Innovation Briefing: GLP-1 Misuse, Eating Disorders, and the Case for Clinical Oversight

12% of U.S. adults have now taken a GLP-1 medication, but a growing body of research shows a meaningful share of them are getting no clinical oversight at all. In this Live Innovation Briefing, Dr. James Lyda and Dr. Nishu Uppal walk through the latest research on GLP-1 misuse and eating disorder risk.

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Why GLP-1 misuse is a bigger risk than most employers realize

GLP-1 misuse includes escalating a dose early, taking less than prescribed, extending the duration between doses, tampering with an injector pen, sharing medication without a prescription, stretching a pen to save money, and under-dosing. It also includes taking a GLP-1 when it isn't a good fit for the individual patient.

A 2026 study published in JAMA Psychiatry (Piper et al.) surveyed U.S. adults with eating disorders and found that 32% reported lifetime GLP-1 use — roughly double the 12–15% seen in the general population — and 10% reported misuse, with another 10% reporting use of a compounded product.

The overlap between GLP-1 use and eating disorders is real, and often invisible

In the US, the lifetime prevalence of anorexia nervosa is about 0.8%, bulimia about 0.28%, and binge eating disorder about 0.85%. For an employer with 10,000 covered lives, that's roughly 190 people across those three diagnoses alone, before accounting for the far more common patterns of grazing, nighttime eating, and emotional eating. GLP-1s are not indicated for eating disorder treatment, and their appetite-suppressing effects can reinforce restrictive eating patterns in members who have an active eating disorder.

What the research says about hunger, not just weight loss

A landmark 2025 New England Journal of Medicine review reframed hunger as two distinct systems: homeostatic hunger (eating because the body needs calories) and hedonic hunger (eating in the absence of caloric need, driven by emotion, habit, or lifestyle triggers). GLP-1s appear to suppress hedonic hunger while someone is on the medication, which is a large part of why the majority of people who lose weight on a GLP-1 and then stop it regain that weight within one to two years. Hedonic hunger is measurable using a validated tool called the Power of Food Scale, which makes it possible to design behavioral treatment around it rather than relying on medication alone.

A separate meta-analysis of GLP-1 trials (using liraglutide vs. placebo) found a low-to-medium effect (standardized mean difference of roughly 0.35) on both eating restraint and emotional eating. This is evidence that the right behavioral support paired with medication can meaningfully change eating behavior, not just body weight.

Five questions to ask any GLP-1 or weight management vendor

Dr. Lyda recommends a five-question evaluation checklist for benefits leaders and consultants when discussing GLP-1 programs:

1. What do you screen for before the first dose — and what is your eating disorder screen, specifically?
2. What do you rescreen for at regular intervals (e.g., week 12, week 24), and what score triggers a referral?
3. Who does a member talk to when they stop eating or stop medication — a licensed clinician, or a support inbox?
4. What is your plan for discontinuation, and what do your persistence and regain numbers look like at 12 and 24 months?
5. What else do you treat?

As Dr. Lyda puts it: "A prescribing pathway with no eating disorder screen isn't just a lighter touch program — it's a pathway that could unknowingly hand a powerful appetite suppressant to someone with a restrictive illness."

Why "cheaper GLP-1 pricing" alone doesn't solve the underlying problem

Dr. Uppal's closing point directly addresses the budget conversation many employers are having right now: "It's really important to avoid the bridge to nowhere." Switching to a lower-cost GLP-1 vendor without addressing why people cycle on and off the medication just delays the same cost problem - it doesn't fix it. The research shows the real driver of long-term ROI is pairing GLP-1 medication with behavioral support and co-treatment of related comorbidities so members don't regain the weight, and don't need the medication indefinitely.

About the panelists

James Lyda, PhD is a licensed psychologist and the Director of Mental Health at Goodpath, where he leads eating disorder screening efforts for GLP-1 members. Nishu Uppal, MD, MBA is Goodpath's Medical Director, a practicing internal medicine physician at Massachusetts General Hospital, and a health policy researcher on faculty at Harvard Medical School.