Can I take a GLP-1 medication like Ozempic if I have a history of an eating disorder?

Possibly, but it requires a careful conversation with your GP about your history. GLP-1 receptor agonists (semaglutide, tirzepatide and others) dramatically reduce appetite and food intake. For most people, that is the therapeutic goal. For someone with a history of restriction behaviours — anorexia, orthorexia, or patterns that were never formally diagnosed — the same pharmacological effect can interact with existing drives in ways that worsen the underlying condition. This does not mean GLP-1 medications are universally contraindicated in people with eating disorder history, but it does mean that screening and monitoring are important, and that your GP should know your full history before prescribing.

What is the SCOFF questionnaire and can it help?

SCOFF is a five-question validated screening tool for eating disorders, widely used in general practice and hospital settings. The questions ask about feeling sick after eating, loss of control over food, weight loss of more than 6 kilograms in three months, body image perception, and whether food dominates your life. It is brief enough to complete in a routine consultation and performs reasonably well as a starting point for identifying patients who warrant further assessment. If your GP is considering a GLP-1 medication for weight management and has not asked about your relationship with food and eating, SCOFF is one framework they might use — though a conversation is often more useful than a questionnaire alone.

GLP-1 medications and eating disorders: the screening gap

What just happened

A study published in JAMA Psychiatry has landed in Australian general practice with some urgency. Among 436 adults presenting to eating disorder clinics in the United States, researchers found that 32.1% had used a GLP-1 receptor agonist — the drug class that includes semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro). Of those, 10.1% had misused the medication, and a further 9.9% had used compounded or unregulated products.

The finding that is prompting the most concern among clinicians: a proportion of patients were using GLP-1 medications not for weight management in the conventional sense, but to sustain restriction behaviours — using the powerful appetite suppression to deepen and maintain an eating disorder. The drug was functioning as a tool of the illness, not as a treatment for comorbid weight concerns.

RACGP newsGP reported on the findings on 25 June 2026, with Dr Karen Spielman putting it plainly: “If you are not screening for eating disorders in people presenting for weight loss, then you are doing harm.”

This matters in an Australian context because the scale of GLP-1 prescribing is now enormous. Nearly 500,000 Australians — roughly 2% of the adult population — take GLP-1 medications monthly. Sales increased nearly tenfold between May 2020 and April 2025. Fifteen per cent of GPs report multiple daily patient inquiries about weight-loss medications. The access pathway is active and expanding — and the eating disorder screening question has not kept pace with it.

The both-and

The clinical signal is real

Eating disorders are common, often under-recognised, and disproportionately affect the populations most likely to seek weight management support. Binge eating disorder, in particular, has significant overlap with obesity — the two conditions are not mutually exclusive, and a person presenting with concerns about their weight may have an active or historical eating disorder that was never formally identified.

Adding a powerful appetite suppressant in that context, without first understanding the person’s relationship with food, hunger, and restriction, carries genuine clinical risk. The concern is not hypothetical. The JAMA Psychiatry data documents exactly what the clinical logic would predict: GLP-1 medications dramatically reduce appetite and food intake. For someone already driven by compulsive restriction, that pharmacological effect can feel like relief — quieting the internal conflict that normally drives compensatory behaviours — while simultaneously deepening the physiological harm of restriction.

The nausea profile of GLP-1 medications is also worth naming. Nausea is the most common side effect, particularly in early weeks of treatment. For most people it is an inconvenience that settles. For someone with a history of purging or food avoidance, nausea that reinforces not eating is harder to read as a side effect and easier to accommodate as a pattern.

What screening looks like in practice

There is a reasonable question about what eating disorder screening looks like in a busy general practice setting. The short answer: it does not require a full psychiatric evaluation before every weight management conversation. Brief validated tools — the SCOFF questionnaire is five questions — can identify patients who warrant a longer conversation before a GLP-1 prescription is considered. The questions are simple and can be asked as part of a routine intake.

The harder issue is that eating disorders in adults, particularly adults presenting with weight concerns, are not always visible. The cultural narrative around weight loss is deeply normalised; restriction that in a younger patient would raise immediate clinical concern may read differently in a 45-year-old presenting with metabolic risk factors. The illness can be disguised — including from the person living with it — by the language of health management.

What the study cannot tell us

The JAMA Psychiatry study is US-based, drawn from a clinical sample of adults already engaged with eating disorder services (n=436). This is not a representative population. It tells us about the downstream consequences of untreated or insufficiently screened eating disorders — not the general community of GLP-1 users. The rate of misuse in the broader Australian population is unknown and almost certainly lower.

The study also does not establish causation. It is possible that some patients with eating disorders sought GLP-1 medications because their restriction was already severe, rather than the medication creating the restriction. Both directions of effect are clinically plausible and both warrant attention.

The implication for practice is not that GLP-1 medications are contraindicated in anyone who has a history of disordered eating. It is that the conversation before prescribing needs to include that territory — and that monitoring during treatment should include questions about relationship with food, not just weight trajectory.

2 cents

If you are considering GLP-1 medications for weight management, your GP should ask about your history with food, eating, and body image. If that question does not come up, it is worth raising yourself. Not because GLP-1 medications are off-limits for people with past or current eating difficulties, but because the starting point matters: what you are trying to treat, what the medication does physiologically, and whether additional support alongside it would be helpful.

If you are currently taking a GLP-1 medication and notice your relationship with food has shifted in a way that feels concerning — restriction that feels compulsive rather than simply reduced appetite, fear of eating returning, a pull toward eating less than the medication already drives — that is worth naming in your next GP appointment. It is not something to manage quietly.

These medications are powerful. That is precisely why they work. It is also why the conditions under which they are started matter.

Verdict: yes — worth knowing about.

Sources cited

JAMA Psychiatry — GLP-1 receptor agonist use in eating disorder patients (2026). https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2850584
RACGP newsGP — ‘Very worrying’: Study sounds alarm on GLP-1 misuse. 25 June 2026. https://www1.racgp.org.au/newsgp/clinical/very-worrying-study-sounds-alarm-on-glp-1-misuse
Medical Republic — GLP-1 RAs being used to sustain eating disorders. 25 June 2026. https://www.medicalrepublic.com.au/glp-1-ras-being-used-to-sustain-eating-disorders/126788