Weight-loss medications like Ozempic and Rybelsus are reshaping how doctors approach obesity and diabetes. But for patients with a history of eating disorders, these drugs may carry risks that are not fully understood.
Semaglutide-based medications, including Ozempic, Wegovy, and Rybelsus, are known to reduce hunger and promote weight loss. However, experts warn these same effects can trigger or worsen disordered eating behaviors in vulnerable individuals.
Unexpected Consequences for Some Patients
Penny Gautreaux began taking Rybelsus in 2023 to manage type 2 diabetes. Almost immediately, she experienced gastrointestinal side effects and a drastic loss of appetite. For Gautreaux, who was in recovery from an eating disorder, the medication revived harmful habits. She started skipping meals and found herself emotionally reacting to weight loss in a way that alarmed her.
“I understood that I would cause more damage through restriction and relapse than was worth the risk,” she said after deciding to stop the medication.
Gautreaux is among the millions of Americans who have used GLP-1 receptor agonists, the class of drugs that includes Ozempic and Rybelsus. While they are effective at reducing appetite and body weight, their psychological effects are not always beneficial—particularly for people with eating disorders.
A Double-Edged Sword
GLP-1s have shown promise in reducing binge eating episodes in individuals with binge eating disorder or bulimia nervosa. Small studies suggest these medications may help by reducing food cravings and the mental preoccupation with eating, also known as “food noise.”
For example, Helen Purves, who was diagnosed with binge eating disorder, said Mounjaro—a GLP-1 medication—helped her regain control. “Now I’m so much less hung up on what I want to eat or when my next meal is,” she said.
But other cases show the opposite trend.
Dr. Elizabeth Wassenaar, a psychiatrist with the Eating Recovery Center, has treated patients who relapsed into restrictive eating after starting GLP-1s. Some developed complications like low blood pressure and slowed heart rate—signs of malnutrition. Others used the medication intentionally to suppress appetite, worsening their conditions.
Risks Often Go Undetected
Some individuals may not realize they have an eating disorder until symptoms escalate on a GLP-1. One patient, who requested anonymity, began obsessing over minute food details after starting Ozempic. He was later diagnosed with atypical anorexia. “Neither I nor my doctor realized I had a history of disordered eating,” he said.
Psychiatrists like Dr. Brad Smith warn that these drugs can reinforce food avoidance and obsessive thoughts in those with conditions like anorexia or bulimia. “For some, GLP-1s may prolong disordered patterns,” he said.
Dr. Steven Shamah, a gastroenterologist at Lenox Hill Hospital, said that suppressing appetite without addressing emotional eating behaviors may only lead to future problems. “When a dose is missed or discontinued, patients may binge,” he noted.
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