GLP-1 Drugs, Ozempic Misuse, and Eating Disorder Relapse

Rapid weight loss, reduced appetite, and feeling full on less food are among the major benefits of the glucagon-like peptide-1 (GLP-1) receptor agonist weight loss drugs semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound). But for people at risk of developing or relapsing into an eating disorder, such as anorexia or bulimia, these benefits can be triggering. And for those who actively struggle with an eating disorder, GLP-1s may offer an appealing shortcut to dangerous goals.

Here, experts explain how the benefits of GLP-1s can mirror symptoms of an eating disorder, why they can raise the risk of relapse, and how to approach the medications safely.

Ozempic Misuse: GLP-1s and Unhealthy Weight Loss

The benefits of GLP-1s, including rapid weight loss and appetite changes, overlap with many hallmarks of eating disorders. For this reason, it can be difficult for patients and healthcare providers alike to discern whether the medication is working as intended or the person has had a relapse into disordered eating, says Brad Smith, MD, a physician in Madison, Wisconsin, and the chief medical officer for the Emily Program, a network of eating disorder treatment centers. It also means that GLP-1s can validate and reinforce disordered thoughts and behaviors rather than raise the red flags that may otherwise prompt intervention.

While research exploring GLP-1 misuse and eating disorder relapse is still limited, experts say they’re seeing a growing number of cases firsthand. “We’re seeing both instances of GLP-1 misuse and active relapse in our practice,” says Ruth Elliott, LICSW, the director of clinical services at Multi-Service Eating Disorders Association in Newton, Massachusetts.

Part of the problem is a lack of thorough patient screening. Some telehealth companies providing GLP-1s don’t require an in-person visit with a healthcare provider, and instead rely on clients to be honest about their weight and eating disorder history to determine eligibility, says Elliott.

Even when someone pursues GLP-1s through conventional methods, few medical providers complete the appropriate mental health and eating disorder screenings. Some prescribe GLP-1s to treat binge eating disorder — a serious condition involving rapidly eating large meals with a loss of control, followed by feelings of intense shame — despite these drugs not being approved for that purpose, says Elliott.

“It’s important to emphasize that GLP-1s aren’t approved treatments for eating disorders, and weight loss itself isn’t a treatment or cure for the complex psychological, social, and cultural roots of these illnesses,” says Sam DeCaro, PsyD, a licensed clinical psychologist and the director of clinical outreach and education for the Renfrew Center, an eating disorder treatment center in Philadelphia.

In fact, GLP-1s can actively reinforce these illnesses, experts say. For many people with an eating disorder, the desire to lose weight is deeply embedded in the illness, making weight loss medications especially appealing to those who haven’t yet reached a full state of recovery, says Dr. Smith.

Rapid Weight Loss, Body Image, and Weight Stigma

Anorexia and bulimia are defined by an unhealthy obsession with body weight and a distorted self-image. Unfortunately, the widespread and growing use of GLP-1s may be fostering an environment of weight stigma that encourages eating disorder development and relapse.

“Whether it’s someone in a larger body being offered these medications when they haven’t indicated a desire for weight loss, or the media impact of seeing your favorite celebrity in a smaller body, the culture has shifted even more toward the idea that thinness is health and well-being,” says Elliott.

For someone in eating disorder recovery, rapid weight loss can reinforce these cultural ideals and even undo years of work on body acceptance during therapy. Physical changes, which are often drastic, can be seen in the mirror, while positive comments from friends and family further validate the idea that thinner is better.

"A lot of times, people have worked hard in therapy to be able to put those thoughts onto the back burner so they can be active and productive, and these thoughts aren’t impacting their daily functioning,” says Smith. “Then, a rapid change in their body weight can lead to putting more focus on it. It puts the issues on the front burner again."

Appetite Changes and Intuitive Eating

“These effects can make it harder to follow a structured, nourishing eating schedule … one that promotes a peaceful relationship with food and rebuilds body trust over time,” says DeCaro.

If GLP-1s are interfering with your intuitive eating practices, Smith recommends reaching out to your prescribing physician and an eating disorder professional to reassess whether the potential benefits are worth the risks. You may also benefit from re-engaging with the registered dietitian or eating disorder professional who helped you establish intuitive eating practices in the first place, he says.

GLP-1 Side Effects Can Mirror Purging

The gastrointestinal side effects of GLP-1s can also create issues for people with eating disorders, says Smith. Vomiting, in particular, is a hallmark of bulimia, as is diarrhea from laxative abuse, making people with a history of this eating disorder especially vulnerable to relapse.

“Even without GLP-1s, individuals who have struggled with purging or vomiting behaviors are prone to relapse if they develop a sickness where they’re vomiting,” says Smith.

If you’ve recovered from bulimia and self-purging behaviors, yet the nausea, vomiting, or feelings of fullness you experience from GLP-1 use triggers thoughts and urges to purge again, get in touch with your prescribing provider and an eating disorder professional. They may recommend a different medication or reassess your use of GLP-1s entirely, says Smith.

Red Flags to Watch For

There are a number of physical and emotional effects that may signal you’re on a dangerous path with your GLP-1 use. Here are the red flags Elliott says to pay attention to in your own behavior.

• Avoiding doctor visits or skipping follow-ups
• Being secretive about eating habits with providers, friends, or family members
• Hair loss or other signs of malnutrition
• Obsessive thoughts about food, weight, or exercise
• Persistent fatigue or low energy

If you’re experiencing any of the above changes, reach out to your doctor or an expert in eating disorders before you go too far down the wrong path.

How to Use GLP-1 Drugs Safely if You Have a History of Anorexia or Bulimia

Given the risks for people with a history of eating disorders, it’s important to involve your full care team before you start a GLP-1.

“The ideal scenario is that there’s a conversation between the patient, the provider who’s prescribing this medication, and at least one of the professionals working with the individual on their eating disorder,” says Smith. “The biggest danger is when someone is ordering these medications online without any monitoring going on, and these risks and benefits haven’t been considered.”

This collaboration shouldn’t end once the prescription is written. DeCaro emphasizes the importance of establishing a clear safety plan with your care team. This plan should monitor for eating disorder urges or symptoms, set boundaries around the pace and amount of weight loss, ensure adequate nutrition and hydration, and include a strategy for adjusting or discontinuing the medication if symptoms worsen.

The Takeaway

• Experts warn that the primary effects of GLP-1 drugs, such as rapid weight loss and suppressed appetite, can dangerously mirror or validate eating disorder symptoms, and can conflict with eating disorder recovery strategies.
• The accessibility of these drugs through telehealth and a lack of proper mental health screening increase the risk of misuse, such as using GLP-1 drugs to reinforce disordered behaviors rather than treat underlying health issues.
• GLP-1 medications can physically disrupt intuitive eating by chemically overriding the body’s hunger and fullness signals that patients in recovery work hard to reconnect with.
• If you have a history or risk of anorexia or bulimia, you should only use these powerful weight loss drugs under the close supervision of a collaborative care team with a clear safety plan in place.