The Hidden Risk: Abuse Potential for GLP-1 RAs Among Adolescents with Eating Disorders and in Weight-Restrictive Activities

Introduction

Adolescence is a critical period marked by rapid physical, psychological, and emotional development. During this stage, individuals are especially vulnerable to mental health disorders, including eating disorders (EDs). This risk is heightened for adolescents involved in weight-restrictive activities such as gymnastics, ballet, wrestling, or figure skating, where weight and body shape are often closely scrutinized and regulated.

Amid increasing societal pressures to remain thin, the popularity of prescription weight-loss medications like Wegovy and Ozempic (GLP-1 receptor agonists) has grown significantly. These medications, originally developed for managing type 2 diabetes and later approved for chronic weight management, are now being misused by individuals without medical necessity. Alarmingly, some adolescents (including those with EDs) are obtaining counterfeit versions of these drugs through unregulated sources like Instagram and Snapchat. These knockoffs often contain undisclosed or harmful substances, posing serious health risks. Greater awareness is needed about the abuse potential of these drugs and the dangers posed by the unregulated market targeting vulnerable youth.

Understanding Eating Disorders in Adolescents

EDs are complex psychiatric conditions characterized by disordered eating patterns and a preoccupation with weight, shape, or body image. These disorders often stem from psychological distress and are commonly co-occurring with conditions such as anxiety, depression, and obsessive-compulsive disorder. Some major types of EDs include anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED).

According to the National Eating Disorders Association (NEDA, 2021), EDs frequently begin during adolescence because it is a period marked by identity formation and social comparison. During this time period, disordered eating can emerge as a maladaptive coping mechanism to handle extreme pressure and stress. This is particularly true in high-pressure environments like weight-restrictive sports, where appearance and weight are closely monitored and evaluated.

Weight-Restrictive Activities and Their Impact

Certain sports and activities demand strict weight control or favor specific body types, often glamorizing thinness and penalizing deviation. These environments can foster perfectionism and rigid control, which are both known risk factors for EDs. Gymnastics, dance, figure skating, long-distance running, and wrestling are particularly associated with this pressure.

Research has shown that athletes in weight-sensitive sports are significantly more likely to engage in harmful weight control behaviors, including purging, fasting, or using performance-enhancing substances. Mountjoy et al. (2018) found that such athletes have an elevated risk for disordered eating, often driven by internal and external demands to “make weight” or maintain a competitive physique.

These athletes may be more inclined to misuse weight-loss drugs like Wegovy or Ozempic as a means of maintaining weight control, especially when more traditional methods such as dieting or exercise no longer yield the desired results.

Understanding GLP-1 Receptor Agonists

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide (Ozempic, Wegovy), work by mimicking natural gut hormones that regulate appetite and blood sugar levels. For people with obesity or type 2 diabetes, these drugs have shown remarkable effectiveness in promoting weight loss and improving metabolic health.

However, these medications are not approved for cosmetic or non-medical weight loss. Moreover, they come with a range of potential side effects, including nausea, vomiting, pancreatitis, gallbladder disease, and gastrointestinal distress (Wilding et al., 2021). Their long-term effects in adolescents (especially those without medical indications) are not well studied, which raises concerns about misuse.

Limited Access and the Rise of the Black Market

Many adolescents (particularly those with a history of EDs) are unable to obtain a legitimate prescription for GLP-1 RAs. Healthcare providers may be reluctant to prescribe weight-loss medications to young individuals who do not meet medical criteria or whose ED history makes pharmacological intervention inappropriate.

As a result, some adolescents may turn to the black market for GLP-1 RAs, where access is anonymous and prescription-free. Social media platforms like Instagram, TikTok, and Snapchat have become key hubs for distributing counterfeit or illegally obtained weight-loss medications. These counterfeit drugs are often unregulated, may be contaminated, and sometimes don’t contain the advertised ingredient at all.

Users report dangerous side effects, including excessive vomiting, gastrointestinal bleeding, severe dehydration, and hospitalization. In worst-case scenarios, counterfeit drugs may contain amphetamines, insulin, or other unlisted substances, causing acute or life-threatening reactions. The FDA and other health authorities have issued multiple warnings about the rise in counterfeit semaglutide products being sold online or through unauthorized sellers (FDA, 2023).

Conclusion

The intersection of adolescent eating disorders, weight-restrictive sports, and the misuse of weight-loss medications like Ozempic and Wegovy poses a growing public health concern. As societal pressures to be thin persist, and as these medications gain popularity, adolescents are increasingly at risk of turning to dangerous alternatives outside the healthcare system.

Efforts must be made to increase education, awareness, and protective measures, particularly for adolescents involved in appearance-focused or weight-sensitive activities. Health professionals, parents, educators, and coaches must work together to shift the culture around weight, body image, and performance and ensure that youth have access to safe, ethical, and evidence-based support.

References

FDA. (2023). Beware of counterfeit Ozempic sold online and in social media marketplaces. U.S. Food & Drug Administration. Retrieved from https://www.fda.gov

Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., ... & Ljungqvist, A. (2018). The IOC consensus statement: Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine, 52(11), 687–697.

National Eating Disorders Association (NEDA). (2021). Eating Disorders Statistics. Retrieved from https://www.nationaleatingdisorders.org/statistics-research-eating-disorders

Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., ... & Kushner, R. F. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989–1002.

Assessed and Endorsed by the MedReport Medical Review Board