Concerns Emerge Over Weight-Loss Medications and Eating Disorder Risk, Prompting Calls for Stricter Prescribing

Concerns Rise Over GLP-1 Weight-Loss Drugs and Eating Disorders

Concerns are growing regarding the potential for GLP-1 weight-loss medications to trigger new eating disorders or exacerbate existing ones. This has led to widespread calls for stricter prescribing guidelines, enhanced patient support, and increased regulatory oversight, particularly concerning telehealth practices in Australia.

Background on GLP-1 Medications and Mental Health

GLP-1 medications, widely used for weight management, are increasingly under scrutiny for their potential impact on mental health, specifically in relation to eating disorders. The notable rise in their prescription has coincided with reports from patients and experts detailing adverse effects on eating behaviors.

Disturbing Patient Experiences Emerge

Several individuals have reported a return or intensification of eating disorder symptoms while using these weight-loss medications.

Kacey Martin, 33, who has a history of bulimia and binge/restrictive eating, initially noted a reduction in food preoccupation after starting weight-loss medication. However, she later observed a troubling resurgence of problematic behaviors, including purging, increased body-checking, and a heightened psychological focus on her weight.

Claire Munch was hospitalized with an eating disorder after a telehealth provider prescribed weight-loss drugs. Her general practitioner had previously declined to prescribe the same medication due to her disclosed eating disorder history.

In 2023, Ms. Munch sought weight-loss drugs through the telehealth provider Juniper, completing an online questionnaire where she disclosed her history of an eating disorder, severe depression, and post-traumatic stress disorder.

Despite her disclosures, she was prescribed the medication based on her body mass index, without a video consultation. Ms. Munch stated that the medication acted as a trigger, leading to a relapse of her eating disorder and approximately five months of hospitalization that year.

Expert and Organizational Concerns Mount

Health professionals and eating disorder organizations have voiced significant concerns about the implications of GLP-1 medications.

Dr. Terri-Lynne South of the Royal Australian College of General Practitioners (RACGP) highlighted concerns about patients developing "atypical anorexia." This condition describes individuals with a history of larger body sizes becoming excessively preoccupied with weight, dieting, and exercise while using these medications. Dr. South emphasized the importance of preventing unhealthy relationships with food and potential shifts between eating disorder types.

Josephine Money, a spokeswoman for Dietitians Australia, noted that GLP-1 medications can make it challenging for many individuals to consume adequate nutrition.

She suggested that a "starved brain" can lead to increased food-related thoughts, anxiety, fear, and a drive for control, which are cognitions associated with anorexia.

Dr. South advocated for mandatory face-to-face consultations with a doctor before prescription, along with improved access to dietitians, psychologists, and exercise physiologists to provide comprehensive support.

The Butterfly Foundation, a national eating disorder charity, has reported receiving numerous calls to its helpline from individuals using these medications who have eating disorders, as well as from concerned caregivers.

Regulatory and Prescribing Scrutiny Intensifies

Regulatory bodies have initiated actions and discussions regarding prescribing practices for weight-loss medications.

The Australian Health Practitioner Regulation Agency (AHPRA) has taken regulatory action against doctors, pharmacists, and nurses for inappropriate prescribing of GLP-1 medicines, particularly through telehealth. These instances have been linked to suppressing the hunger of patients with anorexia, resulting in emergency hospitalizations.

AHPRA stated that practitioners are required to conduct comprehensive assessments to identify patient vulnerabilities, such as disordered eating or body image concerns, before prescribing weight-loss medication.

Eating disorder groups report that patients can easily exaggerate their Body Mass Index (BMI) during online questionnaires to obtain medication via telehealth, sometimes without direct doctor screening. Dr. Michael Wright, RACGP president, noted that Ms. Munch's case highlights communication breakdowns among some medical telehealth providers.

He emphasized patient safety over access or convenience and raised concerns about providers operating outside Medicare not being held to the same standards.

Telehealth Provider Responses and Industry Practices

Following her recovery, Ms. Munch contacted Juniper to express concerns about their prescribing processes. Juniper's Clinical Director, Dr. Matt Vickers, apologized and offered a refund for the medication. Ms. Munch later received discount codes and promotional emails from Juniper, prompting a second apology letter from Dr. Vickers.

The letter outlined changes made by the company, including improved staff training and the implementation of mandatory video calls for all consultations in September 2023, to align with AHPRA Medical Board guidelines.

Juniper, part of EUC Management, offers Ozempic-style drugs. Dr. Vickers stated Juniper's commitment to patient safety, regular review of safeguards, and implementation of mandatory training on patient risk factors and audit processes for risks such as eating disorders. He also noted a review of marketing processes to prevent communications from reaching inappropriate patients.

Concerns about marketing practices persist, with Ms. Munch continuing to be exposed to weight-loss drug advertisements on social media. The Eating Disorder Alliance and other bodies have expressed concerns that marketing for weight-loss treatments, including promotional sales, could target vulnerable individuals. Dr. South also highlighted concerns about some telehealth companies potentially exploiting loopholes in advertising laws.

Data and Ongoing Discussions

The Therapeutic Goods Administration (TGA), in conjunction with federal Health Minister Mark Butler, stated that there is no evidence of an increase in eating disorders specifically linked to GLP-1 drugs, though they are aware of some reports. The TGA has received five reports of eating disorders linked to GLP-1 medications since 2012.

The Department of Health, Disability, and Ageing is aware that The Butterfly Foundation has received calls regarding GLP-1 drugs. The TGA is engaged in discussions with regulatory bodies to strengthen integration between prescribing platforms and primary care.