Another Ozempic side effect? Facing the holidays with no appetite

Kim Tyler calls herself air-traffic control for her family, and her kitchen is its hub. Her mother, cousin, daughters and four grandkids circulate, daily, feasting on things she makes.

"I'm the one that's trying new recipes and making everyone try something new," she says. She stuffs her cabinets with exotic spices and obscure varieties of vinegar she acquires on travel. And she draws inspiration from local bounty: Halibut and salmon pulled from waters near her home in Soldotna, Alaska, fill her freezer. "I make osso buco with moose," she says.

In short, food is central to Tyler's life. "I think it's a mom thing, it's a family thing. I'm really looking forward to Thanksgiving because I get to make dinner for everybody."

Yet Tyler herself has no desire to eat. Going on the drug Wegovy last summer switched off decades of what she calls "emotional binge eating," replacing it with an apathy for eating. She lives on the outskirts of her own family feasts.

"I still love to cook for people, I still love to watch my family eat," she says. "I still like to make things for people — I just don't care for it for myself. I'm completely apathetic."

For many people, the holidays are a celebration of food and family, but they can be complex to navigate for people learning to live without an appetite, or the social comforts that come with communal eating.

As more obesity treatments come to market, more people run into experiences like Tyler's, says Dr. Christopher McGowan, an obesity specialist and CEO of True You Weight Loss in Cary, N.C. The new obesity and diabetes medications can tamp down normal appetite, and leave some dreading food-focused holidays.

People can lose their lust for food for other reasons too, including stress, grief, and illness.

I started experiencing this several years ago, no thanks to irritable bowel syndrome, a chronic but not life-threatening digestive condition. It made my body associate food with pain in a way that almost completely eroded my sense of hunger.

But I also associate food with love and share my family's collective obsession with it; like Tyler, even now, I convey love through fresh, homemade dinners I prepare for my kids.

So losing my appetite was just that: a loss. I miss how much I once looked forward to meals, or the satisfaction of feeding a deep craving.

At holiday meals, my parents send me pitiful glances as they relish third and fourth helpings. In their native Japan, especially, leaving food on a plate is considered insulting to the chef. I don't order entrees at restaurants unless my teenagers attest they will finish what I cannot.

For patients in treatment for diabetes or obesity, losing the craving for food can be liberating. But McGowan says there are some impacts patients find disturbing or dulling enough that some wish to come off them.

"Some patients will say they lost a friend; food has been comfort for them for years, as it is for most of us, and suddenly they're robbed of that," he says. "They're learning and re-learning how to cope with stressors when they can't turn to food."

And especially during the holidays, the national focus on food and family can compound that stress. Partly, McGowan says, that may be because there's a etiquette to not eating: "None of us want to insult the chef, but what if the chef is your mother or grandmother?"

Also, weight loss, body shape and food consumption are common, touchy subjects at a holiday dinner table, and McGowan says patients worry about being on the receiving end of someone's judgment or commentary. He advises them to come prepared with phrases to use in response, like "I'm focusing on my health."

And he tells them to savor at least some of the social benefits of eating together: "Take small amounts of each thing, you know, really enjoy it and and express your enjoyment and satisfaction and tell the chef, whoever that is, how much you're enjoying it."

But the medications have taken most of the enjoyment out of food for Tyler, the grandmother in Alaska. With a lowered appetite, she has to be careful to get the nutrition she needs – and she is focused on continuing to lose weight. To her, food is now a numbers game: Using a phone app, she tracks her consumption of everything from grams of protein to glasses of water — not to mention the 53 pounds she's shed to date.

"I think I have to be careful that I haven't traded one obsession for another --the numbers I keep talking about — that's the obsession now," she says. "I've never weighed myself for years and years and years, and now I get a little obsessed about it."

That also worries Johanna Kandel, CEO of the National Alliance for Eating Disorders, who says the new drugs could potentially worsen an already grave prevalence of eating disorders. Specifically, she worries about a newly recognized condition called ARFID — short for Avoidant/Restrictive Food Intake Disorder, which she says is characterized by an extreme disinterest or even fear of food.

And as with other eating disorders, people might feel they are under the microscope when they're around the dinner table; it can also affect their appetite for social gatherings.

"There's a lot of comments that will happen, like, 'Can you just eat,'" Kandel says. "When I was going through my eating disorder, it was like everyone held their breath as I was sitting there and eating."

Kim Tyler says a lack of appetite hasn't made her any less social. For one thing, there aren't many restaurants in her town of just over 4,000. And if anything, she says the joy of food has been replaced by the joy of being able to exercise and play outside with her grandkids.

"I have so much more fun with them, and I can do more with them," she says.

Only occasionally, Tyler remembers sugary or salty things she loved and misses, like Hawaiian soy sauce she once loved eating with rice — neither of which she eats anymore.

But for now, she's fine with the tradeoffs of life without an appetite.

Will she — or many others using weight-loss drugs long term — eventually bore of that life? She says maybe. "I'm still only three months in. Ask me a year from now if it's a chore." [Copyright 2023 NPR]