No matter how generally beneficial or safe a drug is, it can be misused. A study out today, for instance, shows that people with eating disorders are taking GLP-1 medications like semaglutide (the active ingredient in Ozempic and Wegovy) in ways they shouldn’t be.
Researchers at the University of Louisville and others looked at a large sample of people with eating disorders. Roughly a third reported having used GLP-1s in their lifetime—a much higher rate than the general public—while some have openly misused them.
“People with eating disorders are a clinically diverse population who may be consuming GLP-1 RAs in contraindicated ways to maintain eating disorder psychopathology through rapid restriction and weight loss,” they wrote in their paper, published Wednesday in JAMA Psychiatry.
GLP-1s and eating disorders
GLP-1s have revolutionized the treatment of obesity (and type 2 diabetes) in recent years, allowing people with obesity to reliably lose more weight than they likely would with lifestyle changes alone. Given these effects, though, it might seem obvious that some people who aren’t obese but are desperate to lose weight, such as those with eating disorders, would try to take GLP-1s as well. Though all GLP-1s require a prescription, people have been able to obtain compounded or otherwise unregulated versions of these drugs with relative ease.
According to the researchers, though, no study has tried to gauge how prevalent GLP-1 use and misuse are among people with eating disorders—until now, at least.
The authors examined data from a still-ongoing study of people with eating disorders (including people who reported they were in remission). People were recruited through a network of other studies unrelated to GLP-1s, advertisements from national organizations, and targeted outreach online. As part of the study, people were asked whether they were currently taking or had ever taken a GLP-1 medication; they were also asked where they had obtained their GLP-1 and how they were using it. The researchers classified misuse in several ways, such as starting on a larger dosage than prescribed, increasing a dosage before recommended, or sharing the drug with people who didn’t have a prescription.
All told, 436 people with eating disorders were included in this study. Just over 32% reported lifetime use of a GLP-1 drug, while 22% reported currently taking one. These rates are far higher than those seen among the American public. The researchers cite one study estimate of 15% lifetime use, though a recent survey estimates it’s closer to 18%. Roughly 10% of people had also misused a GLP-1 drug in their lifetime, the researchers further found, and around 10% reported having taken a compounded GLP-1.
What this means
The researchers point out that GLP-1s are not indicated for any eating disorders, which include some conditions that can be tied to a higher risk of cardiovascular or metabolic problems like binge eating disorder or atypical anorexia nervosa (someone with anorexia who is at a “normal” or higher weight range after losing substantial weight). It’s worth noting that some research suggests GLP-1s could be an effective treatment for binge eating disorder. Interestingly enough, lifetime rates of GLP-1 use were lower among people with typical anorexia (around 10%).
At the same time, these findings are based on self-reports, meaning it’s possible these rates of use and misuse among people with eating disorders could actually be higher. And even if GLP-1 drugs might be helpful for some eating disorders, it’s likely others are using them to achieve dangerously low body weights or restrictive diets. The still prevalent gray and black market surrounding these medications also indicates that people with these conditions can easily obtain them without medical or regulatory oversight.
The researchers say future studies will aim to provide more precise estimates of GLP-1 use among people with different types of eating disorders and to better track patterns of misuse, among other things. Regardless, it’s clear that more effort is needed to ensure these medications are being taken appropriately, particularly by people with a history of these conditions, the researchers say.
“GLP-1 RA pharmacovigilance is urgently needed as the commercial market expands from injectable to oral products and new formulations,” they wrote.
