Associations between Weight Loss Medication Use and Eating Disorder Symptoms In a Sample of Higher-Weight Black Women and Men

Background and Purpose: Glucagon-like peptide-1 (GLP-1) medications for weight loss have been proposed as a treatment for eating disorders, especially binge eating disorder (BED), but evidence is mixed, and concerns about eating disorder symptoms exacerbation and use of these medications for extreme appetite suppression are warranted. In addition, the line between effects of the medications (e.g., loss of appetite, frequent vomiting) and eating disorder symptoms is blurry. Furthermore, it is unclear whether patients using these medications report symptoms that may be problematic if they see them as desired effects of the medication. The current study examines self-reported eating disorder symptoms in a sample of Black men and women with Body Mass Index (BMI)>25, comparing those who report using a weight loss medication to those who do not. This study helps address an important gap, because Black individuals are less likely to be offered weight loss medications, and are under-represented in trials investigating the effectiveness and side-effects of weight loss medications.

Methods: A cross-sectional survey was administered to 473 individuals who identified as Black, English speaking, aged 35+, and BMI>25. Participants were mostly female (n = 371, 79.8%) and the mean age was 48.7 (SD = 9.9, range = 35-81). The survey assessed factors related to weight stigma and health care utilization and included the 13-item Eating Disorder Examination Questionnaire (EDE-Q-13) and a single item measuring whether the respondent was currently taking a prescription weight loss medication. EDE-Q-13 subscales were calculated (restricted eating, shape and weight overvaluation, bingeing, purging, and body dissatisfaction), and analyses were completed using t-tests.

Results: Out of the 473 respondents, 80 (16.9%) indicated they were currently using a weight loss medication. There was no difference between current users and non-users in body dissatisfaction or purging. Current medication users scored significantly higher (p<.05) on the restricted eating subscale (mean=3.23 (SD=1.96) vs. 2.49 (SD=2.01)), the shape and weight over-valuation subscale (3.05 (SD=2.35) vs, 2.39 (SD=2.30)), and the bingeing subscale (1.25 (SD=.95) vs. 0.95 (SD=1.37)).

Conclusions and Implications: Black, higher-weight, users of weight loss medications reported more symptoms of eating disorders in some domains, compared to non-users. The EDE-Q-13 restricted eating subscale focuses on effort put forth to restrain eating, suggesting that those using these medications may be actively trying to restrict food intake, possibly in addition to intake reduction caused by the medication. Higher scores on the bingeing behavior subscale suggest that medication users’ bodies may be responding to restriction and energy imbalance by driving rapid food consumption, despite the reduction in hunger cues felt normally while using these medications. Without longitudinal data, it is impossible to determine whether people higher in shape and weight overvaluation are more likely to use weight loss medication, including GLP-1s, if people using the medications then place greater importance on their shape and weight, or both. This study suggests that further study of weight loss medication use and eating disorder symptoms using longitudinal designs are warranted, and that more nuanced evidence is needed before adopting these medications as potential treatments for eating disorders.