GLP-1s Meet a Rising Eating Disorder Crisis

GLP-1 weight-loss drugs rank among the biggest biotech breakthroughs of the last decade. Yet for people with eating disorders, the same drugs can carry a far darker risk: worsening symptoms, faster weight loss, and misuse that clinicians are already seeing.

A new report estimates that the global incidence of anorexia nervosa and bulimia nervosa rose 71% between 1990 and 2023. By 2023, an estimated 18.1 million people were living with one of those two disorders, and the true number is likely much higher once other eating disorders enter the picture.

A Global Crisis That Is Still Growing

Eating disorders are mental health conditions in which eating behaviors affect a person’s health. They include anorexia nervosa, bulimia nervosa, binge eating disorder, and others. Anorexia nervosa involves a fear of weight gain, while bulimia nervosa involves bingeing and purging.

Ruhai Bai at the Children’s Hospital of Nanjing Medical University in China and his colleagues gathered data from studies and surveys covering populations around the world. They used statistical models to fill gaps in the data, then estimated the annual incidence of anorexia nervosa and bulimia nervosa across 204 countries and territories between 1990 and 2023.

The findings, published in JAMA Psychiatry on Wednesday, measured the global health burden through disability-adjusted life years, or DALYs. One DALY represents a year of healthy life lost. In 2023, the two disorders “cost the world the equivalent of about 3.83 million years of healthy life,” Bai says.

The researchers expect the numbers to keep rising. Their model predicts that anorexia nervosa and bulimia nervosa could affect 21.8 million people by 2050, while Cheri Levinson, a clinical psychologist at the University of Louisville in Kentucky, says those two conditions represent less than half of all eating disorders.

“The true impact of these disorders is probably three times the rate that they’re reporting,” Levinson says. She has specialized in eating disorders for almost 20 years, but says she is now seeing more patients with more severe symptoms than at any other time in her career. “This is the worst I’ve seen things,” she says.

Social Media Adds Fuel to the Fire

Bai and his colleagues did not explore why eating disorders have risen, though Bai points out that population growth cannot explain the entire increase. Social media may have played a role, especially as users encounter filtered and modified images of skinny influencers who may have undergone cosmetic surgery or extreme dieting.

Cynthia Bulik, a clinical psychologist at the University of North Carolina, says “Social media comparisons, influencers, challenges, diet trends can all be precipitating … events for an eating disorder.” She adds, “Between 1990 and 2023 there has clearly been an upsurge of those types of environmental exposures.”

Many influencers also promote “thinspiration” or “fitspiration” content, and users with eating disorders appear more likely to engage with it. That engagement can lead to even more of the same material appearing in their feeds, creating a powerful loop that keeps harmful content in view.

A University of Melbourne investigation described as taking place “a couple of years ago” found that TikTok users with eating disorders received 4343% more “toxic eating disorder videos” than users without those disorders. 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 social isolation that accompanied lockdowns added another pressure point. Research conducted in 2021 found that the number of people hospitalized with eating disorders in the US doubled between 2018 and 2020, though researchers do not yet have good data on how trends progressed after 2023.

Why GLP-1 Drugs Raise New Alarms

Levinson says the problem is reaching younger ages and greater severity. “There are more eating disorders, more severe eating disorders… and we’re seeing earlier ages of onset,” she says. “We’re seeing eight- and nine-year-olds with eating disorders.” She adds, “From what I’m hearing and seeing, I am not going to be surprised if that number isn’t at least doubling again.”

Against that backdrop, GLP-1 weight-loss drugs have exploded in popularity. A Gallup survey conducted earlier this year suggested that 15% of Americans had used one of these drugs for weight loss. Drug companies are working on formulations that are easier to take and more effective, while many people can buy versions through compound pharmacies or dubious online sources.

In a small study published earlier this year, Levinson and her colleagues found that 30% of people with eating disorders had used GLP-1 drugs. The drugs might benefit some of those people, but 10% appeared to have misused them, a figure Levinson believes is also an underestimate.

Levinson says she and her colleagues have seen children develop eating disorders after receiving GLP-1s for medical reasons. They have also seen others, including children as young as 11, buy versions of the drugs over TikTok. To some clinical psychologists, these drugs can represent something more sinister: a potential trigger for eating disorders.

“We’re very concerned that GLPs will lead to even faster and more extreme weight loss in people with anorexia nervosa, and that patients will come to us in even more advanced stages of illness that become difficult to reverse,” Bulik says.

Bulik and Levinson are continuing to study how GLP-1 drugs affect people with eating disorders. Both urge medical professionals to consider those risks, and guidelines published earlier this month recommend screening for eating disorders before prescribing the drugs, along with more patient education and stronger monitoring.

The next phase of GLP-1 medicine will need more than easier doses and stronger weight-loss results. It will also need safeguards that recognize how these drugs can intersect with a growing mental health crisis. If you think you or someone you know might have an eating disorder, the National Eating Disorders Association provides information and support.

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