As we have discussed in previous blogs, GLP-1 RAs and similar medications have reshaped conversations around weight, metabolism, and chronic disease.
As their use expands, an important, and often under-discussed question emerges: What is the role of these medications in individuals with current or past eating disorders, including Anorexia Nervosa and Atypical Anorexia Nervosa?
The answer is not straightforward. It requires careful clinical judgment, interdisciplinary collaboration, and a deep understanding of both physiology and psychology.
Laura and I recently explored this nuance on our podcast, Eat Kale and Cupcakes (Episode 3: GLP-1 and GLP/GIP Medications: What We’re Considering as Dietitians, available on all platforms).
At this time, research specifically examining the use of GLP-1 medications in individuals with Anorexia Nervosa or Atypical Anorexia Nervosa is extremely limited, meaning much of clinical decision-making relies on extrapolation, caution, and individualized care.
How GLP-1 Medications Affect Appetite and Weight
GLP-1 medications work by:
- Increasing feelings of fullness (satiety)
- Slowing gastric emptying
- Reducing overall food intake
These effects can improve blood sugar regulation and support weight loss in some individuals.
However, these same mechanisms closely mirror patterns seen in restrictive eating disorders, making context essential, especially for those with a history of disordered eating.
Hunger, Metabolism, and Interoceptive Awareness
Hunger is not just behavioral, it’s deeply physiological. (This is why we differentiate four different types of hunger in our practice).
Many individuals already experience inconsistent internal signals. Conditions such as insulin resistance, Type 2 Diabetes, Polycystic Ovary Syndrome (PCOS), and menopause can also disrupt hunger and fullness cues.
When GLP-1 medications suppress appetite, it may become more difficult to reconnect with the body’s cues, a key component of long-term eating disorder recovery.
Risks of GLP-1 Medications in Eating Disorders
1. Appetite Suppression Can Reinforce Restriction
For individuals with Anorexia Nervosa, reduced appetite is not neutral. It can reinforce undereating and make it harder to meet nutritional needs.
2. Atypical Anorexia Nervosa Is Often Missed
Not all eating disorders occur in smaller bodies. Individuals with atypical anorexia may experience severe restriction and medical complications without being classified as underweight.
Because GLP-1 medications are often prescribed based on weight or BMI, this population is at higher risk of being overlooked.
3. The Restrict–Binge Cycle May Continue
For those who cycle between restriction and binge eating, appetite suppression may seem helpful, but it does not address the root issue.
Without adequate nourishment, the cycle often persists: Restriction → binge eating → distress → renewed restriction
See our blog on how to take the shame out of overeating.
GLP-1 Medications and Muscle Loss, Bone Health, and Long-Term Use
GLP-1-related weight loss includes both fat mass and lean muscle mass. Without adequate nourishment, the amount of lean mass lost can be much higher.
Read our blog on GLP-1 and muscle.
For individuals with a history of Anorexia Nervosa or chronic undernourishment, this raises concerns about:
- Muscle loss
- Reduced strength and metabolic health
- Increased risk of bone loss over time
There are also long-term considerations. Weight regain is common after stopping GLP-1 medications, which can create reliance on ongoing use and reinforce external control over internal regulation.
Psychological Impact: What GLP-1 Medications Don’t Address
Eating disorders are not just about food, they are also about coping, control, and emotional regulation.
While GLP-1 medications may change how much someone eats, they do not address the underlying drivers of disordered eating.
Without psychological and behavioral support, symptoms may shift rather than resolve.
When Are GLP-1 Medications Appropriate?
There is no one-size-fits-all answer.
GLP-1 medications may be appropriate in certain cases, such as when:
- There are clear medical indications
- The individual has a strong foundation in eating disorder recovery
- Care is guided by an interdisciplinary team.
Careful screening and ongoing monitoring are essential.
A Recovery-Focused Approach to Nutrition
For individuals actively experiencing restriction or disordered eating patterns, the priority is stability. We recommend an individual works very closely with their team, particularly their RD to establish and maintain a solid nutrition foundation.
A recovery-oriented, empowerment approach includes:
- Regular, consistent eating
- Adequate intake of all three macronutrients: carbohydrates, protein, and fat
- Understanding the four different types of hunger
- Rebuilding trust with physical hunger and fullness cues
- Addressing underlying psychological factors
Focusing solely on weight loss without this foundation may unintentionally reinforce disordered eating behaviors.
The Bottom Line: GLP-1 Medications and Eating Disorders
GLP-1 receptor agonists are powerful tools. For individuals with current or past Anorexia Nervosa or Atypical Anorexia Nervosa, their use requires thoughtful, individualized consideration that goes beyond weight alone.
Because when we widen the lens, the goal isn’t just about weight change, it’s long-term health, stability, and a more sustainable relationship with food and the body.
Continue the Conversation
This is not a one-size-fits-all topic and you deserve care that reflects that.
📚 Explore our GLP-1 Masterclass for a more comprehensive, evidence-based approach.
🤝 Connect with us for individualized support tailored to your unique physiology, history, and goals.
References
Bartel, S., McElroy, S. L., Levangie, D., & Keshen, A. (2024). Use of glucagon-like peptide-1 receptor agonists in eating disorder populations. International Journal of Eating Disorders, 57(2), 286–293. https://doi.org/10.1002/eat.24109
Chiappini S, Vickers-Smith R, Harris D, et al. Is There a Risk for Semaglutide Misuse? Focus on the Food and Drug Administration’s FDA Adverse Events Reporting System (FAERS) Pharmacovigilance Dataset. Pharmaceuticals (Basel). 2023;16(7):994. Published 2023 Jul 11. doi:10.3390/ph16070994
Kałas M, Stępniewska E, Gniedziejko M, Leszczyński-Czeczatka J, Siemiński M. Glucagon-like Peptide-1 Receptor Agonists in the Context of Eating Disorders: A Promising Therapeutic Option or a Double-Edged Sword?. J Clin Med. 2025;14(9):3122. Published 2025 Apr 30. doi:10.3390/jcm14093122
Krug I, Dang AB, Portingale J, Li Y, Won YQ. Beyond Weight Loss: GLP-1 Usage and Appetite Regulation in the Context of Eating Disorders and Psychosocial Processes. Nutrients. 2025;17(23):3735. Published 2025 Nov 28. doi:10.3390/nu17233735
