The Alarming Rise of Ozempic and GLP-1 Agonists Abuse Among Clients with Eating Disorders

In recent months, I have noticed a concerning trend among my clients: a sharp rise in online prescriptions and misuse of medications like Ozempic (semaglutide) and Mounjaro (tirzepatide), which were originally intended to manage Type 2 diabetes. These GLP-1 medications, while potentially life-saving for those with genuine medical needs, are increasingly being prescribed to individuals who do not medically qualify for them, including those with active eating disorders. This trend not only underscores the pervasive nature of diet culture, but also reveals a concerning interplay between medical treatment and the enabling of disordered eating behaviors.

Why the Rise in GLP-1 Use?

An FDA Loophole

The increase in widespread off-label prescription of GLP-1 drugs for weight loss is partly driven by the current shortage of these FDA-approved medications. When a drug is listed on the FDA’s shortage list, compounding pharmacies can legally produce alternative versions of the drug without violating patents. This regulatory loophole, originally intended to help diabetic patients get the medication they need, has inadvertently led to an increase in compounded semaglutide products marketed for weight loss​ (5-6).

The Appeal of Weight Loss Drugs in Diet Culture

Additionally, aggressive marketing & celebrity endorsement of these compounded versions as quick weight-loss solutions has contributed to their misuse, particularly among individuals vulnerable to disordered eating (6-7). I personally see upwards of half a dozen advertisements boosting, “We have Semaglutide!” along my daily 20-minute commute.

Our society’s obsession with weight loss and thinness is nothing new. Many of us remember Fen-Phen, the “miracle” weight loss drug turned nightmare of the 1990s (1). For decades, diet culture has promoted the idea that smaller bodies are healthier, more attractive, and more worthy of love and respect. Pathologizing individuals in “larger” bodies has only served to reinforce this attitude. Such toxic messaging, understandably, leads individuals to engage in harmful behaviors, such as chronic dieting, caloric restriction, extreme exercise, and, increasingly, the misuse of GLP-1 medications like Ozempic and Wegovy.

For those struggling with eating disorders, the promise of rapid weight loss that these drugs offer can be undeniably appealing. Many of my own clients report feeling immense pressure to maintain or achieve a certain body size despite understanding that recovering from an eating disorder requires accepting that a person’s body shape & size is not within their control. Many see these medications as a quick fix to achieve those culturally applauded weight loss goals and alleviate the intense emotional & physical discomfort they feel at their current size. However, I have seen this misuse exacerbate their already complex and dangerous relationship with food, body image, and health.

The Risks of Misusing GLP-1 Agonists like Ozempic & Semaglutide

While GLP-1s can be effective for their intended use, these drugs are not without serious side effects. These medications work by mimicking a hormone that regulates blood sugar and slows digestion, making the folks who take them feel full for longer, which can lead to weight loss. However, in individuals with eating disorders, this effect of GLP-1 use can be dangerous. While research is woefully limited, potential risks include severe malnutrition, a risk factor for developing refeeding syndrome, as well as electrolyte imbalances, muscle wasting, and other potentially life-threatening complications (8-9).

Ragen Chastain, a speaker, writer, researcher, and advocate for size-inclusive healthcare, emphasizes the lack of early research into these risks:

“The real question is why there wasn’t investigation into this from the beginning with these new weight loss drugs (5).”

This oversight, she argues, has left many vulnerable to worsening disordered eating behaviors, as these medications rapidly reduce appetite and can reinforce harmful weight-loss goals.

Moreover, the use of these medications in individuals with eating disorders can reinforce disordered eating behaviors. By suppressing appetite and causing rapid weight loss, these drugs can engrain the belief that weight loss is the ultimate health goal, overshadowing the importance of nourishing the body and maintaining a balanced relationship with food.

Provider Perspectives on GLP-1 Medication Misuse in Individuals with Eating Disorders

Winter Groeschl, a Licensed Professional Counselor (LPC), has observed troubling trends in the misuse of medications like Ozempic and semaglutide among individuals with eating disorders. She notes that the use of these medications, initially intended for diabetes management, has skyrocketed in their off label use, which is marketed as a quick weight loss solution.

“The projection of this drug being the cure for ‘weight loss’ is highly problematic and continues to perpetuate weight stigma.”

This widespread promotion not only overlooks the complex nature of weight and health but also dangerously simplifies the narrative around these drugs, leading to their misuse.

“The heartbreaking piece is navigating medical professionals—doctors, psychiatrists, endocrinologists, etc.—prescribe these medications to individuals with disordered eating or eating disorders without screening at all for potential eating disorders,” says Winter.

This lack of screening can lead to severe consequences, including malnutrition and the worsening of disordered eating behaviors, as these medications suppress appetite and disrupt the body’s natural hunger cues. Winter emphasizes the need for healthcare providers to thoroughly assess the risks and appropriateness of these medications, particularly for those with a history of eating disorders.

Read Winter’s full interview here.

As for myself, I have seen clients who are still actively suffering from anorexia and bulimia bulimia receive prescriptions for GLP1’s via weight loss clinics and be prescribed a highly restrictive diet, sometimes referred to as “The Ozempic Diet,” a low-calorie meal plan that has no scientific basis and is less than half of the average energy intake a healthy adult needs (3).

One of my clients, who we will call Stefania, is in their late 20s and has been in long-term eating disorder recovery since childhood. She reported startling information after receiving a prescription for semaglutide from a weight loss clinic:

“They put me on an 800 calorie per day diet that is more restrictive than my own eating disorder! This has really messed with my head,” she says. “I am not supposed to eat pretty much anything other than a small amount of lean protein and vegetables. Grains, fats, fruits, salt— pretty much everything else— is off the table.”

Within 6 months of following this prescribed food & drug protocol, my client needed her gallbladder removed.

The impact this GLP-1 prescription has had on her health and her recovery is devastating. And no one is being held accountable.

A Call to Action for Healthcare Providers

The rise in the misuse of Ozempic and other GLP-1 agonists among individuals with eating disorders calls for increased awareness and caution among healthcare providers. Prescribing these medications without thoroughly assessing the patient’s mental and physical health can have devastating consequences. It is crucial for providers to screen extensively for eating disorders, using more robust testing measures than relying purely on self-report, and for providers to recognize potential for misuse in vulnerable populations.

For those of us in the eating disorder recovery field, this trend serves as a reminder of the importance of holistic, compassionate care. Our clients need support not just in managing their physical health, but also in addressing the underlying psychological factors that drive their disordered eating and their desire. We must advocate for treatments that promote overall well-being rather than focusing solely on weight loss.

Supporting Clients in Eating Disorder Recovery

If you or someone you know is struggling with an eating disorder and is misusing medications like Ozempic (semaglutide) or Mounjaro (tirzepatide), it is important to seek help immediately. Recovery is possible, but it requires a comprehensive approach that addresses the physical, cognitive, social, and emotional aspects of the disorder.

At Cosana Coaching, we are committed to helping individuals break free from the grips of diet culture and other systems of oppression to develop a trust-based relationship with food and their bodies. Our programs are designed to support clients in reclaiming their power, experiencing ease with eating, and finding joy in & beyond nourishment. We offer a weight neutral approach to improving health and are capable of supporting individuals across the lifespan, starting with individuals as young as 13 years old.

NOTE: Recovery coaching is a supplement to, not substitute, for medical and/or psychiatric care & dietary support.

Final Thoughts

The rise in GLP-1 misuse among individuals with eating disorders is a troubling reflection of our society’s continued obsession with weight loss and the . As professionals, we must be vigilant in recognizing and addressing this trend, ensuring that our clients receive the care they need to recover fully. Let’s work together to create a world where health is not measured by the size of our bodies, but by our ability to live fully and freely.

If you or a loved one are struggling, email info@cosanacoaching.com to learn how recovery coaching can support you/their journey towards health & healing after disordered eating.

Disclaimer:
This article is for educational purposes only and is not a substitute for medical advice, nor is it attempting to provide medical advice. If you are experiencing a medical emergency, please call 911 or go to the nearest emergency room. If you are experiencing a mental health emergency, call 988.

Sources:

1. https://www.medpagetoday.com/special-reports/slipperyslope/51044
2. https://sizeinclusivemedicine.org/glp1/
3. https://health.clevelandclinic.org/how-many-calories-a-day-should-i-eat
4. https://open.substack.com/pub/weightandhealthcare/p/are-glp-1-drugs-causing-eating-disorders?r=29e9zl&utm_campaign=post&utm_medium=web
5. https://kffhealthnews.org/news/article/glp1-compounding-pharmacies-wegovy-zepbound-copycat-drugs-shortages/
6. https://www.fda.gov/drugs/human-drug-compounding/compounding-when-drugs-are-fdas-drug-shortages-list
7. https://www.politico.com/newsletters/prescription-pulse/2024/07/26/compounding-the-glp-1-craze-00171314
8. https://www.psychologytoday.com/us/blog/talking-about-trauma/202405/the-risks-of-ozempic-for-people-with-eating-disorders
9. https://www.nationaleatingdisorders.org/glp-and-eating-disorders/