Swati Sri
April 27, 2026: Glucon-like Peptides-1 (GLP-1) agonists stabilize blood glucose by stimulating insulin secretion and suppressing glucagon production in the body. Besides that, they are known to suppress hunger and have changed the lives of many both in expected and unexpected ways.
GLP-1 drugs have achieved a widespread level of popularity and notoriety as weight-loss medicines over the past half-decade. The drugs, which include brands like Novo Nordisk’s Wegovy and Eli Lilly and Company’s Zepbound, essentially mimic gut hormones to function as appetite suppressants. According to the World Health Organization, 14 million people globally experienced an eating disorder (ED) in 2019. In the United States, approximately 9% of the population (28.8 million Americans) will experience an ED at some point in their lifetime. The FDA approval and some other regulatory bodies’ passing of the drugs for weight loss has added to the problem. And yet, there is no FDA warning. No mandatory screening protocol. No requirement to monitor patients for the psychological aftermath of what these drugs can do to the brain’s relationship with food.
This is the Ozempic paradox. A drug class celebrated as a revolution in metabolic medicine, generating profits on a scale the pharmaceutical industry has rarely seen, while quietly creating conditions in which some of the most vulnerable patients in any clinical setting are being placed in harm’s way.
The money
To understand the scale of what is at stake, you first have to understand the financial machinery behind GLP-1 receptors. These are not niche drugs. They are among the fastest-growing pharmaceutical products in recorded history.
The GLP-1 agonists market was valued at $43.1 billion in 2024 and is predicted to reach $260.1 billion by 2034, growing at a compound annual growth rate of 19.9%. The market is currently dominated by two companies: Denmark’s Novo Nordisk and American giant Eli Lilly. Novo Nordisk’s Ozempic generated revenues that grew from $270 million in 2018 to $18.7 billion in 2025. Wegovy, its obesity-specific GLP-1, saw sales surge from $212 million in its first year to $6.1 billion in 2025.
Eli Lilly has not been left behind. Mounjaro, approved in 2022, generated $483 million in its first year before surging to $11.5 billion in 2024, with analysts expecting sales to reach $18 billion in 2025. Most recently, Lilly’s obesity GLP-1 Zepbound brought in $2.3 billion in Q1 2025 alone, up almost 345% year-on-year. HealthQuill
In the US, roughly one in eight adults — 12% — have tried a GLP-1 drug, and 6% are currently using one. These are no longer niche prescriptions; they are household names reshaping the pharmaceutical landscape, popular culture, and increasingly psychiatry waiting rooms.
GLP-1 receptor agonists work by mimicking a gut hormone that signals satiety to the brain, slowing gastric emptying and suppressing appetite. For patients with type 2 diabetes or obesity, this mechanism is often life-changing. But because they also influence appetite and reward processes, these medications may shape eating behaviours, emotions, and body image, raising new challenges for eating disorder research and clinical care.
“To lead to weight loss, these medications are prescribed in two to five times the dose needed to treat diabetes,” says Dr Rebecca Boswell, PhD, director of Penn Medicine Princeton Center for Eating Disorders. “This is a massive dose of hormone that affects not only the gut, but the entire body, with major implications for eating processes and eating disorders.”
The double-edged sword
For binge eating disorder (BED) and bulimia nervosa, the early evidence is cautiously optimistic. Small pilot studies and case reports indicate promising reductions in binge eating frequency, body weight, and comorbidities with GLP-1 RAs like liraglutide and dulaglutide, and importantly, these agents demonstrate a favourable psychiatric side effect profile compared to existing options. A February 2025 meta-analysis by Radkhah et al., the first systematic review and meta-analysis on the efficacy of GLP-1 analogs in the treatment of eating disorders, confirmed that patients receiving GLP-1 agonists experienced greater weight loss and significantly improved Binge Eating Scale scores, though heterogeneity was noted and the study included only five studies with a total of 182 patients.
The picture for restrictive eating disorders is entirely different and far more alarming. For conditions like anorexia nervosa and atypical anorexia nervosa, the appetite suppression and weight loss induced by GLP-1s increase the risk of malnutrition, dangerous electrolyte imbalances, and potentially life-threatening complications like refeeding syndrome.
A recent case report described a 39-year-old patient who misused semaglutide to induce rapid weight loss, resulting in atypical anorexia nervosa. GLP-1 RAs prescribed for elevated BMI could inadvertently exacerbate an undiagnosed eating disorder or lead to new-onset disorders. One patient relapsed into disordered eating after ten years of recovery. When prescribed a GLP-1 RA, she had a full relapse, with disordered eating thoughts, preoccupation with body size, and weight loss so rapid she required hospitalisation.
Some physiological side effects of GLP-1 RAs, particularly nausea and vomiting, might trigger somatic memories in individuals with a history of bulimia nervosa, catapulting a person back into the mindset of having the disease.
The screening gap
Perhaps the most troubling dimension of this issue is structural. “There’s no protocol in place to screen for eating disorders prior to prescribing GLP-1 receptor agonists,” says Dr Boswell. “In addition, those taking these medications are not monitored for the psychological, social, or medical effects of malnutrition, which can be an issue at any body size.”
There are no clinical studies on the effects of GLP-1s on symptoms of anorexia or atypical anorexia. “We don’t have any data on these drugs and people with eating disorders,” says Susan McElroy, a psychiatrist at the University of Cincinnati College of Medicine, largely because obesity and eating disorders are still viewed in medicine as separate, rather than overlapping, conditions.
Navigating the healthcare system can be challenging. Many weight loss specialists, pediatricians, and primary care providers may have limited training in eating disorders, while many eating disorder clinicians may lack familiarity with GLP-1 medications, type 2 diabetes, or cardiovascular disease. Without proper screening and expertise, individuals may be underdiagnosed or misdiagnosed.
The atypical anorexia problem is particularly acute. Of particular concern to clinicians are people considered “atypical anorexics” — those who starve themselves and meet the clinical definition of anorexia but who are not underweight. “Those folks in particular are at high risk of being harmed by these medications because many doctors don’t know what atypical anorexia is,” says one Washington DC psychologist, and therefore might prescribe GLP-1s based on body size alone.
Real cases are already emerging. One clinician reported receiving an early morning call from an alarmed therapist about a patient with anorexia taking a GLP-1 drug despite having a BMI of 16. who was acquiring the drugs online by lying about their weight.
Off-label use and the online access problem
Off-label prescribing of GLP-1 receptor agonists solely for weight loss, especially in individuals who do not meet FDA-approved criteria, has risen sharply in recent years. While precise numbers are not publicly available, poison control hotline data suggest that calls for overdose in GLP medications has tripled in recent years.
A 2023 analysis of adverse-event reports submitted to the FDA found that misuse reports for semaglutide were four times higher than for other GLP-1 drugs at the time — rates comparable to those for phentermine-topiramate (Topamax), a combination weight-loss stimulant drug.
The clinical risks do not exist in a vacuum. They are amplified by a cultural moment in which GLP-1 drugs have become synonymous with rapid transformation, aspirational thinness, and through social media, a resurgent diet culture that eating disorder clinicians say they have not seen this intense in a generation.
Many experts worry that the heavy marketing and societal embrace of GLP-1 drugs are bringing back a cult of thinness, including among actors, singers and social media celebrities who previously preached acceptance of diverse body types.
Dr Boswell notes that the popularity of GLP-1 receptor agonists and their integration into social conversations can reinforce weight bias and the thinking that living in a larger body is problematic or not acceptable.
The scale of the problem
Of all the neuropsychiatric disorders we know of, anorexia nervosa has the highest mortality rate, with 5% of those affected dying within four years of initial diagnosis. The documented prevalence of anorexia nervosa is about 4% globally, or 150 million people.
Patients with any pre-existing mental health condition had more than double the risk of those without of developing an eating disorder within two years of starting GLP-1 agonists. Some estimates place as many as 35% of new eating disorder diagnoses as coming from people on GLP-1 agonists. These numbers remain contested and under-studied, but they point toward a population-scale risk that the pharmaceutical industry’s investment priorities have yet to take seriously.
How is it that as an industry, we have invested trillions of dollars in GLP-1 agonists and related drugs without paying attention to what this Pandora’s box has unleashed? We have multiple approved products, dozens in late-stage clinical trials, new companies getting funded seemingly every day, and a frenzy of M&A activity, but not a single approved medication to help the millions of people who struggle with, and die from, anorexia nervosa every year.
Prior to initiating GLP-1 RAs, clinicians should use screening tools such as the Screening, Brief Intervention, and Referral to Treatment for Eating Disorders for adults and the Stanford-Washington University Eating Disorder screen for college-aged students, says Cynthia Bulik, PhD, distinguished professor of eating disorders and founding director of the UNC Center of Excellence for Eating Disorders at the University of North Carolina at Chapel Hill.
For individuals with eating disorders or disordered eating behaviours, these drugs can be harmful when not used for their intended purpose, when inadequately monitored, or when used for weight loss motivated by weight stigma or fat phobia.
The consensus among eating disorder specialists is not that GLP-1 drugs are inherently bad, they are not. For the right patient, with proper metabolic indications and careful monitoring, they are genuinely transformative. But in a prescribing environment where one in eight adults is now using these drugs, where online access is trivially easy, and where no national screening requirement exists, the gap between who these drugs are designed for and who is actually using them has become dangerous territory and the patients most at risk are often the least visible to the clinicians writing the prescriptions.
