On January 14^th, Monte Nido Vice President of Adolescent Medicine Rebecka Peebles, MD, FAAP, CEDS, DABOM. In this Monte Nido continuing education session, “The Weight of It All: Medications, Messaging & the Risk to Eating Disorder Recovery,” Dr. Peebles examined the rapid rise of GLP-1 receptor agonist medications and their implications for eating disorder risk, treatment, and recovery. The presentation focused on how these medications work, how weight-centric messaging shapes care, and why clinicians must approach prescribing and assessment with caution—particularly for individuals with current or past eating disorders.  

The session emphasized that weight loss medications exist within a broader cultural and medical context, and that their effects cannot be separated from issues of weight stigma, weight suppression, and eating disorder vulnerability.  

Key Takeaways

• GLP-1 medications cannot be viewed as weight-neutral interventions. Their effects on appetite, metabolism, and the central nervous system introduce meaningful risks for individuals with current or past eating disorders.
  

• Weight suppression is a critical clinical risk factor. GLP-1–associated weight loss may increase eating disorder vulnerability, medical instability, and poorer recovery outcomes, regardless of body size or BMI.
  
  

• Weight-centric messaging can obscure harm. Appetite suppression and weight loss may mask eating disorder symptoms, delay diagnosis, and reinforce stigma, particularly for patients in larger bodies.
  

• Medical and psychological side effects require careful monitoring. Loss of lean body mass, gastrointestinal distress, mood changes, and weight cycling pose heightened concerns in eating disorder treatment and recovery.
  

• Ethical, weight-inclusive care is essential. Clinicians should screen for eating disorders prior to prescribing, discuss risks transparently, monitor patients closely, and prioritize long-term recovery over short-term weight outcomes.
  
  

The Growing Presence of GLP-1 Medications  

While GLP-1 medications were originally introduced for diabetes management, their use at higher doses for weight-related indications has expanded significantly.  

Key points highlighted in the session included:  

• GLP-1 receptor agonists have been used clinically since 2005, with earlier formulations prescribed at lower doses  

• Newer medications and dosing regimens have increased weight loss outcomes  

• Public familiarity with medications such as Ozempic, Wegovy, Mounjaro, and Zepbound has grown rapidly  

• Increased access and demand have led to broader prescribing patterns and new clinical questions  

This growth has outpaced many clinicians’ training around eating disorder risk and weight-inclusive care.

How GLP-1 Medications Work  

GLP-1 is a hormone released in response to food intake that influences both metabolic and neurological processes.  

GLP-1 medications:  

• Increase insulin secretion  

• Decrease glucagon release  

• Slow gastric emptying  

• Reduce appetite and hunger signaling  

• Act on receptors in the central nervous system  

GLP-1 receptor activity in the brain, pancreas, liver, stomach, and adipose tissue, reinforce that these medications affect more than weight alone. These widespread effects help explain both their clinical impact and their potential risks.  

Weight Loss Outcomes and Long-Term Patterns  

Weight loss outcomes associated with GLP-1 medications highlight important limitations. While significant weight loss can occur during active treatment, the outcomes over time are variable.  

The session highlighted that:  

• Weight loss typically plateaus after an initial period  

• Weight regain commonly occurs after medication discontinuation  

• Repeated cycles of loss and regain raise medical and psychological concerns  

Focusing solely on short-term weight loss obscures longer-term patterns and may contribute to harm, particularly for individuals vulnerable to eating disorders.  

Side Effects and Medical Risks of GLP-1 Medications

It is important to address side effects and medical risks associated with GLP-1 medications. These risks are clinically significant and require careful monitoring.  

Side effects include:  

• Gastrointestinal symptoms such as nausea, vomiting, constipation, and diarrhea  

• Loss of lean body mass, with slides indicating that a substantial portion of weight loss may come from muscle  

• Mood-related changes, including depression, anxiety, and suicidal behavior  

• Increased risk of gallstones and hypoglycemia  

These effects may be especially concerning in patients with eating disorders, where nutritional status and medical stability are already compromised.  

Weight Suppression as a Key Risk Factor  

A central concept in the webinar was weight suppression, defined as the difference between a person’s highest historical weight and their current weight. Weight suppression is a significant risk factor in eating disorder development and recovery outcomes.  

The presentation highlighted that:  

• Weight suppression can increase eating disorder risk regardless of BMI  

• Larger degrees of suppression are associated with greater symptom severity  

• Weight suppression is linked to medical instability and poorer recovery outcomes  

Weight suppression should be understood as a clinical concern rather than a marker of success.  

Weight Stigma and Clinical Messaging  

Weight-centric messaging in healthcare contributes to stigma and harm, and framing thinness as healthier or more desirable reinforces bias and can negatively impact patient care.  

Key points included:  

• Weight stigma influences how patients are assessed, diagnosed, and treated  

• Patients in larger bodies may receive delayed or inappropriate care  

• Fear of judgment can lead patients to avoid healthcare settings  

Weight stigma is not neutral, and it directly affects clinical outcomes.  

GLP-1 Medications and Eating Disorders  

The presentation addressed clinical scenarios in which GLP-1 medications intersect with eating disorder care. These included individuals prescribed GLP-1s prior to an eating disorder diagnosis, as well as individuals who developed eating disorder symptoms after starting medication.  

The session highlighted concerns that:  

• Appetite suppression may mask eating disorder symptoms  

• Weight loss may be misinterpreted as clinical improvement  

• Binge eating disorder may be misdiagnosed, particularly in larger-bodied individuals  

It is necessary to emphasize the importance of careful screening and ongoing assessment.  

Ethical Considerations and Clinical Responsibility Around GLP-1 Medications

The session concluded with guidance for clinicians navigating these complexities. The presenter emphasized the need for weight-inclusive, ethically grounded care that prioritizes safety and informed consent.  

Recommendations outlined included:  

• Screening for eating disorders before initiating GLP-1 medications  

• Discussing risks related to weight suppression and discontinuation  

• Monitoring medical, nutritional, and psychological status closely  

• Collaborating across disciplines  

• Approaching concerns with curiosity rather than judgment  

Ethical care requires attention not only to what medications can do, but also to whom they may harm.  

Rethinking GLP-1 Medications Through an Inclusive and Informed Lens

This continuing education session underscored that GLP-1 medications cannot be viewed in isolation from cultural messaging, weight stigma, and eating disorder risk. While these medications play a role in metabolic care, they also introduce significant clinical considerations, particularly for individuals with current or past eating disorders.  

The presentation emphasized that weight loss is not synonymous with health, and that protecting eating disorder recovery requires intentional, informed, and weight-inclusive clinical practice.  

Learn more through Monte Nido’s Continuing Education webinars for professionals.

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