Takeaway
Use caution when prescribing GLP-1s to patients with eating disorders, or factors like rapid weight loss or restrictive eating. Screen for disordered eating and involve eating‑disorder specialists if risk is present.
Lifelong learning in clinical excellence | March 6, 2026 | 4 min read
By Bernadette Wharton-Hawthorne, MD, Johns Hopkins Medicine
Recognizing misuse of GLP-1s
“Could Ozempic be a safe way for me to lose weight?” asked the patient, a student-athlete with a history of anorexia. They elaborated that a GLP-1 receptor agonist (like semaglutide, tirzepatide) might quiet down their “food noise” and showed me a TikTok from an Olympic athlete who had asked her doctors about Ozempic for similar reasons.
“Did the doctors prescribe it?” I asked. The patient replied that they hadn’t. Olympian aside, we talked about why starting a GLP-1 at their stage of anorexia recovery seemed to run against treatment goals. Those goals included maintaining a healthy weight, eating more regularly, and expanding food variety. I was concerned that a GLP-1, and presumed subsequent calorie restriction, may worsen their distortions and obsessions around food and their body, not quiet them.
“Yeah, I figured. Worth a shot,” they responded with a wry smile and slight chuckle. They seemed to know that using a GLP-1 might feed, rather than satiate, the eating disorder.
A growing concern among eating disorder providers
My concerns seemed to match those in the broader eating disorder (ED) field for the potential of GLP-1s to contribute to the development or worsening of ED symptoms by facilitating restrictive eating behavior and reinforcing the desire to lose further weight, whether medically justified or not.
Dietary restriction is a well-recognized risk factor for the development and maintenance of EDs; and GLP-1s may enable restriction and consequently trigger ED symptoms through known mechanisms of actions—decreased hunger signals, increased satiety—and have side effects as well, like delayed gastric emptying, nausea, and diarrhea. Furthermore, evidence suggests that greater interest in GLP-1s from patients is associated with increased body dissatisfaction, weight concerns, increased body checking, and disordered eating behaviors—all risk factors for developing an ED.
Atypical anorexia—a vulnerable population
While no large studies on GLP-1s and their potential relation to ED development or maintenance have been published, evidence increasingly suggests concern may be founded. Recent case studies and news articles suggest a link between use of GLP-1s and worsening ED symptoms in individuals with atypical anorexia.
Atypical anorexia is listed in DSM-5 as an example of an Other Specified Feeding and Eating Disorders and includes all the criteria of anorexia nervosa (AN), other than significantly low body weight. Like in anorexia nervosa, patients with atypical anorexia engage in restrictive dieting and compensatory weight control behaviors, have lost significant weight, and are excessively preoccupied with body shape or food. However, because they start losing weight at higher baseline BMIs, they typically don’t appear visibly underweight and present at normal or above normal weights.
This demographic is particularly vulnerable—because they’re not underweight, clinicians may not screen for an eating disorder. Providers may miss or dismiss concerning behaviors in someone with atypical anorexia and prescribe a GLP-1 based solely on their presenting weight, putting them at risk for worsening ED symptoms.
Social media, misinformation, and ease of access
Complicating counseling and treatment of patients on GLP-1s is the ease of access to these medications. Type GLP-1 into any social media search bar, and you’ll see infinite posts, mostly from people who have used the medications, influencers in the fitness/wellness space, and a small fraction from accounts run by licensed medical providers. Drug ads, media reports, and social media often include misinformation or incomplete information on risks. Similarly, access via tele-prescribing often comes with limited medical oversight. Patients can obtain GLP-1 prescriptions by mail order unbeknown to their primary medical care providers. As GLP-1s are not controlled substances, they typically won’t appear in PDMP or other databases, creating opportunity for secrecy or surreptitious use, though data on rates of misuse are not known at this time.
More study is needed, but use caution for now
There’s not enough data yet to create clear recommendations for use of GLP-1s in patients with, or at risk for, eating disorders. However, clinicians should be aware of potential for harm, especially in patients with anorexia and restrictive behaviors—including those with normal or high weight.
We can consider the following when trying to mitigate risks:
1. Screen patients for eating disorder risk prior to initiating GLP-1 therapies.
A quick and validated screening tool is the SCOFF that consists of five questions that can be delivered verbally and can screen for an eating disorder. Other risk factors to explore beforehand may include body image concerns, distorted beliefs around weight, body shape, or food, evidence of weight suppression (difference between lifetime highest weight and current weight), or recent rapid weight loss.
2. Continue to monitor and assess for eating disordered behavior after prescribing GLP-1s.
Signs that a restrictive eating disorder may be developing can include consistently eating below nutritional needs (e.g. <800-1000 kcal/day), intentionally skipping meals, intensifying fear of weight gain despite being at a healthy weight, desire to lose further weight beyond recommended treatment goal, or a growing preoccupation with calories or body shape.
3. Consider a multi-disciplinary approach when prescribing GLP-1s in patients with eating disorder risk factors.
Cognitive behavioral therapy is an effective treatment for eating disorders. In patients with a history of an eating disorder, disordered eating behavior, or disordered thoughts around food, consider whether they may benefit from psychotherapy while taking a GLP-1. Referral to an eating disorder specialist—psychiatrist, therapist, or dietician with expertise in eating disorders—may be advisable.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.