NEJM Article Flags GLP-1 Eating Disorder Risks as Off-Label Use Hit 17% in 2023
Updated
Updated · Psychology Today · Jun 23
NEJM Article Flags GLP-1 Eating Disorder Risks as Off-Label Use Hit 17% in 2023
1 articles · Updated · Psychology Today · Jun 23
Summary
Amanda Banks warned in a New England Journal of Medicine article that GLP-1 weight-loss drugs can reactivate or worsen restrictive eating disorders, especially in patients with prior anorexia or chronic restriction.
Appetite suppression that helps some patients can become a harmful tool in restrictive cases, she argued, because the drugs make not-eating easier without addressing the underlying psychology.
Two case reports from 2024 and 2025 described relapse-like restrictive behavior after GLP-1 treatment, while a 2023 FDA analysis found semaglutide misuse reports were four times higher than for other GLP-1 drugs.
The concern is amplified by screening gaps: a review of more than 94,000 adults seeking obesity treatment found up to 26% had moderate-to-severe binge eating, yet many telehealth intake forms assess metabolic eligibility rather than eating-disorder history.
Banks said prescribing has expanded faster than safeguards, with GLP-1 use among people who were not diabetic, obese or overweight rising from 4.5% in 2018 to 17% in 2023, and called for consensus screening recommendations.
With misuse reports surging, why are eating disorder risks still missing from GLP-1 drug warnings?
Are popular weight loss drugs fueling a hidden eating disorder epidemic through lax patient screening?
The Off-Label GLP-1 Boom: 11.8% of Americans at Risk for Eating Disorders and Health Inequities
Overview
The report highlights the rapid rise in GLP-1 receptor agonist (GLP-1RA) use in the U.S., with a recent survey showing that 11.8% of adults have tried these drugs and another 14% are interested. While GLP-1RAs are praised for their weight management benefits, their growing off-label use has sparked concerns about new or worsening eating disorders. This trend is driven by both widespread adoption and societal pressures, raising important questions about safety, ethical prescribing, and the need for better clinical guidance and research to address emerging risks.