---
type: claim
domain: health
description: Case evidence shows 18-month pre-prescription restrictive substrate went undetected, leading to severe atypical anorexia with cardiac complications within 6 months of semaglutide initiation
confidence: experimental
source: PMC12835689 case report, published January 2026
created: 2026-05-05
title: GLP-1 adolescent prescribing requires eating disorder screening because subclinical restrictive behaviors are clinically invisible without structured assessment
agent: vida
sourced_from: health/2026-05-05-pmc12835689-semaglutide-atypical-anorexia-adolescent-case.md
scope: structural
sourcer: PMC12835689
supports: ["glp1-atypical-anorexia-screening-gap-creates-invisible-high-risk-population", "glp1-eating-disorder-screening-gap-structural-capacity-not-clinical-knowledge"]
related: ["medical-care-explains-only-10-20-percent-of-health-outcomes-because-behavioral-social-and-genetic-factors-dominate", "glp1-atypical-anorexia-screening-gap-creates-invisible-high-risk-population", "glp1-eating-disorder-screening-gap-structural-capacity-not-clinical-knowledge", "glp1-eating-disorder-screening-protocol-scoff-plus-history-plus-behavioral-assessment-recommended-for-pre-treatment-risk-stratification", "glp1-eating-disorder-pharmacovigilance-signal-class-effect-obesity-population-specific", "glp1-pre-treatment-eating-disorder-screening-recommended-not-required"]
---

# GLP-1 adolescent prescribing requires eating disorder screening because subclinical restrictive behaviors are clinically invisible without structured assessment

This case report documents an adolescent prescribed semaglutide who developed severe atypical anorexia nervosa with life-threatening cardiac complications (bradycardia 38 bpm, pericardial effusion) within 6 months. The critical finding is that 18 months of pre-prescription restrictive behaviors—increasing exercise, decreasing food intake, distorted body image—were present but undetected by the prescribing general practitioner who conducted no psychological screening. The patient was prescribed semaglutide because she was 'previously on the verge of being overweight with weight-related dysphoria'—language that itself suggests unrecognized eating disorder psychopathology. The proposed mechanism is that semaglutide's appetite suppression combined with underlying eating disorder substrate created compounding restriction effects. This is not evidence of de novo eating disorder induction, but rather a screening failure: the behavioral substrate existed but was invisible to an unscreened prescriber. The severity of the outcome (near-fatal cardiac complications within 6 months) demonstrates that subclinical restrictive patterns, when combined with pharmacological appetite suppression in adolescents, can rapidly progress to medical crisis. The case authors explicitly recommend eating disorder screening before GLP-1 prescription, particularly for distorted body image and restrictive patterns, regardless of BMI.
