Questions Eating Disorder Specialists Have About Weight Loss Drugs

Uncertainty about popular weight-loss medications raises concerns among experts about potential impacts on eating disorders, highlighting the urgent need for more research and a cautious approach to prescribing these medications.

There’s still a lot researchers don’t know about popular weight-loss medications — and that lack of studies could have consequences for eating disorders, experts say.

The medication semaglutide, sold under brand names such as Ozempic and Wegovy, is a type of glucagon-like peptide-1 receptor agonist or GLP-1 agonist. Although originally prescribed for diabetes, semaglutide is becoming increasingly popular for weight loss.

As medication becomes more available, experts say they worry about the impact of these weight loss products on eating disorders.

“We saw clinically that more and more people who had started taking GLP-1 agonists and who had new onset or worsening eating disorder symptoms were coming into our clinical services,” said Aaron Keshen, co-director of the Provincial Health Service. Nova Scotia Eating Disorders and assistant professor in the department of psychiatry at Dalhousie University in Halifax, Nova Scotia.

Eating disorders affect about 1 in 10 people in the United States, according to the National Association of Anorexia Nervosa and Associated Disorders, a nonprofit organization that provides support services to people with these disorders. After opioid addiction, it has the second highest crude death rate of all mental illnesses, according to the association.

The possibility that GLP-1 agonists may worsen or increase the prevalence of eating disorders “makes us have to go very slowly and be very deliberate about when we prescribe them,” said Jennifer Gaudiani, an eating disorder physician and founder and director. doctor at the Gaudiani Clinic in Denver.

The scope of research into the relationship between eating disorders and weight-loss medications is quite limited, leaving experts with many unanswered questions, says Susan McElroy, director of research at the Lindner Center of HOPE and professor in the department of psychiatry and behavioral neuroscience at the University of Cincinnati College of Medicine.

“I consider eating disorders to be the last frontier in psychiatry,” he added. “The field of eating disorders is difficult because we are simply ignored.”

Can these medications treat binge eating disorder?

Are there cases in which these medications effectively help patients with eating disorders? Maybe, experts say. Generally, if a medication causes weight loss, there’s a good chance it will also reduce binge eating, McElroy said.

Binge eating disorder is the most common eating disorder. But, as with anorexia and bulimia nervosa, there isn’t enough research into how to treat it with medication, he added.

“We desperately need more compounds to treat people with eating disorders,” McElroy said.

In theory, these medications could help, but they are not approved for treating binge eating disorder, he added.

“There is little preliminary evidence that perhaps GLP-1 agonists can reduce binge symptoms in some individuals,” Keshen said, “but the evidence is quite weak at this point, and certainly not enough to recommend that people take agonists.” of GLP-1 for binge eating”.

Keshen and McElroy worked on a 2023 paper published in the International Journal of Eating disorders that reviewed existing literature on GLP-1 agonists and eating disorders. The studies they found on binge eating disorder were small and many didn’t test against a placebo, Keshen said.

“More investigation needs to be done,” he added. “And that could happen in the future.”

Can they bring back an eating disorder?

Eating disorders occur in people of all shapes, weights and health conditions — so doctors may unknowingly prescribe these medications to people with a history of or even an active eating disorder, Gaudiani said.

“Their ability to pay for a medication that causes weight loss, while also causing medical complications, is concerning,” he said.

Gaudiani said he has heard reports of people in remission from an eating disorder having it reignited after taking a GLP-1 agonist.

Eating disorders are complicated psychosocial illnesses, Gaudiani said, and the process of weight loss can trigger an increase in restrictive dieting, which can bring up “old gremlins.”

Additionally, these medications suppress appetite. Feeling full too quickly or feeling sick after eating too little can disconnect a person from their innate hunger and fullness signals, she added.

“If someone has a history of eating disorders, or just has temperamental traits, and is surrounded by a society that is extremely focused on weight loss and fatphobia, and they start to lose weight,” Gaudiani said, “it’s not unimaginable, but it can develop into something that becomes quite obsessive and quite unhealthy mentally and physically for them.”

Can they unleash a new monster?

With little research on the subject, experts can’t say whether GLP-1 agonists would make someone more likely to develop an eating disorder, but there is reason to be concerned, Gaudiani said.

“Many eating disorders begin with restricting food intake and losing weight. It has been proven that the act of reducing caloric intake and the act of losing weight physiologically triggers eating disorder behaviors, even in those who otherwise do not would be considered temperamental or socially prone to them”.

Gaudiani referenced the 1944 Minnesota Starvation Experiment, in which individuals volunteered to starve. so that researchers could experiment with the best feedback methods.

There was an effect that researchers didn’t expect when the volunteers were starved, he said. They became obsessed with food, read cookbooks, and constantly chewed gum, cutting the food they ate into bite-size pieces to spend more time eating, and judging people in restaurants who they considered to be greedy.

“In short, they were acting like someone with anorexia,” Gaudiani said. “There’s something in our brain that fundamentally changes when we get inadequate calories and lose weight.”

There is also a risk for behaviors like bulimia, Keshen added. If people have a suppressed appetite, they may not eat anything during the day and then overeat at night — which can result in purging behaviors, he said.

“Perhaps a moderate degree of weight loss is a healthy outcome for some individuals,” Keshen said, “but it will never be a healthy outcome to achieve rapid weight loss due to excessive pathological dietary restriction.”

How to protect people vulnerable to eating disorders?

First, health care providers who prescribe these medications need to screen for history of eating disorders, active eating disorders and even vulnerability to an eating disorder, Keshen said.

“It may be worth trying to treat the eating disorder first, or perhaps not using a GLP-1 agonist in this patient,” he said.

If the doctor and patient choose to move forward with medication, it is important that they also review information about eating disorders and the importance of eating structured meals, Keshen said.

Diet is something that people taking appetite-suppressing medication should regularly review with themselves, Gaudiani said.

“Human beings, like all mammals, need to eat throughout the day to have the energy to do what they want with their body and mind, and so we have to check: “Am I eating enough? “How often am I thinking about food and my body?”

If people with a history of eating disorders revert to old behaviors while taking GLP-1 agonists, they should contact their doctors and therapists, Gaudiani said.

And for those who have not been diagnosed with an eating disorder, or who may not even meet the threshold for one, if thoughts about weight and food are distracting from goals and priorities, it may be time to seek out an eating disorder specialist. if resources are available, she said.

“If not, visiting eating disorder treatment websites or listening to podcasts can just help bring some support and clarity to what you’re going through,” Gaudiani said.