Subscribe to The Post Most newsletter for the most important and interesting stories from The Washington Post. <\/a><\/p>\n\u201cIn reality, I just wanted to be smaller,\u201d she said. A bottle of Wegovy pills – $149 – arrived soon after.<\/p>\n
Stories like this are alarming doctors, psychologists and patients working on recovery who say these drugs pose a serious threat to people with eating disorders. Providers on the front lines said they are routinely encountering patients like these taking GLP-1 drugs, some of whom have suffered a relapse and others who have developed an eating disorder for the first time while on the medications.<\/p>\n
Heavy promotion, easy access and a lack of warning labels add to the allure for people who are obsessed with losing weight, they say.<\/p>\n
Ozempic, Wegovy, Zepbound – and off-brand copies sold on the internet – have revolutionized the weight-loss industry because they are remarkably effective in suppressing appetite. But in addition to the better-known risks of gastrointestinal distress, providers said, there is a more hidden side effect.<\/p>\n
Even some younger teens are getting prescriptions, providers say, despite the fact that major telehealth websites selling the drugs require that patients be at least 18. They went online and lied about their age and weight to gain access, sometimes using their parents\u2019 credit cards. Others got them through pediatricians with parental consent to treat obesity.<\/p>\n
Rebecka Peebles, who handles clinical intake for a national eating disorder treatment provider, Monte Nido, as its vice president of adolescent medicine, said the number of its patients who report using the drugs is rising.<\/p>\n
\u201cWe have at least three people who present daily who are on a GLP-1, not for diabetes, but because they were put on it for weight loss,\u201d she said.<\/p>\n
A perspective article in the New England Journal of Medicine published in April, which notes that studies on this topic are sparse, estimated that more than 420,000 people could develop an eating disorder with long-term use of the drugs. That equates to a little over 1 percent of the 33 million Americans who have reported taking them.<\/p>\n
The Food and Drug Administration labels on the drugs do not list eating disorders as a side effect.<\/p>\n
Part of treatment for patients with eating disorders is helping them recognize their natural hunger cues. GLP-1s suppress those cues, providers said, undermining eating disorder treatment.<\/p>\n
\u201cThese medications do the same things that actual anorexia does,\u201d said Wendy Oliver Pyatt, co-founder of remote treatment platform Within Health and Galen Hope, a Florida treatment center.<\/p>\n
Heavy advertising for the medications reinforces Americans\u2019 tendency to glamorize thin bodies, creating even more social and psychological pressure to cut back on food.<\/p>\n
Rebecca Boswell, who directs the Princeton Center for Eating Disorders, said she was speaking with a group of eighth-graders about body image when they began singing the Ozempic advertising jingle, in unison. \u201cIt was unnerving,\u201d she said.<\/p>\n
Advertising typically cites side effects such as gastrointestinal distress or nausea but says nothing about danger associated with stifling hunger signals to the brain.<\/p>\n
\u201cThese medications are sort of being sold as no big deal, when in fact they are quite a big deal,\u201d said Elizabeth Wassenaar, a regional medical director in Denver for Eating Recovery Center, which operates a national network of treatment clinics.<\/p>\n
Researchers in Tulsa documented the effect of GLP-1s on several individual patients in a study published last year in the journal Obesity Reviews. While the recommended caloric intake for women is at least 1,600 for women and 2,000 for men, one patient limited food intake to 400 calories a day, another restricted to 300 to 350 calories a day, and a third cut it to 400 to 600 daily calories.<\/p>\n
Another patient started one of the drugs and the next day launched on a liquid diet of water and Diet Coke and did not eat for 13 days, losing 21 pounds in less than two weeks.<\/p>\n
\u201cThe patient felt such a strong absence of hunger that she described a dietary plan of \u2018fasting for six days and eating one time a week\u2019 as her stated plan for long-term weight reduction,\u201d the study said.<\/p>\n
Medical societies whose members treat patients with obesity and dietary issues last year recommended routine screening for eating disorders when GLP-1 drugs are prescribed. But in practice such screenings are not routinely conducted, providers said.<\/p>\n
The American Academy of Family Physicians, for instance, says it has not adopted screening recommendations. The academy said it views the drugs as one tool for physicians deciding how to treat their patients. It does not believe it necessary to make \u201cgeneralized recommendations driven by a single clinical concern.\u201d<\/p>\n
Novo Nordisk, the manufacturer of Ozempic and Wegovy, did not respond directly to whether it believes its drugs are being abused. It said doctors should be aware of risks to their individual patients.<\/p>\n
\u201cWe recognize that eating disorders are serious conditions. In that context, we trust that health care professionals – regardless of practice setting (e.g., in-person or via telehealth) – are appropriately evaluating the patient\u2019s medical history, individual risk factors, and that they determine the most appropriate clinical course,\u201d Novo Nordisk spokeswoman Liz Skrbkova said in an email.<\/p>\n
Eli Lilly, which makes Zepbound, also said doctors and patients should make treatment decisions.<\/p>\n
\u201cAs part of our routine safety review process for obesity management medications, we are working closely with regulators regarding potential safety topics, and we will continue to review data, including any data regarding eating disorders,\u201d the company said. Eli Lilly announced Thursday that a new experimental GLP-1 drug is even more powerful than its current offerings, resulting in an average of 28 percent weight loss in a late-stage clinical trial.<\/p>\n
The Food and Drug Administration did not directly answer when asked whether it had concerns about the effect of the drugs on people with eating disorders or if it was examining the issue.<\/p>\n
\u201cThe FDA monitors the safety of drug products after they enter the market by identifying and evaluating safety signals and taking regulatory action when appropriate,\u201d a spokesperson for the agency said.<\/p>\n
Greek yogurt, half a bagel and some nuts<\/b><\/p>\n
Shirley D., 62, a Navy veteran and retired contract manager who lives in Dayton, Nevada, has been diagnosed with binge eating disorder. Out of shame that is common in the disorder, she severely restricted her food intake for years to avoid the stigma of having a large body.<\/p>\n
One year she ate almost nothing but sandwiches from Subway. Another year she said she ate pistachios and little else. That was before she participated in treatment and grew more accepting of her weight.<\/p>\n
But then GLP-1s came along, said Shirley, who spoke on the condition of partial anonymity due to the sensitive nature of her condition.<\/p>\n
\u201cI feel bad that I\u2019m back to my old ways,\u201d she said.<\/p>\n
She settled on Zepbound, which she said has improved her diabetes scores. But she said she\u2019s started restricting food again, which is worrying her doctors.<\/p>\n
Shirley said she eats Greek yogurt, maybe half a bagel and some nuts every day. She knows she is depriving her body of nutrition and worries about the long-term effects of malnutrition on her bones and joints.<\/p>\n
\u201cI haven\u2019t had a lot of side effects, other than socially,\u201d Shirley added. \u201cYour friends want to go out to eat, and I don\u2019t want to go out to eat, because I don\u2019t want to eat food.\u201d<\/p>\n
But she has lost about 30 pounds in the last several months, reaching 189 pounds. The most she ever weighed was 240 and prefers how she looks now after suffering the daily indignities of having other people judge her weight.<\/p>\n
\u201cThere\u2019s two schools of thought fighting in me,\u201d Shirley said, \u201cand the GLP-1 is winning.\u201d<\/p>\n
\u2018Anorexic heroin\u2019<\/b><\/p>\n
AJ Jasper, 40, has been struggling with anorexia for about 30 years. Three years ago, at a time when he was a healthy weight, he relapsed after purchasing GLP-1s from various apps without ever seeing a doctor. Using multiple drugs at once, he dropped 50 pounds within three to four months.<\/p>\n
\u201cThe apps make it frighteningly easy. It is like anorexic heroin to my brain chemistry,\u201d said Jasper, a social worker in Chicago.<\/p>\n
This past winter, he went into triple organ failure – his kidneys, liver and heart were all affected – leaving him too weak to walk or even turn in bed at times. During his most recent inpatient stay he required a feeding tube, and his treatment was further complicated by the presence of GLP-1 medications in his system.<\/p>\n
Jasper is now in outpatient treatment and has returned to a healthy weight.<\/p>\n
\u201cAnyone with an eating disorder should stay far away from these medications,\u201d he said. \u201cThe past three years have really damaged my life and my health, and I don\u2019t want anyone else to go through this.\u201d<\/p>\n
Williams, the 5-foot-1 Houston bridesmaid, developed anorexia after gaining weight from being put on steroids for a cheerleading injury while in high school. By the time she was hospitalized, she weighed 60 pounds.<\/p>\n
She dabbled in varying fads without success over the years – vibration plates, weight-loss powders ordered off TikTok. Late last year, she ordered Wegovy and had it delivered. The dose was low, the weight wasn\u2019t coming off yet, but the feeling of control felt familiar.<\/p>\n
When her 4-year-old daughter, who is tall for her age, burst into tears after not being able to find a birthday dress that fit, Williams realized she didn\u2019t want her daughter to internalize the same negative body image that had shaped her own life.<\/p>\n
She decided to quit, aiming to lose weight in a healthy way.<\/p>\n
\u201cI was scared to get further into it,\u201d Williams said. \u201cIt\u2019s an addiction.\u201d<\/p>\n
Years earlier, she had created a Facebook group for people recovering from eating disorders, which recently has grown to nearly 200 members across the country. GLP-1s is the main topic. But whenever someone advertises the drugs, she deletes the posts and blocks the user.<\/p>\n
\u201cGLP-1s may get you some results,\u201d Williams said, \u201cbut they are not going to be help you love your body any more.\u201d<\/p>\n
Razzan Nakhlawi contributed to this report.<\/p>\n
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