‘It’s alarming’: How Ozempic is being misused and worsening eating disorders

If someone had told my teenage self that a magical drug would make me thin, I’d have taken it without question. Not that I had an eating disorder, at least not in the sense that I ever starved myself or made myself sick after meals. But back then, negative thoughts about my body consumed me in a way that was far from healthy. This was despite the fact that I was, objectively, slim already. But like all of my female friends, I was riddled with insecurities about the way I looked, and would remain so until my mid-twenties.

Now, that magical drug exists. It’s called semaglutide – though you probably know it as Ozempic or Wegovy – and while it’s helping millions of people with type 2 diabetes, as it’s licensed to do, it’s also being obtained by people with eating disorders (or in some cases simply a desire to be slimmer) who are using the drug off-label as a quick fix for weight loss. Reports of this began in 2023, when a Wall Street Journal article revealed that some doctors were prescribing Ozempic to binge-eating patients to help treat their condition.

Now, it’s common to hear stories of recovering bulimics, as well as those with anorexia, accessing Ozempic through back channels (in the UK, you can easily obtain the drug from pharmacies by fudging responses to an online survey) and using it as an extension of their eating disorder. I know two women doing just that – and at least three others considering it. One told me over Christmas that she was desperate to get hold of some so that she’d finally be happy. She was joking, I think. But the remark illustrated a startling fact: that the advent of weight-loss drugs has inadvertently provided a group of vulnerable, unwell people with a new way to exacerbate their illness.

“We know that people have been able to get hold of Ozempic when they shouldn’t, for example by amending weight details when requesting it from online pharmacies, or getting it through the black market,” says Tom Quinn, head of external affairs at Beat, the UK’s leading eating disorders charity. “Eating disorders will not suddenly be improved by the person affected losing weight – while it might bring their BMI [body mass index] down in isolation, it will do nothing to address the eating disorder and could make symptoms worse.”

While those suffering from an eating disorder might be lured in by the promise of quick weight loss, there’s a lingering question mark over what happens if and when they stop taking the drug. “If somebody gains weight after their prescription finishes, this could trigger feelings of shame and guilt, which could contribute to an eating disorder developing or a relapse,” adds Quinn.

Semaglutide works by mimicking the body’s GLP-1 hormone, which stimulates insulin production and lowers blood sugar levels. This means your appetite is curbed and the process of food moving into the small intestine is slowed right down, so you feel full more quickly, too. It can be a revelation for those with type 2 diabetes and can also reduce the risk of heart disease and stroke.

However, the risks attached to taking these drugs off-label, without proper medical supervision, are high, with potential side effects including gallbladder disease, kidney failure, pancreatitis, and changes in vision. And those are just the ones we know about; given how new these drugs still are, there’s no concrete research on the long-term effects. For those with eating disorders, though, the psychological risks are arguably higher.

“It is very important to understand that Ozempic is not licensed for weight loss in the UK for individuals without diabetes,” says Fiona Yassin, eating disorder specialist and clinical director of The Wave Clinic, a treatment centre in Malaysia, where they’ve noticed an uptick in the number of young people using or considering the drug. “By using these medications to change how we feel about ourselves, we’re mimicking the behaviour seen in substance use disorders, where substances are used to manage internal discomfort. It’s alarming, and the potential medical consequences are enormous.”

As well as the risk of provoking a relapse or prolonging recovery from an eating disorder, there are fears that physical side effects won’t put people off but will rather only strengthen a reliance on the drug. “Nausea, vomiting, abdominal pain, diarrhoea and constipation also disrupt regulated eating, which is generally considered to be the most healthy approach to achieving and maintaining a healthy weight and is the mainstay of the treatment of eating disorders,” says Dr Lorna Richards, a consultant psychiatrist at a private rehabilitation centre in Surrey, who specialises in eating disorders.

“I have patients who have told me that they have not been honest about their weight when accessing these services because they feel compelled to lose weight as a result of ‘eating-disordered’ thoughts, despite being within the healthy weight range or indeed underweight,” she adds. “They know it is dangerous, but the ease of access is too difficult to ignore.”

It doesn’t help that there has been an avalanche of stories about celebrities dropping weight thanks to these drugs, which has helped to normalise their use and detract from the perception of risk. Oprah Winfrey, Kelly Clarkson and Amy Schumer have all spoken publicly about using them with varying levels of success. “There’s an unhelpful narrative that ‘everyone is taking it’, including various famous names who have publicly praised [these drugs],” adds Quinn. “If medication claims to help with weight loss, is glamorously advertised and, more importantly, can be obtained without stringent checks, the higher the chances that someone will try it themselves.”

It’s unavoidable on social media, too. “I recently saw an image on Instagram of a well-known celebrity whose drastically smaller physique sparked discussion among many users,” notes Yassin. The comments on the post were a mix of speculation over Ozempic use and compliments on their appearance, as well as outright criticism and judgement. “For some, seeing the physical changes – especially those that society has come to idealise – and the attention they bring can drive the desire to replicate the same results, despite the risks,” she explains. “This visibility creates a feedback loop – people using the drug, becoming more noticeable, and others wanting to follow suit.”

Just the other day, I was listening to an episode of the hugely popular celebrity gossip podcast Deux U, which is hosted by an anonymous Instagrammer whose account, DeuxMoi, boasts more than 2 million followers. Midway through, there was an advertisement for Ozempic. “The persistent and widespread coverage in the media sadly compounds the overriding societal message that thin bodies are ideal, placing significant value on weight and body control,” adds Dr Richards. “This affects everyone, but is particularly dangerous for those with eating disorders and low self-esteem. Prior to these medications becoming available, I think this message had started to shift towards a healthier approach to bodies and weight.”

Unfortunately, we’ve been heading this way for some time: consider the ongoing conversations around the dearth of body diversity in the world of fashion, and the rising number of industry folk rumoured to be taking Ozempic – last year, a friend found an Ozempic pen [used to deliver an injection of the drug] left behind in the fridge at her Paris hotel room during the city’s Fashion Week.

I’m grateful to have shaken off my own insecurities, mostly thanks to therapy, but I’m becoming concerned about those around me who haven’t quite got there, and are either taking, or considering taking, Ozempic in order to lose weight without there being any medical need to do so. “If you’re concerned about a loved one, the best thing to do would be to speak to them as soon as you can,” advises Quinn. “It’s helpful to not put them on the spot and to use a more gentle line of questioning, for example, ‘I wondered if you’d like to talk about how you’ve been feeling’ would work better than ‘You need to get help’.”

However, greater changes are urgently needed at a higher level in order to combat the rise of people accessing weight-loss drugs without proper prescriptions. Evidently, the restrictions around them are far too lax. “Safeguards should be in place for the prescription of these medications, including a requirement for comprehensive assessment of physical and psychological parameters before treatment is started,” says Richards. “This should include verified BMI and screening for eating disorders.”

The problem speaks to wider concerns about how eating disorders are understood, managed and treated. The fact that people can access weight-loss drugs without any kind of screening for their mental wellbeing is particularly alarming to practitioners. “We’d urge weight-management services to always screen for an eating disorder, regardless of whether or not somebody is being prescribed medication,” says Quinn. “They should also regularly check in with people to assess their relationship with food and weight, and to look out for signs of an eating disorder.” Otherwise, well, as Ozempic becomes more widely available and increasingly normalised, we can expect these issues to get a lot worse in the coming years.

If you’re worried about your own or someone else’s health, you can contact Beat, the UK’s eating disorder charity on 0808 801 0677 or at beateatingdisorders.org.uk