Examining the Risks of GLP-1 Therapies in Obesity and Eating Disorders

The recent surge in the use of GLP-1 receptor agonists, such as semaglutide and tirzepatide, for weight management has sparked significant discussion within the medical community regarding their implications for individuals with obesity, particularly concerning the co-occurrence of eating disorders. GLP-1 therapies present a dual-edged sword, offering potential benefits in reducing appetite and improving metabolic health while also posing risks of exacerbating existing eating disorders or contributing to the development of new ones.

Obesity is recognized not merely as a metabolic disorder but as a complex interplay of physical and mental health challenges that necessitate a holistic approach to treatment. According to Gretchen Zimmermann, MBA, RD, Vice President of Clinical Strategy at Vida Health, the misconception that individuals with obesity are devoid of eating disorders is damaging. "The intersection of obesity, mental health, and disordered eating is intricate and often misunderstood," Zimmermann stated in her commentary published on June 18, 2025.

The prevalence of eating disorders among individuals with obesity is significant. Research indicates that Binge Eating Disorder (BED) affects 1-3% of the general population but is reported in as many as 47% of those seeking weight loss treatments in clinical settings. Similarly, Night Eating Syndrome (NES) is estimated to occur in approximately 2% of the general population, with prevalence rates considerably higher among individuals with obesity. These disorders frequently go unrecognized in obesity treatment settings due to prevailing weight stigma and misconceptions surrounding eating disorders.

The potential for GLP-1 therapies to exacerbate disordered eating behaviors arises from their mechanism of action, which suppresses appetite by slowing gastric emptying. While this can aid weight loss, it may inadvertently reinforce unhealthy eating habits, particularly in individuals with a history of restrictive eating behaviors. The extended feelings of fullness can lead to meal skipping and disconnection from natural hunger cues, resulting in inadequate nutritional intake. Dr. Sarah Johnson, a Professor of Nutrition at the University of California, Los Angeles, warns, "The loss of natural hunger signals can lead to serious health risks, including malnutrition and metabolic disturbances."

The consequences of overlooking eating disorders in obesity treatment can be dire. Individuals are often praised for weight loss achieved through disordered eating patterns, which can reinforce harmful behaviors and delay appropriate treatment. Common obesity interventions, such as aggressive dieting and certain medications, may unintentionally worsen eating disorders, leading to a cycle of weight loss and unhealthy behaviors. Dr. Mark Thompson, a clinical psychologist specializing in eating disorders at the Mayo Clinic, emphasizes the importance of addressing underlying psychological factors. "Without a focus on mental health, the physical aspects of obesity treatment may fall short of achieving true, sustainable health improvements," he stated.

To mitigate risks associated with GLP-1 therapies, a multi-disciplinary approach is essential. This includes the integration of behavioral health specialists, registered dietitians, and certified health coaches into obesity treatment plans. These professionals can monitor for signs of emerging disordered eating behaviors, provide nutritional education, and ensure a supportive environment for patients. Zimmermann advocates for a comprehensive approach, stating, "A patient-centered model that prioritizes both mental and physical health is crucial for the long-term success of obesity treatments."

In conclusion, while GLP-1 receptor agonists represent a promising advancement in obesity management, their potential risks necessitate careful consideration and oversight. The intersection of obesity and eating disorders highlights the need for a nuanced understanding of treatment strategies that prioritize sustainable health outcomes over mere weight loss. The goal should extend beyond achieving lower body weight; it should encompass fostering a healthy relationship with food and body image. As the medical community continues to explore these therapies, it is imperative that they address both the physical and psychological dimensions of obesity treatment to promote holistic well-being.

About the Author: Gretchen Zimmermann is a registered dietitian and board-certified obesity and weight management specialist. Her work at Vida Health focuses on the intersection of physical and mental health, utilizing evidence-based approaches to optimize patient care. She holds a BS from Kansas State University and an MBA from William & Mary.