“It’s like anorexic heroin to my brain.” –40-year-old male with a long-standing history of anorexia who relapsed after purchasing a GLP-1 medication.
Weight loss medications known as GLP-1 receptor agonists work by suppressing hunger signals. They have been a remarkable treatment for those who suffer from obesity and its health consequences, such as diabetes, hypertension, and sleep apnea. However, because of the easy accessibility, heavy promotion, and emergence of online weight loss platforms, many users are obtaining these prescriptions for non-medical indications.
Last year, one of my middle-aged female patients decided she wanted to fit into a high-fashion dress for her high school reunion. In addition to frequent gym visits, she bought off-label Ozempic from a doctor in Dubai, where her daughter lives. When I saw her several months later, she was emaciated. Her once small frame now looked like she was suffering from a debilitating illness—her bones stuck out, her skin sagged, and her cheeks were hollow.
Today’s Washington Post reported the experience of a 27-year-old woman with a history of anorexia as a teen who wanted to fit into her bridesmaid’s dress at her sister’s wedding. She found a website that promised easy access to weight-loss prescriptions. While filling out their form, she lied about her characteristics, citing an incorrect, heavier weight and decreased mobility. After entering her payment information, she received a bottle of Wegovy pills in the mail a few days later.
What Are GLP-1 Drugs?
GLP-1 receptor agonists mimic a naturally occurring hormone called glucagon-like peptide-1, which helps regulate blood sugar, slows stomach emptying, and signals satiety to the brain. For those who suffer from obesity-related medical conditions, these medications can provide substantial physical health benefits. However, because these drugs directly influence appetite, eating behavior, and body weight, they also intersect with the psychological and emotional dimensions of eating. Although data exists for the potential benefit of these medications in addressing some forms of binge eating disorder, their use must be weighed against their potential to do unintended harm.
Primary among these concerns is the potential for these medications to be abused by individuals with eating disorders, especially those with anorexia nervosa or bulimia nervosa. Both of these disorders are characterized by the pathologic pursuit of thinness through severe dietary restriction or other extreme behaviors such as self-induced vomiting, laxative abuse, or compulsive exercise. For these patients, use of GLP-1 medications can represent a symptom of this pathologic pursuit of thinness, which could be potentially life-threatening, as was the case in the man quoted at the beginning of this article. After reaching a healthy weight, he relapsed after purchasing several weight-loss medications from different online sites. He lost 50 pounds in four months and developed multi-organ failure, requiring hospitalization and nutrition through a feeding tube.
Eating Disorder Specialists Are Concerned
Rebecka Peebles, a pediatrician who is the director of medical research for Monte Nido, an eating disorders program, said the number of her patients who report using these medications is on the rise. Part of an eating disorders program is retraining patients how to respond to normal hunger cues. However, these medications can be counterproductive because they suppress natural hunger signals. In effect, they mimic what patients with anorexia nervosa experience. For individuals already vulnerable to restrictive tendencies, this blunting of appetite can make under-eating feel deceptively easy and socially acceptable.
In addition, because these medications often lead to rapid weight loss, they may unintentionally reinforce unhealthy beliefs about food restriction, thinness, or body control. In some individuals, especially those with a history of eating disorders, the medications can become psychologically problematic.
Social Context Matters
GLP-1 medications are being prescribed in our culture, which is intensely focused on thinness, dieting, and appearance. Social media has amplified the phenomenon, with celebrities and influencers openly discussing rapid weight loss, while others quietly use these medications without disclosure. According to Elizabeth Wassenaar, regional director for an eating disorder treatment center in Denver, “These medications are being sold as no big deal.” In a survey published in Obesity Reviews, participants who reported taking GLP-1 medications restricted their nutritional intake to as few as 400 to 600 calories per day. For reference, the recommended daily calorie intake for women is at least 1,600. One participant reported that she subsisted on water and Diet Coke, losing 21 pounds in three weeks.
The Importance of Screening
Experts increasingly recommend that clinicians screen patients for current or past eating disorders before prescribing GLP-1 medications. The National Association of Anorexia Nervosa and Associated Disorders states, “If you have a current or past eating disorder, please approach these medications with extreme caution and ensure you are working closely with a healthcare provider who understands eating disorders. Regular monitoring is essential to watch for side effects or the return of disordered eating behaviors.” However, the American Academy of Family Physicians has not adopted consistent guidelines. In general, they view these drugs as one tool in a broad armamentarium to treat their patients. They have not created “generalized recommendations driven by a single clinical concern.” The manufacturers of several weight loss drugs (Wegovy, Ozempic, and Zepbound) have left the decision-making to providers and patients. There is no mention of the risks to those with pre-existing eating disorders in their accompanying literature.
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A More Balanced Conversation
GLP-1 medications can genuinely improve health and quality of life for many people. At the same time, they may pose significant psychological risks for others, particularly those with a history of disordered eating.
A thoughtful approach requires moving beyond simplistic narratives about weight and recognizing that physical and mental health are deeply intertwined. Safe prescribing should include collaboration between medical providers, nutritionists, and mental health professionals whenever possible. Ultimately, the goal should not simply be weight loss at any cost, but long-term health, psychological well-being, and a healthier relationship with food.
