The impact of GLP-1 on Eating Disorders

First published during Eating Disorders Awareness Week, February 2025.

GLP-1 Medications and Why They Matter Here

A growing number of American adults are taking GLP-1 (glucagon-like peptide-1) receptor agonists. These medications were first developed and approved to treat type 2 diabetes. Some, such as Wegovy, are approved for weight management, and others, such as Ozempic and Mounjaro, are also prescribed for weight loss. They work by slowing gastric emptying, reducing appetite and increasing the feeling of fullness, which can lead to significant weight loss.

For people with diabetes and related health conditions, GLP-1 medications can be an important tool for improving health, including lowering blood pressure and cardiovascular risk. But for people who have, or are at high risk of developing, an eating disorder, these medications can worsen serious problems and may contribute to new ones.

The Concern for People With Eating Disorders

Rapid weight loss and extreme food restriction, both of which can happen while taking GLP-1 medications, can reinforce disordered eating behaviors and disrupt recovery. People who lose weight quickly may also receive well-meaning compliments on their bodies. In a culture focused on diets and weight, those comments can unintentionally strengthen harmful messages about body size, health and self-worth.

What I Have Seen in Practice

I have seen patients with disordered eating histories who were prescribed weight loss medications. They lost weight, but their mental health suffered as they moved into very restrictive and obsessive relationships with food, exercise and weight. Appetite suppression from these medications appeared to intensify food avoidance, which raises the risk of malnutrition and medical instability.

Eating Disorders Affect People of Every Size

The common picture of someone with an eating disorder is young, female, very thin and white. That picture is incomplete. People with eating disorders come in all shapes, sizes, genders, races and ages. Being in a larger body does not mean a person has no active eating disorder or history of disordered eating. Research suggests that people with higher body weight are more likely to engage in disordered eating behaviors, yet they are diagnosed with eating disorders less often than people at lower weights.

Some physicians want their patients to reach a "healthy" body mass index (BMI). BMI is an imperfect measure, and many clinicians are moving away from relying on it. Weight loss medications are not the right choice for everyone, particularly people in larger bodies who may be vulnerable to their unintended risks.

What Screening Could Look Like

So how can healthcare providers balance the benefits of these medications with the possible risks? The protocols for bariatric surgery may offer ideas. Before surgery, patients complete a series of tests, including a physical exam, blood work, urinalysis and imaging. Many programs also require a mental health evaluation beforehand. It can identify concerns that might affect the outcome and help the patient understand the lifestyle changes ahead. If concerns come up, patients receive therapy or medication management before surgery, and most receive counseling afterward to support their adjustment and to watch for changes in mental health.

Prescribers of weight loss medications could consider a similar approach. According to the National Eating Disorders Association, an estimated 9% of the U.S. population, about 28.8 million Americans, will have an eating disorder in their lifetime. GLP-1 prescriptions have also become more available through telehealth providers, in some cases without careful screening, which is especially concerning.

What We Do Not Know Yet

We do not yet know the long-term effects of GLP-1 medications on mental or physical health. Screening people for eating disorders and disordered eating before these medications are prescribed, and monitoring closely afterward, may help prevent unintended consequences such as worsening disordered thoughts and behaviors and setbacks in recovery.

Health Is More Than a Number

People who are struggling to improve their mental and physical health trust their healthcare professionals to care for both. Health is a complicated picture, and it is much more than the number on a scale.

If This Is on Your Mind

If you are taking or considering a GLP-1 medication and have a history of disordered eating, or you are noticing changes in your relationship with food, it can help to talk with your prescriber and a mental health professional who knows eating disorders. Please do not stop a prescribed medication without talking with the person who prescribed it.