Ozempic Misuse: GLP-1s and Unhealthy Weight Loss
The benefits of GLP-1s, including rapid weight loss and appetite changes, overlap with many hallmarks of eating disorders. For this reason, it can be difficult for patients and healthcare providers alike to discern whether the medication is working as intended or the person has had a relapse into disordered eating, says Brad Smith, MD, a physician in Madison, Wisconsin, and the chief medical officer for the Emily Program, a network of eating disorder treatment centers. It also means that GLP-1s can validate and reinforce disordered thoughts and behaviors rather than raise the red flags that may otherwise prompt intervention.
While research exploring GLP-1 misuse and eating disorder relapse is still limited, experts say they’re seeing a growing number of cases firsthand. “We’re seeing both instances of GLP-1 misuse and active relapse in our practice,” says Ruth Elliott, LICSW, the director of clinical services at Multi-Service Eating Disorders Association in Newton, Massachusetts.
Part of the problem is a lack of thorough patient screening. Some telehealth companies providing GLP-1s don’t require an in-person visit with a healthcare provider, and instead rely on clients to be honest about their weight and eating disorder history to determine eligibility, says Elliott.
Even when someone pursues GLP-1s through conventional methods, few medical providers complete the appropriate mental health and eating disorder screenings. Some prescribe GLP-1s to treat binge eating disorder — a serious condition involving rapidly eating large meals with a loss of control, followed by feelings of intense shame — despite these drugs not being approved for that purpose, says Elliott.
“It’s important to emphasize that GLP-1s aren’t approved treatments for eating disorders, and weight loss itself isn’t a treatment or cure for the complex psychological, social, and cultural roots of these illnesses,” says Sam DeCaro, PsyD, a licensed clinical psychologist and the director of clinical outreach and education for the Renfrew Center, an eating disorder treatment center in Philadelphia.
In fact, GLP-1s can actively reinforce these illnesses, experts say. For many people with an eating disorder, the desire to lose weight is deeply embedded in the illness, making weight loss medications especially appealing to those who haven’t yet reached a full state of recovery, says Dr. Smith.
The risk may be even greater for people with co-occurring mental health conditions, which are common among those with eating disorders. GLP-1 users with preexisting mental health conditions, including depression, anxiety, and bipolar disorder, are 2.4 times more likely to be diagnosed with an eating disorder than those without a mental health history.
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