We Are Not Outside This

My husband and I were watching TV the other night, just a regular evening, nothing remarkable — and we noticed it. Back to back. GLP-1 ads. Then another one. Then a different brand, same message.

Your body is a problem. Here is the solution. Ask your doctor.

It was relentless. And it wasn't an accident.

The algorithm has decided that our bodies are problems and it is very, very good at offering the solution. It knows what we watch, what we scroll, what we pause on for two seconds too long. It is not neutral. It is not passive. It is working — actively, continuously, with significant resources behind it — to make people believe that a smaller body is a better body and that the path there is a prescription away.

And our clients are marinating in it between every single session.

What's happening in their living rooms?

Think about what your clients are absorbing between the time they leave your office and the time they come back. The ads on their phones. The before and after photos on their feeds. The cultural conversation that has shifted so completely that GLP-1s are now dinner party conversation, morning show segments, celebrity confessions. 

And it is relentless in the way that only an algorithm can be — personalized, persistent, and invisible enough that most people don't register it as influence. It just feels like the air they're breathing.

Are we asking about it?

Are we curious about what our clients are absorbing between sessions — not just the events of their week, but the cultural water they're swimming in? Are we creating space for them to name what the algorithm is doing to them, to their relationship with their body, to the quiet voice that says maybe I should look into that?

Because if we're not asking, we're leaving a significant piece of their experience unnamed. And unnamed things don't stay small.

The harder question.

Here it is.

Clinicians are not immune to the culture we live in. The same algorithm that followed your client into their living room followed you into yours. The same ads. The same before and afters. The same cultural drumbeat that says smaller is healthier, more disciplined, more worthy.

What is that doing to you?

Not theoretically. Actually.

When a client talks about their body, are you noticing any subtle pull — any barely-there assumption — about what their body should look like or what health means for them? When a client mentions they've started a GLP-1, what happens in you before you have a conscious thought about it?

This is not about shame. This is about honesty. We cannot be curious about our clients' relationship with their bodies if we haven't examined our own relationship with the culture that's shaping both of us simultaneously.

The algorithm doesn't make exceptions for graduate degrees. It doesn't care that you know about diet culture. It is designed by some of the most sophisticated behavioral scientists in the world to work on human brains — and your brain is a human brain.

What this looks like in practice.

A few invitations — not prescriptions, just things worth sitting with:

Start asking. Make it a regular part of your intake and ongoing work — what are clients absorbing culturally around their bodies? What are they seeing? What's landing? You don't have to have answers. Curiosity is enough.

Notice the unsaid. When a client mentions weight loss, a new medication, a change in eating — notice what you feel before you respond. That half-second before the clinical brain takes over is information.

Do your own inventory. What are you watching, scrolling, absorbing? What has the algorithm decided about your body? When did you last examine what it's been quietly telling you — and whether you've been believing it?

Supervision and consultation are for this too. Not just the hard clinical cases. The hard cultural ones. The places where the water we're all swimming in starts to affect the work without us noticing.

We are not outside this.

That's the thing I most want to say.

We do not get to sit outside the culture and observe it clinically from a safe distance. We are in it — navigating it, absorbing it, being shaped by it — at the same time we're trying to help our clients do the same.

That's not a flaw in the model. That's just the truth of doing human work as a human.

The question isn't whether the algorithm is affecting us. It is. The question is whether we're paying attention.

Dr. Jamie English is a licensed clinical social worker, supervisor, and educator. The DJ English blog explores the inner life of the clinician — the parts of this work we don't always talk about out loud.