The dark side of the ‘miracle jab’: why eating disorder safety cannot be an afterthought

In recent years, glucagon-like peptide-1 receptor agonists (GLP-1s), such as Ozempic (semaglutide; Novo Nordisk), Wegovy (semaglutide; Novo Nordisk) and Mounjaro (tirzepatide; Eli Lilly) have been propelled to the forefront of both medical innovation and public discussion. 

The surging demand for GLP-1s, fuelled in part by social media amplification and celebrity endorsement, has collided with constrained NHS access to create a two-tier market. On one side is a booming regulated private sector: online pharmacies and weight-loss clinics prescribe once-weekly injections, sometimes without robust clinical assessment, ongoing monitoring or multidisciplinary support typically associated with safe prescribing. 

In June 2025, an undercover BBC investigation revealed serious concerns about two online pharmacies that permitted patients to falsify health information to obtain access to the medications, despite regulatory rules designed to prevent this^​1​. 

On the other side, weight-loss medications are also being illegally sold via beauty salons, social media platforms and unlicensed websites, with associated deaths reported in the media^​2–4​.

From a clinical perspective, we have significant concerns that GLP-1s may be misused by individuals with eating disorders and that GLP-1 use for weight loss may, in some cases, precipitate the development of an eating disorder. These risks are likely to be heightened when prescribing occurs without the structured oversight, psychological assessment and monitoring that are essential for safe use.

Similar concerns were raised by the Royal College of Psychiatrists (RCPsych) in March 2023. “We are aware that some messaging framing semaglutide as a quick-fix weight-loss aid may act as a potential trigger for those living with an eating disorder and poses a real danger for abuse of the medication,” it said in response to National Institute for Health and Care Excellence (NICE) guidance on semaglutide treatment in England, published earlier that month.

The college went on to underscore the urgent need for robust safety measures to ensure appropriate and responsible prescribing^​5​. 

To date, however, existing safeguards have largely focused on traditional pharmacovigilance and supply regulation, rather than proactively addressing risk of misuse in vulnerable populations. In October 2024, the Medicines and Healthcare products Regulatory Agency (MHRA) issued a reminder to healthcare professionals regarding the prescription-only status of GLP-1s, retiring the importance of adverse reporting and the need to remain vigilant to potential misuse^​6​.

In parallel, in February 2025, the General Pharmaceutical Council (GPhC) strengthened requirements for pharmacies providing pharmacy services at a distance. The GPhC mandated the independent verification of crucial clinical information, such as BMI, through methods beyond patient self-reporting. These include video consultation, clinical record access or communication with another healthcare professional, explicitly excluding reliance on telephone or online questionnaire assessment alone^​7​. 

While such regulatory steps are necessary, they remain insufficiently tailored to the specific risks faced by individuals with, or at risk of, eating disorders. Notably, there is currently no coordinated framework that embeds routine psychological screening, multidisciplinary oversight or longitudinal monitoring into GLP-1 prescribing pathways. Addressing these gaps will require a coordinated effort across clinical, regulatory and policy domains to ensure that the rapid expansion of GLP-1 use does not inadvertently expose vulnerable populations to harm.

Misuse of weight-loss medications

People with eating disorders are particularly vulnerable to misusing medications as a perceived shortcut to weight loss or to reinforce existing restrictive behaviours. Previous research has documented the misuse of substances ranging from metformin^​8,9​, diuretics and laxatives^​10​, to illicit drugs, including amphetamines and cocaine^​11​. GLP-1s represent a new and concerning avenue for misuse, given the substantial weight loss seen in clinical trials. 

Although quantitative data on GLP-1 misuse among eating disorder populations are lacking, anecdotal reports suggest rising incidence. In 2024, Guerdjukova et al. reported a patient with atypical anorexia who experienced rapid weight loss of 20kg across 9 months by escalating semaglutide doses and shortening dosing intervals^​12​. A recent investigation by ITV News reported that 78% of the 14 eating disorder clinics that it contacted had treated patients with anorexia and bulimia nervosa who had obtained the weight-loss medications online. Alarmingly, one clinic in Oxfordshire indicated that 60% of its recent patients had used these products^​13​. 

The risks associated with using GLP-1s for weight loss outside their licensed indications remain largely unstudied and no specific guidance currently exists regarding their use or safety in individuals with current or past eating disorders. For this population, the physical health implications can be particularly severe. Rapid and excessive weight loss may exacerbate malnutrition, dehydration, electrolyte imbalance and cardiac complications, all of which are associated with fatality. In February 2025, MHRA figures revealed 82 deaths linked to GLP-1s up to January 2025, 22 of which were related to their use for weight-loss purposes^​14​. 

These safety issues emerge against the backdrop of a broader public health challenge: the rising prevalence of eating disorders. National data from 2023 revealed a significant increase in those with eating disorders, rising sharply from 0.8% of those aged 17–19 years in 2017 to 12.5% in 2023^​15​. Meanwhile, the charity Beat Eating Disorders estimates that 1.25 million people in the UK have an eating disorder.

Given the prevalence of eating disorders in the UK, the potential ‘at risk’ pool of GLP-1s being used in an eating disorder context is non-trivial. 

A perfect storm

Several factors converge to create an environment with a heightened potential for misuse. First, the commercial and societal momentum behind weight-loss therapies is high. GLP-1s are often portrayed in the media and marketing as “miracle injections” or “skinny jabs” — messages that may directly appeal to those with an eating disorder. Although direct UK data on uptake by people with eating disorders is lacking, the convergence of rapid growth and regulators warnings of misuse provides context for concern.

Second, the prescribing ecosystem of GLP-1s is complex, spanning NHS and private settings, alongside a flourishing grey market. In 2023, the MHRA seized over 15.5 million doses of illegally traded medicines in the UK, including semaglutide-containing “weight-loss” products^​16​. In 2025, the MHRA reported a 163% rise in seizures of weight-loss injection pens over a three-month period^​17​. These figures reflect the high demand and blurred boundaries between legitimate prescribing and illicit distribution. 

Finally, weaknesses in online prescribing practices have enabled unsafe access as they often rely on self-reported information, without adequate verification of medical history or screening for eating disorders. Reports indicate that individuals with active eating disorders have been able to obtain prescriptions after completing only brief online questionnaires. One high-profile case involved an underweight woman (38kg) with anorexia nervosa who used an AI-generated image to purchase monthly subscriptions of Wegovy from an online provider^​18​. In response, the GPhC has tightened regulations, requiring in-person or video consultations and verified BMI checks from a GP or medical records. However, enforcement and compliance will determine whether these measures truly protect vulnerable patients.

Strategy for prevention

Preventing misuse among those with eating disorders requires a coordinated strategy across clinical, regulatory and professional domains. Mandatory screening for current or past eating-disorder behaviours must be implemented into pre-treatment assessments.

In 2025, Richards et al. advocated the use of validated tools such as the ‘SCOFF’ questionnaire, the ‘Eating Disorder Examination Questionnaire’ or the ‘Binge Eating Scale’ to proactively screen for eating disorders^​19​. Ongoing monitoring for signs of eating disorders and weight trends should be in place and “timely mental health referrals should be made to address potential exacerbations of disordered eating patterns”. Furthermore, Richards et al. urged national regulators to strengthen pharmacovigilance for GLP-1s, including routine collection of misuse cases, adverse outcomes and hospitalisations in the context of eating disorders^​19​. 

Professional bodies, including the Royal Pharmaceutical Society and RCPsych, should collaborate to issue clear guidance for prescribing GLP-1s in populations with or at risk of eating disorders. Existing frameworks for high-risk drugs, such as the NICE guidelines for stimulant prescribing in ADHD and opioid safety protocols, could serve as models, emphasising structured assessment, multidisciplinary oversight, ongoing monitoring and follow-up. Lastly, patients must be informed about the risks of GLP-1s in the context of eating disorders, including rapid weight loss, malnutrition, refeeding syndrome and the potential worsening of cognitive and behavioural symptoms.

It could be argued that GLP-1s hold therapeutic potential for certain eating disorder subtypes, particularly binge eating disorder and bulimia nervosa. A recent meta-analysis of five studies (n=182) found significant improvements in Binge Eating Scale scores in those receiving GLP-1s compared with controls (− 8.14 points; 95% CI − 13.13 to − 3.15; p < 0.01)^​20​. However, these studies involved short follow-up durations, ranging from 12 weeks to 26 weeks, and often involved individuals with comorbid obesity. As Bartel et al. (2023) have emphasised, future research should include longer-term follow-ups, since eating disorder symptoms may have a delayed onset related to attenuating medication effects over time and possible symptom rebound upon discontinuation^​21​. While some clinicians may argue that screening for eating disorders could delay access, deter prescribing and add burden, the potential consequences of omission are far greater.

Critical role of pharmacy

Pharmacists, positioned at the interface of prescribing and patient use, are critical to ensuring the safe and ethical use of GLP-1s. They should remain vigilant for red flags, such as repeated early refill requests, unexplained dose escalations, discrepancies in reported weight, or prescriptions for individuals with a low or rapidly declining BMI. Each supply should be carefully reviewed for clinical indication and appropriateness, taking into account the patient’s medical and medication history. Where possible, weight and BMI should be verified during a face-to-face consultation and robust monitoring of weight trends and side effects should be implemented.

Importantly, the GPhC’s updated ‘Guidance for registered pharmacies providing pharmacy services at a distance’ mandates independent verification of weight, height or BMI for weight‑management medicines; prescribers may no longer rely solely on patient‑completed online questionnaires but must establish two‑way communication or access clinical records^​7​. 

Routine screening conversations — such as: “Have you ever had an eating disorder?” or “Are you currently under the care of an eating disorder service?” — can open crucial discussions and prevent harm. Furthermore, by accessing the national care record service, pharmacists can obtain important clinical information, such as prior or current eating disorders and safeguarding issues. 

Pharmacists can play a pivotal role in safeguarding the appropriate use of GLP-1s through clinical vigilance, patient education, multidisciplinary collaboration and timely reporting. In a landscape where these drugs are rapidly transforming weight-management medicine, their intersection with eating disorder populations represents a red flag that demands immediate attention.

Pharmacists must act as custodians of safe care and ensure that a journey toward weight loss does not become a gateway to deeper harm.