Eating disorders & GLP-1s: What employers need to know

Nishu Uppal, MD, MBA

Nishu Uppal, MD, MBA

Principal Physician, Population Health

Dr. Uppal is a practicing internal medicine physician and healthcare policy researcher trained at Brigham and Women's Hospital. He has published in leading journals including NEJM, JAMA, and Health Affairs, and holds an MD from Harvard Medical School and an MBA from Harvard Business School.

James Lyda, PhD

James Lyda, PhD

Director of Mental Health

Dr. Lyda is a multi-state licensed psychologist, with over 20 years of experience delivering evidence-based, technology-driven, and value-based mental health care. His research and advocacy have focused on improving mental health outcomes for underserved populations and reducing stigma, among other topics. He holds a Ph.D. in Counseling Psychology from the University of Oregon and completed his postdoctoral fellowship at UC Berkeley’s University Health Services.

By Nishu Uppal, MD, MBA, and James Lyda, PhD

This article is part of The Signal, a monthly column from Goodpath’s clinical team on the emerging research, clinical data, and broader learnings and trends shaping the future of obesity and cardiometabolic treatment.

Semaglutide and tirzepatide are FDA-approved to treat obesity, type 2 diabetes, obstructive sleep apnea, and cardiovascular risk reduction. Clinical trials are actively underway to expand those indications – including into substance use disorders and beyond. 

Although GLP-1 medications may hold therapeutic potential for binge eating behaviors, they are currently not approved for the treatment of any eating disorders, and experts broadly agree they should be avoided in individuals with active eating disorders due to concerns about misuse and the potential to worsen disordered eating behaviors. 

Yet access to GLP-1 medications has shifted dramatically, from primary care practices and specialists operating within structured clinical settings to direct-to-consumer telehealth platforms and compounding pharmacies that have made GLP-1 prescriptions easier and faster to obtain. For example, one secret shopper study published in JAMA in July of 49 commercial websites selling semaglutide or tirzepatide for weight loss found that 92% issued a prescription, and the median time to prescription was less than one day. 67% required no interaction with a licensed clinician. Only 55% asked about eating disorder history, diet, or activity level. 

What should benefits leaders who manage employer-sponsored health plans know about the effects of GLP-1 medications on eating disorders, and how can GLP-1 benefits be designed to avoid misuse and clinical safety issues? In this article, we review key considerations for this population and opportunities for employers to design better benefits strategies. 

Understanding your population with EDs, and the risks of GLP-1 use 

How common is GLP-1 use and misuse by individuals with eating disorders in the United States? One recent study published in JAMA Psychiatry sought to quantify this by examining 436 adults with documented eating disorders. 32.1% of them reported lifetime GLP-1 use – more than double the rate in the general U.S. adult population – and 22% were currently taking a GLP-1 medication. 10% of those adults with eating disorders who had taken a GLP-1 medication reported misuse – including administering a dose at a different amount or for a different duration than what was prescribed – which carries implications for overall health outcomes, patient safety, and costs. 

Eating disorders are more common than many realize, and are critical to consider in the context of GLP-1s. While prevalence estimates vary, a recent review published in JAMA found that eating disorders globally affect 2% to 5% of individuals during their lifetime. Eating disorders affect approximately 5.5 million Americans, and binge eating disorder, bulimia nervosa, and anorexia nervosa are estimated to affect approximately 2 million, 600,000, and 400,000 adults, respectively.

In a 10,000 employee population, that’s roughly 200 people who may have experienced one of these three eating disorders – not including other atypical eating patterns like emotional eating, nighttime eating, and grazing that also complicate GLP-1 use. 

GLP-1 agonists work, in part, by slowing gastric emptying, reducing hunger signaling or so-called “food noise”, and blunting the brain’s response to food. For most people with obesity, those mechanisms are valuable for treatment. But for someone with a restrictive eating disorder, those same mechanisms can reinforce a pathological pattern that is already dangerous. 

For this reason, in 2025, four clinical societies – the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and the Obesity Society – jointly recommended screening for binge eating disorder, anorexia, bulimia, and night eating before initiating a GLP-1 medication. 

In a 2026 World Psychiatry consensus study, experts reached 100% agreement that GLP-1s should generally be avoided in people with active restrictive or restraint/purging-type eating disorders, particularly anorexia nervosa and bulimia nervosa. Experts also reached ~95% consensus that clinicians who are prescribing GLP-1 medications therefore need to assess all individuals for a current eating disorder or history of an eating disorder prior to the prescription. Even if individuals show no signs of an eating disorder at the time of GLP-1 initiation, experts agreed that all individuals who are receiving GLP-1 medications should be regularly monitored for signs of an eating disorder, including signs of extreme appetite loss, weight loss rates, and other clinical indicators.

Evidence-based eating disorder treatment rests on psychotherapy and rebuilding a nutritional approach with a foundation of regular meals, adequate portions, intuitive eating, and a normalized relationship with food. GLP-1 medications, when used without the appropriate clinical oversight, may counteract this treatment approach. 

Designing an evidence-based weight management program 

All clinically rigorous weight management programs that are prescribing GLP-1 medications should be screening individuals for eating disorders and other mental health concerns before providing access to GLP-1s – and at regular intervals during their treatment. 

Standard BMI eligibility screenings are not equipped to filter out individuals with eating disorders or those who are in recovery. Eating disorders are present in individuals across weight profiles, including in adults with obesity. According to a recent perspective published in NEJM, only 6% of people with an eating disorder are diagnosed as medically underweight. This tells us that many individuals with eating disorders using a GLP-1 medication for weight loss could have cleared a standard BMI-based eligibility screen. Restricting access based on weight or BMI alone leaves the highest-risk individuals undetected. 

Benefits leaders should consider programs that institute the following standards based on the clinical guidelines outlined above and evidence-based practices for eating disorders: 

  • Use a validated eating disorders screening instrument 
  • Administer the screening instrument at intake and repeat at regular intervals during the program 
  • Score individuals against published thresholds 
  • Connect individuals with positive flags through a defined referral pathway to clinical evaluation and evidence-based psychotherapy specifically for eating disorders
  • Develop standardized patient and provider educational materials on GLP-1 medications and EDs

The screening itself is not enough. A positive flag on a screener at any point in an individual’s program means that individual warrants more clinical attention. The actions that come after a screener are critical for patient safety and long-term outcomes. 

What to carry forward for effective GLP-1 program design 

The promise of GLP-1 medications is real, and so is the responsibility that comes with offering them at scale. To ensure effectiveness, organizations must target the right recipients, maintain strict clinical oversight, and integrate connected care for comorbidities like eating disorders. 

The employees most at risk from an unmanaged program may be the least visible, and standard weight and BMI eligibility screens will not surface them. Validated screening at intake and at regular intervals, scored against published thresholds and backed by a defined referral pathway, is what separates a program that delivers results from one that quietly puts its most vulnerable employees in harm's way.

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