A Size 4 Can Now Get on a GLP-1. Is That a Problem?
The GLP-1 questionnaire asks for your weight—but not why you want to change it.
Posted June 3, 2026 | Reviewed by Kaja Perina
Two hours. That is how long it takes, in 2026, to go from opening a website to receiving a GLP-1 prescription in your inbox. A questionnaire (asking for your height and weight, no fact-checking), a remote review by a clinician you will never meet, and a confirmation arrives.
A prescription used to mean a doctor had looked at you, assessed a condition, and determined that medical intervention was necessary.
But the woman completing the short questionnaire on her phone is not sick. She just wants to fit back into the jeans she hasn't worn in two years. She did her research, she can afford the medication , and she has spent years managing her body the hard way, counting, restricting, working out, with far less to show for it. So when the confirmation arrives in her inbox, she doesn't feel like a patient. She feels like a woman who finally has access to something that actually works.
Do we leave it there, or do we ask what it means that access to a powerful prescription medication now requires nothing more than a credit card and a wifi connection?
When semaglutide was first approved for weight management , you needed a body mass index (BMI) of 30 or higher, or a documented medical condition. The drug was designed for people whose weight was defined as a chronic disease. Then the thresholds disappeared. In March 2024, the Food and Drug Administration removed the specific BMI requirements from semaglutide's label, partly to correct for the limitations of BMI as a measurement tool, a metric that researchers had long argued was developed on European populations and doesn't translate well across different bodies. Tirzepatide followed seven months later.
Into that open door walked an industry that had been waiting. Compounding pharmacies produced cheaper unbranded versions, telehealth platforms built businesses around them, and suddenly the ads were everywhere, not aimed at people who had struggled with obesity for decades, but at thin, young women who wanted to lose a few pounds before summer.
You Know What You Want. Do You Know Why?
The telehealth questionnaire asks for your weight, which might be completely within normal range. It does not ask what your mother said about her own body when you were growing up.
That memory , for many women, is where the story actually starts. And yet the desire to lose weight among women who don't need to lose weight is so normalized it barely registers as a story at all. In 2025, 61 percent of American women said they wanted to lose weight, a number that has remained remarkably stable since 1951, regardless of what the culture was telling women about body positivity .
The desire to be thin feels personal, but the research suggests it is largely borrowed. So when you think about informed consent as a straightforward thing, you read, understand, and decide, it's worth pausing on the assumption underneath it: that the desire itself arrived independently. And for body image , for the way you feel standing in front of a mirror, that is almost never entirely true.
Women who have absorbed the cultural ideal of thinness pursue it because they have come to associate being thinner with psychological rewards like confidence and happiness , and social ones like better relationships and professional success. And it runs deeper than aspiration. Research consistently shows that excess weight is culturally associated with laziness and lack of discipline, associations that have nothing to do with health and everything to do with moral judgment. Researchers have found that body dissatisfaction and the desire to lose weight are driven primarily by the internalization of these cultural ideals, not by an objective assessment of your body. The woman who ordered her GLP-1 online and did her research is still making a decision inside a story she didn't write.
Her choice is real, but so is the question of what is actually being treated. Because if a size 4 qualifies for a prescription, and the desire to go down a size is statistically more about social norms than about health, then what we have built is a very efficient delivery mechanism for a very old anxiety , this time in the form of medicine.
The Price Nobody Quotes You
The confirmation arrives in your inbox. What it doesn't include is a conversation about what this medication might cost you, not financially, but psychologically.
The research on mental health and GLP-1s is still catching up with the prescriptions being written. A large 2024 cohort study found a significant association between GLP-1 treatment and increased risk of major depression and anxiety. A 2025 paper suggested the drugs may drive depression and suicidal ideation specifically in people with a genetic predisposition toward low dopamine function. Other studies have found no psychiatric risk, and some have even shown modest reductions in depressive symptoms. The science is not settled, and it is rarely part of the conversation before you sign up.
Thinness has never been free. You have always paid for it in some currency, restriction, obsession, time, self-criticism. The question GLP-1s are bringing to the surface is whether you have simply found a more efficient payment method and whether efficiency is the same thing as safety.
Who decides that? You, ideally. But only if someone first asks you the questions the form left out.
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Flatt, R. E., et al. (2022). Psychometric properties of the Perceived Benefits of Thinness Scale in college-aged women. Eating Behaviors , 44, 101592. https://doi.org/10.1016/j.bodyim.2021.11.005
Gallup. (2026). Half of Americans want to lose weight. https://news.gallup.com/poll/700112/half-americans-lose-weight.aspx
Kornelius, E., Huang, J. Y., Lo, S. C., et al. (2024). The risk of depression, anxiety, and suicidal behavior in patients with obesity on glucagon like peptide-1 receptor agonist therapy. Scientific Reports, 14, 24433. https://doi.org/10.1038/s41598-024-75965-2
Ringel, M. M., and Ditto, P. H. (2019). The moralization of obesity. Social Science and Medicine, 237, 112399. https://doi.org/10.1016/j.socscimed.2019.112399
Sharafshah, A., et al. (2025). In silico pharmacogenomic assessment of glucagon-like peptide-1 (GLP1) agonists and the genetic addiction risk score (GARS) related pathways: Implications for suicidal ideation and substance use disorder. Current Neuropharmacology, 23(8). https://doi.org/10.2174/011570159X349579241231080602
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Yael Hallak is a NY Licensed Mental Health Counselor, researcher at The New School’s Gender & Health Lab, and journalist at Haaretz writing about women, health, and the psychology of self-control.
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.