There’s trouble brewing beneath the GLP-1 buzz.
As Americans embrace blockbuster weight-loss drugs like Ozempic and Wegovy in record numbers, providers are warning of a troubling ripple effect: patients sliding back into restrictive eating disorders — and others developing them for the first time.
“I think there should be a button that you have to click saying ‘I am consciously making a choice that could really harm my health,’” Dr. Zoe Ross-Nash, a licensed clinical psychologist, told The Post. “Like on cigarette boxes, it says, ‘This could cause cancer.’ OK, well, this [drug] could cause an eating disorder.”
The solemn warning comes amid growing concern about shrinking celebrities — who may or may not be on GLP1s — and whether they’re stick-thinness may fuel a return to early-2000s weight stigma or the “heroin chic” look of the ’90s.
GLP-1s work by mimicking one or two hormones the body naturally produces to curb appetite, slow digestion and regulate blood sugar.
As a result, people tend to feel fuller longer, eat smaller portions and experience less “food noise” — or frequent, often intrusive thoughts about eating.
The medications have been widely praised for helping people who are overweight or obese slim down quickly, as well as for other clinical uses, including managing type 2 diabetes, reducing cardiovascular risk factors and treating obstructive sleep apnea.
But Dr. Thea Gallagher, a clinical psychologist at NYU Langone, said the very benefits these drugs are celebrated for can also become “a slippery slope for some people.”
“A lot of people with restrictive eating disorders — what they’re looking for is to not be hungry,” she explained. “So I think the idea is like, ‘Oh my gosh, wouldn’t it be nice to not have that food noise, because I’m trying to not eat at all, or really very minimally?’ That could be very dangerous.”
While prescriptions typically require patients to meet specific criteria — like a BMI of 30 or higher — Gallagher and Ross-Nash said they’ve treated people with eating disorders who managed to skirt the rules and get their hands on GLP-1s.
“I had a patient who was like, ‘Yeah, I lied about my weight so I could get it prescribed,’” Gallagher noted.
Even when patients obtain the drugs legitimately, GLP-1s can still trigger relapses in people with a history of disordered eating.
“Both restriction and purging behaviors are reinforced by GLP-1s,” Ross-Nash said.
For example, the most common side effects reported by GLP-1 users are gastrointestinal problems, including nausea and vomiting.
“I’ve seen people relapse into their history of bulimia just from food poisoning because vomiting is triggering,” Ross-Nash said.
She added that many patients also stop eating when their stomachs feel unsettled.
“So not only are we restricting because we don’t feel good, but then we’re also purging the food that is in our system because we’re nauseous,” Ross-Nash said.
While GLP-1s are generally intended for long-term use to sustain weight loss, research shows most people stop taking them within a year or two.
That transition can also be triggering for people with a history of eating disorders and even for those without.
“When my [underweight eating disorder] clients’ weight is restored, they have a whole team celebrating them,” Ross-Nash explained. “When clients on GLP-1s’ weight is restored or they gain the weight back … they’re going to be perceived as a failure.”
“Like, you lost all this weight and then it’s their fault, when, in reality, it’s the medication,” she continued. “And they genuinely learned no skills to support themselves in finding success.”
That perception can fuel a fixation on body shape and weight — a hallmark of disordered eating that treatment often works to shift away from, Gallagher explained.
“The biggest challenge with an eating disorder is how much it just takes over your brain and your mental capacity,” she said. “It can be really like a prison of your own mind.”
Even people who qualify for a GLP-1 and lose weight in a healthy way can face negative mental fallout once they’ve reached their desired physique.
“I have a patient right now who has lost a significant amount of weight on a GLP-1 and it was probably amazing for her health,” Gallagher said. “But now I do think we’re heading into the territory where we have a bit of a phobia of food.”
The effect is often reinforced by the positive attention people receive after slimming down.
“I think a lot of people are afraid to gain any weight back, or they want to keep losing to keep getting the good attention,” Gallagher said. “That’s how a lot of eating disorders develop.”
The prescribing information for drugs like Ozempic and Wegovy, which contain semaglutide, instructs doctors to ask patients about any history of mental health issues before prescribing the medication.
“Patient safety is our top priority,” a spokesperson for Novo Nordisk, which manufactures the drugs, told The Post. “Semaglutide’s efficacy and safety have been extensively demonstrated in people with obesity/overweight with robust evidence for improving health outcomes.”
To further support patients, both Ross-Nash and Gallagher recommend taking GLP-1s in consultation with a mental health professional, not just a primary care provider — regardless of prior eating disorder history.
“Weight-loss medication can affect anyone, so I don’t think it just has to be limited to individuals with an eating disorder history,” Ross-Nash said.
“Talk about it with your friends. Talk about it with your support team. Talk about it with a therapist,” she continued. “And know you are so much more than your appearance and your weight.”
