The Ozempic Era and Eating Disorders: What the GLP-1 Conversation Is Getting Wrong

Scrabble letters spelling out Ozempic

There is a particular kind of cultural moment happening right now. Ozempic jokes circulate on social media. Celebrities deflect questions about sudden weight loss. Telehealth platforms advertise GLP-1 prescriptions with the same ease as ordering contact lenses. New diets have given way to injections, and the message — implicit and sometimes explicit — is that the problem of weight has finally been solved. That the brain's relationship with food can be chemically hacked with a weekly injection.

For most people, this stays at the level of cultural noise. For people with eating disorders, it is something else entirely. Eating disorders are serious mental health disorders — life-threatening, complex, and chronically misunderstood by the general public. And the GLP-1 conversation, as it is currently happening, is leaving them almost entirely out.

At the Baltimore Therapy Group, we work with people in Towson, Baltimore, Roland Park, Fells Point, and across the region who are navigating this intersection in real time: patients asking whether Ozempic might help them, patients already taking GLP-1 medications whose eating behaviors are shifting in ways they don't understand, and patients whose healthcare providers never asked about their history with food before writing a prescription. This post is for them.

What Are GLP-1 Medications?

GLP-1 receptor agonists are a class of medications that mimic glucagon-like peptide-1, a natural hormone the body produces after eating. GLP-1 regulates blood sugar, slows digestion, and signals fullness to the brain. Originally developed to manage type 2 diabetes, GLP-1 medications are now among the most widely prescribed drugs in the country — largely because of their significant effects on weight loss.

Common GLP-1 medications include semaglutide (Ozempic, Wegovy), liraglutide (Victoza, Saxenda), tirzepatide (Mounjaro, Zepbound), and dulaglutide (Trulicity). All are designed to be used alongside lifestyle changes and require consistent monitoring by healthcare providers. Benefits may reverse if the medication is stopped, often leading to weight regain and blood sugar spikes — meaning these are not short-term interventions for most people who take them.

Is GLP-1 Similar to Ozempic?

This comes up constantly. Ozempic is a GLP-1 medication — specifically, it is semaglutide prescribed for type 2 diabetes. Wegovy is the same compound at a higher dose, approved for weight management. When people ask whether GLP-1 is "like Ozempic," the answer is that Ozempic is one type of GLP-1 medication. The one that has most captured public attention.

How GLP-1 Medications Change Eating Behaviors

GLP-1 medications do not just reduce appetite. They change how the brain processes hunger, fullness, and the rewarding properties of food at a neurological level. GLP-1 receptors exist throughout the brain — in the hypothalamus, which controls appetite, and in the mesolimbic reward system, the same circuitry involved in addiction and compulsive behavior.

People taking GLP-1 medications commonly report reduced food cravings, less emotional eating, and a quieting of the constant mental preoccupation with food that researchers call "food noise." Animal studies have also shown that GLP-1 receptor activation reduces the rewarding properties of high-calorie food in the brain — findings confirmed in a landmark randomized, placebo-controlled neuroimaging study in humans (van Bloemendaal et al., Diabetes, 2014). These are real changes in brain chemistry. Not willpower. Not discipline.

This is precisely what makes the intersection with eating disorders so complicated.

What Are the 4 Types of Eating Disorders?

Eating disorders are frequently dismissed as lifestyle choices or reduced to their most visible symptoms. Eating disorders are serious mental health disorders characterized by severe disturbances in eating behaviors and thoughts about food, which can lead to serious health problems and significant medical complications. They result from a complex interaction of genetic, biological, behavioral, psychological, and social factors — including family history, social factors like diet culture and weight stigma, and individual psychological vulnerabilities.

They are not choices. Eating disorders can lead to serious health complications including heart and kidney problems, and can be life-threatening if not treated properly.

Anorexia nervosa

Anorexia nervosa is characterized by an intense fear of gaining weight, a distorted body image, and extreme restriction of food intake leading to dangerously low body weight. People with anorexia nervosa may also use excessive exercise, self-induced vomiting, or laxatives to control weight. A known medical complication of repeated purging is damage to tooth enamel from stomach acid. Anorexia nervosa has one of the highest mortality rates of any psychiatric disorder — starvation and suicide are among the leading causes of death.

Bulimia nervosa

Bulimia nervosa involves recurrent episodes of binge eating followed by compensatory behaviors — purging, fasting, or excessive exercise — to prevent weight gain. People with bulimia nervosa may be of normal weight, underweight, or overweight, which makes the disorder difficult for family members and loved ones to recognize. Over time, repeated purging can cause stomach problems, damage to tooth enamel, and other serious medical complications.

Binge eating disorder

Binge eating disorder involves recurrent episodes of consuming large amounts of food with a sense of loss of control — at least once a week over a three-month period — without compensatory behaviors. It is the most common eating disorder in the United States and is frequently accompanied by depression, anxiety, and sometimes obsessive compulsive disorder or substance abuse. People with binge eating disorder typically experience intense guilt, shame, or disgust after binge episodes.

Avoidant/Restrictive Food Intake Disorder (ARFID)

ARFID involves a severe pattern of avoiding certain foods or selective eating that results in failure to meet nutritional needs — without the body shape or body weight concerns central to anorexia nervosa. ARFID can persist into young adulthood and beyond, significantly disrupting daily life and social functioning.

What the GLP-1 Conversation Is Getting Wrong

Here is what gets left out: eating disorders are common in the very population most likely to be prescribed GLP-1 medications.

A systematic review of over 94,000 adults seeking obesity treatment found that 14% had binge eating disorder on clinical interview and up to 26% reported moderate-to-severe binge eating on self-report measures (Melville et al., Int J Eating Disorders, 2025). Among young adults with overweight or obesity in the general population, nearly 29% of women and 15% of men reported disordered eating behaviors. Body mass index alone does not predict eating disorder risk — and using it as the primary metric for GLP-1 candidacy misses a significant proportion of people who need a more careful evaluation.

These are not edge cases. They represent a significant proportion of people sitting in front of healthcare providers right now, receiving GLP-1 prescriptions — often without any eating disorder screening.

A standard that isn't being met

The National Institute of Mental Health, the National Institute of Diabetes and Digestive and Kidney Diseases, and major obesity medicine organizations all recognize that weight management treatment must account for mental health. A joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and the Obesity Society explicitly states that restrictive eating disorder is a general contraindication to GLP-1 use — and that individuals with a history of eating disorders should be referred to an eating disorders specialist before these medications are prescribed (Mozaffarian et al., Am J Clinical Nutrition, 2025).

That standard is not consistently being met. And the cultural celebration of appetite suppression and weight loss as straightforward goods makes it less likely, not more, that patients will volunteer their eating disorder history — or that healthcare providers will think to ask.

From our therapists — We see this gap regularly in our work. Someone comes to us already taking a GLP-1 medication — prescribed quickly, often through a telehealth platform — and no one has asked about their history with food. Sometimes they haven't thought to mention it. Sometimes they were afraid it would disqualify them from treatment they wanted. The screening conversation isn't happening consistently, and that leaves a lot of people without the support they actually need before they start.

When GLP-1 Medications May Help — and When They May Harm

The research on GLP-1 medications and eating disorders does not tell a simple story.

Potential pros and cons of GLP-1 meds

The case for binge eating disorder

For binge eating disorder, preliminary evidence is cautiously encouraging. A systematic review of 12 studies found consistent reductions in binge eating behaviors with liraglutide, semaglutide, and dulaglutide (White et al., Pharmacotherapy, 2026). A rapid review of 25 studies similarly found that liraglutide and semaglutide reduced binge eating episodes and prevalence, with food cravings improving with semaglutide in 6 of 7 studies (Jebeile et al., Obesity Reviews, 2026). In one observational study of 69 people with obesity, the proportion reporting emotional eating dropped from 72.5% to 11.5% after three months of semaglutide (Nicolau et al., Physiology & Behavior, 2022). A meta-analysis found that liraglutide reduced binge frequency by approximately 1.28 fewer episodes per week compared to placebo (Choudhury et al., Clinical Therapeutics, 2026). The largest psychiatric meta-analysis to date — 80 randomized controlled trials, over 107,000 patients — also found significant improvements in restrained eating and emotional eating with GLP-1 medications compared to placebo (Pierret et al., JAMA Psychiatry, 2025).

These findings are meaningful — though most studies are small, follow-up periods are limited, and there is not yet sufficient evidence to recommend GLP-1 medications as a treatment for eating disorder symptoms (Bartel et al., Int J Eating Disorders, 2024). GLP-1 use for binge eating disorder is currently off label — these medications are not FDA-approved for treating any eating disorder. Lisdexamfetamine (Vyvanse) remains the only FDA-approved medication for binge eating disorder. Cognitive behavioral therapy remains the most evidence-based treatment, and Dialectical Behavior Therapy can also play an important role in supporting emotion regulation and behavior change. GLP-1 medications, where appropriate, belong as part of a comprehensive treatment plan — not a standalone fix.

The risk for restrictive eating

For anorexia nervosa and restrictive eating disorders, the picture reverses. GLP-1 medications can cause profound appetite suppression — an effect that, for someone with restrictive eating, can reinforce dangerous patterns of food restriction, reduce food intake to medically dangerous levels, and provide what feels like medical sanction for not eating. There are documented case reports of extreme appetite suppression and psychiatric complications requiring GLP-1 discontinuation in people with restrictive eating patterns (Leziak et al., J Psychiatric Research, 2026).

For bulimia nervosa, the evidence is too limited to draw conclusions. The appetite-suppressing effects might reduce binge eating — but could also reinforce the food restriction that typically precedes binges and worsen the cycle overall (Schaefer et al., Psychiatric Clinics of North America, 2026).

From our therapists — What we find in practice is that the same medication can mean very different things depending on a person's history. For someone whose primary struggle has been binge eating, reduced food preoccupation can feel like relief — sometimes genuine, meaningful relief. For someone with a history of restriction, that same quieting of hunger signals can slide almost imperceptibly into something dangerous. The medication doesn't know the difference. The treatment team needs to.

What the Side Effects of GLP-1 Medications Mean for People With Eating Disorders

The most common side effects of GLP-1 medications are gastrointestinal: nausea, vomiting, diarrhea, constipation, abdominal pain, and upset stomach. These stomach problems typically peak during dose increases and improve over time for most patients. Feeling dizzy, mood changes, and in rare cases allergic reactions have also been reported. Contact your healthcare provider immediately if you experience symptoms that concern you.

For people with eating disorders, these "ordinary" side effects land differently. Nausea that reduces appetite in a typical patient can become a tool for restriction in someone with anorexia nervosa. Vomiting as a medication side effect can reinforce purging behaviors in someone with bulimia nervosa. The physical effects of GLP-1 medications do not occur in a neutral psychological context — they arrive in a body and a mind that already has a complicated relationship with food, body weight, and physical sensation.

The largest psychiatric safety meta-analysis to date found that GLP-1 medications were not associated with increased risk of serious psychiatric adverse events overall (Pierret et al., JAMA Psychiatry, 2025), and a post-hoc analysis of the major semaglutide weight management trials found no differences in depression, suicidal ideation, or suicidal behavior compared to placebo (Wadden et al., JAMA Internal Medicine, 2024). However, a pharmacovigilance study using the WHO's global adverse drug reaction database found disproportionate reporting of eating disorder adverse events with all three major GLP-1 medications (Nishida et al., Clinical Nutrition, 2025). Physical and mental health cannot be treated as separate concerns. Proper treatment requires proper assessment — including full mental health and medical history — before prescribing begins, and close monitoring throughout.

What to Do If You Have an Eating Disorder and Are Considering a GLP-1 Medication

Graphic of GLP-1 considerations

Tell your healthcare provider your full history. Eating disorders are frequently underreported because of shame or the belief that the disorder is "in the past." A complete medical history — including your relationship with eating, body shape concerns, and food — is essential before any GLP-1 decision is made.

Ask whether you have been screened. If your provider hasn't addressed eating disorders or your mental health history, ask directly: "Have I been screened for eating disorders before starting this medication?"

Request a referral if needed. If you have a history of eating disorders, you are entitled to a referral to both an eating disorders specialist and an obesity medicine specialist (Mozaffarian et al., Am J Clinical Nutrition, 2025). This is not asking for too much — it is the treatment standard.

Monitor your relationship with food closely once you begin. Watch for signs that the medication is reinforcing disordered eating behaviors — including feeling relief rather than concern about not eating, developing rigid rules around certain foods, or noticing that family members are expressing concern about your eating patterns or weight loss.

Contact your healthcare provider immediately if you notice significant mood changes, a return of disordered eating thoughts, signs of gaining or losing weight in ways that feel out of control, or any other symptoms that concern you.

From the therapists — One of the hardest parts of this conversation is that people with eating disorders are often not believed — or not taken seriously — when they raise concerns with prescribing providers. If you've tried to flag your history and felt dismissed, that's worth addressing directly in therapy. Advocating for integrated care, for a treatment plan that accounts for your mental health alongside your physical health, is not asking for too much. It's asking for the standard of care you deserve.

Getting Help

Eating disorders are serious, life-threatening conditions — and specialized eating disorders treatment using evidence-based approaches that work can make full recovery possible with proper care and the right support. If you or a loved one is struggling with eating, food, or body image — with or without a GLP-1 medication involved — please reach out.

At the Baltimore Therapy Group, our experienced therapists in Baltimore — including clinicians who focus on eating disorder treatment — work with individuals in Baltimore, Canton, Mt. Washington, Towson, and throughout the greater Baltimore area who are navigating eating disorders, disordered eating, and the complex questions that arise when mental health and medical treatment intersect.

A Final Word

GLP-1 medications are not villains in this story. For many people, they represent a genuine medical advance — one supported by robust clinical trials and meaningful improvements in metabolic health. But the cultural conversation surrounding them — one that frames appetite suppression and weight loss as unambiguous goods, and treats gaining weight as the only health problem worth solving — is not a neutral backdrop for people whose relationship with eating has already caused life-threatening harm.

The National Institute of Mental Health has long recognized eating disorders as among the most medically serious and undertreated mental health conditions. The Department of Health and Human Services framework for eating disorder treatment emphasizes integrated care — not just medical management of weight, but psychological support, proper nutrition, substance abuse screening where relevant, and ongoing monitoring of eating behaviors across a patient's full health picture.

Full recovery from an eating disorder is possible. But it requires treating the whole person. GLP-1 medications may, for some people, be part of that picture. But they are not the whole story — and the current conversation is not doing enough to say so.

Talk with Us

The Baltimore Therapy Group provides therapy for adults across the Baltimore area, including Roland Park, Fells Point, Canton, Mt. Washington, and Towson. If you would like to schedule therapy with a counselor in Baltimore or learn more about our expert counseling services and other practitioners on our team, we welcome you to reach out.

Eating DisordersHeather Z. Lyons, PhDOzempic, GLP-1, eating disorders, disordered eating