Publish Date: August 29, 2026
Author: James McKnight
Source: Shrink Speak substack
GLP-1 drugs like Ozempic and Wegovy can ease binge eating but may destabilize restrictive eating disorders—the case for psychiatric screening before prescribing.
Weight loss is a widespread struggle in American society. For some, the desire to lose weight is purely aesthetic—they look in the mirror and hope to lose a few pounds in order to fit better into clothing or feel more confident showing skin. For others, weight loss is medically advisable—and may pose a considerable challenge. The latter population has multiplied exponentially in recent decades, and obesity now afflicts 40% of American adults and 21% of children. The advent of GLP-1 weight loss medications, such as Ozempic and Wegovy, therefore, has seemed like a miracle cure for many.
A Remedy for Binge Eating Disorders
Glucagon-like peptide-1 (GLP-1) agonists were originally approved by the FDA to treat Type 2 diabetes and were later approved by the FDA for chronic weight management. They work by increasing insulin secretion, decreasing glucagon secretion, slowing gastric emptying, and regulating appetite—ultimately reducing food intake and increasing satiety, resulting in weight loss. Since they were first developed in the early 2000s, these medications have evolved to become more potent and are associated with greater weight loss than earlier versions. Use of GLP-1 agonists has risen rapidly in recent years: roughly 1 in 8 American adults (about 12%), or over 30 million people, currently use a GLP-1 medication, with as many as 18% reporting having tried one at some point.
Due to their appetite-suppressing qualities, GLP-1 drugs can produce real benefit in treating binge-eating disorders. While current data is somewhat limited, a systematic review of five studies with 182 participants found that GLP-1 agonists produced significantly greater weight loss, lower BMI, and reduction in waist circumference compared to controls.
A Pitfall for Restrictive Eating Disorders
But there is another side to the GLP-1 conversation related to eating disorders. Emergent research suggests that individuals may be using GLP-1 agonists to maintain restrictive eating disorders such as Anorexia Nervosa (characterized by extreme restriction of calorie intake) and Bulimia Nervosa (characterized by periods of binge eating followed by purging, strict dieting, or over-exercising) through rapid dietary restriction and weight loss.
This is not a minor concern. Anorexia Nervosa has the highest mortality rate among neuropsychiatric disorders, causing the deaths of roughly 5% of those affected within four years of diagnosis.
I have personally heard of these concerns from my fellow physicians. One colleague of mine living in a major city in the south recently told me of a patient who had started a GLP-1 and experienced a sudden change in her eating disorder. She had previously suffered from Bulimia Nervosa, but after starting on the GLP-1, her disorder changed to Anorexia Nervosa. While both disorders can be life-threatening and must be taken seriously, Anorexia Nervosa is considered more dangerous due to the rapid onset of physical deterioration associated with it.
Atypical Anorexia can also pose a challenge to physicians prescribing GLP-1 agonists. Atypical Anorexia Nervosa occurs when a person with Anorexia Nervosa remains at a weight in the normal range despite substantial loss. In other words, patients with Atypical Anorexia may present with obesity and medical co-morbidities, and physicians may misdiagnose them as having a Binge Eating Disorder and prescribe a GLP-1.
Finally, some evidence suggests that GLP-1 medications may trigger latent eating disorders. One physician described a patient who had recovered from Anorexia Nervosa ten years prior and had a full relapse after being prescribed a GLP-1, requiring hospitalization.
Better data is needed to determine whether GLP-1 agonists have led to an increase in restrictive eating disorders.
Overall, there is a documented rise in eating-disorder-adjacent presentations tied to GLP-1 use, concentrated in restrictive-type disorders and in relapse of previously recovered patients. In a recent study, 10% of people with eating disorders reported misusing GLP-1 drugs, and 9.9% admitted to using compounded products (or non-brand-name products, which exist in a regulatory gray zone) in order to achieve weight loss. But the overall data is still lacking—most current evidence is in the form of case reports, clinician surveys, and adverse-event data rather than population-level studies.
The Mental Health Angle
Thus GLP-1 drugs sit at a genuine clinical crossroads—they demonstrate real benefit for binge-type disorders and real risk for restrictive ones. And while GLP-1 agonists are not available over the counter, the barriers to acquiring them via prescription may put patients with restrictive eating disorders at risk.
The drugs themselves may also cause adverse mental health events as side effects. One study found 372 psychiatric adverse event reports (1.18% of all reports) associated with GLP-1 agonists, prompting an investigation by the European Medicines Agency into safety concerns. At the same time, however, regulators (including the FDA) ultimately didn’t confirm a causal link, and the broader psychiatric literature shows a modest antidepressant-like effect in some populations. Overall, findings are constrained by limited sample diversity, variable outcome measures, and consistent underrepresentation of individuals with psychiatric illness in the major trials.
Eating Disorders in Minority Populations
Minority populations also deserve far more attention in GLP-1 research. It is a persistent myth that restrictive eating disorders are absent among minority populations. Although Anorexia Nervosa is diagnosed less often in Black and Hispanic populations than in white populations, some researchers attribute this to underdiagnosis rather than true lower incidence—which means that some populations of color are less likely to be diagnosed or treated for Anorexia Nervosa despite having the same or similar symptoms.
There are no studies yet exploring the possible misuse of GLP-1 agonists for restrictive eating disorders among people of color—and given the risk of underdiagnosis for these populations, this should be flagged as a research gap.
A Call for Mental Health Screening
GLP-1 agonists are a genuinely useful drug class that can be therapeutic for one disorder and destabilizing for its near-neighbor. It is imperative, therefore, that psychiatric screening, not just BMI or waist circumference, play a role in prescription. Physicians should evaluate patients for mental disorders, focusing on restrictive eating disorders, before moving forward with prescription. They should also be on the lookout for atypical anorexia and ensure that racial bias is not coming into play.
In addition, further research, long-term studies, and clinical trials for these types of drugs must take patients with restrictive eating disorders into account. Finally, official data must be gathered as soon as possible to determine whether these drugs have led to an increase in restrictive eating disorders, especially in underserved or overlooked populations.