GLP-1s Meet a Rising Eating Disorder Crisis

GLP-1 weight-loss drugs have become one of the biggest biotech breakthroughs of the last decade. Now, as millions use them for weight loss and diabetes, eating disorder specialists are warning that the medications may intensify a crisis already spreading across the world.

Emerging evidence suggests some people with eating disorders are misusing GLP-1s, while studies point to nutrient deficiencies among users. The result is a collision between powerful weight-loss drugs, rising pressure to look thin, and limited research on how these medications affect people outside their traditional medical uses.

A Global Eating Disorder Crisis Is Expanding

A new analysis estimates that the global incidence of anorexia nervosa and bulimia nervosa increased by 71% between 1990 and 2023. In 2023, an estimated 18.1 million people were living with one of those two disorders, and the number could reach 21.8 million by 2050.

The findings, published in JAMA Psychiatry on Wednesday, draw on studies and surveys from populations around the world. Ruhai Bai at the Children’s Hospital of Nanjing Medical University in China and his colleagues used statistical models to fill data gaps, estimating the annual incidence across 204 countries and territories.

The team also measured disability-adjusted life years, or DALYs. One DALY represents a year of healthy life lost. In 2023, anorexia nervosa and bulimia nervosa “cost the world the equivalent of about 3.83 million years of healthy life,” Bai says.

Those two conditions represent less than half of all eating disorders, says Cheri Levinson, a clinical psychologist at the University of Louisville in Kentucky who has specialized in eating disorders for almost 20 years. Binge eating disorder is also an eating disorder, and Levinson says the true impact is “probably three times the rate that they’re reporting.”

“This is the worst I’ve seen things,” Levinson says. She is seeing more patients with more severe symptoms than at any other time in her career, and many of her patients are misusing GLP-1s.

Why GLP-1s Could Add New Pressure

Eating disorders are mental health conditions in which eating behaviors affect a person’s health. Anorexia nervosa involves a fear of weight gain, while bulimia nervosa involves bingeing and purging. Some people have a genetic predisposition to these conditions, but an external factor can trigger their onset.

Stress and social pressure to be skinny can act as triggers. Often, simply restricting food intake can trigger an eating disorder, Levinson says. That risk matters as GLP-1 drugs move beyond their traditional role as long-term, even lifelong, medications for managing diabetes or tackling obesity.

There is little research on how these drugs work in people without conditions such as diabetes or obesity, and even less research on short-term “crash” diets. Yet nearly 30 million Americans are taking GLP-1 medications for weight loss and diabetes, creating a huge population whose eating patterns and nutritional health need close attention.

An August review of multiple studies from the Harvard T.H. Chan School of Public Health and the University of Copenhagen found that GLP-1 users were deficient in vitamin B12, protein, and fiber. The review found that 43 percent of users were eating inadequate amounts of protein, while researchers at Ohio State University say 10 million Americans are not getting enough B12.

Low fiber intake can lead to nausea, bloating, and constipation, “creating a cycle in which patients eat even less.” The body needs protein and fiber to maintain a healthy weight and fight blood sugar spikes that can leave people at risk of developing diabetes, according to the Mayo Clinic.

Young Users Face Nutrient Risks

The concern reaches children and teenagers. American children under 12 are taking GLP-1 drugs to fight obesity at 300 times the rate of seven years ago. A September study from Northwestern University found that nearly one in six children aged 10 to 17 who took GLP-1s for a year were diagnosed with nutrient deficiencies.

Vitamin D deficiency was the most frequent complication. Vitamin D is added to milk and cereal, while vitamin D, iron, and calcium are especially important during adolescence, when deficiencies may have lasting effects on skeletal health and overall development.

Middle-aged and older adults showed a similar pattern. A January review found that vitamin D deficiency affected 13.6 percent of more than 480,000 adults after a year of treatment.

More research is needed, but the Cleveland Clinic says nutrient deficiency not tied to GLP-1s has led to soft bones, stunted growth, and soft bones. Possible signs include weakness, fatigue, inattention, dry skin or rashes, hair loss and brittle hair, infections, low body temperature, and reduced heart rate.

Social Media Can Feed the Cycle

The rise in eating disorders cannot be explained by population growth alone. Bai and his colleagues did not explore the reasons, but social media may have played a role.

Cynthia Bulik, a clinical psychologist at the University of North Carolina who has studied and treated eating disorders since the early 1980s, points to an upsurge in environmental exposures between 1990 and 2023. Filtered and modified images of skinny influencers, some of whom may have undergone cosmetic surgery or extreme dieting, reach many social media users.

Some influencers promote “thinspiration” or “fitspiration” content. Users with eating disorders appear more likely to engage with it, which can lead platforms to deliver even more of the same material. A University of Melbourne investigation found that TikTok users with eating disorders received 4343% more “toxic eating disorder videos” than users without the disorders, along with more dieting and exercise content. Many received over 1000 problematic videos per month.

Bulik describes social media as “quicksand” for people with, or at risk of, eating disorders. The covid-19 pandemic and the isolation of lockdowns may have added to the damage: research conducted in 2021 found that the number of people hospitalized with eating disorders in the US doubled between 2018 and 2020.

“As GLP-1 prescriptions reach millions of patients across diverse and often under-resourced clinical settings, integrating nutrition into this care model is not just advisable; it is urgent,” the researchers say. That warning points toward the next challenge: making sure weight-loss treatment does not overlook eating behavior, mental health, or the nutrients the body needs.

Stay connected via Google News

Follow us for the latest AI News