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.

Aoun L, Almardini S, Saliba F, et al. GLP-1 receptor agonists: A novel pharmacotherapy for binge eating (Binge eating disorder and bulimia nervosa)? A systematic review. Journal of Clinical & Translational Endocrinology. 2024;35:1000333.

 

“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.

Collins L, Costello RA. Glucagon-Like Peptide-1 Receptor Agonists. PubMed. February 29, 2024.

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.

FDA. FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014. June 4, 2021.

 

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.

FDA. FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014. June 4, 2021.

 

GLP-1 agonists also delay gastric emptying, which can help those using Wegovy or Ozempic feel fuller for longer.

Collins L, Costello RA. Glucagon-Like Peptide-1 Receptor Agonists. PubMed. February 29, 2024.

 

In some cases, including binge eating disorder, GLP-1 medications can be useful. But that might not be the case for all eating disorders.

“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.  

“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.

CDC. Obesity and Overweight. January 5, 2023.

CDC. Adult Obesity Facts. May 14, 2024.

 

In total, 45% of adults say they would be interested in taking a weight loss drug if they heard it was effective and safe.

Montero A, Sparks G, Kirzinger A, et al. KFF Health Tracking Poll July 2023: The Public’s Views Of New Prescription Weight Loss Drugs And Prescription Drug Costs. KFF. August 4, 2023

 

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.”