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None of us got where we are solely by
pulling ourselves up by our bootstraps.
- Thurgood Marshall

Feeling Judged
Not wanting to feel stupid often leads to bad decisions. Ignore the voice in your head that tells you other people are going to think you’re an idiot. You’re almost certainly wrong about what you believe others think about you anyway. Don’t be afraid to be different—none of us are the same anyway.

Harmful or Harmless?
What We Know About Electronic Partner Surveillance.
Online partner monitoring and its impact on our romantic relationships.

KEY POINTS-
"Electronic partner surveillance" means using technology to monitor a romantic partner's activities.
Partner surveillance is often considered an expression of jealousy, insecurity, and distrust.
Yet many partners engage in surveillance for practical or caring motivations.
Electronic surveillance should only be used in ways that respect both partner's autonomy and privacy.
Mobile devices have made it much easier to stay connected with our romantic partner. Unburdened by the physical constraints of the offline world, partners can be in constant contact with each other and stay updated on each other’s lives, whether through texting or through social media.

These same online sources of information may also be used to monitor what our partner is doing and who they are interacting with. This is called electronic partner surveillance.

Electronic partner surveillance is a heavily discussed topic in scientific literature. In many cases, electronic partner surveillance is considered a particularly harmful phenomenon, and many studies have shown that these surveillance behaviors can have a negative impact on partners’ mental health and their satisfaction with the relationship (for an overview of this literature, see, for example, Caridade et al., 2019). In extreme cases, electronic partner surveillance can even be linked to offline (or "face-to-face") psychological and physical partner violence (e.g., Schokkenbroek et al., 2022).

Who Finds It Harmful—And Who Doesn't?
While these research findings make it very clear that electronic partner surveillance can be harmful with (severe) negative consequences, several scientific studies imply that most people who actually engage in electronic partner surveillance do not perceive these behaviours as harmful (e.g., Lucero et al., 2014). In fact, partner surveillance practices seem to be rather normalized among certain people: Checking a partner’s phone and messages is often perceived as common (Stonard et al., 2017), and some young adults interpret their partner’s surveillance practices as "proof of love" (e.g., Borrajo et al., 2015).

Increased ICT use (Phillips & Klest, 2022), increased expectations for constant communication (Basting et al.., 2023), and, consequentially, the normalization of partner surveillance behaviours could be part of the reason why people who experience partner surveillance do not recognize their partner’s behaviours as harmful.

But another explanation, by Ashcraft (2000), suggests that one reason it might be difficult to identify harassment and controlling behaviours as abuse is due to the fact that the language used to describe abuse generally emphasizes physical actions. This makes non-physical forms of intimate partner violence, such as electronic partner surveillance, much harder to recognize. Indeed, recent studies have found that the young adults in their sample failed to identify certain violent behaviours and did not perceive behaviours that demonstrated control and jealousy as alarming (Rebollo-Catalan & Mayor-Buzon, 2020).

Can It Sometimes Be Harmless?
Another way to look at the normalization of electronic partner surveillance is that maybe not all surveillance behaviours are maliciously driven by insecurity, distrust, or jealousy. In some or perhaps even most cases, partner surveillance may be an expression of commitment and care.

Monitoring a partner’s social media activity, for example, could be a way to stay more connected with their world. Checking a partner’s location, on the other hand, could be a way to make sure they are safe.

Indeed, a recent survey among Flemish adults revealed that although most did not think partner surveillance is appropriate, most of the reasons they imagined that they would engage in this behaviour were related to care (e.g., checking if the partner came home safely) or to practical reasons related to managing the household (e.g., estimating when to start cooking based on the partner’s live location) (Dereymaeker et al., 2022). Additionally, in some couples, electronic partner surveillance occurs consensually or even bidirectionally, with both partners monitoring each other’s online and offline activities.

What Does This Mean for Couples?
It makes a lot of sense that most people would disapprove of partner surveillance practices when they hear about them for the first time. However, approaching partner surveillance as an inherently ill-intended practice would mean ignoring other important and insightful perspectives that paint a less malicious picture.

What's more, what works for some couples may not work that well for others. While digital technology is omnipresent in our daily lives, none of us have yet received a clear manual on how to build and navigate healthy relationships in these vastly changing and intertwining online and offline environments. Most people are simply trying to figure out, often through trial and error, what works for them and their relationship.

Still, we do know this: For the good of both partners and the relationship, electronic partner surveillance should be used in a way that respects both partners’ privacy and autonomy, and that allows both partners to have a say in what works for them.

BODY IMAGE
What Are the Risks and Benefits of Weight-Loss Shot?
Questions, answers, and considerations from two health professionals.
Reviewed by Vanessa Lancaster

KEY POINTS-
“Ozempic face” and digestive and endocrine risks have been reported as possible side effects of taking semaglutide medications.
Restricting nutritional intake can affect mood and mental health, whether by shot or dieting.
Doctors report that people who stopped taking semaglutide medications have hunger return to the same, if not a greater, level than before.

You’re in your doctor’s office when "You need to lose weight" booms through the room. They offer Wegovy or Ozempic as a solution.

I hear about this happening often. And as an eating and body image specialist, I have some questions. I'm not alone. For example, the topics of Ozempic and Wegovy dominated a recent professionals' consultation group. Many of our patients, family members, and friends have been offered these shots for weight loss, not diabetes. None of us clinicians knew much about these medications. (And we probably should because we are people in the eating and body image field!)

What is Ozempic? Wegovy?
What happens if someone stops taking it? Do people have to take the shots forever?
What are the long-term effects?
How might taking Ozempic or Wegovy affect mental health? Physical health?
Are these injections a solution to body-image issues?
I imagine many people considering Ozempic or Wegovy probably have these questions, too. So I invited my colleague, eating disorders specialist Jessica Johns-Green, LPC, to join me in finding answers to some of those questions.

1. What are Ozempic and Wegovy?
Ozempic and Wegovy are both semaglutide medications. Using their brand names, Ozempic was FDA approved in 2017 for type 2 diabetes management and Wegovy in 2021 for weight management. Depending on which, the dosing differs. For readers who like a summary, these semaglutide medications can make you feel full while eating less by jockeying the hormones. For those who want more details, these shots help the pancreas release the right amount of insulin and slow the stomach's natural process. According to the FDA’s report in June 2021, semaglutide drugs mimic a hormone called GLP-1 that stimulates insulin secretion and lowers glucagon released from the liver (FDA, 2021).

2. What happens if you stop taking it? Do you have to take the shots forever?
Evidence indicates that the weight generally comes back (Wilding et al., 2022). Reports from doctors’ observations are that people who stopped taking semaglutide medications have hunger return to the same if not a greater, level than before (Lovelace, 2023). This phenomenon mirrors much of what we know about extreme dieting generally–when the body has been deprived, the hunger typically returns with a vengeance (Coutinho, 2018; Siahpush et al., 2015). Increased appetite means the most likely scenario is the lost pounds or kilograms returning. Some semaglutide users gained back more than before (Constantino, 2023).

So do you have to take the shots forever? Well, from our reading, “It depends.” Evolving research will likely reveal a clearer answer.

3. What are the long-term effects of being on Ozempic or Wegovy?
Though much is still unknown, here’s what science says so far:

Semaglutide medications carry the risk of thyroid cancer in animal trials (National Library of Medicine, 2023).
In people who have used the drug longer term for diabetes, there may be a risk of kidney disease (Leehey et al., 2021).
Further, we might not be unreasonable to wonder about the long-term effects on hormone levels and functioning. But it will take some time to gather more information.

4. How can it affect your physical health? Mental health?
Physically, users routinely complain of nausea, vomiting, fatigue, racing heart, and changes to bowel movements such as diarrhea or constipation (Wegovy® Side Effects, n.d.). Dehydration has also been reported, which can also put kidneys at risk (Ozempic, n.d.). Another common side effect is something termed “Ozempic face," which is when the face looks aged and sagging. It is not clear what causes this facial change. Some doctors speculate that it may result from rapid fat loss (Cohen, 2023).

In terms of mental health, much remains to be seen. Do you know anyone on it? Starting with the Minnesota Starvation Experiment nearly 80 years ago, science has repeatedly shown that undereating can result in symptoms such as increased anxiety, obsessiveness, social isolation, high to low moods, irritability, euphoria, etc. (Keys et al., 1950). Are you (or they) experiencing any of these types of symptoms? For those who started Wegovy or Ozempic for body-image disturbances, are those issues fixed?

5. Is this a solution for body-image issues?
For most of us, body image results from many years and layers of conditioned beliefs that play out as we look in the mirror or see ourselves in photos, window reflections, and our minds. Based on other populations that change their bodies to improve how they feel emotionally, it is not likely that these weight-loss medications will offer a permanent solution to poor body image (Lacroix et al., 2022).

Because semaglutide weight-loss injections are a newer approach, we asked a psychiatric nurse practitioner specializing in eating and body image issues, Esder Shin, for her opinion. She said,

Ozempic and other weight-loss medications might be a tempting solution for many; however, it is important to understand that these medications may actually exacerbate body image issues and worsen symptoms of disordered eating and gastrointestinal problems. This can cause one to feel even more self-conscious about themselves. I cannot stress enough to my patients how important it is to work on developing a healthy relationship with their bodies where patients can allow themselves to achieve a greater sense of self-confidence and overall well-being.

Wrapping Up
At this point, we feel concerned about weight-loss shots potentially triggering or exacerbating eating disorders for those vulnerable. No one can know who is biologically at risk of developing a clinical eating disorder. An imbalance in energy/nutritional intake versus energy output can push the metaphorical “on” button for someone who has it inside of them. We are also aware of various studies supporting that most diets and extreme attempts at weight loss do not result in sustained weight loss (Mann, 2018), meaning the diets fail you and not the other way around. Still, research on these weight-loss injections continues to evolve. So, it seems that it's a “wait and see” for all of us.

While you sort out how you feel about the potential risks and benefits of using these shots for weight management, speaking to a well-trained therapist in eating, body image issues, and eating disorders could benefit you.

Please note that nothing in this article constitutes professional advice or therapy.