Abbey's Kitchen on GLP-1 drugs: what holds up under scrutiny

What did @abbeyskitchen actually say?

Abbey Sharp, a registered dietitian, weighed in on a viral moment from a plus-size creator named Selena who disclosed she was on a weight loss journey. Abbey's core argument: plus-size creators should not have to apologize for seeking weight loss, whether through diet, surgery, or "a weight loss drug like a Zempic." She positioned herself as someone who supports patient autonomy, saying she backs people whether they want to "fit into pre-baby clothes" or "reverse your diabetes." She did not share dietary advice or dosing information. The video was largely a defense of Selena's right to make her own choices without public judgment, framed through Abbey's identity as a non-diet-culture, body-neutral RD.

Does the science back this up?

On the autonomy point, yes, the evidence is solidly on her side. Weight stigma research consistently shows that public shaming and social pressure around weight loss decisions do real harm. The pushback Abbey describes is not hypothetical.

On the clinical equivalence she implies between cosmetic goals and medical ones, that gets murkier. GLP-1 receptor agonists like semaglutide were developed and tested primarily in populations with obesity-related comorbidities. The landmark SURMOUNT-1 trial (Jastreboff et al., 2022, NEJM) showed tirzepatide produced 20.9% mean weight loss in adults with a BMI of 30 or higher, with or without type 2 diabetes. The SELECT trial (Lincoff et al., 2023, NEJM) showed semaglutide reduced major cardiovascular events by 20% in people with established cardiovascular disease. These are not trials of people wanting to fit into pre-baby clothes. The risk-benefit calculus is genuinely different depending on baseline health status, and Abbey glossed over that distinction.

What did they get wrong (or right)?

Abbey got the stigma piece right. She got the framing of patient autonomy mostly right. But her line equating wanting to "lose 10 pounds to fit into pre-baby clothes" with wanting to "reverse your diabetes" as equally valid reasons for GLP-1 use is where she stumbled. That equivalence matters clinically.

GLP-1 agonists carry real side effect profiles: nausea, vomiting, gastroparesis risk, pancreatitis concerns, and for some formulations, thyroid cancer signals in rodent models. The FDA-approved indication for semaglutide (Wegovy) requires a BMI of 30 or higher, or 27 or higher with a weight-related comorbidity. Prescribing outside those parameters is not automatically wrong, but it is a clinical decision that deserves more nuance than "I support you." Abbey is not giving medical advice here, and to her credit she does not claim to. But she also does not say "talk to your doctor about whether this is appropriate for you," which would have been the responsible add.

What should you actually know?

GLP-1 receptor agonists are legitimate, FDA-approved medications with meaningful clinical evidence behind them. They are not snake oil. But the evidence base is strongest for people with higher BMI and obesity-related comorbidities, not for people with minor cosmetic goals. That distinction matters when weighing side effects against benefits.

The weight stigma Abbey is pushing back against is also a documented clinical problem. A 2020 systematic review (Tomiyama et al., 2020, Nature Reviews Endocrinology) found that weight stigma is associated with increased cortisol, inflammation, and avoidance of healthcare. Telling fat people they need to justify their medical decisions with a "list of personal health parameters" is not just unkind, it is a documented barrier to care.

If you are considering a GLP-1 medication, the decision should involve a licensed clinician who knows your full health history. Cosmetic intent is not a disqualifier, but it does shift the risk-benefit conversation. No TikTok video, including this one, substitutes for that conversation.