GLP-1 drugs such as Ozempic have, in three short years, changed our attitudes to the body. They’ve revived a cultural fervor for thinness that has been blamed for everything from the closure of wine bars to killing off the body positivity movement. What began as a seeming miracle drug posited to help those most in need of losing weight for health reasons has led to a clamor in which one in eight Americans have tried the drugs and telehealth companies have offered cheaper off-brand versions with very little oversight.
Ozempic (the brand name for semaglutide) and other GLP-1s mimic a natural hormone in the body, stimulating insulin and slowing the rate of stomach emptying after eating, increasing one’s sense of fullness. But the very qualities that make GLP-1s such powerful tools for weight loss also make them potentially dangerous for those who struggle to adequately feed themselves.
Some healthcare specialists say that an injection enabling people to eat dramatically fewer calories in a day resembles nothing less than a drug-induced – or at least, a drug-encouraged – eating disorder. Dr Kimberly Dennis, a psychiatrist and expert on eating disorders in the US, is quoted as saying: “These drugs are rocket fuel for people with eating disorders.” Another doctor told Bloomberg News directly that they had seen patients with “drug-induced” anorexia. For people who are prone to anorexia, bulimia and other eating disorders, easy access to GLP-1s is causing alarm.
Many healthcare professionals are concerned that those with restrictive eating disorders should not be on appetite-suppressant drugs, says Pamela Keel, a psychologist and eating disorder expert at Florida State University. She says medications should not be being prescribed to help a malnourished person stay malnourished, regardless of their weight. After all, “we are not interested in helping people do a better job of having an eating disorder.”
GLP-1s not only make it easier to restrict consumption by suppressing appetite, they could also encourage other disordered behavior such as purging. Because the stomach empties more slowly on these drugs, it can make it easier to vomit up food, says Keel.
A good doctor would be aware of a patient’s history of eating disorders and would be able to take those risk factors into account. However, GLP-1s are increasingly easy to access through telehealth platforms such as Hers, Eden and Ro, which only require online consultations. To see just how easy it would be to lie about my own health and my need for these drugs, I went on the website of one well-known telehealth platform. I went through the various intake forms and surveys, telling the truth about my health in all instances but over-reporting my weight.
I was quickly approved and charged for compounded semaglutide. At no point was I put in contact with any kind of doctor.
The interactions between Ozempic and eating disorders are complex. There are concerns that drug could retrigger a restrictive eating disorder in someone diagnosed with one previously, or even trigger one in someone who hadn’t had one before. Complicating matters is that there is evidence to suggest that Ozempic can be helpful to people with binge eating disorder, and many people who cycle between patterns of restrictive eating and overeating.
Because these drugs are still so new, there’s no longitudinal data on how they affect eating disorders in the long term. One theory of how anorexia is triggered is that calorie restriction and “starvation mode” flips a metaphorical switch in the brain of those who are predisposed, says Terry Schwartz, the interim executive director of the Eating Disorders Center for Treatment and Research at the University of California, San Diego.
It’s not yet known whether GLP-1s can flip this switch, but there is a medical precedent for this, Schwartz says. The anti-seizure medication Topamax (also known by its generic drug name, topiramate) has side effects of weight loss and suppressed appetite. We now know that this drug can increase the risk of developing an eating disorder. “I saw a number of people … who developed a syndrome like anorexia nervosa on Topamax,” Schwartz says – disordered behaviors that disappeared once they stopped the drug. And this is something scientists are considering as they continue to monitor and study GLP-1s and their effects.
There is more consensus that these drugs could trigger a relapse in someone who has already suffered from disordered eating. At the age of 30, Lily, a retail worker in Australia, found that climbing even just a few stairs had her pausing to catch her breath. Her body mass had swelled in recent years, but she had put off seeing the doctor even as her fatigue grew heavier and heavier. Even when she started wetting herself she still found it hard to see the severity of her symptoms.
When she finally went to the doctor in June 2023, Lily was stunned to hear her diagnosis of adult-onset type 1 diabetes. She knew she had been unhealthy, gaining 70kg in the past five years, having developed some binge eating tendencies. But for most of her life, Lily had actually been unhealthily underweight. It seemed unreal that she could develop diabetes so quickly.
To get her diabetes under control, she was told she needed the help of a GLP-1 drug. She told her endocrinologist that she’d had anorexia for over a decade and felt that suppressing her appetite was a bad idea.
“He did not give two shits, excuse my language,” Lily says. And so, against the advice of her long-term psychiatrist and dietician, Lily was put on Ozempic. She relapsed immediately.
In Lily’s case, she was lucky that a friend noticed her symptoms and urged her to tell her psychiatrist. Though she is still technically overweight, her psychiatrist helped her pivot to simply maintaining her current weight, which has helped Lily pull herself out of her relapse. She stopped losing weight and stopped weighing herself. She regularly checks in with both her psychiatrist and her dietician to make sure she’s eating enough, even while she remains on Ozempic.
Lily’s feelings toward Ozempic are complicated. Her blood sugars are down and her cholesterol is at a better place. In contrast to her previous “all-or-nothing” mindset with food, she’s able to eat “normal” meal portions for the first time in her adult life.
The Ozempic keeps her urges to binge at bay, she says, and now she doubts whether she can ever go off it. When a hernia repair surgery forced her to pause her Ozempic usage for about a month in June 2024, the ferocity of her returning appetite scared her. “All of my thoughts about food came back exactly the way that they were before, and it was horrifying,” she says. “I felt so out of control and I was miserable.”
Lily, like many people with eating disorders that don’t fit into neat boxes, is wedged between an urge to binge that is tempered by the Ozempic and the impulse to restrict that the Ozempic enables.
‘Food noise’ and binge eating
Though anorexia nervosa is probably the most well-known eating disorder, binge eating disorder, which causes compulsive and chronic overeating, is about four times more common in girls and women of all ages than anorexia nervosa and twice as common as bulimia nervosa, according to a comprehensive Harvard report. The potential for GLP-1s to help those with binge eating disorder is a source of some optimism. Research has started to come out over the past couple years suggesting that these drugs could be a valuable tool to curb binges.
GLP-1 is a natural hormone in the body that spikes when we eat a meal. In-progress research suggests that GLP-1 responses are blunted or muted in people with a history of binging, says Keel, so it’s possible these medications could help rebalance their hormone.
Megan, a 39-year-old nurse in Jersey City, New Jersey, sought out Ozempic in May of 2023 after struggling with cycles of binging and purging for all of her adult life. She eventually switched to Mounjaro, and the change for her has been dramatic. Before she started taking GLP-1s, Megan would get hunger pangs throughout the day that would consume her mind and affect her body. She would wake up in the middle of the night from the discomfort – and the urges wouldn’t settle until she got up to eat food from the fridge. With GLP-1s all of that went away.
Experiencing physical discomfort driving her to binge, and then relief that the medication provided, Megan realized how much of her disorder was a biological condition, and not just a matter of discipline. “I thought it was a willpower issue and I always blamed myself,” Megan says. But all this has “made me forgive myself for what I went through”.
We’ve already seen that GLP-1s reduce “food noise” and people’s preoccupations with eating, so “for somebody who has binge eating disorder, these could be helpful tools,” says Leslie Heinberg, a Cleveland Clinic psychologist and expert in obesity and eating disorders. Preliminary studies do show that these drugs hold promise in reducing binge eating behaviors, but more research is needed, she says.
Control and shame
The idea that we need to tame our bodies to be thin dates back to at least the Enlightenment, with distinctly racist roots. It can be traced back to the idea that those in bigger bodies lack self-control and refinement, says Sabrina Strings, a professor of Black studies at the University of California, Santa Barbara, who studies portrayals of gender, race and bodies. GLP-1s, she says, provide a medicalized avenue for that control.
Control and shame, coincidentally, feature strongly in the mindsets of those with eating disorders, notes Debra Safer, a psychiatrist at Stanford’s medical weight loss clinic. The tension between semaglutides and body acceptance is palpable.
This was true for Morgan, a 27-year-old marketing project manager in Chicago. After spending most of her life unhappy in her body and struggling with disordered eating, Morgan began therapy in 2022 where she learned about the Health At Every Size framework, which teaches people to strive for optimal health without focusing on size or weight. Even after a lot of unlearning unhealthy mindsets and learning to appreciate her body, Morgan eventually decided that Wegovy was the right choice for her. “It’s been kind of earth-shattering to admit to myself that it could be something that helps me,” she says. Her decision has sometimes felt like a betrayal of her values, but the relief the medication has brought her is undeniable – her joint pain has been reduced and the noise around food has been reduced.
Lurking underneath the whole conversation of GLP-1s and eating disorders is the difficult truth that cultural fatphobia contributes to the prevalence of eating disorders, says Maria Rago, a psychologist in Illinois and the president of the board of directors for the National Association of Anorexia Nervosa and Associated Disorders. There are many people who are against these drugs because of how they contribute to the idea that we can and should all be thin, she says – there’s a fear that this will contribute to more eating disorders, and that “people will never be able to accept their bodies, they’ll always be told: ‘Well, you could be thinner, just use this medicine.’”
For now, what clinicians can do is what most of them are already doing: screening patients for a history of eating disorders before prescribing GLP-1s. If a patient has an active eating disorder they’ll be sent to treat that first, says Chika Anekwe, an obesity medicine physician at Massachusetts General hospital and an instructor of medicine at Harvard University. But if a patient has just a history of restrictive eating disorder, that won’t necessarily disqualify them from GLP-1 use. It’s a case by case assessment of “do the benefits outweigh the potential risk?” she says.
Lily thinks her doctors “should have been more careful when they prescribed it to me”, she says. “I know that I had diabetes, and that my diabetes was really bad and that I was very sick, but I think they should have been more careful when they prescribed it to me.” Ultimately, however, she is grateful to be on Ozempic. The thought of trying to rein in her binge eating disorder without Ozempic feels scarier to her than what she’s doing now, managing her restrictive impulses while on it. And swirled in with all of this is the misplaced shame and embarrassment of needing to be on Ozempic in the first place, of having lost control to the point of needing medical intervention. All told, she says: “This has been one of the most confusing things that I’ve ever done to my own body.”
• In the US, help is available at nationaleatingdisorders.org or by calling ANAD’s eating disorders hotline at 800-375-7767. In the UK, Beat can be contacted on 0808-801-0677. In Australia, the Butterfly Foundation is at 1800 33 4673. Other international helplines can be found at Eating Disorder Hope
