Written by: Angela Derrick, Ph.D. & Susan McClanahan, Ph.D.
Date Posted: March 16, 2026 3:22 am
For most of my adult life, I carried between 30 and 90 pounds above what doctors considered my optimal weight, even though I ran marathons in my 30s and did nearly everything I was told should work.
For many people, conversations about weight feel impossible to win.
If you want to change your body, you risk being seen as rejecting body positivity or giving in to cultural pressure. If you practice acceptance, you may worry that you are ignoring legitimate health concerns.
Many people find themselves wondering the same thing.
Is it possible to love your body and still want it to change?
That question has become even more complex with the rapid rise of GLP-1 medications such as Wegovy, Zepbound, and Ozempic. These medications are changing the landscape of weight treatment and metabolic health. At the same time, they have stirred intense cultural conversations about fatphobia, body positivity, and the meaning of self-acceptance.
For many individuals, the experience is deeply personal.
It is about health history. Family history. Hormones. Mental health. And the complicated emotional relationship many of us have with food and our bodies.
At SpringSource: Eating, Weight & Mood Disorders, we see this complexity every day in our clinical work. People often arrive carrying a mix of hope, shame, confusion, and curiosity.
They want to care for their health.
They want freedom from stigma.
And they want to feel at peace in their bodies.
That tension is real. And it deserves compassion rather than judgment.
A recent New York Times Opinion video highlighted this tension through the story of Gabriella Lascano, a former body positivity influencer who began questioning some aspects of the movement as her own health concerns evolved.
As she reflected on her experience, Lascano posed a question many people are asking today:
“I started to wonder if loving myself at any size had become an excuse to ignore how big I was getting.”
Her perspective illustrates a broader cultural shift. The body positivity movement emerged as a necessary response to decades of harmful beauty standards and widespread fatphobia. It created space for people in larger bodies to exist without shame and to challenge discrimination and stigma.
But as medical research continues to evolve and new treatments like GLP-1 medications become available, many individuals are finding themselves navigating a more nuanced reality.
For some, self-acceptance and medical treatment are not opposites. They can coexist.
One member of the extended SpringSource community shared her experience of navigating that complexity.
She describes struggling with weight for most of her adult life, particularly during peri and post menopause. Yet her story challenges many of the stereotypes often attached to larger bodies.
In her 30s she ran multiple marathons. She has always been active and moderately athletic.
Still, weight remained stubbornly resistant to change.
Like many women, she was balancing several biological realities at the same time. A family history of heart disease and obesity. Hormonal shifts in midlife. Clinical depression that was successfully treated with medication, but carried the side effect of weight gain.
The only way she could ever make the scale move at all was by eliminating carbohydrates entirely. Even then the changes were modest and impossible to sustain long term.
Over time the familiar cycle of dieting returned. Restriction, exhaustion, and eventually the weight coming back.
Looking back, she now understands that her brain and hormones were fighting a biological battle that willpower alone could not overcome.
For years she carried between thirty and ninety pounds above what medical charts defined as an optimal range.
Much of my weight gain intensified during perimenopause, when my body began changing in ways that felt completely outside my control.
At one point during a particularly stressful period of life, the number climbed toward the higher end of that range.
It was a time when everything seemed to fall apart at once. Work stress. Housing instability. Relationship struggles. Sleep disruption. The emotional strain of the pandemic layered on top of everything else.
During that period, she stopped fighting the battle entirely.
Instead, she began practicing acceptance. Letting go of constant attempts to change her body brought a surprising sense of relief.
For the first time in years, she felt some peace.
But the desire to support her long-term health never fully disappeared.
For many women, these experiences intensify during midlife. Hormonal shifts associated with perimenopause and menopause can significantly affect metabolism, appetite regulation, sleep, and mood. Estrogen plays an important role in how the body stores fat, regulates hunger signals, and processes insulin. As estrogen levels decline, many women notice weight changes that feel sudden and difficult to control despite maintaining the same eating and exercise habits that worked earlier in life.
At the same time, midlife often brings increased responsibilities and stress. Many women are balancing demanding careers, caring for children or aging parents, navigating relationship changes, and managing their own evolving health needs. These biological and social pressures intersect in ways that can make weight changes feel both frustrating and deeply personal. Understanding the hormonal and psychological context of midlife can help reduce shame and open the door to more compassionate, effective care.
When GLP-1 medications first began appearing in the news, her doctor mentioned that a diabetes medication was being prescribed off-label for weight loss.
At the time, the treatment was financially out of reach.
Like many people in the United States today, she found herself in a frustrating middle ground. She met the medical criteria for treatment because of both her weight history and her family history of heart disease, but insurance would not cover the medication.
Years later she made a decision that felt both practical and symbolic.
After paying off her car, she decided to take the money that had gone toward her monthly car payment and put it toward Zepbound.
She had waited so long for access to treatment. Even though the medication remained expensive, she felt her health could not wait any longer.
And for the first time since she was a young adult, something changed.
Her body began functioning in a way that finally felt aligned with her efforts.
For the first time in decades, the constant food noise in my mind went quiet.
The constant food noise that had lived in the background of her mind for decades disappeared.
Suddenly, there was space to make food choices calmly rather than through a constant internal negotiation.
What surprised her most about starting the medication was not just the physical change.
It was the emotional one.
Without the constant pull toward food, she found herself feeling unusually exposed.
For several months, she describes feeling like a raw nerve ending. Emotions that had previously been buffered by food began surfacing more directly.
Some relationships suddenly looked different.
Conflicts that had been easy to smooth over began to feel impossible to ignore.
Patterns of self-abandonment became more visible.
She began noticing moments when someone was dismissive or belittling in ways she had previously overlooked.
Before, she might have numbed the stress with food and moved on.
Now she found herself confronting uncomfortable truths.
Food had been helping me cope for years. When that changed, I suddenly had to face emotions I had been pushing aside.
Food can function as an incredibly effective emotional anesthetic. When that coping mechanism changes, people sometimes discover feelings they had been carrying quietly for years.
For her, this emotional adjustment was the most unexpected part of the journey.
It was also the moment when support became essential.
These are the kinds of experiences therapy can help people untangle. When old coping strategies shift, therapy can provide space to process emotions, understand relationship patterns, and develop healthier ways of caring for oneself.
None of these experiences exist outside of a larger cultural context.
Fatphobia remains deeply embedded in many areas of society, including healthcare. Individuals in larger bodies are often blamed for complex medical conditions or dismissed when seeking care.
This stigma creates a painful contradiction.
People may feel pressure to lose weight in order to be treated with respect. At the same time, they may feel criticized or accused of betraying body positivity if they pursue medical treatments such as GLP-1 medications.
Weight-inclusive care offers a different perspective and recognizes that weight is not simply a matter of discipline.
Dr. Angela Derrick notes, “body size is shaped by many factors, including genetics, hormones, metabolism, medications, mental health, stress, and social environment. Therefore, there is no one treatment or approach that will be right for everyone. At SpringSource, we do a careful assessment to gather information about all of these factors so that we can work uniquely with each individual. It doesn’t serve our clients if we are rigid or try to apply one model to everyone.”
For the community member who shared her story, starting a GLP-1 medication did not mean abandoning body acceptance.
Instead, it meant acknowledging something that many medical organizations now recognize. Obesity is often a chronic and relapsing condition that may require long-term treatment.
At first, she hoped the medication might permanently reset her metabolism.
Over time, she let go of that hope.
Instead, she began thinking about the medication as one tool among many for supporting her long-term health.
For the first time in her life, it is a tool that actually works.
The cultural conversation about weight often pushes people toward extremes.
On one side is the message that bodies must be controlled, disciplined, and reduced.
On the other side, there is the belief that wanting to change one’s body represents a failure of self-acceptance.
Most people live somewhere in between.
They want to respect their bodies.
They want freedom from shame.
They also want access to medical care that may improve their health.
These goals do not have to contradict one another.
Looking back, much of my thinking about weight had been shaped by an all-or-nothing mindset.
If I was going to succeed, I believed I had to eliminate entire food groups. Carbohydrates were the most obvious example. For years I thought the only way I could possibly lose weight was to cut them out completely. The problem was that approach was never sustainable.
At medical appointments I was often told, repeatedly, that I needed to lose weight. What was rarely offered was a meaningful strategy that acknowledged the biological realities I was navigating. There was little discussion of hormonal changes in midlife, the metabolic effects of long-term dieting, the weight-related side effects of antidepressant medication, or the fact that I was otherwise relatively healthy and active.
The message was simple. Lose weight.
But the path forward was never clear.
Experiences like this can reinforce the kind of rigid, black-and-white thinking that many people develop around food and body size. Either you are being “good” or you are failing. Either you are strictly controlling food or you have lost control entirely.
At SpringSource: Eating, Weight & Mood Disorders, we often take a different approach.
One of the clinical frameworks we use is harm reduction. Harm reduction recognizes that health behaviors exist along a spectrum rather than in rigid categories of success or failure. Instead of demanding immediate or perfect change, the goal is to reduce suffering and improve health in ways that are realistic, sustainable, and compassionate.
This approach is especially important in the treatment of eating disorders, where rigid thinking about food, weight, and control can become deeply entrenched.
A harm reduction model allows clinicians and clients to work collaboratively toward meaningful improvements without reinforcing shame or perfectionism. It may involve supporting small shifts in eating patterns, strengthening emotional coping strategies, improving body awareness, or addressing the psychological factors that shape a person’s relationship with food.
For some individuals, GLP-1 medications can become part of this broader harm reduction framework. When used thoughtfully and with appropriate mental health support, these medications may reduce the physiological drivers of overeating or binge eating while allowing individuals to explore new ways of caring for themselves.
At the same time, harm reduction reminds us that medications alone do not resolve the emotional and relational dimensions of eating.
Real healing often involves learning how to move away from rigid rules and toward a more flexible and compassionate relationship with food, body, and self.
In this sense, harm reduction aligns naturally with the deeper goals of both body acceptance and mental health care. It allows space for people to pursue improved health while also challenging the shame and stigma that so often surround body size.
At SpringSource: Eating, Weight & Mood Disorders, we work with many individuals navigating complex feelings about weight, health, and identity. Our experienced therapists provide treatment for eating disorders and body image concerns.
We specialize in:
• Eating disorders and disordered eating
• Weight-inclusive mental health care
• GLP-1 mental health support
• Body image and emotional eating
• Midlife mental health and hormonal changes
Whether someone chooses to pursue medical weight treatment or not, therapy can help untangle the emotional layers that often accompany body changes.
Because ultimately, healing is not just about the body.
It is about the relationship we have with ourselves.
The question of whether someone can love their body and still want it to change is not really a contradiction.
It is a reflection of how complex being human is.
Self-acceptance does not mean ignoring medical realities. And seeking medical care does not mean rejecting self-respect.
For many people, the path forward looks less like choosing sides and more like holding both truths at once.
You can honor your body.
You can challenge the stigma that surrounds larger bodies.
You can care for your health in ways that feel aligned with your values.
For many of us, the real work is not choosing between body acceptance and medical care, but learning how to hold both with compassion.
At SpringSource: Eating, Weight & Mood Disorders, we believe that people deserve thoughtful, evidence-based mental health care that recognizes both the biological and emotional realities of living in a body.
If you are navigating body image concerns, eating difficulties, or the emotional experience of GLP-1 medications, our clinicians are here to support you.
Because no one should have to navigate these questions alone.
This article includes reflections from a writer and member of the extended SpringSource community who shared her lived experience with GLP-1 medication and weight stigma. Individual experiences with GLP-1 medications vary, and decisions about treatment should always be made in consultation with a qualified healthcare professional.
We provide in-person therapy in Northbrook and Chicago, with telehealth therapy available throughout Illinois.
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