GLP-1 Medications and Disordered Eating: Understanding the Health Risks

The increased popularity and use of glucagon-like peptide-1 receptor agonists, more commonly referred to as GLP-1s, have become part of everyday conversations. Originally approved to treat Type 2 diabetes, GLP-1 use has shifted to aid in weight loss and treat obesity. The benefits of GLP-1s continue to be studied as potential treatment options for a variety of other conditions, including obstructive sleep apnea, substance abuse, metabolic liver disease and osteoarthritis.

Following approval by the Food and Drug Administration, GLP-1s are being used more by adults and adolescents alike, with one study reporting a greater than 50% increase in use over a two-year period.

How Do GLP-1s Work?

GLP-1s help support weight loss by reducing a person’s appetite, food cravings and taste preferences while also increasing feelings of fullness. This generally leads to fewer calories consumed at meals and snacks. While weight loss is reported in both adults and adolescents using GLP-1s, plateaus in weight loss also have been reported with long-term use.

Nutrition-Related Risks of GLP-1s

GLP-1 use is linked to a range of negative side effects, including:

• Vitamin and mineral deficiencies
• Inadequate protein intake
• Loss of muscle mass
• Decreases in bone density

Gastrointestinal side effects including nausea, vomiting, diarrhea and constipation have been reported, potentially reducing appetite and food preferences further. While increased symptoms of depression and anxiety have been reported, some studies have shown an improvement in a person’s mood with use. GLP-1s are viewed as a lifelong medication to maintain a person’s weight loss, as weight regain has been reported after discontinuation of the medication.

GLP-1s have become more widely used and are often viewed as a safe way to lose weight. However, affordability of the medication and biases in healthcare can influence the availability of these medications. Together, this may lead to individuals obtaining prescriptions for GLP-1s without proper screening and a comprehensive assessment. Routine follow-up care and appropriate oversight by a healthcare professional is important to help ensure nutritional adequacy and management of side effects.

GLP-1s and Disordered Eating Concerns

Celebrity endorsements and social media posts can make it seem like being thin is the “ideal” body type. This message may lead some people to feel unhappy with their bodies and to try unhealthy eating or weight-loss behaviors. It also may increase interest in GLP-1 medications and raise the risk that some people will use them inappropriately.

There also is concern about using GLP-1s in people who have a history of disordered eating or eating disorders, but more research is needed. Unhealthy eating behaviors and weight-loss practices that come from body dissatisfaction are common warning signs of both disordered eating and diagnosable eating disorders.

Eating disorders are life-threatening psychiatric illnesses that impact a person’s entire body. Individuals of all ages, body sizes and genders can be diagnosed with an eating disorder, with the highest prevalence seen in adolescents, girls and women. Changes in appetite, hunger and fullness cues, in addition to gastrointestinal side effects, may reinforce strict food rules, disordered eating behaviors and patterns leading to dangerous weight loss.

Eating disorders are frequently mischaracterized as only occurring in underweight individuals. However, research shows higher weight individuals are increasingly affected. Using GLP-1s to treat obesity has raised concerns that some people may develop restrictive eating disorders.

There also are concerns about binge eating, purging and misuse of these medications among adolescent males. Comprehensive screening is needed to ensure appropriate prescribing and to avoid reinforcing disordered eating behaviors.

Do GLP-1s Have a Potential Role in Eating Disorder Treatment?

Although concerns have been raised with using GLP-1s for individuals diagnosed with an eating disorder, some positive associations have been reported. Specifically, research suggests GLP-1s may be of interest in the treatment of binge eating disorder (BED).

BED is characterized by binge eating, food preoccupation and body image dissatisfaction. Using GLP-1s in BED treatment has shown potential benefits in reducing food cravings and thought preoccupations, in addition to weight loss. However, researchers have raised concerns about weight regain and the return of disordered eating patterns after discontinuation of the medication. This highlights the need for ongoing research and longer-term studies.

Working With Your Healthcare Team

While GLP-1s have been linked to improvements in health for certain groups, research is ongoing for their potential benefits in treating additional health conditions. Proper screening, oversight and support by healthcare professionals, including registered dietitians, is essential. Individuals should fully understand the potential risks, side effects, nutritional needs, medication cost and long-term requirements associated with GLP-1s prior to starting the medication.