Welcome to The Thin Line, The New York Post’s new series about the darker side of GLP-1 drugs. Though GLP-1 agonists sold under brand names like Ozempic have helped millions of people lose weight, manage diabetes and improve other health conditions, they are not without risks. Check back for more stories about the lesser-known downsides of these wildly popular medications.
“Ed” was back — and this time, he was in the driver’s seat.
The familiar voice telling Jenn Nourse not to eat had started growing louder after decades of lingering quietly in the back of her mind, a reminder of the eating disorder she’d battled as a teen.
“I’d flirted with my symptoms on and off throughout my life,” she told The Post. “But I didn’t have a full-blown relapse until I started taking GLP-1s.”
The rise of weight-loss drugs such as Ozempic and Wegovy has been nothing short of meteoric, with millions turning to the injections to shed pounds and improve their health. But beneath the dramatic before-and-after photos is a darker reality for some users.
Six health care providers across the country told The Post they’ve treated patients whose long-dormant eating disorders resurfaced while on the drugs — as well as others who developed new struggles with food and body image.
“It doesn’t just affect people who are in the throes of acute illness,” said Dr. Brad Smith, chief medical officer for the Emily Program, a national organization that specializes in eating disorders. “It can affect people who’ve been in recovery or have had good functioning for a long time.”
GLP-1 drugs work by mimicking hormones that curb appetite, slow digestion and regulate blood sugar. Users often feel fuller longer, eat less and experience reduced “food noise” — or frequent, often intrusive thoughts about eating.
They’ve been widely praised for helping people with obesity lose weight, in addition to treating conditions like type 2 diabetes and sleep apnea. But for some, it’s come at a cost.
“We’ve seen people that were prescribed these medications — even when they weren’t seeking them for weight reduction but for another medical reason — who’ve run into a slippery slope where it brought back their eating disorder symptoms and behaviors,” Smith said. “It has had a significant negative impact.”
Old wounds, new triggers
Nourse, 50, began restricting food at 16 — around the time she started noticing her muscular, athletic build. A guidance counselor noticed too, commenting on her “thunder thighs.”
“It’s interesting how one comment can set somebody on a path of literal destruction,” she said.
Her life was already unstable. She had left home and was couch-surfing while juggling school, a part-time job and multiple sports.
She soon turned to diet pills and laxatives, quietly cutting back at meals.
“Those are the earliest memories I have of trying to influence how my body looked,” she said. “It gave me a feeling of security. It was a way for me to gain some control.”
By 19, Nourse was dangerously underweight and hospitalized in a pediatric eating-disorders ward. After she was discharged and started college, her illness morphed into a relentless cycle of restriction, bingeing and purging.
“I realized, ‘Hey, I can eat under 1,000 calories a day and be fine,’ and Ed loved that.”
Jenn Nourse
“Ed, as I named him, kept me safe from the realities of the world,” said Nourse, an emotional health practitioner in Ontario.
After she had children, Ed largely faded into the background — until February 2024, when she stepped on the scale and was “alarmed” by her “significant” weight gain.
Her doctor referred her to an obesity specialist, who recommended semaglutide — the active ingredient in Ozempic and Wegovy — noting it could also help with her insulin resistance and fatty liver. She didn’t tell the doctor about her history of anorexia and bulimia.
Within weeks, warning signs began to surface. Her appetite vanished, and the food noise disappeared.
“I had the ability to go throughout the day without eating and not feeling hungry,” she said. “Then I realized, ‘Hey, I can eat under 1,000 calories a day and be fine,’ and Ed loved that.”
A familiar spiral
For some patients, the slide began before the first jab.
Jo Clark-Smith hadn’t actively struggled with an eating disorder in nearly 20 years before getting a GLP-1 prescription.
The 35-year-old data scientist from Virginia has familial hypercholesterolemia, a genetic condition that elevates “bad” cholesterol and increases the risk of heart attack and stroke.
“I’ve done the diets. I’ve done the exercise. And I could never get the cholesterol to go down,” they said.
Clark-Smith’s doctor prescribed Wegovy — a medication shown to help lower cholesterol — but didn’t discuss their history of disordered eating, which included roughly six months of food restriction at 14.
“As soon as I picked it up from the pharmacy, I was on the Wegovy subreddit, I was looking at thinspo stuff. I felt like I was 14 again.”
Jo Clark-Smith
Experts say this type of oversight is common, as many doctors aren’t screening for eating disorders before prescribing — a sharp departure from other weight-loss interventions, such as bariatric surgery.
“A psychological screening would happen before moving forward with that process. Here, with [GLP-1s], that’s not really happening,” said Sarah Davis, a licensed psychotherapist and certified eating disorder specialist.
Prescribing information for drugs such as Ozempic and Wegovy — which contain semaglutide — instructs doctors to ask patients about any history of mental health issues before prescribing the medication.
“Patient safety is our top priority,” a spokesperson for Novo Nordisk, which manufactures the drugs, told The Post. “Semaglutide’s efficacy and safety have been extensively demonstrated in people with obesity/overweight with robust evidence for improving health outcomes.”
But before Clark-Smith took their first dose, familiar thought patterns came rushing back.
“As soon as I picked it up from the pharmacy, I was on the Wegovy subreddit, I was looking at thinspo stuff,” they said. “I felt like I was 14 again.”
Clark-Smith became consumed by thoughts of weight loss — the clothes they’d be able to fit into, how skinny they’d be.
“Should I just not eat? Should I throw up what I eat?” they recalled thinking. Clark-Smith stopped taking the drug after two months, but some of the thoughts still linger.
A prescription for trouble?
As Nourse’s relapse deepened, her mental health started to unravel.
“Everything revolved around what I was going to eat next or what I wasn’t going to eat,” she said. “The food noise and Ed were in full-blown party mode.”
That all-consuming mindset is one of the toughest battles for people with eating disorders, according to Dr. Thea Gallagher, a clinical psychologist at NYU Langone. “It takes over your brain and your mental capacity. It can be really like a prison of your own mind.”
As the pounds dropped, the compliments poured in.
“It was giving Ed what he wants to hear — that I need to keep going,” Nourse said.
Seven months into the medication, she hit a breaking point and started working with a specialized dietitian and trauma therapist, slowly weaning off the drug. But even without it, the illness tightened its grip.
“I did not want to eat because the power of the eating disorder was just as strong as the GLP-1,” Nourse said.
Once off semaglutide, food restriction took over her life, and bulimia followed.
It’s a pattern Dr. Zoe Ross-Nash, a licensed clinical psychologist and certified eating disorder specialist, has seen before.
“What the GLP-1 is encouraging is eating disorder behaviors,” she said. “So then it makes sense that those behaviors are then reinforced, and they continue.”
Eventually, Nourse entered an intensive outpatient program at a local hospital. Today, she’s slowly rebuilding.
“Ed isn’t in the driver’s seat any more,” Nourse said. “But people who have a history of disordered eating really need to be honest with themselves before starting this medication.”
As GLP-1 prescriptions surge, experts say awareness — among doctors and patients alike — is critical.
“I don’t think [GLP-1s] are inherently good or bad, but for people with eating disorder vulnerability, context, screening and monitoring matter so much,” Davis said.
And while GLP-1s have helped many, experts caution they aren’t a cure-all.
“Let’s go back to, like, Florida in the early 2000s when the opioid epidemic was really bad. Opioids are helpful for people when needed,” Ross-Nash said. “GLP-1s can be helpful for people when needed — but it can very quickly turn into something very damaging.”
