Over the past year, a particular kind of person has started showing up in my inbox. They are usually in their thirties or forties. They had largely or fully recovered from an eating disorder, sometimes diagnosed, sometimes not. They got better, or better enough. They built a life.
A doctor, or a friend, or an ad suggested a GLP-1. Ozempic, Wegovy, Mounjaro, Zepbound. And somewhere in the first few months, the eating disorder they thought was behind them walked back in.
If this is you, I want you to know two things before anything else. You are not unusual. And you did not do anything wrong.
Why GLP-1s can bring an eating disorder back
GLP-1 medications work, in part, by turning down appetite. For someone with no eating disorder history, that’s the mechanism. For someone whose brain has been wired by an eating disorder to experience not eating as safety, control, or relief, it’s something else: it’s the illness, handed back with a prescription.
Here’s what I hear, almost word for word, from client after client:
“Then I noticed I was proud of how little I was eating.”
“The weight came off and people said I looked great, and I felt that old pull.”
“I started to fear hunger and see it as a bad thing.”
The medication suppresses your hunger cues, and for someone with an eating disorder history, reduced hunger is fuel. The illness grabs onto it. I’m not hungry becomes I shouldn’t eat, and the familiar voice comes back: don’t eat, focus on the weight, eating is bad. Not because you’ve lost your willpower or forgotten what you learned in recovery, but because an eating disorder is an illness, and this is what the illness does when it’s given an opening. For a brain with that history, the gap between the medication’s effect and the eating disorder’s voice can close in weeks.
And the praise makes it worse. Weight loss in our culture is treated as an unambiguous good. Nobody asks whether you’re eating. Nobody asks whether you’re cold all the time, or whether your hair is thinning, or whether your world has started to get smaller. They say you look amazing. The eating disorder agrees.
The part nobody warned you about
Most people starting these medications are never asked about eating disorder history. Not by the prescriber, not by the telehealth service, not by the med spa. It’s not on the intake form. If it had been, a lot of the people I’m seeing would have had a different conversation before the first injection.
And even when the history is known, it often doesn’t change anything. Weight stigma runs deep in medicine. A clinician can know you had an eating disorder and still believe, sincerely, that the most important thing for your health is for you to be smaller, that your history is unfortunate but your weight is the problem to solve. In that frame, a medication that makes you eat less looks like a solution rather than a risk. The eating disorder couldn’t have designed a better ally.
I say this not to blame prescribers, who are mostly doing what the guidelines tell them, but because I think it’s important that you understand the relapse wasn’t a personal failure. Nobody checked whether the door was locked before they opened it.
There’s also a medical piece that gets missed. Restriction plus a GLP-1 is not the same as a GLP-1 alone. Dehydration, electrolyte shifts, gallbladder problems with rapid loss, slowed heart rate. These are real, they happen at every body size, and they’re easy to overlook in someone whose weight still looks “fine” to a clinician who isn’t thinking about eating disorders.
What I’d want you to know
The medication question is yours to make, with help. We’re not going to tell you to stop taking it, and I’d be suspicious of anyone who does that over the internet. Whether to continue, taper, or stop is a decision for you, your prescriber, and a therapist who understands eating disorders, made together, not by the eating disorder. What I will say is that the decision shouldn’t be made alone, and it shouldn’t be made in a state of under-nourishment, because an underfed brain is not a good decision-maker about food.
Part of you may want to keep the weight off. Wanting that is understandable. It doesn’t mean you failed at recovery, and it doesn’t mean you’ve betrayed anything you believe. It makes you a person living in a culture that has told you your whole life that smaller is better. You can hold that wish and still decide that the eating disorder doesn’t get to run your life again. Those aren’t in conflict. Working with that ambivalence is most of what early treatment is.
The way out is the same as it was last time. Regular, adequate eating, on a schedule, not on appetite, because appetite is currently being chemically suppressed and cannot be trusted to tell you what you need. Getting a medical team that’s actually looking. Finding someone to talk to who won’t congratulate you on the weight loss. Letting the people who love you know what’s happening, because the eating disorder thrives in private.
You caught it. You noticed. You’re reading this. That is the thing that separates a relapse from a return to the illness: somebody saw it early, and this time it’s you.
If you want help
This is a lot of what we do at Body Liberation Collective: adults whose eating disorder history has been reactivated, by a GLP-1 or anything else, who want to get their footing back without being told to lose weight or to stop caring that they want to. We work weight-inclusively, we coordinate with your prescriber and your doctor, and we don’t start from the assumption that you did something wrong.
If you’re reading this and recognizing yourself, reach out. You don’t have to have decided anything about the medication to make the call.
Body Liberation Collective provides eating disorder therapy in Scarsdale, NY and virtually across New York, New Jersey, and Connecticut. This post is for information and isn’t a substitute for medical or psychological care. If you’re having thoughts of harming yourself, please contact the 988 Suicide & Crisis Lifeline.