Depression, Bias, Food Noise, and GLPs with Dr. Robyn Pashby
Have you ever noticed how mood and weight seem to affect each other? How depression can change your appetite or how anxiety can make it hard to eat regularly or stay active? It’s not a coincidence. The connection between mental health and weight is deep, complex, and often overlooked in traditional care.
Joining me today is Dr. Robyn Pashby — a licensed clinical health psychologist, author, and nationally recognized expert in the psychological and behavioral treatment of obesity and obesity-related chronic health conditions. She’s also the founder of Health Psychology Partners in Washington, D.C., and serves on multiple boards and committees in the obesity medicine space.
In this episode, we’ll unpack the relationship between weight, mental health, eating disorders, and stigma—and talk about how understanding these connections can lead to more compassionate, effective care.
Keep reading to learn how mood, medication, and mindset all shape the way we understand weight—and what true, whole-person care really looks like.
Why Mental Health and Weight Are So Closely Linked
The link between weight and mood disorders—like depression and anxiety—is so complex. It’s what experts call a bi-directional relationship, meaning it goes both ways. People living with higher weight are more likely to experience depression and anxiety, and those dealing with these mood disorders can also see changes in their weight over time.
There’s a lot happening behind the scenes here. Biologically, things like cortisol levels and chronic stress play a big role. When the body’s constantly in stress mode, it affects mood, appetite, and even how fat is stored. But beyond biology, there’s also the emotional side of it—especially when it comes to weight stigma. Feeling judged or excluded, whether it’s at the doctor’s office or just out in public, creates this constant background stress that wears people down emotionally.
And childhood experiences matter too. Growing up with trauma, food insecurity, neglect, or a parent struggling with mental illness can all shape how someone manages emotions, hunger, and stress later in life. It’s not just about willpower or habits—it’s about how the body and mind have been trained to cope since day one.
When Mood Messes with Weight (and Why It’s Not Just in Your Head)
Mood disorders can seriously affect weight. Depression often comes with fatigue, sleep issues, and changes in appetite. Over time, those shifts can lead to gradual weight gain, even for people who never struggled with it before. And when clinics offer quick prescriptions or one-size-fits-all plans, they often overlook the deeper reasons behind it all—like stress, biology, and the emotional weight of living with a mood disorder.
Real care means looking at the whole person—their mental health, physical health, and life story. When people are handed generic advice that doesn’t fit their reality, they end up blaming themselves for not “trying hard enough.” But it’s not their fault. Our brains are wired to focus on problems, and that instinct can easily turn inward, creating even more guilt and frustration.
To make things more complicated, some antidepressants and antipsychotics can cause weight gain, too. So while people are working to care for their minds, they’re also navigating changes in their bodies. That’s why compassionate, personalized care matters—it helps people feel seen, supported, and understood. Because mood and weight aren’t separate—they’re deeply connected.
When Mental Health Meds Affect Weight (and Why Speaking Up Matters)
When it comes to mental health treatment, one thing that doesn’t get talked about enough is how certain medications can affect weight. Many people managing depression or anxiety also deal with weight concerns, and sometimes, the very meds meant to help can make those concerns worse.
For years, the focus was simple: stabilize mood first. And that makes sense because mental health always comes first. But what wasn’t always considered is how gaining weight as a side effect can affect someone’s self-esteem or mood even more. It can feel like trading one struggle for another, which is incredibly frustrating.
The good news is there are now more weight-neutral options available—medications that support mental health without major changes to weight. It might take some trial and error, but it’s completely okay to talk to your prescriber about it. Saying something like, “I’m worried this medication might cause weight gain. Are there more weight-neutral options we can try?” can open up the conversation. Not every prescriber automatically considers weight effects, so being informed and speaking up really helps. Because mental and physical health shouldn’t compete; you deserve care that supports both.
You Know Your Body Best—And That Deserves to Be Heard
One of the most frustrating things patients go through is being brushed off when they say a medication caused noticeable weight gain. Imagine starting a new prescription and realizing you’ve gained 30 or 40 pounds in just a few months, only to be told, “Well, the average weight gain is about 5%,” or worse, “It probably wasn’t the medication.” It’s invalidating and discouraging—especially when you know something in your body has changed.
That kind of response feeds the outdated idea that weight changes always come down to personal choices, like eating too much or not moving enough. But patients aren’t imagining it. They know their own bodies better than anyone else. When those experiences get dismissed, it breaks trust and makes people less likely to seek care or stick with treatment.
For healthcare providers, the message is simple: believe your patients. Listening without judgment can make a huge difference. And for patients, if you’re not being heard, you have every right to find someone who will listen. Everyone’s body reacts differently to medication, and not everything fits neatly into the “average.” Trust yourself, speak up, and remember—you deserve care that validates your experience and supports your whole health.
The Hidden Link Between Medications, the Gut Microbiome, and Weight Gain
At a recent obesity medicine summit, one of the most surprising takeaways was how certain medications can actually change the gut microbiome—and with it, metabolism. One speaker talked about research on the antipsychotic medication risperidone, explaining that it alters the balance of anaerobic bacteria in the gut. Those changes reduce the number of active bacteria, which can slow down metabolic rate.
It’s a clear reminder of just how complex the relationship between medication and weight really is. So many people notice weight gain after starting a new prescription, even when nothing about their diet or activity level has changed. Yet too often, they’re told, “That’s probably not related.” But there are real biological reasons behind it, even if science is still catching up.
That’s why it’s so important for healthcare providers to listen and believe patients when they share their experiences. If someone says, “I gained weight after starting this medication,” that deserves to be taken seriously. Sometimes the most helpful thing a clinician can say is, “I don’t know why that happened, but it sounds like it did—let’s figure out a better option.” Everyone’s body reacts differently, and not every study captures that. Until research becomes more inclusive, the best thing medicine can do is lead with curiosity, compassion, and the willingness to adjust care when needed.
When Food Noise Fades but Shame Noise Stays
The term food noise started with patients using GLP-1 medications like Wegovy or Zepbound. They noticed a quieting of constant food thoughts—no more mental chatter about cravings or guilt over eating. It gave them space to think about life beyond food.
But there’s another kind of noise these medications don’t silence: shame noise. Thoughts like, Will I fit in that chair? Do I look bigger in this jacket? Should I hide my arms? or I wish I looked different in that photo. This kind of noise is tied to body image, social pressure, and years of internalized stigma. Even when food-related thoughts calm down, shame can still echo in the background.
That’s where self-criticism comes in. It’s the voice that constantly points out flaws or mistakes, often shaped by years of judgment—from others and from ourselves. Over time, it becomes automatic, and even when weight or eating patterns change, that critical voice can stay loud. That’s why true healing goes beyond medication. It’s about learning self-compassion, addressing emotional patterns, and finding support that helps quiet both kinds of noise—the one about food, and the one about self-worth.
Asking the Right Questions
When a clinician assumes someone in a larger body can’t have an eating disorder, they often skip important questions—that’s bias at work. But it doesn’t take much to start the right conversation. Tools like the SCOFF questionnaire can help, but even without that, asking honest, open-ended questions can reveal a lot.
Questions like:
Do I fear gaining weight?
Do I wish I could be the same size I was years ago?
Do I feel like my worth depends on my body or the scale?
Do I think about my body most of the day?
Do I try to make up for what I eat?
If the answer to any of those is even a quiet “yes,” it might be time to reach out for help. Because treatment works—but it starts with acknowledging the struggle.
This connects back to the idea of food noise and shame noise. If disordered eating or body image issues aren’t addressed, no medication or weight-loss plan will fully work. Healing the relationship with food has to come first. Many people think, “I’ll fix my body image after I lose the weight,” but it doesn’t really work that way. Those thoughts don’t disappear just because the number on the scale changes.
People often end up moving the goalpost or still feeling unhappy, no matter how much weight they lose. That’s why weight regain can happen—it’s not a failure, it’s a sign that the emotional side still needs care. The real starting point is compassion: understanding that healing your relationship with food and your body isn’t a step backward—it’s the foundation for everything else.
If body image or eating issues aren’t addressed, no medication or diet plan will fully work—healing your relationship with food comes first.
More Than the Weight We Carry
Our guest, Dr. Robyn Pashby, co-wrote a book called The New Food Fight: How the Eating Disorder and Weight Management Worlds Got So Divided—and What We Can Do About It. She shared that it took about three years to complete — definitely a journey.
The book breaks down common myths we see in everyday culture and on social media, like the idea that eating disorders only affect people who look a certain way. Through science, clinical experience, and real stories, Dr. Pashby and her co-authors unpack those misconceptions and talk about how the eating disorder and obesity communities can actually come together to focus on what truly matters: the patient.
As Dr. Pashby said, the weight we carry is more than just what’s on our bodies. Anyone who has lived with obesity knows that. She hopes this book helps people understand that while physical health matters, the emotional and mental weight people carry deserves just as much attention.
Understanding the connection between mood, weight, and mindset is just the beginning. Healing your relationship with food, listening to your body, and practicing self-compassion are essential steps toward true, whole-person care.
Listen to the full episode to dive deeper into Dr. Pashby’s perspective and learn practical ways to support both your mental and physical health.
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