A Banks. N Engl J Med 2026;394:1665-1667. GLP-1 Receptor Agonists and Eating Disorders — Cause for Concern.

An excerpt:

Constraining the growth of the global obesity epidemic would have clear benefits at the individual and population levels. Use of GLP-1 drugs has been linked in some patients to improved cardiovascular outcomes, a reduced risk of kidney disease, a reduced desire to drink alcohol, and potentially protective effects against neurodegenerative diseases. It is therefore easy to understand the substantial interest in investing in the development of these products and the optimism about their public health effects.

Nonetheless, some worrisome signals have emerged…The proportion of GLP-1 receptor agonist prescriptions that were written for people without diabetes, obesity, or overweight increased from 4.5% in 2018 to 17% in 2023…¹

There is also compelling preliminary evidence suggesting that the use of these drugs could exacerbate and lead to new diagnoses of restrictive eating disorders, including anorexia nervosa…³ Lifetime prevalence of anorexia nervosa is as high as 6.3% in women and 0.3% in men,⁴ and the risk of death from any cause among people with anorexia nervosa is more than five times as high as that in the general population…⁵

Nutrient deficiencies, electrolyte abnormalities, orthostatic hypotension, osteopenia, sarcopenia, thinning hair, and other signs of malnutrition have been observed [in users of GLP-1 agents], and the effects of long-term use are still largely unknown…

The cumulative incidence of new eating-disorder diagnoses (most commonly anorexia nervosa) in the full study population was 1.275%…³ this proportion translates to more than 420,000 people who could develop a related eating disorder with long-term use.

Physicians, trialists, regulators, policymakers, and drug developers are unprepared for this coming wave.

My take: GLP-1 RAs are not for everybody; they will likely contribute to eating disorders in many patients.

GLP-1 RAs also have been associated with a higher risk of Nonarteritic Anterior Ischemic Optic Neuropathy (aka ‘eye stroke’) in approximately in 1 in 10,000 recipients. One reference: JAMA Ophthalmology. 2026;144;(3):259-264. New-Onset Nonarteritic Anterior Ischemic Optic Neuropathy and Initiators of Semaglutide in US Veterans With Type 2 Diabetes

Related blog posts:

• In the News: FDA Approves 2nd Oral GLP-1, Another Vaccine Reduces Risk of Dementia, and Costs of Vaccine-Preventable Diseases
• Reduced Dosing of GLP-1 RAs May Work for Maintenance Treatment of Obesity
• GLP-1 Use Associated with Lower Risk of Colon Cancer
• More Pediatric Data Supporting GLP-1 RA Efficacy for MASLD
• The Risks and Absolute Risks of GLP-1 RAs and Gastrointestinal Adverse Events
• Highly Prevalent Pediatric Feeding Disorders
• Changing Approach to Refeeding Syndrome in Children/Adolescents with Eating Disorders
• Prevalence of Avoidant/Restrictive Food Intake Disorders in Pediatric Neurogastroenterology