Right now, about 12% of American aged 18 or older (or 1 in 8 adults) are taking GLP-1 (glucagon-like peptide-1) receptor agonists – medications that were initially developed and FDA-approved to treat type 2 diabetes are also being used off-label for weight loss beyond medical need.. Wegovy, Ozempic, Mounjaro, Trulicity and other similar drugs work by slowing gastric emptying, reducing appetite, and increasing satiety which can lead to significant weight loss. For people with diabetes and associated health conditions, GLP-1 medications offer a long-awaited and even life-saving tool to improve health by reducing the overall risk of diabetes and cardiovascular disease and lowering blood pressure. But for people who have or are at high risk for developing an eating disorder (including anorexia nervosa and other disorders), these drugs can exacerbate – or even cause – serious problems.

Rapid weight loss and extreme food restriction – both of which often occur while taking GLP-1 drugs – can reinforce disordered eating behaviors and disrupt recovery. Those who undergo rapid weight loss while taking these drugs may also receive well-meaning positive comments on their bodies, especially in our diet- and weight-obsessed culture, which unintentionally substantiate harmful messages about body size, weight, health, and self-worth.

I have personally seen patients with disordered eating histories who were prescribed weight loss drugs. While they lost weight, their mental health took a terrible toll as they were driven to extremely restrictive and obsessional relationships with food, exercise, and weight. Appetite suppression induced by GLP-1 medications appeared to intensify food avoidance, increasing the risk of malnutrition and medical instability. Moreover, some individuals who seem as though they qualify for weight loss drugs might not initially present as someone with an eating disorder. While the pervasive stereotype of someone with an eating disorder is someone young, female, and alarmingly thin (and often White), this isn’t the case. People with eating disorders come in all shapes, sizes, genders, races, and ages. Just because a person is in a larger body doesn’t mean that person doesn’t have an active eating disorder or a history of disordered eating. According to one study, individuals with higher body weight are significantly more likely to engage in disordered eating behaviors. However, despite this increased risk, they are diagnosed with eating disorders half as frequently than those with normal or underweight. And while some well-intentioned physicians might want their patients to obtain a “healthy” Body Mass Index (although the BMI is flawed and medical practitioners are increasingly moving away from using it as a barometer of health), weight loss drugs aren’t always the best choice for everyone, particularly for people living in larger bodies who may be susceptible to the unintended risks associated with GLP-1 medications. So how do healthcare providers balance the benefits of these drugs with the potential risks? Looking at the protocols for individuals undergoing bariatric surgery may offer ideas for next steps. When patients undergo bariatric surgery for weight loss, they receive a battery of tests before being operating on – including a physical examination, blood tests, urinalysis, imaging, and more. Many bariatric surgery programs also require a pre-operative mental health evaluation, which can help identify issues that could hinder the success of the surgery and ensure the patient is aware of the hard work ahead of them, including the lifestyle changes that will be needed for long-term success after surgery. If mental health concerns are identified, patients will receive psychological care like therapy or medication management, prior to surgery. Ongoing mental health support is crucial for sustained success and thus, patients typically receive counseling following surgery to support adjustment to a new lifestyle and to monitor for changes in mental health.

Doctors prescribing weight loss drugs would be wise to follow suit. According to the National Eating Disorders Association, 9% of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetime and the extent to which GLP-1 prescriptions have become more readily available through telehealth providers without proper screening is especially concerning.

We don’t know what the long-term effects of GLP-1 drugs will be on mental or physical health – but by screening people for eating disorders and disordered eating before these medications are prescribed and then continuing to closely monitor individuals after they are prescribed (if they are prescribed at all), hopefully we can prevent unintended consequences like worsening disordered thoughts and behaviors and usurping recovery efforts.

With Eating Disorders Awareness Week (February 24-March 2), now is the time to advocate for those who are struggling to improve their mental and physical health and are trusting healthcare professionals to care for both their mental and physical well-being. Health is a complicated picture – and it’s so much more than just the number on a scale.