Do Weight Loss Drugs Like Ozempic Improve or Worsen Eating Disorders? The Answer May Be Both

When Penny Gautreaux started taking Rybelsus, an oral version of semaglutide, it didn’t take long for some of the side effects her doctor had warned her about to hit.

“I noticed stomach pain and gastrointestinal distress almost immediately,” said Gautreux, who began taking the medication in the spring of 2023 to manage her type 2 diabetes. Soon after, “no food sounded appetizing,” she added.

After several weeks on the medication, which uses the same active ingredient as the injectable weight loss drug Ozempic, Geautreaux also began slipping into old disordered eating habits, despite having been in recovery.

Uninterested in eating much anyway, the then-37-year-old started deliberately avoiding meals once again, experimenting with how long she could go without consuming anything.

When, soon after, she discovered she had lost 12 pounds, the news gave her an unwelcome “thrill sensation” she recognized well. That’s when Geautreaux decided to stop taking the medication.

“The severity of physical side effects, along with the complete disinterest in food, was simply too much for me to deal with and maintain my recovery,” she told Health. “I understood that my diabetes was a problem, but I also understood that I would cause more damage through restriction and relapse than was worth the risk if I continued with the medication.”

Geautreaux is one of the estimated 15 million Americans who have taken Rybelsus, Ozempic, Wegovy, or another glucagon-like peptide-1 receptor agonist, or GLP-1.

These prescription medications—originally developed for type 2 diabetes treatment and now, some, approved for obesity—have revolutionized the weight loss industry in recent years, helping to suppress hunger and lower body mass index.

For those with an eating disorder or a susceptibility to them, the swift and extreme changes to appetite and body size triggered by a GLP-1 can produce unique psychological effects.

There’s little research on the subject, but for some people, GLP-1s appear to improve eating disorder outcomes. Data suggest that the medications help with recovery from binge eating—a key component of conditions like binge eating disorder and bulimia nervosa.

But anecdotal evidence reveals that GLP-1s can also have the opposite effect: exacerbating unhealthy thoughts around eating, as Rybelsus did for Geautreaux.

Elizabeth Wassenaar, MD, the regional medical director of the Eating Recovery Center, said she’s seen patients recover from an eating disorder only to suddenly seek treatment again after taking a GLP-1. Some of them have also had complications related to malnutrition, such as low blood pressure and bradycardia, or slowed heart rate.

It’s concerning that people are being prescribed a medication that has the potential to worsen their condition, Wassenaar said—especially given the risks associated with eating disorders. According to one estimate, someone in the United States dies as a direct consequence of an eating disorder every 52 minutes.

The burgeoning connection between GLP-1 use and eating disorders raises more questions about who might be a good fit for the medication and how clinicians can best support patients as they work through improvements or declines in their relationship with food.

GLP-1 medications work by mimicking hormones that regulate insulin, helping to lower blood sugar and manage type 2 diabetes. At the same time, molecules act on brain regions involved in appetite control, slowing stomach emptying and reducing hunger throughout the day.

People taking GLP-1s can start losing weight within weeks, and it’s typical to drop at least 5% of body weight after just three months.

It’s well known that the drugs can cause physical side effects like nausea, constipation, and other gastrointestinal issues. But psychiatrist Brad Smith, MD, chief medical officer at Accanto Health, said the medications can intensify food avoidance for some people, too.

“For those with conditions like anorexia nervosa or bulimia nervosa, these effects may reinforce disordered patterns and heighten obsessive thoughts about food and body image, leading to a worsening of their mental and physical health,” said Smith, who also leads The Emily Program, an eating disorder recovery program at Accanto Health.

Wassenaar said she’s seen patients whose conditions worsened after taking a GLP-1 choose to stay on the medication—essentially prolonging their eating disorder—despite warnings from their care team. Others purposefully seek out GLP-1s to make it even easier for them to avoid food.

Sometimes, a person interested in a GLP-1 might not even be conscious of their own disorder. That was the case for Jerry (who requested a pseudonym to protect his privacy).

When the 24-year-old began discussing the possibility of taking a GLP-1 with his doctor in 2021 to manage his type 2 diabetes, neither Jerry nor his doctor recognized that he had a history of disordered eating.

But after a few months on Ozempic, Jerry wasn’t losing the weight he had hoped to—and said he began “hyper-fixating on very small parts of the things” he was eating, like the calorie count of seasoning or whether his pasta was fresh or reheated, which can have an impact on glycemic index.

After seeking treatment at an eating disorder recovery program, Jerry learned that these behaviors were a new manifestation of a long-standing pattern of disordered eating. He was eventually diagnosed with atypical anorexia, which is characterized by symptoms of anorexia without dropping below a healthy weight.

During treatment, Jerry also realized that his doctor didn’t fully prepare him before going on Ozempic, failing even to inform him that his appetite would drastically shrink.

The recovery program “definitely helped me a lot and made me understand Ozempic a lot better because the dietitians educated me more about its uses and worked through the mental parts of the eating disorder,” he told Health.

Because GLP-1s are so new, it’s tricky to know exactly how many people with active eating disorders take them or how many people see a resurgence of their symptoms after starting the medications. (In one scientific paper that briefly explores the topic, the authors noted only that they had witnessed “problematic use” in their clinical practices.)

Similarly, there’s a lack of research about how common it is for GLP-1 users to develop concerning eating behaviors for the first time while on the drugs. 

As of now, there’s no evidence that there’s a physiological mechanism by which GLP-1s might exacerbate eating disorder symptoms. However, research has found that another mode of weight loss, bariatric surgery, can cause disordered eating.

Though science doesn’t have a firm answer just yet, it appears that GLP-1s could “create an environment where disordered eating behaviors may emerge or be encouraged,” said Steven Shamah, MD, a gastroenterologist and director of endoscopy at Lenox Hill Hospital.

This risk may be more pronounced for people with certain tendencies, such as late-night or emotional eating.

“When we use medications to suppress our hunger signals or appetite, we may not be addressing the underlying problem,” Shamah told Health. “Just suppressing appetite may lead to binge eating when a dose is missed, or when discontinued.”

Despite this risk, researchers have focused more on investigating how GLP-1s might help treat binge eating rather than examining whether the drugs cause problematic eating behaviors. 

Some research suggests that GLP-1s could have a positive effect.

One study from 2024 reviewed a handful of small pilot studies involving a total of 229 people and concluded that people with binge eating disorder and bulimia nervosa had fewer binge-eating episodes after taking GLP-1s for three to six months.

A 2025 analysis including a total of 182 participants with binge eating disorder concluded the same, attributing the effect to how GLP-1s influence brain processes around hunger and reward.

As Sue Decotiis, MD, a weight-loss specialist based in New York City, put it: “For an eating disorder like binge eating, the drug may actually help the patient because GLP-1s reduce food noise.”

That’s what happened for Helen Purves, who was diagnosed with binge eating disorder when she was 36, a condition she had struggled with since age 12. At 40, Purves decided to go on a GLP-1 to lose weight.

After first trying Wegovy and then Ozempic (“both gave me nausea, and neither stopped the food noise”), she found success with Mounjaro, also known by its active ingredient, tirzepatide. 

She has now been on Mounjaro for six months and started seeing her eating disorder symptoms improve almost immediately. 

“Group therapy had helped me feel less guilty about my eating disorder, but it was only when I took a GLP-1 that I realized how badly it ruled me—how strong the pull was, [how] unrelated it was from my body, [and] how much power my mind was having over me,” Purves told Health. “Now I’m so much less hung up on what I want to eat, when my next meal is, what I might buy next time I go to the supermarket.”

Despite the potential, experts say the current studies are too small and short in duration to fully understand the connection between binge eating and GLP-1s. 

“While there’s theoretical evidence that GLP-1s may benefit people who struggle with compulsive eating behaviors in the context of binge eating disorder or bulimia nervosa, we still don’t know the long-term implications of using these medications in people who struggle with disordered eating,” Wassenaar told Health.

“The impact of drugs like semaglutide on mental health is not yet well understood,” she added.

As such—and because no GLP-1s have been FDA-approved for the treatment of eating disorders—Smith said it’s premature for doctors to prescribe GLP-1s solely for this purpose.

For now, experts agree there needs to be more research into how this new class of medications actually affects people living with eating disorders or who have a tendency to develop them. 

A spokesperson for Novo Nordisk, the manufacturer of Ozempic, Wegovy, and Rybelsus, told Health in an email that none of its products are “indicated—nor being studied—for the treatment of eating disorders.”

The spokesperson didn’t address questions about the potential of its blockbuster medications to cause or worsen eating disorders.

Eli Lilly, another GLP-1 maker, is “working closely with regulators regarding potential safety topics” as part of its routine safety review process for tirzepatide, a spokesperson told Health through email. “We will continue to review data, including any data regarding eating disorders.”

“Patient safety is Lilly’s top priority,” the spokesperson added, “and we actively engage in monitoring, evaluating, and reporting safety information for all our medicines.”

In the meantime, experts said clinicians should take an active role in educating their patients who are interested in or currently taking GLP-1s.

This means screening people to uncover potential vulnerabilities to eating disorders, Shamah said. Currently, some prescribing physicians are likely unaware if patients have disordered eating tendencies, either because the symptoms slip through the cracks, the patient actively conceals them, or the patient is too embarrassed to bring them up, Wassenaar explained.

Ideally, she said, if a doctor knows that a patient seeking a GLP-1 has problematic eating patterns, they should use “good clinical judgment” before prescribing it.  

Because GLP-1s affect people both physically and mentally, it’s also crucial that patients who take them receive comprehensive care, said Alexandra Sowa, MD, a dual-board-certified obesity and internal medicine physician and the author of The Ozempic Revolution: A Doctor’s Proven Plan for Success to Help You Reverse Obesity, End Yo-Yo Dieting, and Protect Yourself from Disease.

“People may need a lot more support than they think they need,” she told Health.

Unfortunately, Sowa said, some prescribing physicians simply aren’t familiar enough with the intricacies of GLP-1s to provide the necessary guidance.

Another issue has been the heavy reliance on tailor-made compounded GLP-1s for their relative affordability and accessibility.

These alternative drugs, taken by millions, have sometimes been prescribed by medical professionals via telehealth companies, raising concerns about a lack of continuity of care and a shift away from a patient’s primary care doctor. (In recent weeks, the FDA has taken steps to effectively ban these copycat medications.)

With more people now possibly relying on their doctor for GLP-1s, physicians have an opportunity to communicate more effectively with patients seeking these medications. 

Smith wants to push the conversation even further. As the drugs become increasingly popular, he told Health, it’s worth examining how they might be affecting perceptions of what a healthy body looks like—not just for GLP-1 users but for the population at large.

“Does the weight loss medication frenzy intentionally convey a message that all people can—and should—be smaller? What does that mean in the face of the natural diversity in human body size and shape?” he said. “These are questions to grapple with as the story of GLP-1 medications and those yet to come unfolds.”