Are People With Eating Disorders Misusing GLP-1 Drugs?

Use and misuse of GLP-1 receptor agonists were common in people with eating disorders, interim results of an ongoing cross-sectional study suggested.

Among over 400 people with eating disorders, 32.1% said they have used GLP-1 drugs, and 22% reported current use, wrote Nicholas C. Peiper, PhD, MPH, of the University of Louisville in Kentucky, and co-authors in a research letter in JAMA Psychiatry.

Notably, 10.1% said they have misused the medications, and 9.9% reported using noncommercial compounded products.

“People with eating disorders are a clinically diverse population who may be consuming GLP-1 RAs [receptor agonists] in contraindicated ways to maintain eating disorder psychopathology through rapid restriction and weight loss,” the authors wrote.

GLP-1 drugs are currently indicated for the treatment of type 2 diabetes and obesity, as well as cardiovascular risk reduction, with recent expansions into treating chronic kidney disease and severe obstructive sleep apnea, Peiper and team noted. There are no indications for any eating disorders, including subtypes with higher cardiometabolic comorbidities, such as binge eating disorder or atypical anorexia nervosa.

This interim analysis provides “the first glimpse” of GLP-1 drug use in the eating disorder population, Sahib Khalsa, MD, PhD, of the David Geffen School of Medicine at the University of California Los Angeles, told MedPage Today.

Khalsa, who was not involved in the study, said that if data from the sample are nationally representative, then that suggests rates of GLP-1 agonist use among those with eating disorders are double that of the general adult population (15%), which “would be concerning.”

The take-home message for the general practitioner with “even an inkling” that their patient might have an eating disorder is to assess for the problem and refer the patient to a mental health professional or dietitian, Khalsa said. If a GLP-1 drug is prescribed, clinicians should monitor for maladaptive appetite-related responses, new medical complaints, lab abnormalities, and other risky behaviors.

Peiper and colleagues also pointed out that people with eating disorders must currently navigate “a rapidly evolving risk environment of compounded GLP-1 RAs that are easily obtained without medical or regulatory oversight.”

They stressed that “pharmacovigilance is urgently needed” as the market expands to include new products and formulations.

This interim analysis, conducted from December 2025 to January 2026, was from an ongoing study of people with eating disorders that began recruitment in March 2025 via “a network of federally funded studies unrelated to GLP-1 RA use, advertisements with national organizations, and targeted outreach through online recruitment platforms.” Potential participants were asked to complete an online screening, and answer questions about GLP-1 drug use, if eligible.

Use of GLP-1 agonists was defined as use of semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro, Zepbound), dulaglutide (Trulicity), liraglutide (Victoza, Saxenda), or exenatide (Byetta) for diabetes or weight loss management. Misuse was defined as “taking more than the prescribed starting, titration, or maintenance dose; increasing the dose before prescribed; taking less than the prescribed dose; taking for a longer period than prescribed; disassembling or tampering with the injection equipment; or sharing with family, friends, or acquaintances without a prescription.”

Peiper and team included 436 individuals who met the eligibility criteria. Mean age was 34, 94.2% were women, and 88.5% were white. Mean BMI was 28.5, and 27.2% had anorexia nervosa, 18% had binge eating disorder, 11.7% had atypical anorexia nervosa, 6.8% had bulimia nervosa, and 18% were in remission.

Psychiatric and medical comorbidities were common, including anxiety disorders, mood disorders, gastrointestinal diseases, and heart disease and hypertension. Adverse events were common among those reporting lifetime GLP-1 drug use (32.1%).

Looking at GLP-1 drug use by eating disorder subtype, the prevalence was lowest — just over 10% — among those with anorexia nervosa, and highest for those with atypical anorexia nervosa (over 40%) and binge eating disorder (over 50%).

“Understanding the reasons for that variability, and whether that is tied to harms would be important,” Khalsa said. He noted that a 2023 open-label study he co-authored suggested a “potential clinical benefit” for one subpopulation: people with presumptive binge eating disorder and comorbid obesity. In this population, using GLP-1 drugs was linked to reductions in binge-eating episodes and cravings.

Limitations of the study included its cross-sectional design, nonprobability sampling, and reliance on self-report.

“Follow-up studies will provide more precise estimates among eating disorder subtypes, evaluate demographic differences, and examine key correlates, such as patterns of misuse, sources of acquisition, reasons for use, off-label use, and marketing exposures,” the authors wrote.