Not everyone on a GLP-1 is being screened for an eating disorder first – here’s who’s most vulnerable, and what needs to change.
In Part 1 of this series, we talked about two developments that landed within days of each other: new research showing just how common GLP-1 use and misuse already is among people with eating disorders, and a new Medicare pilot that’s about to put these medications in front of millions more people. Before we get into exactly how these medications can derail recovery, it’s worth answering a more basic question first: who should be paying closest attention?
Who Is Most at Risk for a GLP-1-Related Eating Disorder?
- Anyone with a history of anorexia, bulimia, ARFID, or orthorexia – even if they consider themselves fully recovered
- People with atypical anorexia (a restrictive eating disorder in someone who isn’t underweight), who are frequently missed during screening
- Anyone with a history of disordered eating, even without a formal diagnosis
- Adolescents and young adults, whose relationship with food and body image is still forming
- Anyone who carries significant distress around body image or food
- Anyone obtaining these medications online or without close clinical supervision
What We’re Calling For: Safer GLP-1 Prescribing
Screening before prescribing. There’s currently no national requirement for eating disorder screening before a GLP-1 prescription – most professional guidance only suggests it. Tools like the SCOFF questionnaire or the EDE-Q can help identify risk before the prescription is written, and we’d like to see that become standard practice.
Ongoing monitoring. Anyone with a history of an eating disorder who starts a GLP-1 should be closely watched by both their prescriber and a registered dietitian or mental health professional, especially as the dose increases.
Care coordination. Doctor, dietitian, and therapist should all be talking to each other. Uncoordinated care is a real safety risk here.
Transparency with patients. People deserve to know, clearly, that these medications can disrupt eating disorder recovery – so they can make a fully informed choice.
A Note for Those in Recovery, or Those Who Love Someone in Recovery
If you or someone you love is in recovery and a provider recommends a GLP-1 for any reason, please don’t make that decision alone. Talk with your dietitian and treatment team first. Ask the hard questions: What are the specific risks for someone with my history? Are there safer alternatives to try first? How will my symptoms be monitored if I start? Recovery took real time and effort to build – it’s worth protecting before you take the next step.
A Note for Clinicians and Prescribers
Before you write that prescription, we’d ask you to pause on a few questions: Does this patient have any history of eating disorders or disordered eating? Do they carry significant anxiety around food, weight, or body image? Is BMI being used as the primary – or only – measure of their relationship with food? Is there a dietitian or mental health professional already involved who can watch for eating disorder symptoms? Eating disorders can affect anyone, in any body. The prescription pad shouldn’t be where that gets discovered for the first time.
In Part 3, we’ll get specific about exactly how GLP-1s can derail recovery – from relapse and undiagnosed eating disorders to bone health, hunger cue disruption, and the cultural pressure that makes all of it harder to catch.
Ready for Support?
If any of this sounds familiar – for you or someone you love – you don’t need to figure it out on your own. Schedule a free 15-minute consultation with our team to help us understand what kind of nutrition support fits your needs and connect you with the right dietitian on our team.
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This is Part 2 of a three-part series. Read Part 1: GLP-1 Medications and Eating Disorders: What’s New. Continue to Part 3: GLP-1 Medications and Eating Disorder Recovery: What to Know.
Erica Leon, MS, RDN, CEDS, is the founder and owner of Erica Leon Nutrition & Associates PLLC, an insurance-based, weight-inclusive nutrition practice with offices in White Plains, NY, Old Greenwich, CT, and Hackensack, NJ. The practice specializes in eating disorders, disordered eating, and a range of other nutrition concerns throughout the lifespan.
This blog is intended for educational purposes and does not constitute medical or nutrition advice. Please consult a qualified healthcare provider before making any changes to your care.
Erica Leon is a Registered Dietitian and practices from a Health at Every Size (HAES®) lens. She and her team of eating disorder specialists and Anti-Diet Dietitians provide insurance-based care for eating disorders, disordered eating, chronic dieting, or other health conditions in a safe and non-judgmental space for healing.
We work virtually with our clients from our offices in Westchester County in New York as well as the tri-state areas of New York, New Jersey, and Connecticut, along with Alabama, California, the District of Columbia, Florida, Illinois, Iowa, Maryland, Minnesota, Oregon, Texas, Vermont, and Wisconsin. We are in-network with the following insurance companies: Aetna, Blue Cross Blue Shield, Cigna, Emblem Health and United Healthcare; including Oxford, UMR, and The Empire Plan (NYSHIP).
We take the time to learn where you or your family are in the pursuit of health. Respectful of your individual needs and lifestyle, Erica will provide an honest assessment of whether or not you are a good fit to work together. Click here to schedule a 15-minute Discovery Call with Erica to let us know about your needs, and to see which of our Dietitians is the best fit for you!
