A study published this week in JAMA Psychiatry has quantified something that clinicians have suspected for a while: people with eating disorders are using GLP-1 medications like semaglutide at much higher rates than the general population - and a significant portion are misusing them.
The research, from a team including researchers at the University of Louisville, is the first large-scale study to measure GLP-1 use and misuse specifically among people with eating disorders. The findings are worth understanding.
The Numbers
The study examined data from 436 people with eating disorders, including people who reported being in remission. Participants were recruited through a network of studies, national eating disorder organisations, and targeted online outreach.
Key findings:
- 32% reported lifetime use of a GLP-1 drug (having taken one at some point)
- 22% reported currently taking a GLP-1
- 10% reported lifetime misuse of a GLP-1
- 10% reported having taken a compounded GLP-1
For context, the researchers cite estimates of GLP-1 lifetime use among the general US population at around 15-18%. The eating disorder population is using these drugs at roughly double the rate of the general public.
What Counts as Misuse?
The researchers defined misuse in several specific ways:
- Starting on a larger dosage than prescribed
- Increasing a dosage before the recommended schedule
- Sharing the drug with people who didn’t have a prescription
- Obtaining the drug without a prescription
These are important distinctions. Not all off-label use is misuse, and not all misuse is the same. Someone who increases their dose a few days early is in a different situation from someone sharing their prescription with a friend.
But the 10% misuse rate is notable, particularly because GLP-1 drugs are not indicated for any eating disorder. The medications are approved for type 2 diabetes and obesity - not for anorexia nervosa, bulimia, or other eating disorder conditions.
The Clinical Picture
The study found some interesting patterns across different types of eating disorders.
Lifetime GLP-1 use was lower among people with typical anorexia nervosa - around 10%. This makes some clinical sense, as people with anorexia are generally underweight and may not seek out weight-loss medications.
But for other eating disorders, particularly those involving binge eating or cycles of restriction and weight loss, the rates were much higher. The researchers noted that some eating disorder populations - like people with atypical anorexia nervosa (someone with anorexia who is at a “normal” or higher weight after losing substantial weight) or binge eating disorder - could have metabolic or cardiovascular complications that make GLP-1 drugs seem clinically appropriate.
The problem is that GLP-1 drugs suppress appetite. For someone with an eating disorder characterised by restriction, that appetite suppression could reinforce dangerous patterns rather than help them.
What the Research Says
There’s an interesting wrinkle here. Some research suggests GLP-1 drugs could actually be effective for binge eating disorder specifically. The appetite-suppressing effects that are dangerous for someone with anorexia could theoretically help someone with binge eating disorder who struggles with loss-of-control eating.
This is an area where the science is genuinely unsettled. A 2024 review in the journal Psychopharmacology noted that GLP-1 receptor agonists showed promise for reducing binge eating episodes in preliminary studies, but the evidence base was too small to draw conclusions.
The JAMA Psychiatry researchers acknowledge this complexity. They write that GLP-1 drugs are “not indicated for any eating disorder” but note that “some research suggests GLP-1s could be an effective treatment for binge eating disorder.” The challenge is that the same drug could be therapeutic for one eating disorder and harmful for another.
The Compounding Factor
The finding that 10% of participants had used compounded GLP-1s is particularly relevant for the Australian context.
Compounded GLP-1 drugs - made by compounding pharmacies rather than the original manufacturers - have become a major access point in the US. They’re generally cheaper than brand-name versions and don’t require the same level of medical oversight. But they also don’t go through the same quality testing.
In Australia, the compounding landscape is different. The TGA regulates compounding pharmacies, and compounded versions of approved GLP-1 drugs exist in a regulatory grey area. But the broader point applies: when approved medications are expensive or hard to access, people turn to alternative sources. And those alternative sources don’t always come with appropriate medical screening.
The Australian Context
The study’s findings are relevant for Australia’s peptide research community for a few reasons.
First, eating disorders affect a significant portion of the Australian population. The Butterfly Foundation estimates that around 1 million Australians are living with an eating disorder. That’s a large population that could potentially seek out GLP-1 compounds.
Second, the grey market for peptides and research compounds in Australia includes GLP-1 drugs. We’ve written before about the risks of unregulated products, and the JAMA Psychiatry data suggests that people with eating disorders may be particularly vulnerable to these risks.
Third, the researchers specifically call for “GLP-1 RA pharmacovigilance as the commercial market expands from injectable to oral products and new formulations.” The shift to oral GLP-1 drugs could make these compounds easier to obtain and use without medical oversight - which could increase misuse among vulnerable populations.
What This Means for Research Literacy
This study is a good example of why research literacy matters. The findings don’t mean GLP-1 drugs are inherently dangerous for everyone with an eating disorder. They don’t mean that everyone using compounded versions is misusing them. And they don’t mean that GLP-1 drugs can’t help some people with certain eating disorders.
What they do mean is that the relationship between GLP-1 drugs and eating disorders is complex, and that more research is needed to understand which patients might benefit and which might be harmed.
For the research community, the key takeaways are:
- Self-reported data has limitations. The actual rates of use and misuse could be higher than what the study found, because people may underreport behaviours they know are problematic.
- The grey market makes oversight harder. When people can obtain GLP-1 drugs without a prescription, there’s no physician to screen for eating disorder history.
- Oral formulations change the equation. Injectable drugs have a natural barrier - you need needles and some technical knowledge. Oral drugs remove that barrier, which could increase both appropriate and inappropriate use.
The researchers plan future studies to provide more precise estimates of GLP-1 use across different types of eating disorders and to better track patterns of misuse. That research will be important for informing clinical guidelines and regulatory decisions.
Sources
Source: JAMA Psychiatry - GLP-1 receptor agonist use among people with eating disorders (2026) Source: Gizmodo - People With Eating Disorders Are Misusing Ozempic Source: Psychopharmacology - GLP-1 receptor agonists and binge eating (2024) Source: Butterfly Foundation - Eating disorder statistics Australia
Disclaimer: This article is for educational and informational purposes only. It does not constitute medical advice, therapeutic recommendations, or endorsements of any compound. Grey Highway is a research-education community. We do not sell, supply, or promote the use of research compounds. Always consult a qualified healthcare professional regarding health decisions. For Australian regulatory information, visit the TGA website.