Welcome to The Thin Line, The New York Post’s series about the darker side of GLP-1 drugs. Though GLP-1 agonists sold under brand names like Ozempic have helped millions of people lose weight, manage diabetes and improve other health conditions, they are not without risks. Check back for more stories about the lesser-known downsides of these wildly popular medications.
It’s the age of Ozempic — and America’s favorite weight-loss shots are impacting more than just metabolism.
Across the country, nearly one in five US adults say they’ve tried a GLP-1 drug to slim down or treat chronic conditions like diabetes or heart disease, producing countless success stories.
But behind closed doors, doctors say the drugs are also feeding a dangerous obsession with food and body image that has taken over some patients’ lives.
“We’ve seen people that were prescribed these medications … who have run into a slippery slope with it, bringing back their eating disorder symptoms and behaviors,” Brad Smith, chief medical officer for The Emily Program, a national organization specializing in eating disorders, told The Post.
“We’ve also seen people who have developed more disordered eating or eating disorders as a result of these medications, even without having an eating disorder in the past,” he continued.
It isn’t totally out of the realm of what Smith has seen with other drugs that cause weight loss — like some stimulants — but he said GLP-1s are “a different animal.”
“It’s exceeded anything in the past already,” Smith said. “They’ve certainly had a much higher impact than any of those previous substances.”
Call it “agonorexia” — when GLP-1 agonists create an obsession with food and weight loss in a way that puts patients’ health at risk.
Fullness that feeds an eating disorder
GLP-1s work by mimicking hormones naturally produced in the gut in response to eating, repressing appetite, slowing digestion and controlling blood sugar.
They tend to make people eat less, feel fuller longer and experience less “food noise” — or frequent, often intrusive thoughts about eating.
It’s no wonder doctors say they have become appealing to people already struggling with disordered eating, because the medication makes restricting food intake easier.
Dr. Zoe Ross-Nash, a licensed clinical psychologist, said she’s treated or heard of patients who’ve lied about their weight, stolen friends or family members’ prescriptions and used telehealth platforms with lax screening to access GLP-1s they don’t qualify for.
“We have to be really careful that it doesn’t become something that takes over the mind, because it absolutely can.”
Dr. Thea Gallagher
“I’ve seen individuals say it’s a healthier way to engage in traditional eating disorder behaviors,” she said.
But for some patients, the same effects that once seemed like a healthy solution for stubborn weight have backfired, leaving lasting mental-health damage even after they stop taking the drugs.
“What the GLP-1 is encouraging are eating disorder behaviors,” Ross-Nash said. “So then it makes sense that when those behaviors are reinforced, they continue.”
The side effect trap
Unintended consequences of GLP-1s, such as gastrointestinal issues, don’t help.
“When you’re nauseous, you don’t eat, so not only are we restricting because we don’t feel good, but then we’re also purging the food that is in our system because we’re nauseous,” Ross-Nash said. “Both restriction and purging behaviors are then reinforced by GLP-1s.”
Dr. Thea Gallagher, a clinical psychologist at NYU Langone, said that rapid weight loss alone can distort people’s thinking, particularly if they become clinically underweight.
“When you’re underweight … it can increase body dysmorphia and make those things even worse in the long run,” she explained.
From slim to spiraling
While GLP-1s are generally intended for long-term use to sustain weight loss, research shows most people stop taking them within a year or two. Doctors say coming off the drugs can be just as destabilizing as starting them.
“We’ve had clients come in who have developed a very negative body image and disordered eating,” said Sarah Davis, a board-certified psychotherapist. “Starting the medication and going off of it have been big turning points.”
Ross-Nash has seen the same pattern. She said coming off a GLP-1 can be especially triggering because many patients end up regaining the weight they lost — and then some.
In those cases, she explained, “they’re going to be perceived as a failure, when, in reality, it’s the medication.”
“No one says, ‘Here’s your GLP-1 — by the way, you might get an eating disorder.’”
Dr. Zoe Ross-Nash
The praise people often receive when slimming down can make it harder to stop, pushing them to keep losing even when it’s no longer healthy.
“It can perpetuate and continue the eating disorder behaviors,” Davis said, “especially if they’re used to the appetite suppression, and then their appetite comes back, and then they’re fearful of gaining the weight back.”
And for some, the mental fallout lasts long after the drug is gone.
“I’ve had peers and friends say, ‘Hey, I took this, and now I can’t get my body out of my mind. It’s the only thing I can think about. I’m off the medication, and I still feel like it has taken over my entire life,’” Ross-Nash said.
Raising awareness — and proceeding with caution
What frustrates Ross-Nash most is the lack of warning about the potential risks these blockbuster drugs pose to food and body image.
“No one says, ‘Here’s your GLP-1 — by the way, you might get an eating disorder,’” she said. “People get blindsided by it, and that’s where informed consent needs to be much stronger.”
A spokesperson for Novo Nordisk, which manufactures semaglutide — the active ingredient in Ozempic and Wegovy — told The Post that “patient safety is our top priority.”
“Semaglutide’s efficacy and safety have been extensively demonstrated in people with obesity/overweight with robust evidence for improving health outcomes,” they added.
All six experts interviewed by The Post stressed the need for better awareness among patients and providers. They also called for improved screening for eating disorders in people seeking GLP-1s, looking not only at past diagnoses but also traits that could make someone more vulnerable for developing one.
That includes perfectionism, body dissatisfaction, difficulty regulating emotions or a personal or family history of mental health conditions like anxiety, depression OCD or substance use disorder, according to the National Eating Disorder Association.
While guidelines for GLP-1s like Ozempic and Wegovy instruct doctors to ask patients about their mental health history before prescribing, clinicians say that doesn’t always happen in practice.
“If you think back to bariatric surgery … a psychological screening would have happened before moving forward with that process. And here, with this, that’s not really happening,” Davis said.
And the work doesn’t stop once patients get the medication.
“Primary care providers should be referring patients to dietitians,” said Rachel Naar, a registered dietitian nutritionist who works with eating disorder patients.
“Folks that are on these medications often need to get really creative about how they sustain their energy and preserve muscle mass, and that can be a really hard thing to do,” she explained. “So I think the support of a dietician is super, super helpful in that landscape.”
Experts also want prescribers to connect more patients with therapists who can support them — even if they’ve never had an eating disorder.
Gallagher suggested that the conversation surrounding GLP-1s could also stand to change.
“I think we need to be bringing the focus back to health. Because losing weight, in and of itself, is not healthy,” she explained.
“It might be adding to your health if you’ve been overweight, but we also have to be thinking about healthy lifestyles overall and watching out for if there’s an uptick in these negative connotations about shape and weight and body image.”
“We have to be really careful that it doesn’t become something that takes over the mind, because it absolutely can.”
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