Jenn Nourse, an emotional health practitioner, had a long history of battling anorexia and bulimia, which largely faded after having children. However, in February 2024, after being alarmed by weight gain, she was prescribed semaglutide, the active ingredient in Ozempic and Wegovy, for obesity, insulin resistance, and fatty liver. She did not disclose her eating disorder history to her doctor. Within weeks, Nourse's appetite vanished, and the "food noise" disappeared, leading her to restrict her intake to under 1,000 calories a day, which she described as her eating disorder's "Ed's" ideal scenario. This initial sense of control quickly spiraled into a full-blown relapse of her bulimia, with her illness tightening its grip even after she weaned off the drug seven months later. She entered an intensive outpatient program to recover, realizing the medication encouraged eating disorder behaviors, reinforcing them.
Several healthcare providers across the country have reported treating patients whose long-dormant eating disorders resurfaced or who developed new struggles with food and body image after starting GLP-1 medications. Experts emphasize that the drugs mimic hormones that curb appetite and slow digestion, leading to reduced food noise and feelings of fullness. While beneficial for many, this mechanism can be detrimental for individuals with a predisposition to eating disorders, as it enables extreme restriction. Dr. Brad Smith, chief medical officer for the Emily Program, noted that GLP-1s can affect not only those acutely ill but also individuals in long-term recovery.
The lack of comprehensive eating disorder screening prior to prescribing GLP-1s is a significant concern highlighted by experts. Unlike bariatric surgery, which typically involves psychological evaluations, GLP-1 prescriptions often overlook this crucial step. The prescribing information for Ozempic and Wegovy does advise doctors to inquire about mental health history, yet oversight remains common. Dr. Zoe Ross-Nash, a clinical psychologist, compared the situation to the opioid epidemic, stating that while GLP-1s can be helpful, they can also become damaging. A perspective article in the New England Journal of Medicine estimated that over 420,000 people could develop an eating disorder with long-term GLP-1 use, underscoring the serious threat these drugs pose to vulnerable populations. Jenn Nourse and other experts advocate for increased awareness among both doctors and patients regarding these potential risks, emphasizing that context, screening, and monitoring are vital for individuals with eating disorder vulnerabilities.
