaviours and eating disorders. And so that's where I want to step in and try to understand what's going on on a neurobiological level.

Uh, for example, Ozempic, and these medications are absolute game changer in the in the realm of treating obesity. And then with more people using these, we started to get more anecdotal evidence around other psychological effects that they're having that are related to eating behaviours and eating disorders. And so that's where I want to step in and try to understand what's going on on a neurobiological level.

So you talked about Ozempic - can you give us a quick definition of what kind of drug it is, what other drugs are in that class, and what they've mostly been used for before they became revolutionary in this area of weight?

So you talked about Ozempic - can you give us a quick definition of what kind of drug it is, what other drugs are in that class, and what they've mostly been used for before they became revolutionary in this area of weight?

Yeah, for sure. So when we talk about drugs like Ozempic, we're actually talking about a broader class of medication known as GLP-1

Yeah, for sure. So when we talk about drugs like Ozempic, we're actually talking about a broader class of medication known as GLP-1

receptor agonists. Now, GLP-1 stands for glucagon-like peptide-1. Don't worry, you don't have to remember that. Which is a naturally occurring hormone in the body involved in the regulation of blood sugars. Now, after we eat, GLP-1 helps us to stimulate the secretion of insulin, which lowers our blood glucose, while then also, um, you know, helping to regulate our appetite.

receptor agonists. Now, GLP-1 stands for glucagon-like peptide-1. Don't worry, you don't have to remember that. Which is a naturally occurring hormone in the body involved in the regulation of blood sugars. Now, after we eat, GLP-1 helps us to stimulate the secretion of insulin, which lowers our blood glucose, while then also, um, you know, helping to regulate our appetite.

Now, what we can do with these medications is basically mimic the effects of this naturally occurring hormone, which will then slow, for example, our gastric emptying, our digestion, that makes us feel fuller for longer. And it also um does other things in terms of metabolic health and uh regulating insulin levels. Now, Ozempic is the most famous of these types of medications, but its generic name is actually semaglutide.

Now, what we can do with these medications is basically mimic the effects of this naturally occurring hormone, which will then slow, for example, our gastric emptying, our digestion, that makes us feel fuller for longer. And it also um does other things in terms of metabolic health and uh regulating insulin levels. Now, Ozempic is the most famous of these types of medications, but its generic name is actually semaglutide.

Um, there's some several other ones out on the market now that you might have heard of, for example, Mounjaro or Zepbound, and all of these compounds are quite similar in the sense that they mimic this GLP-1 hormone. Now, historically, these medications were used to treat type 2 diabetes and what they found was that these individuals who are using these GLP-1 medications to regulate their diabetes were also losing weight.

Um, there's some several other ones out on the market now that you might have heard of, for example, Mounjaro or Zepbound, and all of these compounds are quite similar in the sense that they mimic this GLP-1 hormone. Now, historically, these medications were used to treat type 2 diabetes and what they found was that these individuals who are using these GLP-1 medications to regulate their diabetes were also losing weight.

And then someone came up with a genius idea of saying, oh, what would happen if we really upped the dose of these medications in people with obesity? Would they also lose weight?

And then someone came up with a genius idea of saying, oh, what would happen if we really upped the dose of these medications in people with obesity? Would they also lose weight?

And that's when we started to see the emergence of these compounds. And there have been some very large clinical trials for people with obesity that have found that it can help people to lose weight, um, at levels that you can't really ever see with other types of interventions. Um, apart from that, it's also there's now emerging clinical trials that have found that it's effective for conditions like sleep apnoea or for fatty liver disease, and so we're only um at the tip of the iceberg in terms of what is indicated uses could be.

And that's when we started to see the emergence of these compounds. And there have been some very large clinical trials for people with obesity that have found that it can help people to lose weight, um, at levels that you can't really ever see with other types of interventions. Um, apart from that, it's also there's now emerging clinical trials that have found that it's effective for conditions like sleep apnoea or for fatty liver disease, and so we're only um at the tip of the iceberg in terms of what is indicated uses could be.

As you say, there's been this huge buzz about what these drugs can do from a weight loss perspective.

As you say, there's been this huge buzz about what these drugs can do from a weight loss perspective.

But that's not entirely your focus, is it? You're looking at what they might also be doing to the brain. Can you tell us a little bit about what you're doing there?

But that's not entirely your focus, is it? You're looking at what they might also be doing to the brain. Can you tell us a little bit about what you're doing there?

Yeah, exactly. And so, um, our, uh, study is going to be examining the effects of tirzepatide, which is also known as Mounjaro or Zepbound, in adults with binge eating disorder. Binge eating disorder is a very serious eating disorder. It's the most prevalent eating disorder. Um, there's more people living with eating disorder than bulimia nervosa or anorexia nervosa combined.

Yeah, exactly. And so, um, our, uh, study is going to be examining the effects of tirzepatide, which is also known as Mounjaro or Zepbound, in adults with binge eating disorder. Binge eating disorder is a very serious eating disorder. It's the most prevalent eating disorder. Um, there's more people living with eating disorder than bulimia nervosa or anorexia nervosa combined.

And binge eating disorder is characterised by the presence of binge eating episodes, which are characterised by people eating large amounts of food for a short amount of time, often accompanied by feelings of loss of control, guilt, shame, and they really get locked into this really

And binge eating disorder is characterised by the presence of binge eating episodes, which are characterised by people eating large amounts of food for a short amount of time, often accompanied by feelings of loss of control, guilt, shame, and they really get locked into this really

Um, difficult, entrenched cycle that impacts your quality of life and impacts their health and makes it very difficult for them to maintain a positive wellbeing. Whereas bulimia nervosa does have bingeing episodes, but it's also characterised by the presence of compensatory behaviours. So that could be, for example, someone self-inducing vomiting or, you know, exercising to excess to try to compensate for the previous binge eating episode.

Um, difficult, entrenched cycle that impacts your quality of life and impacts their health and makes it very difficult for them to maintain a positive wellbeing. Whereas bulimia nervosa does have bingeing episodes, but it's also characterised by the presence of compensatory behaviours. So that could be, for example, someone self-inducing vomiting or, you know, exercising to excess to try to compensate for the previous binge eating episode.

And what we're interested in this study is to try to understand how tirzepatide

And what we're interested in this study is to try to understand how tirzepatide

impacts the brain processes linked to some of these core eating disorder symptoms such as compulsions to eat, impulsivity around food, or what you as often um heard of in social media, food noise, which is these intrusive thoughts around food where people, for example, can't get this idea out of their head of how they're planning to binge eat.

impacts the brain processes linked to some of these core eating disorder symptoms such as compulsions to eat, impulsivity around food, or what you as often um heard of in social media, food noise, which is these intrusive thoughts around food where people, for example, can't get this idea out of their head of how they're planning to binge eat.

Or a certain type of food that they would like to eat. Now, there's a lot of anecdotal evidence around drugs like Ozempic or tirzepatide, being able to lower the volume of these intrusive thoughts around food. However, on a neurobiological level, we just don't understand how this is occurring and why this is happening. There are GLP-1 receptor, um, GLP-1 receptors located throughout the brain.

Or a certain type of food that they would like to eat. Now, there's a lot of anecdotal evidence around drugs like Ozempic or tirzepatide, being able to lower the volume of these intrusive thoughts around food. However, on a neurobiological level, we just don't understand how this is occurring and why this is happening. There are GLP-1 receptor, um, GLP-1 receptors located throughout the brain.

But it's not really clear why uh a drug that's targeting the gut would have such a huge impact on these brain processes. And so we're really interested in trying to interrogate that further.

But it's not really clear why uh a drug that's targeting the gut would have such a huge impact on these brain processes. And so we're really interested in trying to interrogate that further.

It is a bit surprising, as you said, I mean, if the drug is primarily slowing the gastric processing or whatever, Uh, emptying, is that what you, what you said? Uh, how does that, how does that, um, have any effect whatsoever on attention you pay to certain thoughts or any of the other processes involved in binge eating disorder?

It is a bit surprising, as you said, I mean, if the drug is primarily slowing the gastric processing or whatever, Uh, emptying, is that what you, what you said? Uh, how does that, how does that, um, have any effect whatsoever on attention you pay to certain thoughts or any of the other processes involved in binge eating disorder?

No, that's a great question, Nick. And so we're stipulating this is mainly based off of animal research because we really don't have that much evidence in humans yet around us that by um lowering or slowing down the gastric emptying process, you are impacting food reward pathways. And so

No, that's a great question, Nick. And so we're stipulating this is mainly based off of animal research because we really don't have that much evidence in humans yet around us that by um lowering or slowing down the gastric emptying process, you are impacting food reward pathways. And so

For example, dopamine is probably the most well known neurotransmitter out there. It's very much linked to motivation to find rewards. And so if you are able to slow down the emptying of someone's stomach and say, OK, now you don't need to find that reward. That reward isn't as salient for you anymore. Or if, if you even did find that reward, you wouldn't get as much pleasure from it as you would have previously. That's going to lead to neurobiological changes that extend beyond the gut. It's going to mean that these cues

For example, dopamine is probably the most well known neurotransmitter out there. It's very much linked to motivation to find rewards. And so if you are able to slow down the emptying of someone's stomach and say, OK, now you don't need to find that reward. That reward isn't as salient for you anymore. Or if, if you even did find that reward, you wouldn't get as much pleasure from it as you would have previously. That's going to lead to neurobiological changes that extend beyond the gut. It's going to mean that these cues

around food are no longer as salient as they used to be, or even the predictions that you make within your mind about whether this, um, food will give you pleasure, will start to be diminished. And so that really offers a lot of hope for people with binge eating disorder because it's breaking that cycle of like, oh, if I want to find relief from the stressors of everyday life, or I find myself entrenched in this pattern where as soon as I come home, I start eating one thing, which then leads to me eating everything in the kitchen.

around food are no longer as salient as they used to be, or even the predictions that you make within your mind about whether this, um, food will give you pleasure, will start to be diminished. And so that really offers a lot of hope for people with binge eating disorder because it's breaking that cycle of like, oh, if I want to find relief from the stressors of everyday life, or I find myself entrenched in this pattern where as soon as I come home, I start eating one thing, which then leads to me eating everything in the kitchen.

That's essentially pumping the brakes on that because it's saying, oh, this medication is telling me that, maybe that's not gonna work for me this time.

That's essentially pumping the brakes on that because it's saying, oh, this medication is telling me that, maybe that's not gonna work for me this time.

If it's changing pathways, or if it's in some way, you know, breaking patterns in the way you say.

If it's changing pathways, or if it's in some way, you know, breaking patterns in the way you say.

Does that imply that potentially after a course of treatment with the drug, the problem might be fixed as it were, or does it imply that instead you have to continue to use indefinitely?

Does that imply that potentially after a course of treatment with the drug, the problem might be fixed as it were, or does it imply that instead you have to continue to use indefinitely?

Yeah, and so there's a lot of unknowns around that, and that's something that we are particularly cautious around for this study because studies in

Yeah, and so there's a lot of unknowns around that, and that's something that we are particularly cautious around for this study because studies in

individuals with obesity have found that when individuals stop taking these medications that most often it's accompanied by weight regain, not necessarily to the same level that they had before, they began using the drug, but they do go back to or the weight is gained again.

individuals with obesity have found that when individuals stop taking these medications that most often it's accompanied by weight regain, not necessarily to the same level that they had before, they began using the drug, but they do go back to or the weight is gained again.

And also anecdotal evidence has shown that individuals who stopped taking the drug also report the re-emergence of, you know, intrusive thoughts around food or compulsions to eat and cravings. And what I'm really concerned about in this population is we're talking about people here with this severe psychiatric disorder and often they will report that starting to take these medications, opens up a lot of mental space for them. They feel as if they're, you know, much freer than they had been before or

And also anecdotal evidence has shown that individuals who stopped taking the drug also report the re-emergence of, you know, intrusive thoughts around food or compulsions to eat and cravings. And what I'm really concerned about in this population is we're talking about people here with this severe psychiatric disorder and often they will report that starting to take these medications, opens up a lot of mental space for them. They feel as if they're, you know, much freer than they had been before or

ever in their lives around the relationship with food. But what would happen if they were to suddenly stop taking this medication? Would these intrusive thoughts come back with a vengeance? Would they, for example, feel as if they had failed? And so we have to have a lot of care when we're dealing with this population and this medication. So that's why for this study we're using a multidisciplinary team involving psychiatrists, endocrinologists, and importantly, clinical psychologists that will be delivering CBT in conjunction with the tirzepatide.

ever in their lives around the relationship with food. But what would happen if they were to suddenly stop taking this medication? Would these intrusive thoughts come back with a vengeance? Would they, for example, feel as if they had failed? And so we have to have a lot of care when we're dealing with this population and this medication. So that's why for this study we're using a multidisciplinary team involving psychiatrists, endocrinologists, and importantly, clinical psychologists that will be delivering CBT in conjunction with the tirzepatide.

So, obviously, it's early days and you haven't got all your findings yet, but is it your sense that you can't simply give someone a prescription and expect it to be beneficial overall for binge eating disorder, you'd need to have adjunct treatments as well?

So, obviously, it's early days and you haven't got all your findings yet, but is it your sense that you can't simply give someone a prescription and expect it to be beneficial overall for binge eating disorder, you'd need to have adjunct treatments as well?

I would advocate for that position. I don't think the evidence is there to say that tirzepatide alone or any other GLP1 receptor agonist alone is enough to treat, uh, an eating disorder or binge eating disorder specifically. And it's also important to remember that psychiatric disorders

I would advocate for that position. I don't think the evidence is there to say that tirzepatide alone or any other GLP1 receptor agonist alone is enough to treat, uh, an eating disorder or binge eating disorder specifically. And it's also important to remember that psychiatric disorders

rarely exist in isolation. They're often accompanied by comorbid, um, for example, anxiety disorders or depressive disorders. And so, yes, this medication may prove to be effective at treating some of the core symptoms of binge eating disorder or reducing the frequency of bingeing episodes, but that doesn't mean that it's gonna necessarily help the patient to deal with, for example, the underlying trauma that caused them to use binge eating episodes as a form of coping.

rarely exist in isolation. They're often accompanied by comorbid, um, for example, anxiety disorders or depressive disorders. And so, yes, this medication may prove to be effective at treating some of the core symptoms of binge eating disorder or reducing the frequency of bingeing episodes, but that doesn't mean that it's gonna necessarily help the patient to deal with, for example, the underlying trauma that caused them to use binge eating episodes as a form of coping.

Or for example, if it will then lead to, OK, less mental space is being dedicated to seeking out food or that type of reward, but then now they're gonna be spending more time thinking about, you know, for example, entrenched negative thought patterns or anxious thought patterns. And so that's why I think from a duty of care perspective, we need to accompany it with CBT, which we know is effective for some individuals with binge eating disorder.

Or for example, if it will then lead to, OK, less mental space is being dedicated to seeking out food or that type of reward, but then now they're gonna be spending more time thinking about, you know, for example, entrenched negative thought patterns or anxious thought patterns. And so that's why I think from a duty of care perspective, we need to accompany it with CBT, which we know is effective for some individuals with binge eating disorder.

So by CBT, Trevor, you mean cognitive behaviour therapy.

So by CBT, Trevor, you mean cognitive behaviour therapy.

That's right.

That's right.

So just on that, you mentioned the food noise issue, and you see that a lot on social media, just anecdotally, people talking about these drugs, just dialling down that noise. And you mentioned that with obesity and binge eating disorder. Are you saying that there's not clinical evidence that that that's actually happening, or we just don't know the pathways by which that food noise dials up and down?

So just on that, you mentioned the food noise issue, and you see that a lot on social media, just anecdotally, people talking about these drugs, just dialling down that noise. And you mentioned that with obesity and binge eating disorder. Are you saying that there's not clinical evidence that that that's actually happening, or we just don't know the pathways by which that food noise dials up and down?

Yeah, that's a great question. So the, the situation is that the evidence is lacking. Um, most of these randomised control trials weren't specifically looking at intrusive thoughts around food. Their main primary outcome measure was weight loss, changes in BMI, and some of them maybe they had a questionnaire around food cravings pre-post, 6 months later after taking it, but they're not really

Yeah, that's a great question. So the, the situation is that the evidence is lacking. Um, most of these randomised control trials weren't specifically looking at intrusive thoughts around food. Their main primary outcome measure was weight loss, changes in BMI, and some of them maybe they had a questionnaire around food cravings pre-post, 6 months later after taking it, but they're not really

getting into the granular details of how food cravings are being modified, and when it's happening to these participants, or even their food choices. And so for our city, what we'll be using is something called ecological momentary assessment or EMA, which essentially uses prompts on participants' mobile phones to ask them throughout the day how they're feeling from a mood and affect point of view.

getting into the granular details of how food cravings are being modified, and when it's happening to these participants, or even their food choices. And so for our city, what we'll be using is something called ecological momentary assessment or EMA, which essentially uses prompts on participants' mobile phones to ask them throughout the day how they're feeling from a mood and affect point of view.

Some of their core binge eating behaviours and also how they're feeling around food cravings because I'm really interested in trying to understand the dynamics, the temporal dynamics of what happens first is it the food cravings that happen and then that go down and then the bingeing episodes that disappear or is it the other way around, or are the folks that respond best, the ones that lose the cravings right away and we don't really have that richness in the data yet at all. But I'm also concerned around the way that food noise is being used in social media because

Some of their core binge eating behaviours and also how they're feeling around food cravings because I'm really interested in trying to understand the dynamics, the temporal dynamics of what happens first is it the food cravings that happen and then that go down and then the bingeing episodes that disappear or is it the other way around, or are the folks that respond best, the ones that lose the cravings right away and we don't really have that richness in the data yet at all. But I'm also concerned around the way that food noise is being used in social media because

there's a lot of evidence demonstrating that people that with an eating disorder

there's a lot of evidence demonstrating that people that with an eating disorder

Suffer from problems with interoception. When I say interoception, it means that someone's ability to perceive internal bodily states, and that could be, for example, feelings of fullness, uh, you know, feelings of hunger, or even simple things like, you know, um, being able to count one's heart, heart rate or, you know, sensitivity to touch. And we don't understand whether or not these medications are gonna impact those interoceptive pathways as well. We have evidence

Suffer from problems with interoception. When I say interoception, it means that someone's ability to perceive internal bodily states, and that could be, for example, feelings of fullness, uh, you know, feelings of hunger, or even simple things like, you know, um, being able to count one's heart, heart rate or, you know, sensitivity to touch. And we don't understand whether or not these medications are gonna impact those interoceptive pathways as well. We have evidence

showing that there's a risk of people with obesity taking these medications, often skipping meals or eating very little because they don't feel hunger. And these GLP-1 medications are maybe working too well if weight loss is your primary objective, which we, I really want to reiterate, isn't the primary objective in this population. Our our interest is understanding how it impacts the brain and how it impacts binge eating behaviours, not necessarily weight.

showing that there's a risk of people with obesity taking these medications, often skipping meals or eating very little because they don't feel hunger. And these GLP-1 medications are maybe working too well if weight loss is your primary objective, which we, I really want to reiterate, isn't the primary objective in this population. Our our interest is understanding how it impacts the brain and how it impacts binge eating behaviours, not necessarily weight.

And when we're talking about a population that's so used to this, you know, restrictive and then binge eating cycle that's been probably defining a lot of their adult life, we have to be extremely cautious around whether or not this medication is hijacking those interoceptive pathways and not allowing them to eat in a healthy way.

And when we're talking about a population that's so used to this, you know, restrictive and then binge eating cycle that's been probably defining a lot of their adult life, we have to be extremely cautious around whether or not this medication is hijacking those interoceptive pathways and not allowing them to eat in a healthy way.

And the food noise, as you say, there's a lot of anecdotal stuff on, on TikTok, recognising that's not the most scientific kind of way of gathering data, but I was looking at some TikToks in preparation for this. And the way people talk about food noise being turned off with these medications is just fascinating and

And the food noise, as you say, there's a lot of anecdotal stuff on, on TikTok, recognising that's not the most scientific kind of way of gathering data, but I was looking at some TikToks in preparation for this. And the way people talk about food noise being turned off with these medications is just fascinating and

I was listening to one woman from Australia, and she said she started taking Ozempic, and she said, Is this how normal people live every day? She said, she had no idea how much of her brain power was being taken up with, you know, and it wasn't binge eating, it was, it was mild obesity, but she was saying, I was constantly thinking about, well, should I eat this? And if I eat this, what do I have to do and what exercise will I do to counteract it? And she said, once she started taking this, that just simply went away, which is fascinating from a kind of brain function point of view.

I was listening to one woman from Australia, and she said she started taking Ozempic, and she said, Is this how normal people live every day? She said, she had no idea how much of her brain power was being taken up with, you know, and it wasn't binge eating, it was, it was mild obesity, but she was saying, I was constantly thinking about, well, should I eat this? And if I eat this, what do I have to do and what exercise will I do to counteract it? And she said, once she started taking this, that just simply went away, which is fascinating from a kind of brain function point of view.

But as you say, with your binge eating disorder, um, clients, uh, population, if that then goes away and

But as you say, with your binge eating disorder, um, clients, uh, population, if that then goes away and

The trauma that might be underlying the binge eating disorder then takes over. How do you balance that kind of, maybe the food noise goes away, but is it worse then to have the trauma take up more space?

The trauma that might be underlying the binge eating disorder then takes over. How do you balance that kind of, maybe the food noise goes away, but is it worse then to have the trauma take up more space?

Yeah, that's a really good question. And what you described there from the TikTok evidence, uh, is actually very commonly reported in, in just based on, you know, my interactions with endocrinologists and GPs and what their uh patients are telling them.

Yeah, that's a really good question. And what you described there from the TikTok evidence, uh, is actually very commonly reported in, in just based on, you know, my interactions with endocrinologists and GPs and what their uh patients are telling them.

And I think when you imagine someone with binge eating disorder, imagine that dialled up to 11, you know, they're basically constantly thinking about, OK, well, when I finish this activity, I'm gonna go home and I want to binge or this is gonna be my way of managing the situation and

And I think when you imagine someone with binge eating disorder, imagine that dialled up to 11, you know, they're basically constantly thinking about, OK, well, when I finish this activity, I'm gonna go home and I want to binge or this is gonna be my way of managing the situation and

they want relief from that. I remember just seeing firsthand when I was working in the disorders unit, how much, how debilitating these intrusive thoughts were. It wasn't just around the food itself, it was the actual act of binge eating and just being able to carry out those motions of eating to find that relief. And so if we can open up that mental space for them by giving them this this medication, our hope is that it will then allow them to engage in a more effective way with therapy.

they want relief from that. I remember just seeing firsthand when I was working in the disorders unit, how much, how debilitating these intrusive thoughts were. It wasn't just around the food itself, it was the actual act of binge eating and just being able to carry out those motions of eating to find that relief. And so if we can open up that mental space for them by giving them this this medication, our hope is that it will then allow them to engage in a more effective way with therapy.

Because often a big part of CBT is, for example, identifying triggers, restructuring negative thought patterns, but if you've gone through multiple courses of CBT and you're finding like, oh, this still isn't helping me stop this compulsive behaviour.

Because often a big part of CBT is, for example, identifying triggers, restructuring negative thought patterns, but if you've gone through multiple courses of CBT and you're finding like, oh, this still isn't helping me stop this compulsive behaviour.

Maybe it's time to find something else that can sort of, you know, tip the scales a little bit and allow that intrusiveness to go down and then to be able to face the other issues going on around it. I think the same goes as well in terms of other things like meal planning, or for example, one thing that I'm particularly concerned about around is

Maybe it's time to find something else that can sort of, you know, tip the scales a little bit and allow that intrusiveness to go down and then to be able to face the other issues going on around it. I think the same goes as well in terms of other things like meal planning, or for example, one thing that I'm particularly concerned about around is

with this population is, most people with binge eating disorder do have obesity. They're going to be somewhere between 70 and 80%. And so I'm concerned that these individuals, most likely based on the evidence we have, will begin to lose weight over the course of the study because it's going on for 24 weeks. And they're going to start to receive messages from society, from their peers, from colleagues around their body shape. And this is going to start to internalise, you know,

with this population is, most people with binge eating disorder do have obesity. They're going to be somewhere between 70 and 80%. And so I'm concerned that these individuals, most likely based on the evidence we have, will begin to lose weight over the course of the study because it's going on for 24 weeks. And they're going to start to receive messages from society, from their peers, from colleagues around their body shape. And this is going to start to internalise, you know,

fat biases, you know, internalise the stigma that they may have around their body, and how will they deal with that when on the one hand they're feeling fantastic because they have all this mental space that's been opened up with the food noise, you know, going away and being able to have a better and healthier relationship with food.

fat biases, you know, internalise the stigma that they may have around their body, and how will they deal with that when on the one hand they're feeling fantastic because they have all this mental space that's been opened up with the food noise, you know, going away and being able to have a better and healthier relationship with food.

But then also being reminded of, oh, people did used to perceive me in this way and now they're making these comments around my body. And so that's why going back to your previous question, I think it's so important to accompany this with CBT or with some sort of psychological counselling because they're going to be facing a whole slew of new problems as they begin taking this medication.

But then also being reminded of, oh, people did used to perceive me in this way and now they're making these comments around my body. And so that's why going back to your previous question, I think it's so important to accompany this with CBT or with some sort of psychological counselling because they're going to be facing a whole slew of new problems as they begin taking this medication.

And, as we talked about, may have to keep taking it.

And, as we talked about, may have to keep taking it.

Yes, exactly, and that's something that we're, it's probably the thorniest ethical issue that we're dealing with in the study is we're gonna, you know, be in direct contact with all of our participants, GPs and explain to them, OK, they're participating in the study, receiving tirzepatide over the course of 6 months, and then as the study begins to wind down.

Yes, exactly, and that's something that we're, it's probably the thorniest ethical issue that we're dealing with in the study is we're gonna, you know, be in direct contact with all of our participants, GPs and explain to them, OK, they're participating in the study, receiving tirzepatide over the course of 6 months, and then as the study begins to wind down.

Being in contact with their GPs and saying, OK, do you want to continue to take this? And if so, this is the dosing that they've been using. Um, is there a possibility of a maintenance dose? Where, what would be the best option for their patient? Um, and then that also opens up a whole can of worms around the economics of this

Being in contact with their GPs and saying, OK, do you want to continue to take this? And if so, this is the dosing that they've been using. Um, is there a possibility of a maintenance dose? Where, what would be the best option for their patient? Um, and then that also opens up a whole can of worms around the economics of this

Because it's not cheap, right?

Because it's not cheap, right?

Exactly, um, and it hasn't Been, you know, um, I'm sorry, what you call it in Australia?

Exactly, um, and it hasn't Been, you know, um, I'm sorry, what you call it in Australia?

It hasn't been exactly, it hasn't been approved yet by the PBS for obesity, um, let alone for binge eating disorder, and so there's a lot of, you know, issues around access that we need to be cognizant of.

It hasn't been exactly, it hasn't been approved yet by the PBS for obesity, um, let alone for binge eating disorder, and so there's a lot of, you know, issues around access that we need to be cognizant of.

What do you hope will come of your own research? What, what, uh, will be the fruits of, uh, your labours?

What do you hope will come of your own research? What, what, uh, will be the fruits of, uh, your labours?

Yeah, I think one of the first things that I want to study, um, or understand from my study is what's occurring on a neurobiological level with these medications. Um, why is it having these effects on, you know, intrusive thoughts around food, food craving, or even taste perception, that's something that we didn't have a chance to get into very much now, but there are, there's a lot of anecdotal evidence of individuals taking these medications

Yeah, I think one of the first things that I want to study, um, or understand from my study is what's occurring on a neurobiological level with these medications. Um, why is it having these effects on, you know, intrusive thoughts around food, food craving, or even taste perception, that's something that we didn't have a chance to get into very much now, but there are, there's a lot of anecdotal evidence of individuals taking these medications

who suddenly find that they're not drawn to complex carbs or highly processed foods and they're going straight to the vegetable aisle and they don't when they've never done that in their entire lives and we don't really understand why that's happening.

who suddenly find that they're not drawn to complex carbs or highly processed foods and they're going straight to the vegetable aisle and they don't when they've never done that in their entire lives and we don't really understand why that's happening.

And not drinking.

And not drinking.

And not drinking. That's another example of, not drinking, not smoking, other compulsive behaviours. And so I'd be really interested in understanding, OK, why is it that this

And not drinking. That's another example of, not drinking, not smoking, other compulsive behaviours. And so I'd be really interested in understanding, OK, why is it that this

medication that mimics a hormone in the gut is causing all these other effects on the brain, and specifically what circuits and pathways are being impacted by that. And so that's something more in the short term. And then after that, I would like to get a more nuanced picture of what I was describing before and being able to really track on a very detailed level, the course of treatment and understanding, OK, at what time point do the intrusive thoughts stop, at what dose were these individuals taking these medications? That will then give us some

medication that mimics a hormone in the gut is causing all these other effects on the brain, and specifically what circuits and pathways are being impacted by that. And so that's something more in the short term. And then after that, I would like to get a more nuanced picture of what I was describing before and being able to really track on a very detailed level, the course of treatment and understanding, OK, at what time point do the intrusive thoughts stop, at what dose were these individuals taking these medications? That will then give us some

indications around, OK, whether these treatments are fit for purpose, for example, for people that don't have obesity, but that have binge eating disorder. We really can't gauge that now because in our study, we'll only be recruiting participants with both obesity and binge eating disorder. But I hope that that level of detail will allow us to do that.

indications around, OK, whether these treatments are fit for purpose, for example, for people that don't have obesity, but that have binge eating disorder. We really can't gauge that now because in our study, we'll only be recruiting participants with both obesity and binge eating disorder. But I hope that that level of detail will allow us to do that.

And then the third and the biggest goals are eventually to be able to run a large scale randomised control trial where you know, you have half the participants receiving the treatment, the other half not receiving the the treatment and being able to really gauge whether or not this is effective for binge eating disorder. Now that's a really, uh, you know, big ask and so now I can pass a hat around and take donations and try to get some money for that.

And then the third and the biggest goals are eventually to be able to run a large scale randomised control trial where you know, you have half the participants receiving the treatment, the other half not receiving the the treatment and being able to really gauge whether or not this is effective for binge eating disorder. Now that's a really, uh, you know, big ask and so now I can pass a hat around and take donations and try to get some money for that.

Trevor, it's such fascinating research in terms of the clinical uses of these drugs. One thing we're certainly seeing is that people who wouldn't at all qualify as obese are using these drugs just to get kind of super skinny. We're seeing that kind of return to super skinny people on red carpets. I know this isn't your area of research, but do you think these medications

Trevor, it's such fascinating research in terms of the clinical uses of these drugs. One thing we're certainly seeing is that people who wouldn't at all qualify as obese are using these drugs just to get kind of super skinny. We're seeing that kind of return to super skinny people on red carpets. I know this isn't your area of research, but do you think these medications

have some unintended consequences of just bringing us back to a, you know, we talked about the importance of society, expectations and fat stigma and those sorts of issues. I think when, when we see celebrities going back to, you know, late 90s, early 00s levels of skinniness, is there a danger that that just feeds that cycle of skinny being the, the, the way to go?

have some unintended consequences of just bringing us back to a, you know, we talked about the importance of society, expectations and fat stigma and those sorts of issues. I think when, when we see celebrities going back to, you know, late 90s, early 00s levels of skinniness, is there a danger that that just feeds that cycle of skinny being the, the, the way to go?

Absolutely. And that's something that I'm quite concerned of, especially with this population that I

Absolutely. And that's something that I'm quite concerned of, especially with this population that I

I spend a lot of time interacting with and setting because they are receiving these really harmful messages on a constant basis, especially with social media, and it's quite disheartening when you, you know, look up Ozempic on TikTok or Instagram or any of these things. The images you see are all based around body image and, uh, really putting that thin ideal on a pedestal and it's difficult to then

I spend a lot of time interacting with and setting because they are receiving these really harmful messages on a constant basis, especially with social media, and it's quite disheartening when you, you know, look up Ozempic on TikTok or Instagram or any of these things. The images you see are all based around body image and, uh, really putting that thin ideal on a pedestal and it's difficult to then

have conversations around these medications that focus on the well-being of patients, their health, their mental health, because we know that they're going to probably start receiving comments from their, you know, friends and family around these medications specifically about their body image. And so I think it's something that we need to try to shift the dialogue to more of the potential benefits of this in terms of health.

have conversations around these medications that focus on the well-being of patients, their health, their mental health, because we know that they're going to probably start receiving comments from their, you know, friends and family around these medications specifically about their body image. And so I think it's something that we need to try to shift the dialogue to more of the potential benefits of this in terms of health.

But then also be aware that these can, you know, throw more fuel on the fire in terms of fat biases and stigma that these patients are living with.

But then also be aware that these can, you know, throw more fuel on the fire in terms of fat biases and stigma that these patients are living with.

So Trevor, for someone who's listening and thinking about taking a Ozempic or a similar medication, either for eating disorder or just for weight loss, what would you recommend they consider first?

So Trevor, for someone who's listening and thinking about taking a Ozempic or a similar medication, either for eating disorder or just for weight loss, what would you recommend they consider first?

Yeah, so I think the first thing is you need to speak about this with your doctor. Um, I would really discourage people from trying to obtain these medications through online pharmacies and compounding pharmacies, which, you know, is, uh, readily available option nowadays, unfortunately, it's quite

Yeah, so I think the first thing is you need to speak about this with your doctor. Um, I would really discourage people from trying to obtain these medications through online pharmacies and compounding pharmacies, which, you know, is, uh, readily available option nowadays, unfortunately, it's quite

dangerous sometimes because you don't necessarily know what you're going to get, if it's gonna really be GLP-1 receptor agonists that you think you're ordering. And then when you're having that conversation with your GP or medical professional, um, be very transparent about any sort of eating disorder symptoms that you might be experiencing. Even if you say, oh, I don't have any eating disorder, you might have other preoccupations around your body image, or maybe you have a history of engaging in something like purging behaviours and

dangerous sometimes because you don't necessarily know what you're going to get, if it's gonna really be GLP-1 receptor agonists that you think you're ordering. And then when you're having that conversation with your GP or medical professional, um, be very transparent about any sort of eating disorder symptoms that you might be experiencing. Even if you say, oh, I don't have any eating disorder, you might have other preoccupations around your body image, or maybe you have a history of engaging in something like purging behaviours and

Your doctor might not necessarily ask that question unless you prompt it. And so I would really recommend going to that appointment prepared, knowing that they might be willing to give you the medication without necessarily asking all the questions of you that are necessary to make sure it's the safest decision. And also being aware of the fact that that if you do start taking this, it's a possibility that you might need to start taking it for a long time. What impacts would that have for you in terms of economic impacts or family planning, things like that.

Your doctor might not necessarily ask that question unless you prompt it. And so I would really recommend going to that appointment prepared, knowing that they might be willing to give you the medication without necessarily asking all the questions of you that are necessary to make sure it's the safest decision. And also being aware of the fact that that if you do start taking this, it's a possibility that you might need to start taking it for a long time. What impacts would that have for you in terms of economic impacts or family planning, things like that.

Uh, it's just such fascinating work, Trevor. What's one final takeaway or piece of advice you'd like to leave our listeners with?

Uh, it's just such fascinating work, Trevor. What's one final takeaway or piece of advice you'd like to leave our listeners with?

Yeah, well, I, if I could leave, um, our listeners with one thing, I'd just say, uh, be mindful with the words that you use around body image and weight. You never really truly know what someone else is dealing with and even, um, you know, casual remarks can cause harm. And y'know, if you are someone that's living with an eating disorder, I, um,

Yeah, well, I, if I could leave, um, our listeners with one thing, I'd just say, uh, be mindful with the words that you use around body image and weight. You never really truly know what someone else is dealing with and even, um, you know, casual remarks can cause harm. And y'know, if you are someone that's living with an eating disorder, I, um,

I can understand that it's so frustrating having to go through different courses of treatment, having to navigate the healthcare system, and just feeling as if nothing's working. And so I really really want to encourage someone if they are living with eating disorder or they're caring for someone with an eating disorder, not to lose hope around that. Um, for example, Eating Disorders Victoria has some wonderful peer support groups that you can look up online if you are living with these types of eating disorders and not sure what to do.

I can understand that it's so frustrating having to go through different courses of treatment, having to navigate the healthcare system, and just feeling as if nothing's working. And so I really really want to encourage someone if they are living with eating disorder or they're caring for someone with an eating disorder, not to lose hope around that. Um, for example, Eating Disorders Victoria has some wonderful peer support groups that you can look up online if you are living with these types of eating disorders and not sure what to do.

And then on another point, I think it's really worth reiterating, and this is something that I try to emphasise to patients that I'm speaking to is that, be critical of what you are engaging with on social media. It's hard because it's almost like a knee jerk reaction. I find myself doing this where the second you take out your phone, you're consuming content and you don't necessarily know why just sort of passively getting into your psyche.

And then on another point, I think it's really worth reiterating, and this is something that I try to emphasise to patients that I'm speaking to is that, be critical of what you are engaging with on social media. It's hard because it's almost like a knee jerk reaction. I find myself doing this where the second you take out your phone, you're consuming content and you don't necessarily know why just sort of passively getting into your psyche.

But I just really wanted to emphasise, you don't need a stranger on the internet telling you how to live your life in terms of body image ideals or what medications to take. So I think that's something that I really want to encourage people like, OK, well, question what advice you're getting is really thinking whether or not they have your best interests in mind.

But I just really wanted to emphasise, you don't need a stranger on the internet telling you how to live your life in terms of body image ideals or what medications to take. So I think that's something that I really want to encourage people like, OK, well, question what advice you're getting is really thinking whether or not they have your best interests in mind.

And then last point, which I realised this isn't one, this is like more like 4 or 5 is um.

And then last point, which I realised this isn't one, this is like more like 4 or 5 is um.

It's important to remember that these medications and the use of these medications and mental health care, it's a political issue, let's not beat around the bush. Right now, there's very strong evidence linking obesity and binge eating to socioeconomic status and you know, for example, food deprivation or living in food, food deserts. And what's really troubling is that this these medications are so expensive that down the line we might be in a situation where only people from privileged backgrounds are going to be really able to access them. And so we need to

It's important to remember that these medications and the use of these medications and mental health care, it's a political issue, let's not beat around the bush. Right now, there's very strong evidence linking obesity and binge eating to socioeconomic status and you know, for example, food deprivation or living in food, food deserts. And what's really troubling is that this these medications are so expensive that down the line we might be in a situation where only people from privileged backgrounds are going to be really able to access them. And so we need to

make sure that we're engaging politically within the space to, you know, are we endorsing calls to actually believe in, you know, a humane health system that, you know, allows people to access these.

make sure that we're engaging politically within the space to, you know, are we endorsing calls to actually believe in, you know, a humane health system that, you know, allows people to access these.

Oh, it's fascinating. Thank you for joining us, Trevor. I think it's just, there's so many things in there that we could have spent another hour talking about, but, um, yeah, fascinating research and good luck with your future research.

Oh, it's fascinating. Thank you for joining us, Trevor. I think it's just, there's so many things in there that we could have spent another hour talking about, but, um, yeah, fascinating research and good luck with your future research.

Right, thanks, Cassie. Thanks, Nick.

Right, thanks, Cassie. Thanks, Nick.

You've been listening to Psych Talks with me, Cassie Hayward, and Nick Haslam. A big thank you to our guest today, Dr Trevor Steward.

You've been listening to Psych Talks with me, Cassie Hayward, and Nick Haslam. A big thank you to our guest today, Dr Trevor Steward.

This episode was produced by Carly Godden with production assistance from Mairead Murray and Gemma Papprill. Our sound engineer was Jack Palmer. Thanks

This episode was produced by Carly Godden with production assistance from Mairead Murray and Gemma Papprill. Our sound engineer was Jack Palmer. Thanks

for tuning into PsychTalks, and we'll see you again in two weeks. Bye for now.

for tuning into PsychTalks, and we'll see you again in two weeks. Bye for now.