Heavy promotion, easy access and a lack of warning labels add to the allure for people who are obsessed with losing weight, they say.
Ozempic, Wegovy, Zepbound – and off-brand copies sold on the internet – have revolutionised 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.
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’ credit cards. Others got them through paediatricians with parental consent to treat obesity.
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.
“We 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,” she said.
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% of the 33 million Americans who have reported taking them.
The Food and Drug Administration labels on the drugs do not list eating disorders as a side effect.
Part of treatment for patients with eating disorders is helping them recognise their natural hunger cues. GLP-1s suppress those cues, providers said, undermining eating disorder treatment.
“These medications do the same things that actual anorexia does,” said Wendy Oliver Pyatt, co-founder of remote treatment platform Within Health and Galen Hope, a Florida treatment centre.
Heavy advertising for the medications reinforces Americans’ tendency to glamorise thin bodies, creating even more social and psychological pressure to cut back on food.
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. “It was unnerving,” she said.
Advertising typically cites side effects such as gastrointestinal distress or nausea but says nothing about danger associated with stifling hunger signals to the brain.
“These medications are sort of being sold as no big deal, when in fact they are quite a big deal,” said Elizabeth Wassenaar, a regional medical director in Denver for Eating Recovery Centre, which operates a national network of treatment clinics.
Stevee Williams, centre, with her daughter, Scarlett, and partner, Kobe Chavana. Williams, who has been diagnosed with anorexia, tried a GLP-1 weight-loss drug in response to anxieties about her weight. Photo / Danielle Villasana, For The Washington Post
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 1600 for women and 2000 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.
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 9.5kg in less than two weeks.
“The patient felt such a strong absence of hunger that she described a dietary plan of ‘fasting for six days and eating one time a week’ as her stated plan for long-term weight reduction,” the study said.
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.
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 “generalised recommendations driven by a single clinical concern”.
Williams developed anorexia after gaining weight after being put on steroids for a cheerleading injury in high school. Photo / Danielle Villasana, For The Washington Post
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.
“We recognise that eating disorders are serious conditions. In that context, we trust that health care professionals – regardless of practice setting (eg, in-person or via telehealth) – are appropriately evaluating the patient’s medical history, individual risk factors, and that they determine the most appropriate clinical course,” Novo Nordisk spokeswoman Liz Skrbkova said in an email.
Eli Lilly, which makes Zepbound, also said doctors and patients should make treatment decisions.
“As 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,” 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% weight loss in a late-stage clinical trial.
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.
“The FDA monitors the safety of drug products after they enter the market by identifying and evaluating safety signals and taking regulatory action when appropriate,” a spokesperson for the agency said.
Greek yoghurt, half a bagel and some nuts
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.
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.
But then GLP-1s came along, said Shirley, who spoke on the condition of partial anonymity because of the sensitive nature of her condition.
“I feel bad that I’m back to my old ways,” she said.
She settled on Zepbound, which she said has improved her diabetes scores. But she said she’s started restricting food again, which is worrying her doctors.
Shirley said she eats Greek yoghurt, 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.
“I haven’t had a lot of side effects, other than socially,” Shirley added. “Your friends want to go out to eat, and I don’t want to go out to eat, because I don’t want to eat food.”
But she has lost about 13.6kg in the last several months, reaching 85.7kg. The most she ever weighed was 108.9kg and prefers how she looks now after suffering the daily indignities of having other people judge her weight.
“There’s two schools of thought fighting in me,” Shirley said, “and the GLP-1 is winning.”
‘Anorexic heroin’
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 22kg within three to four months.
“The apps make it frighteningly easy. It is like anorexic heroin to my brain chemistry,” said Jasper, a social worker in Chicago.
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.
Jasper is now in outpatient treatment and has returned to a healthy weight.
“Anyone with an eating disorder should stay far away from these medications,” he said. “The past three years have really damaged my life and my health, and I don’t want anyone else to go through this.”
Williams, the 5ft-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 hospitalised, she weighed 27kg.
Williams plays with her daughter a park in Texas. Photo / Danielle Villasana, For The Washington Post
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’t coming off yet, but the feeling of control felt familiar.
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 realised she didn’t want her daughter to internalise the same negative body image that had shaped her own life.
She decided to quit, aiming to lose weight in a healthy way.
“I was scared to get further into it,” Williams said. “It’s an addiction.”
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.
“GLP-1s may get you some results,” Williams said, “but they are not going to be help you love your body any more.”
Razzan Nakhlawi contributed to this report.