I am recovered from an eating disorder and glp1s have been Iife changing for me. Years and years of forcing myself not to eat and to be miserable and this medication has made my hunger signals "normal". Like "oh, are other people not constantly hungry??" "Other people aren't thinking about food all the time including while they are currently eating??" I do think there needs to be more oversight for folks to get this medication, but I also think it would be harmful to just blanketly say "eating disorder history means no med access". My doctor actually had to leave my eating disorder history out of my prior authorization request for zepbound because my insurance wouldn't cover it otherwise. That being said, I am working very closely with my doctor and my trauma therapist to make sure that I am not triggering any past eating disorder behaviors while on this med. Anyone with an eating disorder history who takes these meds should be working closely with a therapist, psychiatrist, and dietitian.
I'm really glad you wrote about this, as it is such an important topic. There needs to be more awareness spread on the negative effects weight loss can have for some and how disordered our society's view on it mostly is. I'm also happy to hear that you've come so far in your recovery. I actually just wrote about some negative side effects on weight loss as well as I'm so worried about it being so glamorized. Let's spread the message!!
Very important discussion, especially because family history is sometimes treated as a routine intake checkbox rather than what it actually is: one of the most accessible forms of longitudinal biologic data we have in medicine. Patterns across generations can reveal inherited risk, shared environmental exposures, behavioral tendencies, and disease trajectories long before laboratory abnormalities appear. What stood out to me most is the reminder that family history is probabilistic, not deterministic. A strong family history of cardiovascular disease, diabetes, neurodegeneration, or cancer does not guarantee the same outcome, but it can meaningfully shift the threshold for earlier screening, lifestyle intervention, imaging, or preventive strategies. In that sense, it becomes less about predicting destiny and more about identifying opportunity for earlier action.
I also appreciated the implicit point that genetics rarely acts in isolation. Epigenetics, diet, sleep, physical activity, socioeconomic factors, environmental exposures, microbiome composition, and stress physiology all interact with inherited susceptibility. Two individuals can carry similar genetic risk yet experience very different outcomes depending on the biologic environment surrounding those genes.
At the same time, I think medicine still struggles with collecting family history in a sufficiently detailed and dynamic way. Many patients simply do not know the diagnoses, ages of onset, or causes of death within prior generations, and electronic medical systems often reduce complex histories into overly simplified categories. There is enormous room for improvement there.
A thoughtful reminder overall that precision medicine is not only about advanced genomics and AI. Sometimes it begins with carefully listening to the story of a family across time.
Such an important piece, one that hasn't been a big enough part of the conversation on GLP-1s. A part of eating disorder recovery that isn't taken into account for even some physicians is that in order to heal from the ED, many need to "overshoot" or get to a higher weight than prior to the eating disorder, even if only for a stretch of time. It worries me to see the cultural skinnification happening right now and to know how triggering that is for those with EDs. Thank you so much for writing this piece. I hope to see more of like this from you and others.
I am recovered from an eating disorder and glp1s have been Iife changing for me. Years and years of forcing myself not to eat and to be miserable and this medication has made my hunger signals "normal". Like "oh, are other people not constantly hungry??" "Other people aren't thinking about food all the time including while they are currently eating??" I do think there needs to be more oversight for folks to get this medication, but I also think it would be harmful to just blanketly say "eating disorder history means no med access". My doctor actually had to leave my eating disorder history out of my prior authorization request for zepbound because my insurance wouldn't cover it otherwise. That being said, I am working very closely with my doctor and my trauma therapist to make sure that I am not triggering any past eating disorder behaviors while on this med. Anyone with an eating disorder history who takes these meds should be working closely with a therapist, psychiatrist, and dietitian.
Thank you for sharing this perspective!
I'm really glad you wrote about this, as it is such an important topic. There needs to be more awareness spread on the negative effects weight loss can have for some and how disordered our society's view on it mostly is. I'm also happy to hear that you've come so far in your recovery. I actually just wrote about some negative side effects on weight loss as well as I'm so worried about it being so glamorized. Let's spread the message!!
Very important discussion, especially because family history is sometimes treated as a routine intake checkbox rather than what it actually is: one of the most accessible forms of longitudinal biologic data we have in medicine. Patterns across generations can reveal inherited risk, shared environmental exposures, behavioral tendencies, and disease trajectories long before laboratory abnormalities appear. What stood out to me most is the reminder that family history is probabilistic, not deterministic. A strong family history of cardiovascular disease, diabetes, neurodegeneration, or cancer does not guarantee the same outcome, but it can meaningfully shift the threshold for earlier screening, lifestyle intervention, imaging, or preventive strategies. In that sense, it becomes less about predicting destiny and more about identifying opportunity for earlier action.
I also appreciated the implicit point that genetics rarely acts in isolation. Epigenetics, diet, sleep, physical activity, socioeconomic factors, environmental exposures, microbiome composition, and stress physiology all interact with inherited susceptibility. Two individuals can carry similar genetic risk yet experience very different outcomes depending on the biologic environment surrounding those genes.
At the same time, I think medicine still struggles with collecting family history in a sufficiently detailed and dynamic way. Many patients simply do not know the diagnoses, ages of onset, or causes of death within prior generations, and electronic medical systems often reduce complex histories into overly simplified categories. There is enormous room for improvement there.
A thoughtful reminder overall that precision medicine is not only about advanced genomics and AI. Sometimes it begins with carefully listening to the story of a family across time.
Such a true and thoughtful response! Thank you for sharing your clinical perspective on this.
Such an important piece, one that hasn't been a big enough part of the conversation on GLP-1s. A part of eating disorder recovery that isn't taken into account for even some physicians is that in order to heal from the ED, many need to "overshoot" or get to a higher weight than prior to the eating disorder, even if only for a stretch of time. It worries me to see the cultural skinnification happening right now and to know how triggering that is for those with EDs. Thank you so much for writing this piece. I hope to see more of like this from you and others.
So glad you enjoyed this read from our guest writer!