Written by: Angela Derrick, Ph.D. & Susan McClanahan, Ph.D.
Date Posted: April 24, 2026 6:19 am
By now, most people have heard of GLP-1 medications and know someone who is using them. Wegovy, Zepbound, Ozempic are names that have moved from prescription pads into everyday conversation, appearing in news headlines, social media feeds, and dinner table discussions with a speed that reflects just how much cultural weight we collectively attach to the question of body size.
The public conversation around these medications has focused, understandably, on their metabolic benefits and weight loss outcomes. For many people, the relief they offer is real and meaningful. But there is a clinical question receiving far less attention, one that matters enormously to the individuals and families we work with at SpringSource every day.
How do GLP-1 medications intersect with eating disorders?
This is not a simple question, and it does not have a simple answer. The relationship between GLP-1 medications and eating disorders is genuinely complicated: promising in some contexts, risky in others, and poorly understood in ways that the current pace of prescribing does not yet reflect.
A medication that changes appetite will almost always change the emotional relationship a person has with food. For someone whose relationship with food has been a source of struggle, pain, or disorder, that change deserves careful, informed attention.
This article is not intended to alarm, and it is not intended to discourage anyone from pursuing medical care that may be appropriate for them. It is intended to open a conversation that more people, including patients, prescribers, and mental health providers, need to be having.
The honest starting point is this: the research on GLP-1 medications and eating disorders is still limited, and what exists is mixed.
GLP-1 receptor agonists were developed primarily to treat type 2 diabetes and were later approved for chronic weight management. People with eating disorders were largely excluded from the clinical trials that established their safety and efficacy. That means we are, in many respects, working with incomplete data at exactly the moment when these medications are being prescribed at unprecedented scale.
A 2024 review published in the International Journal of Eating Disorders by Bartel, McElroy, Levangie, and Keshen examined the current state of knowledge on GLP-1 use in eating disorder populations. Their conclusion was measured and important: GLP-1 medications could worsen, maintain, or improve eating disorder symptoms, depending on the individual. The authors determined that the evidence base is not yet sufficient to draw firm positive or negative conclusions, and that significantly more research is needed before clinicians can feel confident in either direction.
The National Eating Disorders Association has similarly noted that the few studies conducted to date have involved small sample sizes and short follow-up windows of three to six months, leaving long-term outcomes almost entirely unknown.
What we do know is that a significant screening gap exists. Most GLP-1 prescriptions are written by primary care physicians, endocrinologists, and telehealth providers who may have limited training in eating disorder identification. Atypical anorexia, a condition in which someone meets the clinical and psychological criteria for anorexia nervosa but does not appear underweight, is particularly prone to being missed or misdiagnosed. As we have written elsewhere, you cannot tell whether someone has an eating disorder by looking at them. And in the current prescribing environment, that gap carries real clinical consequences.
The most promising signal in the current research involves binge eating, and it is worth taking seriously, with some important clinical nuance attached.
GLP-1 medications appear to reduce binge eating frequency in some individuals, and the proposed mechanisms make biological sense. These medications act not only on the gut but on brain reward pathways, the same circuits involved in compulsive and reward-driven eating. By modulating dopamine signaling and reducing what many patients describe as “food noise,” GLP-1 medications may ease some of the neurological drivers of binge eating, not just the physical experience of hunger.
A 2025 systematic review and meta-analysis by Radkhah and colleagues, published in Eating and Weight Disorders, examined five studies involving 182 patients with binge eating disorder. Patients receiving GLP-1 agonists showed meaningful improvements in Binge Eating Scale scores. A separate rapid review published in Obesity Reviews in late 2025 by Jebeile and colleagues, which analyzed 25 studies, found that binge eating episodes and prevalence were reduced following treatment with liraglutide and semaglutide.
There is an important clinical distinction that research alone cannot capture: a reduction in binge frequency is not the same thing as eating disorder recovery. It is also worth noting that not everyone who presents with binge eating symptoms has binge eating disorder. Some individuals who appear to have BED are actually experiencing atypical anorexia, bulimia or anorexia. In those cases, a GLP-1 medication that suppresses appetite may feel helpful initially while quietly intensifying an underlying restrictive disorder. This is precisely why thorough clinical assessment matters before and during treatment.
The emotional drivers that underlie binge eating, including shame, anxiety, trauma, loneliness, and the need for soothing that food has reliably provided, do not dissolve because appetite changes. Medication can quiet the signal. Therapy helps a person understand what the signal was saying.
For individuals with binge eating symptoms who are considering or currently taking GLP-1 medications, psychological support is not an optional complement to medical treatment. It is where the deeper work of recovery actually happens.
This is where the clinical picture becomes more complex, and where the stakes are highest.
The same appetite-suppressing mechanisms that may offer relief to someone struggling with binge eating can, in a different individual, activate or intensify patterns of restriction. For someone with a history of anorexia, atypical anorexia, or restrictive eating behaviors, a medication that makes it easier to eat very little, and that is culturally celebrated for producing weight loss, can become deeply dangerous.
Clinicians working in eating disorder settings have begun documenting this pattern. Psychiatrist Susan McElroy at the University of Cincinnati has described patients whose past anorexia appeared to be reactivated by GLP-1 treatment, including cases where tirzepatide or semaglutide seemed to unlock restrictive thinking that had been dormant for years. One case involved a woman who relapsed into full anorexia after a decade of recovery following the prescription of a GLP-1 medication for an unrelated metabolic condition.
A 2024 Medscape report described a patient who relapsed into disordered eating after ten years of recovery, experiencing rapid, dangerous weight loss and a full return of restricting behaviors after starting a GLP-1 medication, ultimately requiring hospitalization.
The population of particular concern is individuals with atypical anorexia. These are people who restrict severely, carry intense fear of weight gain, and meet every psychological criterion for anorexia nervosa, but whose body weight falls in a range that GLP-1 prescribers may read as an indication for treatment. Without eating disorder screening, a prescriber may see a patient in a higher-weight body and recommend a GLP-1 medication without any awareness that they are treating someone in the midst of a life-threatening restrictive illness.
As NPR reported in early 2026, no national guidelines currently require eating disorder screening prior to GLP-1 prescribing. Most professional organizations only recommend it.
Beyond restriction risk, there are other ways these medications can complicate eating disorder recovery. Retraining hunger and fullness cues is a cornerstone of treatment for many eating disorders. GLP-1 medications significantly alter those cues, potentially disrupting recovery work that has taken enormous effort to build. Rapid weight changes can destabilize fragile recovery. The cultural celebration of GLP-1-driven weight loss can reinforce diet culture thinking and deepen body preoccupation. And for individuals with a history of using substances or medications to manage weight, GLP-1 misuse is an emerging and real concern.
None of this is an argument against GLP-1 medications categorically. It is an argument for knowing who you are treating, and for ensuring that psychological support is part of the care plan from the beginning.
Dr. Angela Derrick notes, “As therapists, we have always had the goal of providing individualized and person-centered care to those we treat. However, with the introduction of GLP-1 medications, this becomes even more crucial. What works well for one person may not work well for another, even those with similar diagnoses. More than ever, those in the mental health field, including those who treat eating disorders, are being called to practice what we preach; that flexibility, curiosity, and attunement to each unique situation and personal circumstances are necessary for quality care.”
The World Health Organization, in its updated guidance on GLP-1 medications for obesity, has named Intensive Behavioral Therapy (IBT) as a key component of comprehensive care, not a supplementary option, but a recognized clinical necessity. WHO acknowledges that behavioral and psychological support addresses dimensions of health that medication alone cannot reach.
And yet, for the vast majority of people currently taking GLP-1 medications, that support is not in place.
Most prescriptions are written without any eating disorder screening. Most patients are not connected to mental health care as part of their treatment plan. Most telehealth platforms that dispense these medications at scale do not have the clinical infrastructure to identify or respond to the psychological risks that may emerge.
This is the missing piece, and it is not a small one.
What psychological care and therapy actually provide, that medication cannot, includes the following.
Understanding emotional eating patterns at their roots. Binge eating, restriction, and emotional eating are rarely just about food. They are adaptive responses to emotional pain, relational difficulty, trauma, stress, and unmet need. Therapy creates the space to understand those roots and develop new ways of meeting them.
Supporting body image through change. As weight shifts in either direction, the internal sense of self often struggles to keep pace. Many people experience a disorienting gap between how their body looks and how they feel inside it. Therapy provides a place to process that experience rather than be destabilized by it.
Reducing shame. Shame is one of the most powerful drivers of eating disorder behavior, and it does not disappear just because a medication is working. Without conscious attention, weight loss can actually intensify shame, generating new fears about regaining, new perfectionism around food choices, and new anxiety about maintaining results.
Managing relapse risk. For individuals with eating disorder history, GLP-1 treatment introduces real relapse risk. Ongoing psychological support can identify early warning signs and respond before a full relapse takes hold.
Addressing identity and relationship shifts. When a GLP-1 medication quiets the appetite, people sometimes discover for the first time just how much emotional work food had been doing for them. Feelings that were buffered by eating begin to surface. Relationships shift. Therapy offers a steady place to make sense of those changes.
At SpringSource: Eating, Weight & Mood Disorders, we work with individuals across all stages of GLP-1 treatment, including those considering medication, those currently taking it, and those navigating discontinuation. Our approach is weight-inclusive, non-judgmental, and grounded in decades of clinical experience with eating disorders across the lifespan. Where appropriate, we also draw on harm reduction principles, meeting people where they are rather than demanding immediate perfection in their relationship with food or their body.
If you are considering a GLP-1 medication, or if you are already taking one and wondering whether your emotional experience deserves more attention, these questions are worth sitting with:
These are not questions designed to disqualify anyone from care they may genuinely need. They are questions that can make that care safer, more informed, and more sustainable.
GLP-1 medications are real medical tools that offer meaningful benefits for many people. That is not in question. For some individuals struggling with binge eating, they may reduce suffering in ways that open a door to deeper healing. For others, particularly those with restrictive eating disorder histories or atypical anorexia, they may carry serious risks that the current prescribing environment is not yet reliably identifying or managing.
The cultural conversation has raced ahead of the clinical evidence. That gap matters most to the people it leaves unprotected.
At SpringSource, we believe that integrated care, with medical treatment and psychological support working together rather than in parallel silos, is not just an ideal. It is a clinical necessity. Eating disorders are complex mental health conditions shaped by biology, emotion, relationship, and culture. A medication can address some of those layers. Therapy addresses others. The most durable recovery draws on both.
If you are navigating GLP-1 treatment alongside an eating disorder history, an active eating disorder, or simply a complicated relationship with food and your body, you deserve care that sees the full picture.
We are here for exactly that.
SpringSource: Eating, Weight & Mood Disorders provides specialized eating disorder therapy and GLP-1 mental health support in Chicago and Northbrook, with virtual care available throughout Illinois. We offer a free 15-minute consultation to help you explore your options and find the right level of support.
Call us at 224-202-6260, fill out our contact form, or schedule your free consultation online.
Recovery is always within reach.
About SpringSource: Eating, Weight & Mood Disorders SpringSource is a clinician-owned practice specializing in eating disorders, weight-related concerns, and mood disorders across the lifespan. Founded by Dr. Susan McClanahan and Dr. Angela Derrick, both Ph.D. licensed clinical psychologists and Certified Eating Disorder Specialists with decades of leadership in the field, SpringSource provides evidence-based, weight-inclusive, and deeply individualized care. With offices in downtown Chicago and Northbrook and virtual therapy across Illinois, we are currently accepting new clients for individual therapy, GLP-1 mental health support, and our hybrid Intensive Outpatient Program for Adults.
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