Eating disorder screens predict GLP-1 use

A cross-sectional study published on 19 June 2026 in the International Journal of Eating Disorders surveyed 1,309 US adults from the nationally representative AmeriSpeak panel^[1]. The researchers, led by Jaclyn Siegel at NORC at the University of Chicago, wanted to know whether people who screen positive for eating disorders differ from the general population in their awareness of, interest in, and use of GLP-1 receptor agonists such as semaglutide. The short answer: they are more aware, more interested, and more likely to try to access these drugs outside traditional clinical channels.

What the study measured

Participants completed the Eating Disorder Screen for Primary Care (ESP), a validated five-item tool designed to flag possible eating disorder symptoms. The survey then asked about GLP-1 awareness, personal interest in using GLP-1 medications for weight loss, and whether participants had tried to obtain them. Approximately 10 percent of the sample reported past or current GLP-1 use^[1].

Positive screens linked to higher GLP-1 interest

Adults who screened positive on the ESP showed greater awareness of GLP-1 medications and more interest in using them for weight loss than those who screened negative. Women in the sample were also more interested in GLP-1 drugs than men overall. Notably, individuals with positive eating disorder screens were more likely to report trying to access GLP-1 medications through telehealth pharmacies without a full medical consultation^[1].

The finding about telehealth access is the most clinically consequential. Direct-to-consumer telehealth platforms that prescribe GLP-1 drugs for weight loss have expanded rapidly in the US. If people with undiagnosed or unmanaged eating disorders are disproportionately seeking these drugs through channels that skip structured screening, the risk of harm increases.

Why this matters for GLP-1 prescribing

GLP-1 receptor agonists such as semaglutide suppress appetite and reduce food-reward signalling. Those mechanisms can help people with binge eating disorder reduce episodes. But the same appetite suppression could reinforce restrictive eating patterns in people with anorexia or atypical anorexia. A separate commentary published in the same journal in June 2026 argued that most GLP-1 prescribing pathways currently lack any eating disorder screening step^[2].

A 2026 clinical review in the Psychiatric Clinics of North America reached a similar conclusion: preliminary evidence suggests GLP-1 drugs may reduce weight and binge-eating symptoms in people with binge eating disorder, but these drugs could also cause harm or be misused in other eating disorder populations^[3]. The review called for careful individual evaluation before prescribing.

The telehealth prescribing gap

The rapid expansion of telehealth GLP-1 prescribing has created a gap between access and oversight. Many platforms advertise weight-loss prescriptions with minimal evaluation: a brief questionnaire, a short video consultation, and a prescription shipped to the door. The standard screening questions ask about BMI, diabetes history, and thyroid disease. They rarely ask about binge-purge cycles, restriction, or body-image distress^[2].

This is not unique to GLP-1 drugs. The broader trend toward direct-to-consumer prescribing has raised similar concerns with testosterone, tirzepatide, and compounded peptide formulations. But the scale of GLP-1 demand makes the eating disorder question particularly urgent. By some estimates, more than 15 million Americans have been prescribed a GLP-1 agonist for weight management since 2021, and a substantial portion of new prescriptions now originate through telehealth channels.

What researchers recommend

The Siegel team's recommendation is direct: clinicians working with patients who have eating disorders or body-image concerns should raise GLP-1 medications proactively rather than waiting for the patient to ask^[1]. The reasoning is that patients will seek these drugs regardless, and a clinician-initiated conversation creates space for screening and monitoring.

The Škudar commentary goes further, proposing six priorities: routine eating disorder screening before and during GLP-1 treatment, validated monitoring tools to distinguish normal appetite reduction from emerging eating disorder pathology, and multidisciplinary care models that pair prescribers with mental health clinicians^[2]. None of these are standard practice yet.

Limitations worth noting

The study is cross-sectional, so it captures associations, not causes. It cannot tell us whether eating disorder symptoms drive GLP-1 interest or whether the same underlying body-image concerns drive both the screen result and the drug-seeking behaviour. The ESP is a screening tool, not a diagnostic instrument: a positive result flags risk but does not confirm an eating disorder diagnosis. And the 10 percent GLP-1 use rate in the sample was self-reported^[1].

The survey also did not distinguish between specific GLP-1 medications. Drugs in this class include semaglutide (marketed as Wegovy for weight management and Ozempic for type 2 diabetes) and tirzepatide (Zepbound for weight management, Mounjaro for diabetes). Each has a different side-effect profile and prescribing context, and the eating disorder implications may differ between them. Future research would need to track outcomes by specific drug and dose.

What we do not yet know

No study has yet tracked what happens when people with positive eating disorder screens start GLP-1 therapy without specialist oversight. Whether the appetite suppression helps, harms, or has no net effect on eating disorder pathology in real-world settings is an open question. The authors of the original study recommend that clinicians working with patients who have eating disorders or body-image concerns should proactively discuss GLP-1 medications and that telehealth prescribing platforms should build in screening safeguards.

Anyone considering a GLP-1 medication should discuss both the potential benefits and risks with a healthcare provider, particularly if they have a history of disordered eating.