Eating disorder clinicians say the GLP-1 boom is feeding a return to thin-ideal culture

Clinicians who treat eating disorders say the rapid spread of GLP-1 medications is arriving alongside a cultural turn back toward thinness, and that some people with restrictive eating patterns are getting the drugs without being evaluated for an eating disorder ^[1].

Sam DeCaro, director of clinical outreach and education at The Renfrew Center, an eating disorder treatment organization, told USA TODAY she is concerned about a "larger cultural swing towards the thin ideal yet again" ^[1]. She said the problem is not only who starts the drugs but what happens afterward: many patients are not checked for eating disorders before treatment and are not monitored for symptoms that appear once they are on it ^[1]. DeCaro, who holds a doctorate in psychology, said easier access may let some people use the medication to "make it easier to engage in their eating disorder, make it easier to restrict (and) make it easier to under nourish themselves" ^[1].

She said she hopes treatment teams become standard rather than a single prescriber — a doctor along with a therapist and a dietitian who specializes in eating disorders ^[1].

Dr. Sarah Gupta, a psychiatrist and medical director at the mental health platform Modern Health, drew a clear line between the two eras of diet drugs. She said the pills of the 1990s were aimed almost entirely at weight loss and often lacked strong evidence of broader health benefit, while GLP-1 medications come with growing evidence that they can lower the risk of heart attack and stroke and support metabolic health ^[1]. She called that "something more complex" ^[1].

Gupta also said the cultural effects deserve attention. A medication with real clinical value that becomes highly visible can reshape expectations about body size in ways unrelated to health, she said, and in some people the drugs "may also trigger, or worsen, disordered eating" ^[1].

The comparison with earlier diet pills is one Ashleigh Shields, a professor at Northeastern University's Bouvé College of Health Sciences, finds familiar. Each generation tends to produce its own version of a magic diet pill, she said ^[2]. Fen-phen, the 1990s blockbuster, ended in a $3.75 billion class-action settlement over potentially lethal complications, and supplements made from the herb ephedra are banned by the FDA ^[2]. By contrast, Shields called GLP-1s mainstream and legitimate, and a "godsend" for the people who need them ^[2].

Scale matters here. The National Eating Disorders Association reports that 9 percent of the U.S. population has had an eating disorder at some point in life — nearly 31 million people — and that someone dies as a direct result every 52 minutes ^[2]. The group says how much drugs like Ozempic affect eating disorders is still unknown, and it urges caution ^[2].

Alexis Conason, author of "The Diet-Free Revolution," told Northeastern Global News that before the Ozempic era the culture was moving away from diet thinking, with the idea that weight was not something people could or needed to control ^[2]. GLP-1s changed that, she said, making thinness look like a matter of personal responsibility ^[2]. Shields said "heroin chic is back," describing a return of Y2K-era thinness as the "Ozempic body" ^[2]. She also noted that tolerance to the drugs builds over time, often meaning people regain what they lost and then some, which can leave them vulnerable; she called it a "slippery slope" ^[2].

Not every provider describes the same intake process. Ro, an online platform that prescribes the medications, told USA TODAY that every potential patient completes an online visit covering weight-loss and health goals, clinical status and medical history including diagnoses of disordered eating, and that people with a diagnosed history of disordered eating are screened and directed to in-person care instead ^[1]. On television, "The Secret Lives of Mormon Wives" star Layla Taylor said she used GLP-1 medications despite a history of disordered eating and body image problems, then said in a March Instagram post that she was in treatment and off the drug ^[1].

Why it matters for patients

GLP-1 medications are not approved to treat an eating disorder, and weight loss is not a cure for one, DeCaro said ^[1]. She also said the drugs' long-term effects are largely unknown ^[1]. The National Eating Disorders Association says the full effect of drugs like Ozempic on eating disorders has not been established ^[2].

Screening is the practical question the reporting raises. DeCaro describes evaluation and follow-up monitoring as inconsistent across the settings where the drugs are now prescribed ^[1], while Ro describes intake questions about disordered eating and referral to in-person care for patients with a diagnosed history ^[1]. With FDA-approved GLP-1 pills for weight loss now on the market, the medications are easier to obtain than when they were injection-only ^[1].

Eating disorders are common and can be fatal. NEDA's figures put lifetime prevalence at 9 percent of the U.S. population and deaths at one every 52 minutes ^[2].

The National Alliance for Eating Disorders runs a helpline at 1-866-662-1235, and crisis situations can be handled by texting "ALLIANCE" to 741-741 ^[1].