Health · Eating Disorder Awareness · Women's Health
GLP-1 Medications, Midlife Women and the Emerging Questions for Eating Disorder Awareness
Andrea Hadden B.Phty (Hons) — PreKure Qualified Health Coach · Founder, Guided Growth
Introduction
As a health coach, former physiotherapist, and someone involved in eating disorder advocacy, I have become increasingly interested in a question that few people seem to be asking.
As GLP-1 medications become more common, are we entering an era where weight loss has become harder to read?
Over the past few years, medications such as semaglutide and tirzepatide have transformed obesity treatment. For many individuals these medications have improved metabolic health, reduced cardiovascular risk, and achieved weight loss that had previously felt impossible.
Their benefits should not be underestimated.
Yet alongside this success story, I find myself wondering whether we are facing a new and largely unrecognised challenge.
Increasingly, I hear stories from friends, colleagues and family members who are worried about someone they care about.
A woman in her forties or fifties loses a substantial amount of weight. She no longer joins colleagues for lunch. She frequently comments that she is not hungry. She appears increasingly frail. She seems preoccupied with maintaining her weight loss.
Twenty years ago many people may have wondered whether she was developing an eating disorder.
Today, they wonder whether she is taking a GLP-1 medication.
The reality is that from the outside it can be remarkably difficult to tell the difference.
The new diagnostic blind spot
GLP-1 receptor agonists work, in part, by reducing appetite, slowing gastric emptying, and increasing feelings of fullness. Reduced food intake is therefore an expected treatment effect.
However, many of the observable behaviours associated with GLP-1 use overlap with behaviours commonly seen in restrictive eating disorders:
- Significant weight loss
- Reduced interest in food
- Skipping meals
- Social withdrawal around eating
- Reduced portion sizes
- Increased focus on weight and body shape
For friends, family members and work colleagues, distinguishing between therapeutic weight loss and emerging eating pathology may be almost impossible.
This uncertainty may create what I believe is an important new diagnostic blind spot.
Historically, significant weight loss often prompted concern. Today, weight loss is frequently viewed as evidence of improved health, particularly in a culture that continues to celebrate weight loss as a marker of success.
The unintended consequence may be that warning signs of malnutrition, psychological distress, or restrictive eating are overlooked.
What does the research tell us?
At present, the evidence is surprisingly limited.
Current research does not suggest that GLP-1 medications directly cause anorexia nervosa. However, several recent reviews have concluded that the relationship between GLP-1 medications and eating disorders remains poorly understood.
Researchers have raised concerns that appetite suppression and rapid weight loss may reinforce restrictive eating behaviours in vulnerable individuals, particularly those with:
- A previous eating disorder history
- Chronic dieting behaviours
- Perfectionistic personality traits
- Anxiety-related disorders
- Body image dissatisfaction
Importantly, the long-term psychological impact of widespread GLP-1 use has not yet been adequately studied.
This is not a claim that GLP-1 medications are harmful. Rather, it highlights the need to better understand who may be vulnerable and how clinicians can identify early warning signs.
Weight loss is not always the same as improved nutrition
One of the most important discussions emerging in the literature concerns malnutrition.
Traditionally, malnutrition has been associated with low body weight. However, experts increasingly recognise that an individual can lose weight while simultaneously becoming nutritionally compromised.
A person may remain in a larger body while consuming insufficient protein, vitamins, minerals and total energy to support optimal health.
This distinction is particularly important because many healthcare professionals, family members and patients continue to equate weight loss with improved health.
In reality, weight loss and nutritional adequacy are not the same thing.
The concern about muscle loss
Another emerging issue is loss of lean body mass.
Studies suggest that approximately 25–40% of weight lost during GLP-1 treatment may come from lean tissue, particularly when protein intake is inadequate and resistance training is not performed consistently.
For midlife and older adults this has important implications. Loss of skeletal muscle is associated with:
- Reduced strength
- Reduced physical function
- Increased frailty
- Increased falls risk
- Reduced metabolic health
For postmenopausal women, who are already experiencing age-related declines in muscle mass, this may represent a significant concern.
The challenge is that muscle loss is often invisible. Friends and colleagues notice weight loss. They may not recognise declining muscle mass, nutritional compromise, or emerging frailty.
When does appropriate weight loss become disordered eating?
This may be one of the most important clinical questions of the next decade.
The issue is not whether someone is taking a GLP-1 medication. The issue is whether their relationship with food, weight and body image is becoming psychologically unhealthy.
Warning signs may include:
- Intense fear of weight regain
- Ongoing attempts to lose weight despite reaching a healthy weight
- Anxiety when eating socially
- Increasing dietary rigidity
- Feelings of guilt after eating
- Obsessive focus on calorie intake
- Refusal to increase food intake despite medical advice
- Loss of physical strength and energy
In these situations, the medication may no longer be the central issue. The concern becomes the person's psychological relationship with food and weight.
The view from friends and colleagues
Perhaps the most interesting observation is that many concerns are not coming from clinicians.
They are coming from friends. Work colleagues. Family acquaintances. People who simply notice that someone no longer seems well.
These individuals often do not know whether the person is taking a GLP-1 medication, has an eating disorder, is experiencing depression, has an underlying medical illness, or is facing another challenge entirely.
And perhaps they do not need to know. The more relevant question may be:
Does this person appear physically or psychologically unwell?
If the answer is yes, concern is appropriate regardless of the cause.
As GLP-1 medications become increasingly common, eating disorder organisations, clinicians and researchers may need to consider new questions.
Are we seeing an increase in eating disorders among midlife adults? Are GLP-1 medications altering the way restrictive eating disorders present? Could medically assisted weight loss inadvertently mask the early signs of malnutrition or eating pathology? How can clinicians distinguish between successful obesity treatment and emerging disordered eating?
At present, we simply do not know.
What we do know is that the landscape has changed. Weight loss is no longer automatically interpreted as evidence of dieting, illness, or an eating disorder. Increasingly, it may be interpreted as a medication effect.
That shift may be entirely appropriate in many cases. But it may also mean that some individuals who are struggling become harder to identify.
If you're worried about someone
One of the challenges in this emerging landscape is that most people are not clinicians. They are friends. Work colleagues. Sisters. Partners. Parents.
They may notice changes, but they are unlikely to know whether they are observing a medication effect, an eating disorder, depression, grief, or another health concern.
The good news is that they do not need to make a diagnosis. They simply need to respond with care.
This is particularly important because eating disorders are often hidden in plain sight. Significant weight loss is frequently praised, and behaviours that might otherwise raise concern can be interpreted as signs of discipline, commitment, or successful health improvement.
When GLP-1 medications are part of the picture, it can become even harder to know what is happening. Friends and family may assume that reduced eating, rapid weight loss, or increasing food restriction are simply expected effects of the medication rather than potential warning signs of nutritional or psychological distress.
1. Trust your observation
If something feels different, pay attention to that instinct. Friends and colleagues are often the first people to notice subtle changes in behaviour, mood, eating habits, or physical appearance. You do not need certainty before expressing concern.
2. Start with curiosity, not conclusions
Avoid trying to diagnose the person or work out exactly what is happening. Instead, focus on what you have noticed.
I've noticed you've lost quite a bit of weight recently and don't seem to be joining us for lunch as much. I've been wondering how you're doing.
This approach opens a conversation rather than creating defensiveness.
3. Don't investigate
You do not need to find out whether someone is taking a GLP-1 medication. You do not need to determine whether they have an eating disorder. The goal is not to gather evidence. The goal is to express care.
4. Share the concern
If your concerns persist, consider whether someone closer to the person may also be aware of changes. This may be a partner, sibling, close friend, adult child, or healthcare professional. Often it is helpful to gently compare observations rather than carrying concern alone.
5. Reach out for guidance
If you are unsure what to do, seek support. Organisations such as EDANZ can provide information and guidance to people who are worried about a loved one, even when there is no formal diagnosis. You do not need to wait until a situation becomes a crisis before asking for advice.
6. Keep the relationship intact
Many people seek help months after someone first expresses concern. A single conversation rarely changes everything. Sometimes the most important thing you can do is remain connected. Continue inviting. Continue checking in. Continue showing that someone notices and cares.
Many people who later recover can identify a moment when someone gently expressed concern and opened the door to a conversation.
Final reflection
The arrival of GLP-1 medications represents a significant shift in the way society approaches weight and appetite.
For many people, these medications may provide meaningful health benefits. For others, they may introduce new complexities around nutrition, body image, and psychological wellbeing.
What remains unchanged is the importance of recognising eating disorders early and responding thoughtfully when concerns arise.
Perhaps the most important message is this:
You do not need to know exactly what is wrong before reaching out. Sometimes noticing that something feels wrong is enough.
Questions for the future
- Are GLP-1 medications changing how restrictive eating disorders present?
- Are we seeing an increase in midlife-onset eating disorders, or are we becoming better at recognising them?
- Could medically assisted weight loss inadvertently mask the early signs of malnutrition or eating pathology?
- Are friends and work colleagues becoming an increasingly important source of early concern and intervention?
- How can clinicians distinguish between successful obesity treatment and emerging disordered eating?
- What research and monitoring are needed to better understand these trends in New Zealand?
References
- Brownley KA, Berner LA, Masterson TD, et al. GLP-1 receptor agonists and eating disorders: emerging evidence, clinical concerns and future directions. Nutrients. 2025;17(23):3735.
- National Eating Disorders Association (NEDA). GLP-1 Medications and Eating Disorders.
- Rubino DM, Greenway FL, Khalid U, et al. Effect of weekly semaglutide on body composition in adults with overweight or obesity. Obesity. 2024.
- Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine. 2021;384:989–1002.
- Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. New England Journal of Medicine. 2022;387:205–216.
- O'Neil PM, Birkenfeld AL, McGowan B, et al. Clinical considerations regarding nutritional adequacy and body composition changes during GLP-1 receptor agonist therapy. Obesity Reviews. 2024.
- British Medical Journal. Malnutrition and nutritional monitoring during obesity treatment: emerging considerations in the era of GLP-1 therapies. BMJ. 2025;390:r1512.
- Academy for Eating Disorders. Position Statement on GLP-1 Receptor Agonists and Eating Disorders. 2024.
- Sarwer DB, Polonsky HM. The psychosocial implications of GLP-1 receptor agonist use for weight management. Current Obesity Reports. 2024.
- World Health Organization. Obesity and Overweight Fact Sheet. Updated 2025.
Author note: This article reflects my observations and interpretation of the current evidence and is intended to stimulate discussion regarding an emerging area of clinical and public health interest. While GLP-1 medications have demonstrated significant benefits in the treatment of obesity and metabolic disease, further research is needed to understand their long-term impact on eating behaviours, nutritional status, body composition, and eating disorder risk.
Andrea Hadden is a PreKure Qualified Health Coach, founder of Guided Growth, and a current board member of EDANZ. She has a background in physiotherapy and a particular interest in women's health, family wellbeing, and eating disorder awareness.