GLP-1 Medications and Eating Disorder Recovery: Creating a Safety Plan
If you're taking a GLP-1 medication like Ozempic, Wegovy, or Mounjaro and have concerns about its impact on your eating behaviors or mental health, you're not alone. While these medications can serve legitimate medical purposes for conditions like type 2 diabetes, their effects on appetite, eating patterns, and relationship with food raise serious concerns for anyone with a history of disordered eating or those in recovery from an eating disorder.
Understanding how these medications impact recovery and knowing how to create a safety plan or exit strategy can be lifesaving for individuals navigating this complex terrain.
How Do GLP-1 Medications Impact Eating Disorder Recovery?
For individuals in eating disorder recovery, GLP-1 medications pose serious and multifaceted threats to their progress and wellbeing. Recovery from an eating disorder requires developing a healthy, flexible relationship with food. For example, learning to trust and respond to the body's hunger and fullness signals, and separating self-worth from weight and appearance. GLP-1 medications work directly against each of these essential recovery components.
Responding to internal cues
One of the foundational principles of eating disorder recovery is learning to eat in response to internal cues rather than external rules or restrictions. Individuals work painstakingly to rebuild trust with their bodies, learning to recognize true physical hunger and to eat adequately to meet their needs. GLP-1 medications override these signals, chemically suppressing appetite and making it difficult or impossible to feel natural hunger. This fundamentally undermines the recovery process by removing the very signals that individuals are working to reconnect with and honor.
Disrupted eating patterns
Recovery also involves normalizing eating patterns and challenging the eating disorder's rules about what, when, and how much to eat. GLP-1 medications make normal eating physically challenging or impossible. When someone cannot finish a regular meal due to early satiety or experiences nausea from eating, it reinforces the eating disorder's message that less food is better and that restricting intake is the right approach. Even if the individual intellectually understands that these effects are medication-induced, the experiential reality of being unable to eat can strengthen disordered thought patterns.
The weight loss that typically accompanies GLP-1 use is particularly problematic for individuals in recovery, many of whom have worked to accept weight restoration as part of their healing. Eating disorder recovery often requires individuals to gain weight to reach a healthier set point, and maintaining that weight is crucial for sustained recovery. GLP-1-induced weight loss can trigger intense eating disorder thoughts, anxiety, and a sense of failure or loss of progress. It can also reactivate the addictive quality of weight loss, making individuals vulnerable to relapse.
Social & environmental factors
Social and environmental factors compound these challenges. When someone in recovery is taking a GLP-1 medication, they may receive praise and positive attention for their weight loss from people who are unaware of their eating disorder history. This external validation can be incredibly triggering, reinforcing the eating disorder's promise that thinness brings worthiness and belonging. It becomes exponentially harder to maintain recovery-oriented values when the outside world is celebrating behaviors and outcomes that the eating disorder also values.
For people in recovery from binge eating disorder specifically, GLP-1 medications present a complex situation. While the appetite suppression might initially seem to reduce binge urges, it doesn't address the emotional, psychological, or environmental factors that drive binge eating. When the medication is stopped or becomes less effective, the underlying drivers of binge eating remain unaddressed. This often leads to a resurgence of symptoms. Additionally, the medication can become a new form of compensatory behavior, replacing other methods of weight control that the individual has worked to stop.
Treatment providers report that clients on GLP-1 medications often struggle to engage fully in recovery work. It's difficult to practice intuitive eating when you have no appetite. It's hard to challenge food fears when you feel nauseous at the thought of eating. Skills like mindful eating, learning to sit with discomfort, and distinguishing physical from emotional hunger become nearly impossible to develop when appetite is chemically suppressed.
How to Establish a Safety Plan and Exit Strategy If You're on a GLP-1
If you're currently taking a GLP-1 medication and are concerned about its impact on your mental health or eating behaviors, or if you have a history of disordered eating, developing a safety plan and thoughtful exit strategy is essential. This process should ideally be undertaken with support from healthcare providers who understand both the medical aspects of these medications and the psychological complexities of eating disorders.
Step 1: Conduct an Honest Assessment
Begin by conducting an honest assessment of your relationship with the medication and with food. Ask yourself these critical questions:
Are you taking the medication for a legitimate medical indication like diabetes, or primarily for weight loss?
Have you noticed changes in your eating patterns beyond just reduced hunger? Such as food avoidance, anxiety about eating, or preoccupation with weight?
Are you experiencing any eating disorder symptoms? Ex: Binge eating, purging, excessive exercise, or rigid food rules?
Have you noticed that you're more focused on your appearance or weight since starting the medication?
Answering these questions honestly can help you understand whether the medication is creating problems that outweigh its benefits.
Step 2: Assemble a Support Team
Next, assemble a support team. This should ideally include:
Your prescribing physician who can manage the medical aspects of tapering
A therapist with eating disorder expertise who can help you navigate the psychological challenges
A registered dietitian who specializes in eating disorders and uses a non-diet approach
Trusted friends or family members who can provide emotional support and accountability
Not everyone will have access to all of these professionals, but even identifying one or two supportive people who understand your concerns can make a significant difference.
Step 3: Develop a Tapering Plan
Work with your medical provider to develop a tapering plan. Abruptly stopping GLP-1 medications can lead to rebound hunger, rapid weight regain, and psychological distress. A gradual reduction in dosage, done under medical supervision, can help your body adjust more smoothly. Your doctor can also monitor for any physical complications during this transition.
Be honest with your prescriber about your concerns regarding eating disorder symptoms. If they're not receptive or knowledgeable about these issues, it may be worth seeking a second opinion from a provider who specializes in both metabolic health and eating disorders.
Step 4: Prepare for Physical and Psychological Changes
As you reduce the medication, prepare for physical and psychological changes. Your appetite will likely return, possibly quite intensely at first. This is a normal physiological response, not a sign of failure or loss of control. You may experience anxiety about eating more or fear of weight gain. These feelings are also normal, especially if you've become accustomed to the appetite suppression.
Working with a therapist at Swell Mental Health can help you navigate these emotional challenges. They can provide coping strategies for managing anxiety, processing difficult emotions, and challenging the thoughts that may arise during this transition.
Step 5: Establish Specific Coping Strategies
Establish specific coping strategies for managing the transition. Consider implementing:
Structured meal planning with your dietitian to ensure you're eating adequately even when appetite is suppressed or intense
Regular journaling about your thoughts and feelings regarding food and your body
Self-compassion exercises when you notice self-critical thoughts emerging
Body appreciation activities that focus on what your body can do rather than how it looks
Non-food-related coping mechanisms for stress or difficult emotions, since you may have relied on the medication to manage these feelings.
Step 6: Create Accountability Measures and Warning Signs
Create accountability measures and warning signs to monitor. Identify specific behaviors or thought patterns that would indicate you're moving toward eating disorder territory, such as:
Weighing yourself multiple times daily
Restricting certain foods or food groups
Eating significantly less than your meal plan
Exercising compulsively or as punishment
Experiencing intense distress about weight changes
Isolating from social situations involving food
Decide in advance what actions you'll take if you notice these warning signs, such as reaching out to your therapist immediately, attending a support group, calling a crisis line, or asking a trusted person for help.
Step 7: Evaluate Medication Compatibility with Recovery
If you're in eating disorder recovery or have a history of disordered eating, strongly consider whether staying on the medication is compatible with your recovery goals. For many people, the answer will be that it's not, and that's okay. Recovery and long-term wellbeing are more important than weight loss.
If you do choose to continue the medication for medical reasons, work closely with your treatment team to minimize risks and monitor for any signs that your eating disorder is being reactivated. This might include more frequent therapy sessions, regular check-ins with your dietitian, and clear protocols for what to do if warning signs appear.
Step 8: Reframe Your Thinking
Remember that discontinuing a GLP-1 medication is not a failure. It's a decision to prioritize your mental health and your relationship with food and your body. The weight changes that may occur are a natural response to stopping a medication that suppressed your appetite—they don't reflect a lack of willpower or discipline.
Focus on what you can control: nourishing your body consistently, engaging in joyful movement, surrounding yourself with supportive people, and challenging diet culture messages that tell you your worth is tied to your size.
Step 9: Practice Patience and Self-Compassion
Finally, be patient and compassionate with yourself throughout this process. Transitioning off a GLP-1 medication while protecting your mental health is challenging work. There may be difficult days, setbacks, or moments when you question your decision.
That's all part of the journey.
Keep your focus on long-term wellbeing rather than short-term weight changes, and remember that learning to trust and care for your body without pharmaceutical intervention is a profound act of self-respect and healing.
Moving Forward: Final Thoughts from an Eating Disorder Therapist
The rise of GLP-1 medications has created new challenges in the landscape of eating disorders and body image. By understanding these risks and approaching these medications with caution and awareness, you can make informed decisions that prioritize your mental health and support genuine, lasting wellbeing.
If you're struggling with the decision about whether to continue or discontinue a GLP-1 medication, please reach out to qualified professionals who can support you. You deserve care that honors both your physical and mental health, and recovery is always possible when you have the right support and resources. Trauma-informed eating disorder counseling in Raleigh, NC can offer a supportive space to explore what’s coming up for you, without pressure or judgment. This kind of care recognizes how past experiences, nervous system responses, and diet culture can all influence your relationship with food and your body.
Ready to Take the Next Step in Protecting Your Recovery?
If you’re taking a GLP-1 medication and feeling uneasy about how it’s affecting your relationship with food, your body, or your mental health, that discomfort matters. You don’t need to wait until things feel “bad enough” to reach out. Early support can make all the difference. Working with an eating disorder–informed therapist can help you create a safety plan that protects both your physical and mental health. Follow the steps below to start working with Swell Mental Health:
Reach out today to schedule a consultation and get support that centers your recovery and wellbeing.
Explore my blog posts for insights into eating disorder recovery, trauma-informed care, and more.
If you’re ready to take that next step, I’m here to walk alongside you.
Other Services I offer anywhere in North Carolina:
In addition to online eating disorder treatment, my goal is to provide compassionate support to help individuals process and release trauma stored in the body with trauma and somatic therapy. Rediscover a harmonious relationship between food and your body through my eating disorder coaching services.
About the Author:
Kate is a licensed therapist based in Raleigh, North Carolina, who works with women navigating eating disorders, body image struggles, anxiety, trauma, and burnout. She’s a type-A, recovering perfectionist, dog mom, and avid reader who can absolutely hyperfocus on a new hobby or a good romance novel. SWELL is her love letter to being a new surfer, a wannabe mermaid, and a full-time mental health nerd.
Kate identifies as a highly sensitive person and believes sensitivity is a superpower, though it didn’t always feel that way. Growing up anxious, feeling big emotions, and later working through childhood trauma and eating disorder recovery deeply shaped how she shows up as a therapist. Her lived experience doesn’t define her clients’ journeys, but it does allow her to sit with complexity, intensity, and vulnerability without flinching.
She often works with people who look like they “have it together” on the outside, but internally feel overwhelmed by anxiety, self-criticism, body hatred, obsessive thoughts, or the weight of past experiences. Kate gets how hard it is to ask for help, because she’s been there herself, searching for a therapist and hoping life could feel different.
In therapy, Kate sees the work as a partnership. You bring your lived experience and self-knowledge. She brings clinical expertise, practical tools, and the ability to gently (and sometimes directly) call out the patterns that keep you stuck. Together, you navigate the mess, challenge the inner critic, and work toward a life that feels more grounded, connected, and, yes, SWELL.
