If you’ve been following health and wellness news and trends over the past couple of years, you’re probably familiar with the drug Ozempic, which seems to promise dramatic results for people looking to lose a lot of weight.
The drug glucagon-like peptide 1, or GLP-1, is a relatively new drug that was initially approved by the Food and Drug Administration in 2017 for the treatment of type 2 diabetes. It was designed to improve blood sugar levels, as well as diet and exercise, eventually leading to weight loss.
But research has shown that nearly half of patients who take diabetes medications use them off-label to lose weight. Ozempic in particular has gained popularity for this purpose, especially among celebrities, several of whom have admitted to trying this type of weight loss medication.
A less talked about topic, however, is the considerable impact the drug can have on disordered eating behaviors – a topic on which experts are now sounding the alarm.
And despite some small studies, like this 2023 report in the journal Obesity Pillars, citing these drugs as a potential treatment for certain disordered eating behaviors like binge eating, some mental health professionals, including Elizabeth Wassenaar, MD, regional medical director of the Eating Recovery Center. , worry that GLP-1s may actually exacerbate the precise problem that prescribing doctors are seeking to solve.
To get to the bottom of it, PS spoke to the three experts about the potential impact of GLP-1 drugs like Ozempic on erectile dysfunction and whether or not the two were meant to coexist.
Experts featured in this article:
Elizabeth Wassenaar, MD, regional medical director of the Eating Recovery Center.
Kelli Rugless, PsyD, clinical director of the Project HEAL eating disorder treatment program.
Barbara Kessel, DO, supervising psychiatrist at Equip Health.
A vulnerable population and an overly available market
One of the risks of GLP-1 medications occurs when they are unintentionally prescribed to people who have or are at risk of eating disorders.
Kelli Rugless, PsyD, clinical director of Project HEAL, an eating disorder treatment program, reports seeing more patients who don’t know (or aren’t ready to admit) that they have a disordered relationship with eating disorder. food and their bodies crave medications like Ozempic, then experience a worsening of their mental and physical symptoms over time. Dr. Wassenaar has also seen patients with a history of eating disorders who appeared to be in stable recovery only to experience a relapse after being prescribed the medications.
This problem is because medications are prescribed without screening protocols thorough enough to account for the risk of a person developing a disordered relationship with food or with their body image.
Eating disorders are notoriously difficult to detect, according to Barb Kessel, DO, supervising psychiatrist at Equip Health, a mental health clinic that provides virtual care for eating disorders. She worries that providers aren’t educated enough about eating disorders to even recognize them in some patients before prescribing these “weight loss” medications.
Dr. Kessel says most medical providers, even those working in the mental health field, are not properly equipped to screen for them. “Generally speaking, all staff, including primary care physicians and nurse practitioners, could benefit from better education about eating disorders and their screening,” she says.
But Ozempic is not only available in doctor’s offices. It has become increasingly easier to obtain, with many patients receiving prescriptions for the drug from medical spas, encouraging its use for cosmetic weight loss purposes. “If you have (a provider) who is primarily focused only on weight loss, they could miss some very serious warning signs and worsen the effects of a possible eating disorder,” says Dr. Kessel.
And when someone at risk for eating disorders takes Ozempic, the results can be disastrous.
The growing popularity of Ozempic, Wegovy and similar drugs has brought weight loss into the public discussion in a way that could be triggering for many people, even those who don’t take these drugs themselves. As Patrick Kuklinski wrote in a previous article for PS: “Now that weight-loss drugs have become much more popularized, having a large body makes you feel like you’re ‘stagnant.’ After all, if there is an “easy way out,” why defy our societal norm that “fat is bad”? Because Ozempic made being fat a choice, fat people are expected to simply choose to conform by becoming skinny. »
Fatphobia has never gone away, but many conversations around the current class of weight loss drugs reinforce the stigma around weight in ways that can lead to disordered thoughts and behaviors. Fear of gaining weight, desire to be thinner, and thinking about dieting were all predictors of eating disorder severity, according to a 2022 study published in the Journal of Psychopathology and Clinical Science.
And if that’s the possible outcome of simply living in a world in which Ozempic has become a trend, imagine the consequences of taking the drug, losing weight, and receiving external validation.
Weight-loss medications have the potential to accelerate the mental and physical symptoms of eating disorders, including disordered thought patterns, extreme calorie restriction, and gastroparesis, a condition in which the stomach takes too long to empty its content, explains Dr Wassenaar to PS.
Eating disorders are one of the deadliest mental illnesses; Anorexia specifically has the highest mortality rate of all psychiatric disorders. This makes prescribing a medication that could trigger eating disorders all the more concerning, says Dr. Wassenaar.
A superficial solution to a complex problem
Regarding the use of weight loss medications to “treat” certain subsets of eating disorders, such as binge eating disorder, some experts say it’s simply too early to say for sure whether the medications are actually helpful or could cause long-term problems. .
Dr. Rugless says that although research has indicated that GLP-1 medications may be helpful in reducing binge eating episodes and food noise, she is concerned that providers may prescribe this medication to people with BED without understanding the whole situation, both mental and physical. For example, if a patient notices a weight plateau while taking a weight-loss medication or stops taking the medication, they may be at risk of relapse, she says.
“There is something called the binge-deprivation cycle, which suggests that there is always a period of restriction that precedes a binge episode, and until you address the causes or triggers of the restriction , the binge episodes will continue to occur,” she explains. . “This means that taking GLP-1 drugs, which help people lose weight by suppressing their appetite, has the potential to induce prolonged restriction, which could increase the likelihood and intensity of an episode of binge if/when they choose to stop taking the medication for any reason.”
Additionally, for some people, the sound of food is likely a hunger signal, and ignoring these signals can alter the hormonal balance that drives hunger and fullness in your body, promoting restriction.
This is not to say that GLP-1 medications absolutely cannot help people with BED; but the evidence for their benefits is limited and should therefore be approached with extreme caution. Additionally, if used, they should only be a small part of a treatment plan that also includes mental and physical health support.
Dr. Wassenaar compares this to the opioid crisis, in which many providers initially thought they were treating pain in a positive and helpful way, and didn’t understand the full risks associated with the medications until much later.
“It was only years and decades later that we discovered the dark and tragic side of prescription opioid painkillers and how they could trigger the mental illness of addiction. We are now facing the fallout of this prescribing practice “, she says. “I fear that GLP-1 ARs may have a similar impact on eating disorders, in that we will not know the true damage for many years, and by then countless people will have suffered of a preventable mental illness.”
Access to eating disorder treatment is already difficult, due to stigma, gaps in care and therapists being overwhelmed by a growing clientele. The potential for GLP-1 to create or exacerbate eating disorders “could create an influx of people in need of our services and overburden an industry that is already unable to meet the current needs of people seeking treatment for eating disorders,” says Dr. Wassenaar.
A global approach
Ultimately, the choice to use a GLP-1 medication is up to you and your healthcare professional. But for those with a history of eating disorders, experts encourage taking extra precautions.
You may think that if you have completed treatment for eating disorders, you can use medications like Ozempic without worry. However, according to Dr. Kessel, even patients considered to be in recovery from an eating disorder (meaning they can manage the triggering symptoms without impacting their daily life) should seek counseling if they are considering taking a weight loss medication. like Ozempic.
“It would be extremely helpful to seek help from an eating disorder-informed dietitian, or to make sure they have support for their eating disorder, as we know these Medications can make eating disorders worse,” she said. said.
The best treatment plan is both supervised and comprehensive, experts agree, taking into account both mental issues And physical health.
Emilia Benton is a freelance health and wellness journalist who is particularly passionate about sharing diverse stories and promoting underrepresented voices. In addition to PS, her work has been published by Runner’s World, Women’s Health, Self, Outside, and Houston Chronicle, among others. Emilia is also a 13-time marathon runner and USATF Level 1 certified running coach.