GLP-1s and a Hidden Risk of Weight Loss
The overlooked link between weight loss and eating disorder relapse.
Posted June 1, 2026 | Reviewed by Michelle Quirk
The growing popularity of GLP-1 medications such as Ozempic, Wegovy, and Zepbound has sparked important conversations about obesity, diabetes, and health. Much of the discussion has focused on their ability to reduce appetite and produce meaningful weight loss. For many people, these medications may offer substantial medical benefits.
Alongside the enthusiasm surrounding GLP-1 medications, eating disorder specialists have been asking a different question: What happens when someone with a history of anorexia begins losing weight?
This concern is not simply about appetite suppression. It is about something many eating disorder clinicians have observed for years: For certain individuals, weight loss itself appears capable of reactivating aspects of an eating disorder that had long been dormant.
I have seen this happen in people who considered themselves fully recovered. They were eating normally, maintaining relationships, building careers, and no longer consumed by thoughts of food or weight. Then something caused weight loss. Sometimes it was a diet. Sometimes it was an illness. Sometimes it was a period of stress . Increasingly, the weight loss may be driven by a GLP-1 medication .
The Return of Familiar Patterns
As weight drops, familiar patterns can start to emerge. The person becomes more invested in maintaining the weight loss. The number on the scale carries greater emotional significance. Fear of weight regain can become increasingly consuming. Eating less may begin to feel increasingly rewarding, rekindling the sense of mastery, accomplishment, and control that once made the illness so compelling.
One reason this process can be difficult to recognize is that the early stages of relapse often do not feel alarming. They may feel productive, successful, or even exhilarating.
Many people describe the experience in remarkably similar terms. They often say that it feels as though the eating disorder has awakened.
Weight Loss Is Not a Neutral Event
One of the assumptions built into our culture is that weight loss is inherently beneficial. For many people, that may be true. For individuals with a history of anorexia, however, weight loss is often not a neutral physiological event.
Many recovered individuals are surprised by how quickly old thoughts can return. They assume that because they no longer want anorexia, they are protected from it. In reality, the reemergence of eating disorder thoughts often has little to do with desire. It can feel more like an old pathway becoming active again.
Researchers are still working to understand why this occurs. However, one of the most influential findings in eating disorder research offers an important clue. During the Minnesota Starvation Experiment conducted during World War II, healthy men with no history of eating disorders were placed on a period of semi-starvation. As weight loss progressed, many became preoccupied with food, developed rigid eating rituals, and experienced significant emotional changes.
The study demonstrated that restriction and weight loss do not simply result from eating disorder thinking. They can also help create it.
For individuals who have previously struggled with anorexia, this observation may be particularly relevant. Their brains have traveled this road before. Weight loss may reactivate cognitive, emotional, and behavioral patterns that were central to the original illness. Clinically, many patients describe this not as a conscious decision to return to anorexia, but as a gradual shift in what feels important, rewarding, and worth pursuing.
This phenomenon helps explain why GLP-1 medications deserve special attention in individuals with a history of anorexia.
These medications can produce significant weight loss while simultaneously reducing hunger and increasing feelings of fullness. For many patients, that combination can feel surprisingly effortless.
For someone with a history of anorexia, however, that ease may be part of the concern. The absence of hunger can make inadequate intake feel natural rather than concerning. Weight loss may be interpreted as evidence that things are going well.
GLP-1s and Body Image
Perhaps more importantly, weight and shape can begin to occupy a larger place in a person's identity . What starts as a health goal can gradually become a measure of success, discipline, self-control , or even personal worth. One of the defining features of anorexia is not simply restriction but the increasing importance assigned to weight and shape in self-evaluation. As weight loss progresses, that shift can occur so gradually that neither the individual nor those around them recognize it until it is well underway.
Friends, family members, and healthcare providers may offer praise. Because the process occurs within a medical framework, warning signs that might otherwise attract attention can be overlooked.
A person who begins skipping meals while taking a GLP-1 medication may receive a very different response than a person who begins skipping meals without one, even if the nutritional consequences are identical.
This does not mean that everyone with a history of anorexia should avoid GLP-1 medications. Nor does it mean that every individual who takes one will experience a relapse. It does mean that eating disorder history deserves to be a central part of the conversation. The question is not simply whether a medication helps someone lose weight. It is whether the weight loss begins to reactivate the psychological processes that made the original illness possible.
Nourishment Still Matters
One aspect of this discussion often gets lost amid the excitement surrounding weight loss.
Human beings do not eat simply to manage body size. We eat because food provides the nutrients necessary for every system in the body to function properly. Adequate nutrition supports brain health, hormone production, bone density, immune function, energy levels, concentration , and emotional regulation .
When food intake becomes significantly reduced, whether through dieting, illness, or medication-induced appetite suppression, meeting nutritional needs can become more difficult. In clinical practice, I have worked with many individuals who were surprised to discover that eating too little affected far more than their weight. It affected their mood, their relationships, their ability to think clearly, and their overall quality of life.
Perhaps one unintended consequence of the GLP-1 era is that it has encouraged us to view appetite as a problem to be solved. Yet hunger is not a flaw in human design. Appetite is not evidence that something is wrong. These systems evolved to help keep us nourished and alive.
As GLP-1 medications continue to reshape the landscape of weight management , I hope we can hold two truths at the same time. These medications may offer meaningful benefits for many people. At the same time, individuals with a history of anorexia deserve thoughtful monitoring and informed conversations about the unique risks they may face.
The most important question may not be whether a medication suppresses appetite. It may be whether the weight loss it produces reactivates psychological and biological processes that were thought to be long behind us.
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Melissa Gerson, LCSW, is founder and Clinical Director of Columbus Park Center for Eating Disorders, an outpatient facility providing treatment to individuals of all ages and genders.
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.