(CNN) 鈥� There is still much researchers don鈥檛 know about popular weight loss medications 鈥� and those lack of studies could have consequences for , according to experts.
The medication semaglutide, sold under brand names such as Ozempic and Wegovy, is a kind of or GLP-1 agonist. While originally prescribed for diabetes, semaglutide is becoming more and more popular for weight loss.
As the medication become more available, experts said they worry about the impact of these weight loss products on eating disorders.
鈥淲e noticed clinically that we were getting more and more people into our clinical services that had been started on GLP-1 agonists and had experienced new onset or worsening eating disorder symptoms,鈥� said Dr. Aaron Keshen, codirector of the Nova Scotia Provincial Eating Disorder Service and assistant professor in the Dalhousie University鈥檚 department of psychiatry in Halifax, Nova Scotia.
Eating disorders affect nearly 1 in 10 people in the United States, according to the nonprofit聽, which provides support services for people with these conditions. Next to opioid addiction, it has the second-highest of any mental illness, the association said.
The possibility that GLP-1 agonists could make eating disorders worse or more prevalent 鈥渕akes us have to go really slowly and be very thoughtful about when we might prescribe them,鈥� said Dr. Jennifer Gaudiani, an eating disorder physician and founder and medical director of the Gaudiani Clinic in Denver.
The scope of research on the connection between eating disorders and weight loss medications is quite slim, leaving experts with many unanswered questions, said Dr. Susan McElroy, chief research officer at the Lindner Center of HOPE and the Linda and Harry Fath endowed professor in the department of psychiatry and behavioral neuroscience at the University of Cincinnati College of Medicine.
鈥淚 view eating disorders as the last frontier in psychiatry,鈥� she added. 鈥淭he eating disorder field is hard because we鈥檙e just ignored.鈥�
Can these drugs treat binge eating disorder?
Are there cases in which these medications actually help eating disorder patients? Perhaps, experts said.
Generally, if a medication causes weight loss, there is a good chance it will also reduce binge eating, McElroy said.
Binge eating disorder is the most common eating disorder. But as with anorexia and bulimia nervosa, there isn鈥檛 enough research into how to treat it with medication, she added.
鈥淲e desperately need more compounds to treat people with eating disorders,鈥� McElroy said.
These medications could help in theory, but they have not been approved for treating binge eating disorder, she added.
鈥淭here is a little bit of preliminary evidence that maybe GLP-1 agonists could reduce binge symptoms in some individuals,鈥� Keshen said, 鈥渂ut the evidence is fairly weak at this point, and it鈥檚 certainly not enough to recommend that people take GLP-1 agonists for binge eating.鈥�
Keshen and McElroy worked on published in the International Journal of Eating disorders that reviewed the existing literature on GLP-1 agonists and eating disorders. The studies they found on binge eating disorder were small, and many didn鈥檛 test against a placebo, Keshen said.
鈥淢ore research needs to be done,鈥� he added. 鈥淎nd that may happen in the future.鈥�
Can they bring an eating disorder back?
Eating disorders happen in people of all shapes, sizes and health conditions 鈥� so doctors may prescribe these medications unknowingly to those with a history of or even an active eating disorder, Gaudiani said.
鈥淭heir ability to perhaps pay for a medication that causes weight loss, while potentially causing medical complications, is concerning,鈥� she said.
Gaudiani said she has heard anecdotal evidence of people in remission for an eating disorder have it reignited after taking a GLP-1 agonist.
Eating disorders are complicated biopsychosocial illnesses, Gaudiani said, and the process of losing weight might trigger increased restrictive dieting, which can bring up 鈥渙ld gremlins.鈥�
Additionally, these medications suppress appetite. Feeling full too quickly or feeling sick after only eating a little can disconnect a person from their innate hunger and fullness cues, she added.
鈥淚f somebody has had a history of an eating disorder, or indeed just has temperamental traits, and is surrounded by a society that is extremely focused on weight loss and fatphobia, and they begin to lose weight,鈥� Gaudiani said, 鈥渋t鈥檚 not unimaginable but that could devolve into something that becomes quite obsessive and quite mentally and physically unhealthy for them.鈥�
Can they unleash a new monster?
With little research on the topic, experts can鈥檛 say if GLP-1 agonists would make it more likely for someone to develop an eating disorder, but there are reasons to be concerned, Gaudiani said.
鈥淎 lot of eating disorders do begin with restricted food intake and weight loss,鈥� she said. 鈥淭he act of reducing caloric intake and the act of losing weight physiologically have been proven to trigger eating disorder behaviors, even in those who wouldn鈥檛 otherwise be considered temperamentally or socially prone to them.鈥�
Gaudiani pointed to the Minnesota Starvation Experiment of 1944 in which individuals volunteered to undergo starvation so researchers could experiment with the best refeeding methods.
There was an effect that researchers didn鈥檛 expect when the volunteers were starved, she said. They became obsessed with food, reading cookbooks, chewing gum constantly, cutting the food they ate into little pieces to spend longer eating, and judging people in restaurants they deemed gluttonous.
鈥淚n short, (they were) acting like someone with anorexia,鈥� Gaudiani said. 鈥淭here鈥檚 something about our brains that fundamentally change when we get inadequate calories and lose weight.鈥�
There is also a risk for behaviors such as bulimia, Keshen added. If people have a suppressed appetite, they may not eat at all during the day and then binge at night 鈥� which could then result in purging behaviors, he said.
鈥淧erhaps a degree of moderate weight loss is a healthy outcome for some individuals,鈥� Keshen said, 鈥渂ut it鈥檚 never going to be a healthy outcome to achieve rapid weight loss due to excessive pathological dietary restriction.鈥�
How to protect those vulnerable to eating disorders
First, health care providers prescribing these medications need to screen for a history of eating disorders, active eating disorders and even vulnerability for an eating disorder, Keshen said.
鈥淚t may be worth trying to treat the eating disorder first, or perhaps not using a GLP-1 agonist at all in that patient,鈥� he said.
If a doctor and patient choose to move forward with medication, it is important they also go over information about eating disorders and the importance of eating structured meals, Keshen said.
Nourishment is something people on appetite-suppressing medication should review regularly with themselves, Gaudiani said.
鈥淗umans, like all mammals, need to nourish throughout the day to have the energy to do with our body and minds what we want to do, and so we have to check, 鈥楢m I eating enough?鈥欌€� she said. 鈥溾€楬ow often am I thinking about food and body?鈥欌€�
If those with histories of eating disorders find themselves reverting to old behaviors while taking GLP-1 agonists, they should contact their doctors and therapists, Gaudiani said.
And for those who haven鈥檛 been diagnosed with an eating disorder, or who might not even reach the threshold of one, if thoughts of weight and food are distracting from goals and priorities, it may be time to seek an eating disorder expert if resources are available, she said.
鈥淚f not, going on eating disorder treatment websites or listening to podcasts can just help bring some support and clarity to what鈥檚 going on,鈥� Gaudiani said.
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