A troubling rise in eating disorders — and a new risk from weight-loss drugs

Eating disorders were already a serious public health problem. A new study suggests they have grown substantially worse — and clinicians say the boom in weight-loss drugs could push them further in the wrong direction.

A sharp three-decade rise

Research published in JAMA Psychiatry, drawing on data from 204 countries and territories, found that the incidence of anorexia nervosa and bulimia nervosa rose 71% between 1990 and 2023. By 2023, an estimated 18.1 million people were living with one of the two conditions, and the researchers estimate they cost the world the equivalent of about 3.83 million years of healthy life that year. The team projects the total could reach 21.8 million people by 2050.

Those figures, stark as they are, may understate the problem. According to clinical psychologist Cheri Levinson of the University of Louisville, who was not involved in the study, anorexia and bulimia represent less than half of all eating disorders — meaning the true burden could be roughly three times what the study reports.

Why cases climbed

The researchers did not set out to explain the rise, but clinicians point to several forces. Social media is one: filtered images, diet trends and "thinspiration" content can trigger or worsen disordered eating, and researchers at the University of Melbourne previously found that TikTok's algorithm served users with eating disorders far more toxic eating-disorder videos than other users. The pandemic also played a role — research from 2021 found that hospitalizations for eating disorders in the United States doubled between 2018 and 2020.

Levinson, who has specialized in eating disorders for nearly 20 years, told MIT Technology Review she is now seeing more patients with more severe symptoms than at any other point in her career, including children as young as eight and nine.

The GLP-1 complication

The newest concern is GLP-1 weight-loss drugs, which have surged in popularity — a Gallup survey earlier this year suggested 15% of Americans had used one for weight loss. Clinicians report that some people with eating disorders are misusing the drugs, and a small study by Levinson and colleagues found that 30% of people with eating disorders had used GLP-1s, with about 10% appearing to have misused them. Levinson believes even that misuse figure is an underestimate.

The worry is not hypothetical. Levinson says she and colleagues have seen children develop eating disorders after being prescribed GLP-1s for medical reasons, and others — including children as young as 11 — buying versions of the drugs through TikTok. Cynthia Bulik, a clinical psychologist at the University of North Carolina, warned that the drugs could drive faster and more extreme weight loss in people with anorexia, bringing patients to clinics in more advanced, harder-to-reverse stages of illness.

What clinicians are urging

Both researchers are continuing to study the drugs' effects, and in the meantime they are urging caution from prescribers. New research and clinical guidelines published earlier this month recommend that doctors screen for eating disorders before prescribing GLP-1s, along with more patient education and closer monitoring of people who take them.

The broader lesson of the new data is sobering: a condition long treated as niche is, by these estimates, affecting tens of millions of people and getting worse — and a celebrated class of drugs now needs to be weighed against a risk that was barely on the radar when it took off.

If you or someone you know may have an eating disorder, support and information are available from the National Eating Disorders Association.

Written by the BidAsk Newsroom. Based on reporting from the sources below.