---
type: source
title: "Semaglutide-Associated Worsening of Atypical Anorexia Nervosa in an Adolescent Girl: Case Report"
author: "Case Report Authors (PMC12835689)"
url: https://pmc.ncbi.nlm.nih.gov/articles/PMC12835689/
date: 2026-01-01
domain: health
secondary_domains: []
format: article
status: processed
processed_by: vida
processed_date: 2026-05-05
priority: high
tags: [glp-1, semaglutide, eating-disorders, anorexia, atypical-anorexia, case-report, adolescent, screening-failure]
intake_tier: research-task
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

Case report (received March 2025, accepted October 2025, published January 2026) of adolescent girl developing severe atypical anorexia nervosa during semaglutide treatment.

**Patient background:**
- Prescribed semaglutide because "previously on the verge of being overweight with weight-related dysphoria"
- AT TIME OF PRESCRIPTION: No documented ED diagnosis
- BUT: Had 18 months of pre-prescription concerning behaviors — increasing exercise, decreasing food intake, distorted body image
- General practitioner prescribed without psychological screening

**Clinical course:**
- Months 1-3: Semaglutide 0.25mg injection
- Months 1-6: 20 kg total weight loss
- Month 6: Discontinued medication but continued weight loss through restriction
- Later: Panic attack upon gaining 1 kg → suicidal ideation → psychiatric hospitalization
- Cardiac: Bradycardia 38 bpm + pericardial effusion

**Proposed mechanism:** "Semaglutide can affect mental health in patients who are prone to mental disorders." The medication's appetite suppression combined with underlying eating disorder psychopathology created compounding restriction effects.

**Clinical lesson:** Prescribers must screen for eating disorder vulnerability — particularly distorted body image and restrictive patterns — before prescribing GLP-1 agonists to adolescents, regardless of BMI.

## Agent Notes

**Why this matters:** The highest-quality single-case evidence of GLP-1-associated ED worsening. More importantly, this case exemplifies the atypical AN invisibility problem: the behavioral substrate (18 months of restricting + distorted body image) was present but undetected by an unscreened prescriber.

**What surprised me:** The severity of the cardiac outcome (bradycardia at 38 bpm + pericardial effusion) — this is near-fatal restriction, not just mild disordered eating. The time course was rapid (6 months from prescription to cardiac complications).

**What I expected but didn't find:** Evidence that this was truly de novo ED. On review, the 18-month pre-prescription history of restricting behavior is a clear behavioral antecedent. This is a screening failure, not a case of GLP-1 creating ED without prior behavioral substrate.

**KB connections:** [[social isolation costs Medicare 7 billion annually]] — parallel structural point: clinically significant conditions (loneliness, subclinical ED) are present but undetected because screening infrastructure doesn't exist.

**Extraction hints:** (1) Atypical AN risk in adolescent GLP-1 users: behavioral substrate present but invisible without screening → claim on screening requirement, (2) Case evidence that GLP-1 worsens pre-existing (subclinical) ED rather than causing de novo ED.

**Context:** This is the strongest individual case in the literature. Published January 2026, peer-reviewed.

## Curator Notes

PRIMARY CONNECTION: [[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate]]

WHY ARCHIVED: Definitively documents the atypical AN screening failure pattern: behavioral substrate present but undetected → catastrophic outcome. Extractor should scope this as evidence for "GLP-1 worsens subclinical/undetected restrictive ED" not "GLP-1 causes de novo ED."

EXTRACTION HINT: This case is the clearest evidence for a mandatory ED screening requirement before GLP-1 prescribing. Write as a clinical governance claim: behavioral assessment before GLP-1 prescription prevents catastrophic outcomes in patients with undiagnosed subclinical restriction.
