'I know I'm not taking it for the right reasons': The hidden dilemma of Ozempic

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4 days ago

The last thing Chevese Turner needed was medication to help her lose weight. Twenty years into recovery from binge eating disorder and atypical anorexia, she was done trying to whittle her physique into something it didn't want to be.
But after developing diabetes a few years ago, her doctor prescribed Mounjaro, a glucagon-like peptide-1 receptor agonist, or GLP-1, that helps curb diabetes. A side effect of the medication? Weight loss.
Knowing that, Turner, who lives outside Washington, DC, hesitated. "I don't want to start getting into this mode where I'm like, 'Yay, I'm losing weight,'" said Turner, 57, the CEO of the Body Equity Alliance, an advocacy and coaching organization.
Part of her recovery from BED included learning to eat intuitively and letting her body tell her when it was hungry. Cautiously, she started taking the drug. But, even at a low dose, Mounjaro eliminated her desire to eat, which caused her to drop pounds. This worried her.
"I still have a therapist, and I do everything I can to make sure that I keep in strong recovery," she said.
Her endocrinologist, who had prescribed the medication, didn't understand her concerns. "She said, 'You don't have to eat lunch.' And I was like, 'No, I need to eat lunch and dinner and breakfast and snacks.' She just doesn't get eating disorders at all."
Ozempic is hitting eating disorder centers hard
About one in eight adults is taking a GLP-1, such as Ozempic and Mounjaro, designed for diabetes, and Zepbound and Wegovy, marketed for weight loss. The medications marked a historic breakthrough in obesity medicine, providing a treatment for people with a complex medical condition that wasn't just diet or bariatric surgery. The drugs work by mimicking GLP-1, a natural hormone that helps regulate blood sugar, delay digestion, and signal fullness to the brain. Culturally, doctors say GLP-1s helped to shift a narrative, to help society understand obesity as a medical condition like any other, not a failure of willpower.
But, while originally intended for people with type 2 diabetes or chronic obesity, these drugs have been co-opted by those seeking weight loss — even if it's not medically necessary.
Experts warn that these medications can trigger new eating disorders, worsen existing ones, and complicate recovery. Brittany Lacour, the national director of clinical assessment intake at Eating Recovery Centers, with programs across the country, said the number of people who had come into ERC already on a GLP-1 went from 11 in 2023 to 31 in 2024. So far, there have been 14 cases in 2025, including a 14-year-old child.
"We are seeing people who are coming into treatment with a relapse or new onset, and most of them are presenting with restrictive eating patterns, like anorexia," said Dr. Elizabeth Wassenaar, the regional medical director of Eating Recovery Center of the West. She's also seeing an increase in atypical anorexia, a form of anorexia nervosa where someone is significantly restricting calories but is of average or above average weight.
Dr. Joel Jahraus, the vice president of medical services at Monte Nido, a national eating disorder treatment provider, has seen a 25% to 33% increase in patients already on GLP-1 medications when they enter treatment. Most, if not all, of them have a binge eating disorder. "A year ago there was no one presenting for an intake on a GLP-1, and then it increased to a couple a month going back 6 months," he said. These days, Monte Nido gets about three to five patients a month who are on a GLP-1.
But, Jahraus added, patients often hide their GLP-1 use from the person doing the intake, typically bringing it up only when they show up on-site for actual admission. Doctors attribute their reticence to shame, embarrassment, and the fear that their medications might be taken away from them.
"The effect of these meds can go absolutely contrary to the goals of eating disorder treatment, so it's important to figure that out," Jahraus said. "If they are low body weight and have no other indication for use, such as diabetes or cardiovascular disease, there is no place for the GLP-1 meds because the medication causes further weight loss. If they are normal or above normal body weight, we go through a process to gauge if they'll be successful at stopping their eating disorders, but that comes after treatment is initiated."
'I'm not taking it for the right reasons, but I feel that I need to'
For two decades, Rose, 32, who lives outside Boise, Idaho, wrestled with restrictive eating and bulimia, cycling in and out of residential and nonresidential treatment programs. Anything that would help her shed the 100 pounds she gained when pregnant with her son and quiet the "food noise" — the obsessive thoughts about meals, calories, exercise, and weight that relentlessly plagued her — was enticing.
So when she was diagnosed with diabetes three years ago, she finally had a "legit" medical reason to ask her internist for a prescription for Ozempic. She was elated.
Her endocrinologist, dietician, and therapist were not. For people like Rose, with a history of restrictive eating, the inability to be in tune with their body could be disastrous.
Still, Rose managed to persuade her internist to give her a prescription. He nervously agreed, but with strict conditions: She had to eat at least 1,500 calories a day, not exercise compulsively, and not lose more than two pounds a week.
"As long as I was meeting those goals and all else was OK, I could stay on it," said Rose, who is on disability. (For privacy reasons, she requested anonymity.)
Within days of starting the drugs, which she injected into her abdomen, she noticed a shift. She needed less insulin, and sometimes didn't need any. But more importantly, she no longer spent hours ruminating on food and weight. And her hunger disappeared.
"It actually freaked me out," she said. "I wasn't intentionally restricting, but I had to force myself to remember to eat."
Her daily caloric intake plummeted to about 850 calories and then 350, which she tracked with MyFitnessPal. She did an hour of cardio every day and regularly took laxatives and diuretics, all of which she hid from her team.
Because, of course, she liked the weight loss. She couldn't help herself. As she put it, "I know I'm not taking it for the right reasons, but I still feel that I need to."
Routine screening for eating disorders risk does not occur in many medical settings, including those where GLP-1 drugs are prescribed
Dr. Doreen Marshall
Lars Fruergaard Jørgensen, the CEO of Novo Nordisk, which makes Ozempic and Wegovy, addressed the question of eating disorders in an interview with Bloomberg in June 2024. He said the company was focused on educating physicians "to understand what is approved for type 2 diabetes, what is approved for obesity, what is the mechanism, and how should they be used," adding, "We have to also trust that the physicians, they do what is right for their patient, and they should — for sure — not prescribe for people living with eating disorders."
"Patient safety is Lilly's top priority, and we actively engage in monitoring, evaluating, and reporting safety information for all our medicines. If someone is experiencing any side effects while taking any Lilly medication, we encourage them to speak with their healthcare provider," a spokesperson for Eli Lilly, the maker of Mounjaro and Zepbound, said in a statement to NBC.
Taking GLP-1 drugs without medical supervision is risky. According to a recent report in Annals of Internal Medicine, in 2022 and 2023 about 24,500 emergency room visits were linked to semaglutide, Ozempic's active ingredient, primarily because of severe gastrointestinal side effects such as nausea, vomiting, and abdominal pain.
In 2023, a Louisiana woman sued Novo Nordisk and Eli Lilly, the makers of Ozempic and Mounjaro, accusing them of not disclosing the risk of serious gastrointestinal issues caused by the drugs. (The case is still pending.) As of May 1, there have been 1,809 lawsuits pending against the makers of GLP-1 drugs.
Almost everyone who stops taking the medications regains about two-thirds or more of the weight they lost on them — a widely accepted statistic that can make it hard for someone with an eating disorder to quit the drugs. But we don't yet have solid evidence on the long-term impacts of these drugs on health.
"In our population, people take it to a new level," Jahraus said. "They don't understand the risks involved. What are you going to do when you stop taking the medication for whatever reason, and you gain back two-thirds of the weight you lost? To an eating disorder patient, that's a disaster."
Labels for Wegovy and Zepbound warn of side effects such as nausea and vomiting, but they say nothing about eating disorders, which affect nearly 1 in 10 people in the United States, according to the National Association of Anorexia Nervosa and Associated Disorders. Anorexia nervosa has the highest mortality rate of any mental illness.
Doctors fail to recognize eating disorders in people with larger bodies
Another issue is that many doctors aren't properly trained in eating disorder treatment. "People are often surprised to learn that routine screening for eating disorders risk does not occur in many medical settings, including those where GLP-1 drugs are prescribed," said Dr. Doreen Marshall, the CEO of the National Eating Disorders Association. Many general medical practitioners receive limited or no training or education on eating disorders."
This is especially true when it comes to patients with larger bodies, who may suffer from BED or atypical anorexia. Many doctors see a heavier patient and assume they simply need to lose weight, but that's not always true.
"We're prescribing for higher-weight people what we diagnose as eating disorders in thin people," said Deb Burgard, a psychologist and eating disorders specialist who's one of the founders of the Health at Every Size framework of care.
"The breathless hype about a drug that aims to starve people is that it starves people seemingly without a protest from the starving body," Burgard added. "From our bodies' point of view, starvation is a disaster, no matter the source."
How do you stop?
In an ideal world, Chevese Turner would eliminate Mounjaro, but the world doesn't bend to our whims. Her diabetes is under control, and that's important.
Still, she remains vigilant so she doesn't fall back into her old habits. She began setting a timer to remember when to eat, which she had done in the early stages of her recovery.
"I had worked so hard for a long time to become an intuitive eater, and my whole self has changed because I'm in recovery and I eat intuitively," she said. "It's just a totally different relationship with food and body. So I had to start going back to the very beginning of what I did in my recovery, and that was set timers to remember to eat."
They would be devastated if they knew why I'm really taking it
Rose, who asked a relative to get her Ozempic, saying it was for diabetes
As for Rose, she has lost about 45 pounds since starting Ozempic. After her insurance stopped covering it, she began paying $1,000 a month out of pocket for a similar drug, Rybelsus, that a family member — believing she wanted it for her diabetes — helped her procure.
"They would be devastated if they knew why I'm really taking it," she said. She has had regular appointments with her endocrinologist but never discussed her GLP-1 use.
In mid-May, she ran out of Rybelsus and didn't refill it; it was too expensive. Around this same time, she landed in the hospital with low potassium, which doctors blamed on her overuse of diuretics.
If she had her way, she'd go back on Ozempic to lose another 45 pounds. She's thinking about buying some online, which won't require a doctor's prescription.
This, of course, is dangerous in its own right, as unregulated or unlicensed vendors have been selling fake Ozempic online or in medical spas.
In June 2024, the World Health Organization warned about falsified batches of Ozempic; the National Association of Boards of Pharmacy identified thousands of websites illegally selling fraudulent weight-loss drugs. Worldwide, 42 people were hospitalized after taking fake injections, according to the FDA's Adverse Event Reporting System. Some people died.
Rose knows she's playing with fire. Still, she isn't ready to give up the drug. "I feel like I'm doing better than I have in a while, but the thoughts of wanting to lose weight or take Ozempic don't ever go away."
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