Can Ozempic worsen or trigger eating disorders?
Key Takeaways
GLP-1 weight loss medications are rising in popularity, but questions remain about their relationship to eating disorders.
Drugs like Wegovy may be effective in people with binge eating disorder, but their association with other eating disorders remains unknown.
Experts say that patients should be carefully screened before weight loss medications are prescribed and monitored for signs of worsening eating disorder symptoms or development of new eating disorders.
Weight loss medications are rising in popularity, but questions are being raised about the impact these drugs may have on eating disorders.
Semaglutide, sold as Wegovy and Ozempic, can lead to clinically significant weight loss, but experts say that it could pose a risk of worsening existing eating disorders or triggering new ones.
“In my opinion, I think there is a risk for worsening existing eating disorders. I think the most important thing providers can do is screen for eating disorders prior to treatment. However, in the case of binge eating disorder, there has been evidence recently suggesting that GLP-1 medications can help treat this disorder effectively,” Johanna Finkle, MD, an OB/GYN at The University of Kansas Health System, who specializes in weight management and obesity medicine, tells MDLinx.[]
“I suggest that providers become educated regarding eating disorders. In the case of anorexia, restricting a patient's calories or asking them to journal about their diet can worsen their eating disorder independent of medications.”
Replicating GLP-1, a hormone
Semaglutide comes from a class of drugs known as glucagon-like peptide-1 (GLP-1) agonists.[] Originally used in people with type 2 diabetes, Wegovy was approved by the Food and Drug Administration (FDA) in 2021 for chronic weight management in adults who are overweight or obese and have at least one condition related to their weight, such as high blood pressure, type 2 diabetes, or high cholesterol.[]
When used for weight loss, drugs like Wegovy work by replicating GLP-1, a hormone that is naturally produced in the body and that targets areas of the brain that regulate appetite and intake of food. Wegovy works by mimicking this hormone.[]
GLP-1 agonists also delay gastric emptying, which can help those using Wegovy or Ozempic feel fuller for longer.[]
In some cases, including binge eating disorder, GLP-1 medications can be useful. But that might not be the case for all eating disorders.
“In some cases, these medications can actually improve eating disorders because they affect the brain and the pathways that are responsible for thinking about food and associating it with reward,” Dr. Finkle says.
“However, more research needs to be done to clarify whether these medications can worsen eating disorders. There are different types of eating disorders that we are concerned with: binge eating disorder, anorexia, bulimia, nighttime eating disorder, sleep-related eating disorder. These disorders are complex and have different pathways, and thus may respond to GLP-1 medications in different ways,” she adds.
Mir Ali, MD, a board-certified bariatric surgeon and Medical Director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, says that his clinic hasn’t seen an increase in eating disorders related to weight loss medications.
“We haven't really seen an increase in eating disorders, but we also screen our patients very carefully. If they have a history of eating disorders or [are] prone to eating disorders, then we may have them see a psychologist first and make sure those kind[s] of issues are under control before we prescribe these kind[s] of medications,” he tells MDLinx.
“I think it's a small risk. It's probably a greater risk in people who already have a history of eating disorders. This may be another kind of method for them to reinforce that eating disorder. I haven't seen good evidence that shows that it actually causes an eating disorder in somebody who does not have an eating disorder; it's more…worsening symptoms in people who may have already been treated for an eating disorder.”
In the US, 73.6% of adults over the age of 20 are overweight or obese. More than two in five US adults have obesity.[][]
In total, 45% of adults say they would be interested in taking a weight loss drug if they heard it was effective and safe.[]
Dr. Ali says some people may be at greater risk of developing an eating disorder or experiencing the worsening of an eating disorder due to drugs like Wegovy.
Fixated on results
“These tend to be patients who are perhaps overly fixated on their weight; [who] don't have significant weight to lose but are worried because they maybe gained some weight. It is natural as we age to put on some weight, and sometimes these patients become a little too worried about that, and instead of being more cautious with their diet or other methods of weight loss, they immediately look to a medication. Those are some of the warning signs that maybe it's not the right thing for them,” he says.
Although drugs like Wegovy can lead to significant weight loss, Dr. Finkle argues that it is crucial to closely monitor patients to ensure they don’t lose too much weight.
“I have also seen patients who lose weight and return to a normal BMI and then want to continue to lose weight on these medications. At times, this can lead to a body dysmorphic situation where they want to reach a BMI that may be unhealthy. Recognizing this and speaking with patients and providing education is important,” she says.
“Providers need to educate themselves about eating disorders. I think that if they're going to be prescribing GLP-1 medications, they need to screen for eating disorders. I think a team approach that involves a psychologist, or at least a referral to a cognitive behavioral therapist specializing in eating disorders, is key to the successful treatment of patients with obesity and eating disorders. I think patients need to be closely monitored for excessively restricting calories/food. Patients cannot be handed a prescription for these medications and never monitored for eating disorders or other side effects.”
What this means for you
As drugs like Wegovy rise in popularity, some have expressed concerns that this could lead to an increase in eating disorders. GLP-1 drugs may be effective in people with binge eating disorder, but more research is needed to determine their impact on other eating disorders. Experts say that patients should be thoroughly screened and monitored for worsening or triggering of eating disorders while taking these drugs.