GLP-1s and Eating Disorders: Where Do I Weigh In?

Sep 15

The GLP-1 news is relentless.

They're good; they're bad. They're the fountain of youth; they cause blindness and cancer. They'll trigger anorexia, or they're a miracle cure. For a drug that eliminates noise, they're creating a cacophony. Rarely have I seen anything generate this much judgment, shame, relief, and excitement at once.

I have a bird's-eye view, so let me tell you what I'm actually seeing in the world of eating disorders and GLP-1s.

One caveat first: these drugs have only been well studied in people with diabetes or obesity. Research in binge eating, bulimia, and anorexia is just beginning. Anything unstudied is, by definition, at your own risk. We are in the Wild West, and everything I say below needs to be read through that lens.

Not all eating disorders are created equal.

These drugs are not a miracle, and they're not a silver bullet.

More importantly, what I'd consider for someone with pure restricting anorexia is not the same as what I'd consider for someone who binges, purges, and restricts. They are different and are treated differently. Eating disorders have stages. They are unique and show up differently in people's minds and bodies throughout someone's life.

Stage 1: the honeymoon.

Restriction begins, and it works. People can eat almost nothing and still do everything. They're high on a thinner body and obsessed with staying there: compulsive body checking, constant comparison, intense rituals around what, when, and where they eat.

Some binge and purge too, but a single-minded obsession with thinness pervades everything.

You see this often (not always) in teens and young twenty-somethings.

In my opinion, adding a GLP-1 here would be like throwing gasoline on a wildfire. It isn't clinically indicated, and I think it's probably dangerous. This stage requires therapy and food rehabilitation. Healing means working through what thinness means to them and why it has become the holy grail.

Stage 2: the long haul.

These are people who have hated their bodies for years.

Every bite is a math problem: calories in, calories burned.

They can't emotionally function without the gym. They're depressed, isolated, and exhausted, and they can't figure out how to stop thinking about eating. The anguish about their bodies has become their primary relationship.

Imagine a woman living what looks like a regular life. Two kids, a partner, a job she enjoys. Underneath, a relentless voice hammers her about what her body looks like. She wakes up every morning, and her whole day is organized around whether she overate at dinner last night and what she should not eat today to compensate. She goes to the gym like it's her religion. She cancels plans and isolates when she looks in the mirror and hates what she sees.

No matter what, she is unhappy and uncomfortable in her own skin.

Different animal. Both excruciating. But very different in acuity and chronicity.

What I've seen…

In my own practice, anecdotally, low-dose GLP-1s have begun to help people in Stage 2. They do exactly what the science says: they quiet the noise.

Patients feel freedom from the prison of food and exercise for the first time. They engage with life differently.

Some enter romantic relationships as self-hatred loosens its grip. The woman with the seemingly regular life? She now goes to the gym because she wants to, not because she'll fall apart if she doesn't. She kept dinner plans with friends the week after a night she would once have called a failure.

She told me that in our session and couldn't speak for a full minute.

In a handful of patients, I've watched change that used to take years of therapy. A handful is not a study. But it's enough to make me pay attention.

But this only works alongside therapy.

The food freedom is real- but what fills the space it leaves is the next journey.

Whether you know it or not, your food noise has been your most constant companion.

What do you do in the quiet?

Who are you without it?

Emotions that have been pushed away for years come forward. And how do you run your life without the dictator's voice organizing your inner world? That is far harder than it sounds.

I see it every.single. day.

So, where do I weigh in?

There is no single answer to whether GLP-1s are right or wrong for you.

And here's the part I need you to hear: you may not know which stage you're in.

Almost nobody in Stage 1 thinks they're in Stage 1.

Self-hatred and calorie math live in both stages, and the eating disorder is very good at reading the Stage 2 description and saying, "See? That's me. I just need the noise to stop." That voice is the noise.

Which is exactly why this is not a decision to make alone, or with a telehealth prescriber who has never asked you about your relationship with food. It's a decision to make with someone who knows eating disorders and knows you.

Take this quiz to get a sense of how loud your noise is.

And if you feel organized by food, please talk to someone. You don't have to live this way. You can feel free again, and you deserve it.

My book, No More Food Noise (New Harbinger, January), gives you the tools to address the noise with and without GLP-1s, plus everything I've learned in 20+ years in this field. Pre-orders tell my publisher this is a book people want, so if you can, pre-order here.

Email me with questions- I am here for you.

xxx- Dr. D

Get to Know

Dr. Danielle Shelov

Dr. Shelov's therapeutic approach emphasizes understanding individuals within the context of their families, childhood experiences, relationships, and larger systems as crucial to psychological treatment.