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.
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