From Weight Loss to Risk: Understanding GLP-1’s Impact on Eating Disorders

There’s a lot to be said about GLP-1s today. GLP-1 agonists have provided much-needed innovation in the treatment of overweight and obesity, which has remained stagnant for years. While these drugs have aided millions of individuals in reaching their weight loss goals, many suffer side effects that ultimately lead them to discontinue use, resulting not only in money lost, but weight regain.

But one side effect has been making headlines lately, and it is particularly concerning: In recent months, there has been an uptick in reports of patients seeking treatment for eating disorders related to the use of GLP-1’s.⁽¹⁾ This begs the question: can these medications lead to development of or exacerbate existing eating disorders, and if so, how do we – employers, physicians, and health plans – change course to ensure that people who are taking these medications are supported with the appropriate clinical oversight while taking GLP-1s? 

Let’s step back: Weight loss medication abuse is not new. Diet pills, caffeine, laxatives, and others have been around for a long time, but with the emergence of GLP-1s, we are seeing reports of disordered eating with individuals taking regularly prescribed doses. In some instances, the use of GLP-1’s can create an obsession around food and can further limit or restrict food intake to the point of endangering overall health.^(2,3) Psychologists across the US recently reported seeing increases in patients at their facilities taking prescribed GLP-1’s and symptoms similar to anorexia nervosa.⁽⁴⁾

When the public and medical community hears of “trends” like this, standard practice would suggest that the clinical industry should investigate the validity of such claims by leveraging studies, research and data from manufacturers and/or distributors. In this case, there are no published clinical trials and very limited research on abuse of GLP-1’s to further weight loss and the development of eating disorders. To complicate the scenario, there’s even some anecdotal evidence to support that the use of GLP-1’s can actually help in the treatment of binge eating disorders. 

Here’s what we do know: GLP-1’s suppress appetite ⁽⁵⁾ and for someone with a previous eating disorder, this could spark a disassociation with their normal hunger cues and re-ignite past issues. And for those without an eating disorder history, there can be risk with any restriction of food. When GLP-1s are introduced, it’s imperative to support the treatment with clinical oversight and coaching, to not only ensure the medication is taken as directed, but equally important, to establish the right lifestyle program – including diet and exercise – is part of the complete GLP-1 regime.

As with most medications, there are side effects and results that need to be managed. In the case of GLP-1’s, there’s an overwhelming body of evidence on the success of GLP-1’s in reducing obesity and managing weight loss. Until more data is available related to the potential link between GLP-1 use and eating disorders, employers, providers and health plans should maintain awareness of the potential link while ensuring support is given to members on GLP-1’s that includes ongoing monitoring, education and lifestyle changes. This can include programs like Noom that offer the following features:

• Proper screening of patients with history of an eating disorder or eating behaviors linked to development of eating disorders, including  for conditions such as anorexia, bulimia, and binge eating disorder, before prescribing the drugs for weight loss;
• Provide regular opportunities for re-screening of signs or symptoms of disordered eating while on a GLP-1 medication;
• Educate patients on symptoms of common eating disorders associated with GLP-1 use;
• Utilize a multidisciplinary team to connect with patients and monitor weight loss progress, side effects, mental health, etc; and 
• Prioritize moderate weight loss and educate on the importance of maintaining lean body mass.

Jennifer Jones, MSM RD CCWS, is an experienced healthcare professional with a background in clinical dietetics, wellness programming, and employer health. With over 20 years of experience, she has worked in various settings, including healthcare systems, occupational health organizations and health and welfare benefits advisory firms. After working directly with patients and employees, Jennifer turned her focus to population and employer health to achieve a greater impact on health outcomes. At Noom, Jennifer serves as the Clinical Solutions Consultant to support our teams with alignment on client needs and clinical programs.

References:

1. Weight loss drugs like Wegovy may trigger eating disorders in some patients, doctors warn (NBC News)
2. Journal of Clinical Psychopharmacology: Semaglutide Misuse in Atypical Anorexia Nervosa—A Case Report
3. National Eating Disorders More about impact of GLP-1 with existing eating disorders
4. The questions eating disorder experts have about weight loss medications (CNN) 
5. Wiley: Use of glucagon-like peptide-1 receptor agonists in eating disorder populations
6. Additional: The Collaborative of Eating Disorders Organizations