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GLP-1s: Changing the Landscape of Nutrition, Eating, Bodies, Eating Disorder Care, Culture & Society

Updated: Jul 15

by Kate Sweeney and Kristen Bryk


GLP-1 medications are everywhere. Social media, mass media, friends, peers, family, providers, etc. etc. 


Skinny seems to be back ‘in’ in some areas. Microdosing to manage inflammation in other spaces. The eating disorder space is talking about the impacts on screening, prevention, treatment and reckoning with nuanced conversations about how to best support folks in the age of Ozempic.


Today, we will discuss just some of the research around these drugs, particuarly when it comes to weight loss - what we know and don’t know - and sprinkle in some of what my clinical experience has been thus far.


What are GLP-1 RAs?


GLP-1 (glucagon-like peptide-1) is a naturally occurring hormone that is released mostly by cells in the intestine in response to eating. It also acts on the pancreas and central nervous system to regulate blood sugar and satiety. 


GLP-1 RAs, or glucagon-like peptide 1 receptor agonists, are medications that mimic our body’s naturally occurring GLP-1 and stick around a lot longer than natural GLP-1 when given. 


In 2005, the first GLP-1 medication was approved by the FDA (Food and Drug Administration in the US) for the treatment of type 2 diabetes (T2DM). The second GLP-1 for diabetes was approved in 2014. 


GLP-1 medications that induce weight loss are taken at greater doses than are used for T2DM management.


This higher level of GLP-1s in the body creates more hunger and blood sugar suppression.


Specifically, these medications:


  • Increase insulin secretion from the pancreas

  • Decrease the release of glucose from the liver

  • Slow down how fast the stomach empties, leading to a longer feeling of fullness

  • Reduce appetite and hunger signaling 

  • Act on receptors in the central nervous system


We are also learning how GLP-1s act on sites in the liver, brain, pancreas and other organs of the body. 


Because there are GLP-1 receptors in reward centers of the brain, there does seem to be a reduction in dopamine release and, thus, reduction in pleasure/reward experienced by some. The concern is that this may increase risk for depression, although post hoc analysis of 3377 participants of the STEP trial, in which participants received 2.4 mg/week of semaglutide (Wegovy) or placebo over about 2 hours, did not show any changes in mood (Siegel, et al, 2025).
GLP-1s and eating disorders risks and benefits

What do we know so far?


Weight, lean body mass and bone loss changes: 


Weight loss while on dosages of these medications that induces weight loss ranges from 5% to 20% over 14-18 months as evidenced by randomized control trials (Lincoff, et al, 2023; Ryan, et al, 2024; Aronne, et al, 2024). In real-world settings, this goes down to 8-11% weight loss over 15 months (Mozaffarian, et al, 2025).


This is a higher percentage of weight loss than what is seen in lifestyle-only interventions, which averages around 6-8% weight loss.


More specifically, the 4-year SELECT trial (Ryan, et al, 2024) showed that after 208 weeks (4 years), individuals taking 2.4 mg semaglutide per week lost 11.7% body weight on average compared to 1.5% in the placebo group. However, of note here is that of 17,604 participants who started the trial and were randomized to get the GLP-1 or placebo, only 10% of each group made it to 4 years. The study also has significant limitations, including not being generalizable to population due to lack of racial and ethnic diversity and 72% male. 16.6% of the semagllutide group stopped medication early due to adverse events, which was a significantly higher percentage of drop out than the he placebo group leading authors to conclude that GLP-1 use was associated with discontinuation of the trial.


It is hypothesized that the most common causes for discontinuation of treatment include:

  • Side effects

  • Cost and access

  • Pregnancies or intention to conceive

  • Getting the medication from the internet and not being tracked anymore

  • Not losing weight as expected


In the real world (not in RCTs) and longer term, GLP-1-supported weight loss does not appear to be as high as during periods of initial use. In a global cohort study by Huang et al. (2024), researchers found that patients who remained on GLP-1 RAs for 5 years maintained an average of 5.43% weight loss from their original baseline weight.


Bone and Muscle Mass Changes


Studies indicate that people who lose the most weight the fastest and do not engage in strength training and/or eat adequately have the biggest decline in lean body mass, up to 20% of total weight reduction (Neeland, et al 2024; Jastreboff, et al; 2022). Bone loss is also of concern, and studies are showing that the more weight someone loses, the more their bone mass is lost in weight–bearing areas like the hip (Al Refaie, et al, 2025).


Bone and muscle loss is particularly dangerous in older adults, who can experience sarcopenia, or developing kids and adolescents or really anyone who doesn’t want to risk breaking bones more easily, which we know also increases mortality risk!


In a 24-month retrospective cohort study by Ren, et al 2025, researchers looked at how semaglutide use affected muscle mass, weight/BMI and functional measures such as grip strength and gain speed in elderly individuals with T2DM compared to a cohort not using the medication. The use of semaglutide was associated with lean mass loss and functional decline in older adults with type 2 diabetes, particularly at higher doses.


Clinically, I have seen people lose weight so quickly that when I ask them to take their heart rate laying then standing, it is increasing more than 20 beats per minute indicating a ‘starved heart’, not a healthy one. We see this with malnutrition from restrictive intake and it indicates the heart muscle is not strong enough to handle the fluid shifts when standing up.  


Weight suppression and weight regain:


Basically, anyone who has lost weight while on GLP-1 has a high chance of regaining some or all of this weight once they discontinue use. For each person, the rate of weight gain is different.


This was shown in the SURMOUNT-4 trial by Aronne et al, 2024. This trial enrolled 783 adults with a BMI >27 (without diabetes) who knowingly received tirzepatide (10 or 15 mg weekly) for 36 weeks. Results showed a 20.9% weight loss in on average at 3 months. Then, the remaining 670 participants were randomized 1:1 to either continue tirzepatide or switch to placebo for an additional year. Those who continued tirzepatide lost an additional 5.5% body weight while the placebo group regained an average of 14.0% of body weight from the randomization point, retaining only about 9.9% total weight loss from baseline — meaning the majority of the initial weight reduction was lost upon drug withdrawal.


Even though studies show benefits of these medications on T2DM, cardiovascular health, kidney disease and more, it is important to note that these also go back to baseline when medication is discontinued. This was also shown in an analysis of the SURMOUNT-4 Trial (Horn, et al, 2025) where those who regained weight saw reverals of cardiometabolic parameters like insulin resistance, blood pressure and more.


We know some people have suppressed weight as a result of these medications and the dearth of dieting research is clear that the body does want to go back to its safe weight once off the medications. 


Weight suppression (the difference between the last highest adult body weight and current weight - it can influence how the body and brain respond to weight loss) is a VERY real thing.


This reality can be difficult to manage and thus, it becomes a question for clients whether they want to stay on it long-term or not. 


Nutrition Status while on GLP-1s:


Micronutrients


GLP-1s cause people to eat less in overall intake and variety.


So what does this mean? What do people who take these medications often not get enough of? 


The 2026 NHANES analysis (Frankenfeld et al., 2026, in press) of GLP-1 RA users with type 2 diabetes (2007–2020) showed that compared to non-users, short-term GLP-1 RA users (<1 year) had significantly higher rates of nutritional inadequacy for folate, iron, niacin, potassium, and vitamin B6.


Interestingly, long-term users (≥1 year) had dietary patterns that more closely resembled non-users, with higher caloric intake (~2100 vs. 1700 kcal in short-term users). This suggests that patients may adapt their eating patterns over time or that those who remain on therapy long-term are a selected population with better nutritional habits. 


Maybe that is also why we see a more modest 5% weight reduction over 5 years (Huang, et al 2024).


For those with T2DM, liver disease or those taking certain medications, GLP-1s can increase risk even higher for vitamin B12, iron and fat-soluble vitamin (A, D, E, K) deficiencies. 


Macronutrient deficiencies


Protein is definitely the #1 most-discussed macronutrient when it comes to GLP-1 use and nutrition intake. 


Protein is very important to maintain muscle mass. Recommendations are 1.2 grams per kilogram of ideal body weight per day or higher while on these medications. This is high for some individuals, and can be hard to achieve.


To maintain muscle mass, it is important to eat enough overall, eat enough protein and do weight bearing activity.


Besides protein, it is also very important to eat enough carbohydrates, because when there are not enough carbs, we spare fat mass at the expense of muscle mass.


So, carbs are just as important as protein in the diet of those on these medications. 


At some point, when someone does not consume enough nutrition, overt malnutrition can occur. This comes along with many issues including: hair loss, fatigue, loss of heart muscle, more gastrointestinal issues, negative effects on microbiome, exacerbation of mental health conditions like anxiety and depression, loss of menstruation and difficulty conceiving, exacerbation of poor appetite, lack of skin elasticity, poor concentration….the list goes on.


Overall, our work here at KSN is to support people in getting enough to eat, mitigating lean body mass and bone mass loss, monitoring labs and nutrition status, supplementing with vitamins/minerals when needed and supporting people in their relationship with movement, food and their bodies.


glp-1s and eating disorders

Side effects and risks: 


GLP-1s carry a black box label warning for increased risk of thyroid cancers. This means there is a known link between usage and increased risk of thyroid cancers (Bezin, et al, 2023).


Other common and identified current and potential side effects include (Kim and Yoo, 2025): 

  • Slowing of stomach emptying, nausea, constipation and other GI side effects. I have also observed SIBO.

  • Nutritional inadequacy, which means anything from micronutrient and macronutrient deficiencies to loss of lean body mass to fatigue and exhaustion

  • Significantly high % loss of lean body mass/muscle compared to weight loss by other means

  • Osteoporosis and osteopenia- loss of bone mass

  • Potential mood changes

  • Retinopothy

  • Pancreatitis

  • A study published in JAMA in 2025 indicated that women who had used GLP-1s prior to pregnancy had higher risk for preterm birth, gestational diabetes and hypertensive issues during pregnancy versus those that did not use them (Maya, et al, 2025). A limitation of this study is that the initial pre-pregnancy weight was a self-reported weight.

  • We are still learning about potential microbiome changes with these medications.


Our goal at KSN nutrition in centered around helping people mitigate side effects as much as possible with lifestyle factors like adequate nutrition, constipation management, regular doctor's appointments, stress management, sleep and movement.


Impact on mood and pleasure: 


Anhedonia is the inability to experience pleasure or find joy from things that were once enjoyed. There is some evidence that some people taking these medications experience a bluntness in emotions with things that provided joy and pleasure prior to use.


While we are not entirely sure why this is the case, it seems to be due to the medication’s effect on the reward pathway in the brain.


Eating disorders: 


Recent studies show that people screening positive for an eating disorder, especially women, seek out GLP-1 medications more than those who screen negative for an eating disorder (Siegel, et al, 2026).


Specifically, the study by Siegel et al in 2026 found that a positive screen on the Eating Disorder Screen for Primary Care was linked to awareness of GLP-1s, interest in taking these medications, speaking with a doctor about them, and attempting to access GLP-1s via telehealth pharmacies. These links were stronger for women than men.


Natural GLP-1 response to meals/eating has been hypothesized and in some studies, show to be lower in people struggling with binge eating disorder vs. controls (Geliebter, 2008) however we don’t know why this may be the case and who it extends to. It suggests that perhaps increasing GLP-1 with (lower dose than weight loss) medication may have a beneficial effect on binge eating. A systematic review and meta-analysis looked at 5 studies, of only 182 participants in total, found that the impact of GLP-1 use on binge eating along with BMI and other measurements may be positive for binge eating however results were quite varied and by no means conclusive (Radkhah, et al 2025). Overall, studies are quite small (<75 participants), with short follow up and research is ongoing (White, et al, 2026). There are ongoing clinical trials.


There is still a lot to learn: GLP-1 usage can be a behavior of the eating disorder and can cause weight suppression with rebound weight cycling or significant weight loss resulting in medical instability. For others, it may be beneficial to turn down food salience and allow for lifestyle changes that have long alluded them and an improvement in binge eating. I've seen both in clinical practice.


Screening for eating disorders must be common practice so treatment and interventions can be individualized.  A joint advisory statement from top researchers in the field recommends this in their guideline (Mozaffarian et al, 2025).


Our belief is that we need to be screening for eating disorders among those seeking GLP-1 medications, so we can have nuanced conversations with clients to support their care- GLP-1 or not.


What do people who are taking GLP-1s say?


A recent qualitative study published June 2026 by de Vere Hunt, Ramirez-Posada and Babu in JAMA looked at the experiences of 30 people (10 men, 19 women, 1 non-binary; 23 discontinued GLP-1s and 7 were on) about their experience with the medications.


The themes uncovered were that: 


  • GLP-1s did change the experience of eating and also weight, and not without considerable effort around lifestyle changes and navigating side effects and practical challenges. 

  • Experiences were influenced by the clinical care the participants received, along with their perceptions of external judgement from others and cost of the medication. 

  • Side effects were quite varied among participants.

  • Nutritional and medical management is not standardized - there are no guidelines - and people are therefore confused about their journey on these medications.

  • Those that made lifestyle changes were motivated partly by the weight loss to do it.

  • Emotional support and practical advice was important for participants; however, fear of stigma limited some individuals’ access to peer support.

  • Equity is a concern, as some people had access and cost challenges, leading some to seek these drugs from unregulated sources.


To summarize, people’s experiences vary widely and are very dependent on experiences with clinical care, peer support, stigma, access and side effects.


Questions we need to ask:


As we reflect on GLP-1s and the information we have so far, we at Kate Sweeney Nutrition are thinking about the following questions:


  • What are the cultural and societal impacts of these medications?

  • How is anhedonia affecting those who have this side effect of GLP-1s?

  • How does equity affect stigma around these medications? Around being in a larger body and not taking these medications? 

  • Who is screening for eating disorders and who is not? Why are those not screening not doing so and how can we do better?

  • While lifestyle changes are being recommended as a foundational need for people on these medications, why do many who take these not get the care and support they need to implement such changes?

  • Is weight loss really maintained long-term (5+ years) in people who continue on GLP-1s? Will people who take GLP-1s regain even more weight in the long-term than they lost initially if they discontinue use?

  • Is the initial weight loss on these medications setting people up for worse weight cycling compared to more traditional ‘dieting’?

  • Does 'microdosing' have better long term impacts than high doses used to induce weight loss? What are the long-term side effects of these medications and how do they vary based on dosage?

  • Is the food noise some people experience actually hunger? Is using GLP-1s to reduce food noise actually making it more difficult for some users to listen to their bodies and potentially maintain a healthy weight for them? How do we differentiate between those whom food noise is truly intrusive versus those that it is not? When do we know if the reduction in food noise is too much? When do we know it may be just right?

  • Are there some people with bulimia or binge eating disorder for which low-dose GLP-1s are a successful long-term treatment?

  • Will we see an increase in osteoporosis and fractures in 10-20 years in those who used this medication?

  • Will GLP-1s be used in chronic, inflammatory disease indications like MCAS or ME/CFS at lower dosage to benefit?


Closing thoughts:


There is so much we have discussed in our GLP-1 newsletter this month, and we feel it is best to be simple in our closing thoughts - if you got this far!


GLP-1s are certainly a revolutionary medication making a lot of changes, all at once, to people’s lives, in clinical practice settings and in our society and cultures.


It is our goal at KSN to keep learning, growing with the information, being open minded and supporting people who are interested in these medications in the best way possible - through providing the information we have, giving compassionate care that meets then where they are and monitoring nutrition and other lifestyle factors to mitigate side effects as best as possible.




Works Cited

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Aronne LJ, Sattar N, Horn DB, Bays HE, Wharton S, Lin WY, Ahmad NN, Zhang S, Liao R, Bunck MC, Jouravskaya I, Murphy MA; SURMOUNT-4 Investigators. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA. 2024 Jan 2;331(1):38-48. doi: 10.1001/jama.2023.24945. PMID: 38078870; PMCID: PMC10714284.


Bartel S, McElroy SL, Levangie D, Keshen A. Use of glucagon-like peptide-1 receptor agonists in eating disorder populations. Int J Eat Disord. 2024 Feb;57(2):286-293. doi: 10.1002/eat.24109. Epub 2023 Dec 22. PMID: 38135891.


Bezin J, Gouverneur A, Pénichon M, Mathieu C, Garrel R, Hillaire-Buys D, Pariente A, Faillie JL. GLP-1 Receptor Agonists and the Risk of Thyroid Cancer. Diabetes Care. 2023 Feb 1;46(2):384-390. doi: 10.2337/dc22-1148. PMID: 36356111.



de Vere Hunt I, Ramirez-Posada M, Babu CS, Brown-Johnson C, Linos E, Rodriguez F. Patient Experiences With GLP-1 Receptor Agonists. JAMA Netw Open. 2026;9(6):e2616951. doi:10.1001/jamanetworkopen.2026.16951


Geliebter A, Hashim SA, Gluck ME. Appetite-related gut peptides, ghrelin, PYY, and GLP-1 in obese women with and without binge eating disorder (BED). Physiol Behav. 2008 Aug 6;94(5):696-9. doi: 10.1016/j.physbeh.2008.04.013. Epub 2008 Apr 13. PMID: 18534636; PMCID: PMC5708848.


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Huang Y-N, Liao W-L, Huang J-Y, et al. Long-term safety and efficacy of glucagon-like peptide-1 receptor agonists in individuals with obesity and without type 2 diabetes: A global retrospective cohort study. Diabetes Obes Metab. 2024;26(11):5222-5232. doi:10.1111/dom.15869

Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216.


Keel PK, Bodell LP, Appelbaum J, Williams DL. Test of a biobehavioral model linking weight suppression to binge-eating severity via leptin and glucagon-like peptide 1 in bulimia nervosa and related syndromes in women. Psychol Med. 2025 Jun 27;55:e177. doi: 10.1017/S0033291725100871. PMID: 40576074; PMCID: PMC12234017.


Kim JA, Yoo HJ. Exploring the Side Effects of GLP-1 Receptor Agonist: To Ensure Its Optimal Positioning. Diabetes Metab J. 2025 Jul;49(4):525-541. doi: 10.4093/dmj.2025.0242. Epub 2025 Jul 1. PMID: 40631457; PMCID: PMC12270588.


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Maya J, Pant D, Fu Y, et al. Gestational Weight Gain and Pregnancy Outcomes After GLP-1 Receptor Agonist Discontinuation. JAMA. 2025;334(24):2186–2196. doi:10.1001/jama.2025.20951


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Radkhah H, Rahimipour Anaraki S, Parhizkar Roudsari P, Arabzadeh Bahri R, Zooravar D, Asgarian S, Hosseini Dolama R, Alirezaei A, Khalooeifard R. The impact of glucagon-like peptide-1 (GLP-1) agonists in the treatment of eating disorders: a systematic review and meta-analysis. Eat Weight Disord. 2025 Feb 1;30(1):10. doi: 10.1007/s40519-025-01720-9. PMID: 39891848; PMCID: PMC11787217.


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