Ozempic, Wegovy, Mounjaro—Oh My! In recent years, GLP-1 receptor agonists have garnered significant attention, particularly for their role in weight management. If you visit any celebrity gossip page, you’ll quickly come across commenters speculating about whether or not their favorite A-list celebrities are using medications like Ozempic. Similarly, while scrolling through social media, you might encounter spaces like “Ozempic-Tok,” where creators share their experiences with these medications, unfortunately, often pushing lots of dangerous misinformation.
As a therapist working with clients who have eating disorders, my role is not to automatically villainize these medications, but to help clients understand how they may impact their eating disorder symptoms. The same medication that’s beneficial for one client may pose severe risks for another, depending on their specific eating disorder history. Therefore, it’s essential for both clients and clinicians to examine the nuanced effects of these medications on disordered eating behaviors, hunger cues, and mood from an evidence-based perspective.
What Are GLP-1 Receptor Agonist Medications?
GLP-1 receptor agonists are a class of medications that were initially developed to manage type 2 diabetes. In recent years, with the exception of Wegovy, which is FDA approved for weight loss, these medications are increasingly being prescribed for the off label purpose of weight management. GLP-1 medications include:
- Semaglutide (Ozempic, Wegovy, Rybelsus)
- Dulaglutide (Trulicity)
- Exenatide (Byetta, Bydureon BCISE)
- Liraglutide (Victoza, Saxenda)
- Lixisenatide (Adlyxin)
The Science Behind How GLP-1s Work
GLP-1 receptor agonists work by mimicking the effects of glucagon-like peptide-1 (GLP-1), a hormone that plays a key role in managing appetite and food intake. Specifically, these medications affect brain pathways that regulate hunger and fullness by binding to GLP-1 receptors in the brain’s hypothalamus, the region of the brain responsible for regulating hunger. GLP-1s also help regulate blood sugar and enhance insulin secretion in response to meals, which reduces insulin resistance. They also delay gastric emptying and gut motility, decreasing the tendency for excess glucose to be stored as fat (Shah & Vella, 2014).
A newer medication called Tirzepatide (commercially known as Mounjaro), targets both the GLP-1 receptor and the GIP (gastric inhibitory peptide) receptor, affecting insulin regulation and energy balance (American Diabetes Association, 2023).
GLP-1s Impact on Eating Disorders
GLP-1 receptor agonists can alter hunger and fullness cues by affecting appetite regulation, leading to reduced hunger and increased feelings of fullness. Researchers suggests that these medications may serve to help reduce the frequency and severity of binge eating episodes associated with Binge Eating Disorder (BED) by modifying appetite and food reward pathways. However, the benefits must be weighed against potential risks. There are also concerns that these medications may inadvertently reinforce unhealthy eating behaviors, especially if they lead to an overemphasis on weight control or contribute to more rigid eating patterns (MDLinx, 2024). Even when used in the treatment of binge eating, prescribing physicians must remain cautious, as symptoms associated with Binge Eating Disorder can often shift to more restrictive eating patterns and behaviors in some clients.
For individuals with Anorexia or Bulimia Nervosa, GLP-1 receptor agonists may exacerbate restrictive eating behaviors by further suppressing appetite, potentially leading to increased malnourishment and heightening concerns about weight and body image. This may worsen distorted thoughts about food and the disorder itself (National Eating Disorders Association, 2024).
Gathering data on the impact of GLP-1 medications on restrictive eating disorders is not only challenging but also ethically complex. Consequently, there is limited research on how these medications affect disorders like Anorexia or Bulimia Nervosa. Misuse of these medications, whether through “off-label” overprescribing or illegal acquisition through “backdoor” online channels, adds to the risks and complexity of this issue.
Impact on Mood and Mental Health
Research has indicated that GLP-1 medications may affect brain regions involved in mood and emotional regulation. A 2024 article published in The Journal of Innovations in Clinical Neuroscience noted that GLP-1 medications might impact mood (Manoharan et al., 2024). An experimental study in rodents showed that GLP-1 agonists induced anxiety shortly after treatment began (Andenberg et al., 2016). Additionally, a randomized controlled trial of liraglutide showed a slight numerical imbalance in reports of suicidal ideation among participants (O’Neil et al., 2017). The European Medicines Agency (EMA) has reviewed data on the risk of suicidal thoughts with GLP-1 receptor agonists, including Ozempic, Saxenda, and Wegovy, following reports of increased suicidal ideation and self-injury (EMA, 2023).
Concerns also exist about the psychological impact for patients who experience a “weight loss plateau” as their body adapts to the medication. This can be particularly distressing if their current weight does not meet their weight loss expectations. A recent study raised concerns about GLP-1 medications potentially losing effectiveness over time and the likelihood of “rebound effects” in weight loss and behavioral outcomes (Arillotta et al., 2023). Additionally, genetic and biological factors might make these medications less effective for some individuals, highlighting the need for ongoing research to understand their psychological impact.
Monitoring and Consultation
Given the complex nature of eating disorders and their frequent co-occurrence with other mental health diagnoses, combined with concerns about how GLP-1 medications impact mood, it is crucial for clients taking these medications to be closely monitored by their psychiatric provider. Regular therapy sessions can help clients and physicians track any changes in mood and behavior, as well as support clients with navigating through the psychological aspect of their diagnosis, while working through unhelpful thoughts and behavioral patterns that worsen symptoms. Clients should also work with a dietetic specialist to receive guidance on nutrition, meal planning and to reconnect with internal hunger cues, especially considering the appetite suppressing effects of these medications.
While GLP-1 receptor agonists offer potential benefits for some individuals, particularly those with Binge Eating Disorder, their impact on hunger cues, eating behaviors, and mood must be carefully monitored. Collaboration with healthcare providers and ongoing monitoring are essential to ensure that these medications support overall treatment goals without unintended negative effects.
References
American Diabetes Association. (2023). Tirzepatide (Mounjaro) for the treatment of type 2 diabetes. Retrieved from https://diabetes.org
Andenberg RH, Richard JE, Hansson C et al. GLP-1 is both anxiogenic and antidepressant; divergent effects of acute and chronic GLP-1 on emotionality. Psychoneuroendocrinology. 2016;65:54–66.
Aoun L, Almardini S, Saliba F, Haddadin F, Mourad O, Jdaidani J, Morcos Z, Al Saidi I, Bou Sanayeh E, Saliba S, Almardini M, Zaidan J. GLP-1 receptor agonists: A novel pharmacotherapy for binge eating (Binge eating disorder and bulimia nervosa)? A systematic review. J Clin Transl Endocrinol. 2024 Feb 29;35:100333. doi: 10.1016/j.jcte.2024.100333. PMID: 38449772; PMCID: PMC10915596.
Arillotta D, Floresta G, Guirguis A, Corkery JM, Catalani V, Martinotti G, Sensi SL, Schifano F. GLP-1 Receptor Agonists and Related Mental Health Issues; Insights from a Range of Social Media Platforms Using a Mixed-Methods Approach. Brain Sci. 2023 Oct 24;13(11):1503. doi: 10.3390/brainsci13111503. PMID: 38002464; PMCID: PMC10669484.
Baggio LL, Drucker DJ. Glucagon-like peptide-1 receptor co-agonists for treating metabolic disease. Mol Metab. 2021 Apr;46:101090. doi: 10.1016/j.molmet.2020.101090. Epub 2020 Sep 25. PMID: 32987188; PMCID: PMC8085566.
European Medicines Agency. EMA statement on ongoing review of GLP-1 receptor agonists. 11 Jul 2023. Accessed 8 Apr 2024 https://www.ema.europa.eu/en/news/ema-statement-ongoing-review-glp-1-receptor-agonists
Manoharan SVRR, Madan R. GLP-1 Agonists Can Affect Mood: A Case of Worsened Depression on Ozempic (Semaglutide). Innov Clin Neurosci. 2024 Jun 1;21(4-6):25-26. PMID: 38938530; PMCID: PMC11208009.
MDLinx. (2024, August 8). Can GLP-1 medications worsen or trigger eating disorders? Retrieved from https://www.mdlinx.com
National Eating Disorders Association. (2024). GLP-1 medications and eating disorders. Retrieved from https://www.nationaleatingdisorders.org
O’Neil PM, Aroda VR, Astrup A et al. Neuropsychiatric safety with liraglutide 3.0 mg for weight management: results from randomized controlled Phase 2 and 3a trials. Diabetes Obes Metab. 2017;19(11):1529–1536.
Shah M, Vella A. Effects of GLP-1 on appetite and weight. Rev Endocr Metab Disord. 2014 Sep;15(3):181-7. doi: 10.1007/s11154-014-9289-5. PMID: 24811133; PMCID: PMC4119845.
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Stefanie Lawson is a licensed therapist with nearly a decade of clinical experience, and is the owner of The Mindfulness Space therapy in Greensboro, North Carolina. She specializes in treating underlying depression, anxiety, stress, unresolved trauma, and other mental health concerns that often lead to eating disorders and body image dissatisfaction, including Body Dysmorphic Disorder, in adults and transitional-aged teens.
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