The Perils of the Quick Fix Promise for Eating Disorder Patients

The wish for a quick fix for an eating disorder is the overarching dream for many people seeking help. The universally unfulfilled promise of recovery in treatment programs eager to sweep up more insurance money or the magical cure of GLP-1’s makes the slow and difficult challenge of real recovery much less appealing. Why engage in the challenges when a supposed miracle cure is available?

The reality for eating disorder treatment is that people are going to make their own decisions and often opt for the fast result and hope for the best.

Sadly, any eating disorder clinician knows that there is no quick fix. When there is a treatment program that actually does more than initial stabilization, providers will do everything possible to help their patients get that support. When medication fixes the eating disorder symptoms, enhances recovery or allows for relief of medical symptoms at the root of an eating disorder, patients will be taking those medications.

At the moment, neither of those exists.

These decisions about treatment largely rest on the patient now. Professional advice is still helpful, but the capitalist practices changing health care has come to eating disorders as well. Patients drive their treatment more than ever before and can consume whichever path they prefer.

Treatment programs urge patients who contact them to attend a program with less and less attention paid to what is right for each individual patient. GLP-1’s are available to anyone indiscriminately so people with active eating disorders are forging a new direction in their illness by suppressing appetite and losing weight leading to unknown consequences.

There is no reason to lament the direction of care for people with eating disorders. The path of health care in our society is set, and providers need to adapt to new circumstances.

Any treatment plan needs to focus on stability in a meal plan, adequate nutrition, managing eating disorder symptoms and improving health. The emotional trials of recovery are central no matter these other forces. Recovery may progress despite these new trends rather than in conjunction with them. But that is where our culture is heading. These forces aren’t new.

The people most at risk are those seeking help who are desperate and willing to take any risk necessary. Financial incentive of the eating disorder and weight loss industries overrides any one person’s well-being so patents will need guidance, compassion and kindness to continue on a path to getting well.

The future is unknown, and the outcomes very much unclear. There has not been this much uncertainty and concern about how eating disorder recovery will look in the future. What’s clear is that eating disorders will not diminish with these current trends, and the need for support in recovery is as imperative as ever.

The Risks of Easy Access to GLP-1’s for People with Eating Disorders

As eating disorder clinicians grapple with the potential benefits and risks of the GLP-1’s for our patients, it’s clear that only time will tell how to use them. The sudden availability of the drugs to all patients without medical supervision changes the circumstances meaningfully.

The medications as of now have two uses for people with eating disorders. The first is to help with inflammation which is common for some people with these illnesses. As I have written in recent posts, mast cell activation syndrome (MCAS) appears to have a higher incidence for people with eating disorders. The inflammation caused by mast cells which elicit a strong and inappropriate response of swelling, pain and many other symptoms unnecessarily can be tamed for some people with GLP-1’s.

Second, this class of medications affects hormones related to the gastrointestinal system. For people whose eating symptoms seem connected to dysfunction in these hormones, the drugs can improve hunger/fullness cues and metabolism. However, these benefits don’t cure an eating disorder, and still need just as much active work in recovery. As of now, there is no way to predict who will or will not respond without trying the medication.

Other than these two uses, there is no clear reason to try this intervention to help with eating disorders, and the risks are high.

People with eating disorder frequently have a strong urge to lose weight at all costs. Since the GLP-1’s are marketed largely for weight loss, the online shops sell it only for that purpose and usually recommend an aggressive dosing schedule just to lose weight. At the same time, these programs do not screen for eating disorders and don’t meaningfully assess if patients tell the truth about their intentions.

The result is people with eating disorders who aren’t satisfied with moderate effects of the drugs and then take high doses, eat much less food and lose dangerous amounts of weight only to relapse once the can no longer tolerate the drug.

The medications also don’t curb the eating disorder thoughts, propelled by shame, to restrict, binge or purge. Decreasing food noise is not the same as decreasing eating disorder thoughts. When these thoughts don’t subside, people tend to increase the dose desperately hoping for relief from something the medications don’t affect. Again, the higher doses cause problems with no promise of curing eating disorders symptoms.

Last, the medications, even at lower doses, can decrease hunger-driven binging for some people while causing weight loss. In this situation, people feel somewhat better but also worry about weight gain and choose to restrict more out of fear of weight gain. The restriction leads back to more binging. In this way, the medication encourages eating disorders behavior as a way to survive.

Overall, medicating eating disorders patients with GLP-1’s without any supervision or guidance is very risky. It’s very likely people will take much too high doses, find themselves with worsening behaviors and incredibly demoralized by the idea that this magic cure didn’t work. I am sure these medications will and already do play a role in eating disorder treatment, but they are just a tool. They aren’t the cure everyone is looking for.

The Free Market of GLP-1’s

One recent change to the pharmaceutical market is “direct to consumer” prescriptions. This moniker means that people can buy their own medication without a prescription or real guidance from a prescriber. The pharmaceutical companies’ capitalist drive for profit has transcended even the sacred breach of medicine to begin to allow people to choose their own drugs.

The newfangled experiment in medications recently extended to the GLP-1’s with all the attendant risks of self-diagnosis and self-guided treatment.

From the solo practitioner physician, I can see that the road to this point does not seem to be intentional. Shortages of the GLP-1’s initially due to underestimating the wild success of these medications led the government to allow for pharmacies to compound the drug, essentially bypassing the patent, so pharmacies could mix their own version and sell it at a discounted price.

Once that door opened, there does not seem to be a way to close it. The exact reasons for not closing the loophole are unclear. It could be the market forces, exceedingly high demand or the cultural conceit to overvalue thinness at all costs.

There still is the brand version of GLP-1’s that health insurance will cover, but people who want to try the drugs for any reason can find a cheaper version at a multitude of online shops. The barrier to prescription is minimal: a short call with a medical practitioner, who won’t question the reasons to try the drugs, followed by a prescription. As long as one pays, unlimited prescriptions at a dose of your choice awaits. There is no assessment of medical need or risks, just access to powerful drugs whose long-term effects are still very much unknown.

This next step in the GLP-1 experiment is surprising and has caught many people off guard. It’s hard for doctors to push back against a market that consumers have access to and have to accept that many people will be dosing their own GLP-1’s.

Gradually, people are turning to the drugs in the short-term as a weight loss tool rather than an ongoing medication. They are increasing and lowering their dose at will while experimenting with how their body responds to the drug. The potential outcomes and risks remain unknown.

What does this mean for people with eating disorders? How will this affect the presentation and treatment? How does a person in recovery cope with this reality? I’ll try to answer these questions in the next post.