---
type: source
title: "Doctors Are Worried About Prescribing GLP-1s to Certain Patients"
author: "National Geographic Health"
url: https://www.nationalgeographic.com/health/article/glp-1-drugs-eating-disorder-risks
date: 2025-01-01
domain: health
secondary_domains: []
format: article
status: unprocessed
priority: medium
tags: [glp1, eating-disorders, clinical-concerns, prescribers, anorexia, atypical-anorexia, misuse, online-access]
intake_tier: research-task
---

## Content

National Geographic health article documenting clinician concerns about GLP-1 prescribing in eating disorder-vulnerable populations.

Key clinical findings:
- Case report 2025: 39-year-old patient with anorexia taking a GLP-1 drug despite having an extremely low BMI of 16 — acquired online by misrepresenting their weight
- Some clinicians now state they "won't give a GLP-1 if they discover a patient had a period of anorexia, or even atypical anorexia" — informal contraindication emerging in specialist practice before any formal guideline
- A 2023 analysis of FDA adverse-event reports found misuse reports for semaglutide were FOUR TIMES higher than for other GLP-1 drugs at the time
- Semaglutide associated with remarkably higher levels of abuse, intentional product use issues, and use without a prescription

Key research gap: "To date, no clinical evidence links GLP-1RA use to the onset or worsening of anorexia nervosa" — the mechanistic concern is real but causality unproven in clinical trials

BED-positive evidence: Some studies found decreased binge eating episodes for BED and bulimia nervosa — but small samples (3-6 months only)

Screening: Most patients receive NO evaluation for eating disorders before GLP-1 prescription. Psychologist Robyn Pashby (also quoted in NPR article) again: "hold two truths" framing.

## Agent Notes
**Why this matters:** The FOUR TIMES higher misuse rate for semaglutide vs. other GLP-1 drugs is striking — semaglutide is the highest-profile, most socially amplified agent (Ozempic, Wegovy branding). This suggests the social narrative/media attention around semaglutide specifically creates a misuse signal that is partially a Clay-domain problem: the "Ozempic" cultural narrative drives both (a) high prescribing volume and (b) high-risk off-label use without screening.

**What surprised me:** The BMI 16 case where a patient acquired the drug online by lying about their weight — this documents that the supply chain for GLP-1s has no clinical gate at all for at-risk patients. BMI 16 is severe anorexia territory where appetite suppression is potentially fatal. The clinical gate should be obvious (screen for low weight, screen for eating disorder) but clearly isn't operational even in the extreme case.

**What I expected but didn't find:** Any pharmaceutical company (Novo Nordisk, Eli Lilly) communication about eating disorder risk monitoring in their post-marketing commitments.

**KB connections:**
- [[Big Food companies engineer addictive products by hacking evolutionary reward pathways]] — the "Ozempic" brand narrative creates a parallel to food marketing: aspirational weight loss framing overrides safety awareness
- [[consumer willingness to pay out of pocket for AI-enhanced care is outpacing reimbursement]] — same dynamic for GLP-1s: OOP consumer demand bypasses clinical gatekeeping

**Extraction hints:** The semaglutide misuse rate (4x higher than other GLP-1s) is a specific, citable data point that connects the pharmacovigilance signal to the social/narrative amplification dynamic. Claim candidate: "Semaglutide's higher misuse rate relative to other GLP-1 receptor agonists reflects cultural narrative amplification ('Ozempic') rather than pharmacological superiority, creating a population-selection artifact in eating disorder pharmacovigilance signals."
**flagged_for_clay**: The "Ozempic" cultural narrative as a health risk vector — the brand story creates misuse behaviors. This is the clearest health-narrative intersection so far.

**Context:** Journalism with expert quotes. Not primary evidence but documents clinical practice evolution (informal contraindications emerging before formal guidelines).

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035]]
WHY ARCHIVED: The semaglutide misuse rate (4x higher) and the BMI 16 case document the online access problem specifically — this is the supply chain governance failure, separate from the prescribing guidance failure
EXTRACTION HINT: Focus on the 4x misuse differential and the BMI 16 online acquisition case — these document that online supply chains have no clinical gate whatsoever
