Written By: Samantha DeCaro, PsyD
Director of Clinical Outreach and Education
Marketed as a weight-loss solution, Ozempic and other GLP-1 receptor agonists have raised concerns among eating disorder professionals. While these medications can aid in blood sugar regulation, they may also contribute to disordered eating behaviors, interfere with recovery, and exacerbate existing conditions. This article explores the potential risks of GLP-1As, their impact on eating disorder treatment, and what providers can do to support clients in making informed health decisions.
What are GLP-1 hormones and GLP-1 Agonists (GLP-1A)?
GLP-1 (glucagon-like peptide-1) is a hormone that regulates appetite, food intake, and blood sugar levels. As part of the body’s natural response to food, GLP-1 works by stimulating insulin release when glucose levels are elevated, slowing gastric emptying, and lowering blood glucose levels. It helps us manage our blood sugar and feel full and satisfied when we eat.
In recent years, GLP-1 receptor agonists (GLP-1As) have become prominent in treating type 2 diabetes and targeting glycemic control. These medications – such as semaglutide (brand name: Ozempic) and tirzepatide (brand name: Mounjaro) – work by mimicking this hormone in the body (tirzepatide also mimics the GIP hormone). These medications bind to receptors, stimulating them in much the same way the natural hormones would, but producing a longer-lasting effect. People who rely on these medications to manage diabetes may experience a side effect of weight loss.
GLP-1As Marketed as Weight Loss Drugs
While semaglutides have been shown to be effective in managing blood sugar, these medications are now being offered at higher doses and advertised off-label as weight loss drugs.
With most medications, any side effects will increase when dosages are increased. To maximize the side effect of weight loss, companies have significantly increased the dose of this diabetes medication and rebranded the product (e.g., Wegovy and Ozempic are the same medication often prescribed at different doses). While initial weight loss will likely occur, the body’s response can evolve over time. Studies show that weight loss may plateau while on the drug and reverse once the medication is discontinued.
Potential Risks, Side Effects and Complications
Taking these medications to intentionally pursue weight loss comes with many risks and potential complications. There are a variety of potential side effects that may occur, ranging from the common side effects of nausea, constipation and vomiting to the less common – but more serious events – such as acute kidney failure, pancreatitis, intestinal blockages, depression and even suicidality. These medications are intended to be taken indefinitely, increasing the chances of an adverse event over the course of a lifetime.
GLP-1As can also result in unintended issues secondary to weight loss, such as malnutrition, vitamin & nutrient deficiencies, and muscle loss. When used in conjunction with restricting, these medications could lead to the kinds of health issues typically associated with extreme dieting and restrictive eating disorders. Additionally, due to the demand and expense of brand-name medications, some pharmacies produce and sell unregulated versions of this drug, known as compounded semaglutide. These products pose significant risks, as they may not meet the same safety or quality standards as FDA-approved medications.
The Potential Impact of GLP-1As on Eating Disorder Treatment & Recovery
Eating disorder professionals have raised concerns about the use of GLP-1As for weight loss as they can trigger the onset of an eating disorder, worsen an existing one, contribute to a relapse, and interfere with eating disorder treatment and recovery in various ways. Moreover, GLP-1As are not approved for the treatment of any eating disorder. Here are six reasons why these medications may be harmful in the context of eating disorder recovery:
- Interference with Eating Disorder Treatment Goals: Effective treatment often includes a plan to reconnect with the body’s cues, develop a consistent and nourishing eating schedule, and challenge the overvaluation of weight. GLP-1As effect on appetite and digestion, along with the common side effects of nausea, fullness, and constipation can interfere with this process, making it more difficult for individuals to not only nourish and reconnect with themselves, but also participate in highly effective fear food exposures. In addition, the intentional pursuit of weight loss can shift the focus to the scale, reinforcing the harmful belief that weight is a measure of self-worth and progress.
- GLP-1As Support Disordered Behaviors: For those who struggle with guilt, shame, and anxiety around food, these medications could be misused in a disordered way. For example, individuals may compulsively use the medication as an appetite suppressant to enable restriction or as a purging strategy to compensate for eating. This is especially true for medications prescribed in easily accessible tablet forms.
- Worsening of Symptoms During Use: Individuals struggling with fear foods or food-related anxiety may find that these medications do not improve their relationship with food or help them eat intuitively. Instead, their effects on appetite and digestion may make it easier to use harmful symptoms such as restricting and/or purging via laxatives or self-induced vomiting.
- Worsening of Symptoms After Use: Upon discontinuing the medication, many individuals report regaining weight they lost, leading to feelings of shame and strengthening urges to diet. Prolonged periods of undereating while on the medication can result in intense cravings and urges to binge after the medication is stopped, potentially activating a binge/restrict cycle that is difficult to break.
- Negative Psychological and Emotional Impact: At these higher doses, GLP-1As can suppress the dopamine system, dampening the brain’s reward response to food. However, dopamine also plays a central role in mood regulation, motivation, and cognitive functioning. Diminished dopamine activity can negatively affect other aspects of life, including our mental health, memory, attention, and the motivation needed to fully engage in eating disorder treatment.
- Root Causes & Co-Occurring Disorders: GLP-1As do not address the root causes of eating disorders such as unprocessed trauma, emotional regulation, and low self-esteem. Body image issues are not magically cured with weight loss, either. To achieve lasting recovery, effective eating disorder treatment targets the underlying cognitive, emotional, and relational factors that drive symptoms, as well as any co-occurring mental health disorders.
What Can Providers Do to Support Clients?
As eating disorder providers, it is essential to approach discussions about GLP-1As with compassion and sensitivity. Here are a few key actions to consider:
- Confront Your Personal Biases: Begin by addressing your personal biases about weight and health. Weight is not a reliable measure of health, weight loss does not always indicate improved health, and the intentional pursuit of weight loss is contraindicated in the treatment of eating disorders.
- Encourage Informed Consent: Patients should fully understand the potential risks to these medications, including the potential benefits of not using them at all. They should understand how these medications work and be made aware of the common side effects, lesser-known side effects, and ways these products could interfere with treatment and recovery goals. They should understand that the long-term effects are not yet known, and most of the research available has been sponsored by the same companies that manufacture and sell these products.
- Collaborate with Other Providers: If a client is considering GLP-1As, offer to consult with and educate their prescribing provider on the potential risks and impacts on eating disorder treatment and recovery. Collaborate and refer to providers who understand eating disorders and use a weight neutral, anti-diet approach.
- Validate Emotions: Explore why your client may want to try these medications. Approach the conversation with curiosity and empathy and validate their feelings. Help them identify what they hope to achieve with the medication and whether those goals align with their core values, long-term wellbeing, and goals for sustained recovery.
- Take a Weight– Neutral Approach: Identify other markers of health and progress that do not include weight. Focus on reducing eating disorder symptoms, improving emotional well-being, strengthening relationships, encouraging joyful movement, and increasing self-esteem. Help clients develop a healthier relationship with food and their body without using weight as a measure of progress.
Conclusion
As GLP-1As continue to gain popularity, their risks and potential impacts on recovery must be explored. Providers must be diligent in offering informed, compassionate care that empowers clients to make well-informed decisions about their health and recovery goals.
The intentional pursuit of weight loss is neither an effective intervention nor a cure for body dissatisfaction or disordered eating. Effective treatment modalities target the deeper, underlying issues and co-occurring disorders with emotionally focused, relational, and weight-neutral approaches. By combining education, compassion, empowerment, and evidence-based care, we can help clients make decisions that promote their long-term health and recovery.
If you or a loved one is struggling with an eating disorder, it’s important to seek guidance from professionals who understand the complexities of treatment and recovery. Contact Renfrew today to learn about our evidence-based treatment and personalized care options.
