There\u2019s trouble brewing beneath the GLP-1 buzz.<\/p>\n
As Americans embrace blockbuster weight-loss drugs like Ozempic and Wegovy in record numbers, providers are warning of a troubling ripple effect: patients sliding back into restrictive eating disorders \u2014 and others developing them for the first time.<\/p>\n
\u201cI think there should be a button that you have to click saying \u2018I am consciously making a choice that could really harm my health,\u2019\u201d Dr. Zoe Ross-Nash<\/a>, a licensed clinical psychologist, told The Post. \u201cLike on cigarette boxes, it says, \u2018This could cause cancer.\u2019 OK, well, this [drug] could cause an eating disorder.\u201d<\/p>\n The solemn warning comes amid growing concern about shrinking celebrities<\/a> \u2014 who may or may not be on GLP1s \u2014 and whether they\u2019re stick-thinness may fuel a return to early-2000s weight stigma or the \u201cheroin chic\u201d look of the \u201990s.<\/p>\n Nearly 12% of Americans say they have used a GLP-1 for weight loss, although experts say the true number is likely higher. millaf (Nemchinova) \u2013 stock.adobe.com<\/p>\n GLP-1s work by mimicking one or two hormones the body naturally produces to curb appetite, slow digestion and regulate blood sugar.<\/p>\n As a result, people tend to feel fuller longer, eat smaller portions and experience less \u201cfood noise<\/a>\u201d \u2014 or frequent, often intrusive thoughts about eating.<\/p>\n The medications have been widely praised for helping people who are overweight or obese slim down quickly, as well as for other clinical uses<\/a>, including managing type 2 diabetes, reducing cardiovascular risk factors and treating obstructive sleep apnea<\/a>.<\/p>\n But Dr. Thea Gallagher<\/a>, a clinical psychologist at NYU Langone, said the very benefits these drugs are celebrated for can also become \u201ca slippery slope for some people.\u201d<\/p>\n \u201cA lot of people with restrictive eating disorders \u2014 what they\u2019re looking for is to not be hungry,\u201d she explained. \u201cSo I think the idea is like, \u2018Oh my gosh, wouldn\u2019t it be nice to not have that food noise, because I\u2019m trying to not eat at all, or really very minimally?\u2019 That could be very dangerous.\u201d<\/p>\n While prescriptions typically require patients to meet specific criteria \u2014 like a BMI of 30 or higher \u2014 Gallagher and Ross-Nash said they\u2019ve treated people with eating disorders who managed to skirt the rules and get their hands on GLP-1s.<\/p>\n \u201cI had a patient who was like, \u2018Yeah, I lied about my weight so I could get it prescribed,\u2019\u201d Gallagher noted. \u201cI think it makes it easier to restrict.\u201d<\/p>\n Even when patients obtain the drugs legitimately, GLP-1s can still trigger relapses in people with a history of disordered eating.<\/p>\n GLP-1 medications have the potential to trigger or worsen restrictive eating disorders, experts say. Halfpoint \u2013 stock.adobe.com<\/p>\n \u201cBoth restriction and purging behaviors are reinforced by GLP-1s,\u201d Ross-Nash said. <\/p>\n For example, the most common side effects reported by GLP-1 users are gastrointestinal problems<\/a>, including nausea and vomiting.<\/p>\n \u201cI\u2019ve seen people relapse into their history of bulimia just from food poisoning because vomiting is triggering,\u201d Ross-Nash said. <\/p>\n She added that many patients also stop eating when their stomachs feel unsettled.<\/p>\n \u201cSo not only are we restricting because we don\u2019t feel good, but then we\u2019re also purging the food that is in our system because we\u2019re nauseous,\u201d Ross-Nash said. <\/p>\n While GLP-1s are generally intended for long-term use to sustain weight loss, research shows most people stop taking them within a year or two<\/a>. <\/p>\n That transition can also be triggering for people with a history of eating disorders and even for those without.<\/p>\n \u201cWhen my [underweight eating disorder] clients\u2019 weight is restored, they have a whole team celebrating them,\u201d Ross-Nash explained. \u201cWhen clients on GLP-1s\u2019 weight is restored or they gain the weight back \u2026 they\u2019re going to be perceived as a failure.\u201d<\/p>\n \u201cLike, you lost all this weight and then it\u2019s their fault, when, in reality, it\u2019s the medication,\u201d she continued. \u201cAnd they genuinely learned no skills to support themselves in finding success.\u201d<\/p>\n Experts recommend consulting a mental health professional before starting GLP-1s and during treatment. Wordley Calvo Stock \u2013 stock.adobe.com<\/p>\n That perception can fuel a fixation on body shape and weight \u2014 a hallmark of disordered eating that treatment often works to shift away from, Gallagher explained.<\/p>\n \u201cThe biggest challenge with an eating disorder is how much it just takes over your brain and your mental capacity,\u201d she said. \u201cIt can be really like a prison of your own mind.\u201d<\/p>\n Even people who qualify for a GLP-1 and lose weight in a healthy way can face negative mental fallout once they\u2019ve reached their desired physique.<\/p>\n \u201cI have a patient right now who has lost a significant amount of weight on a GLP-1 and it was probably amazing for her health,\u201d Gallagher said. \u201cBut now I do think we\u2019re heading into the territory where we have a bit of a phobia of food<\/a>.\u201d<\/p>\n The effect is often reinforced by the positive attention people receive after slimming down.<\/p>\n \u201cI think a lot of people are afraid to gain any weight back, or they want to keep losing to keep getting the good attention,\u201d Gallagher said. \u201cThat\u2019s how a lot of eating disorders develop.\u201d<\/p>\n The prescribing information for drugs like Ozempic and Wegovy, which contain semaglutide, instructs doctors to ask patients about any history of mental health issues before prescribing the medication.<\/p>\n