Eating disorder psychopathology relates to weight loss medication and supplement use 6 months later in women.

Eating disorder psychopathology relates to weight loss medication and supplement use 6 months later in women - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Eat Weight Disord . 2026 Mar 6;31(1):29. doi: 10.1007/s40519-026-01833-9 Search in PMC Search in PubMed View in NLM Catalog Add to search Eating disorder psychopathology relates to weight loss medication and supplement use 6 months later in women Diane L Rosenbaum Diane L Rosenbaum 1 Division of Social Sciences, Business, and Education, The Pennsylvania State University, Abington College, 1600 Woodland Road, Abington, PA 19001 USA Find articles by Diane L Rosenbaum 1, ✉ Author information Article notes Copyright and License information 1 Division of Social Sciences, Business, and Education, The Pennsylvania State University, Abington College, 1600 Woodland Road, Abington, PA 19001 USA ✉ Corresponding author. Received 2025 Nov 12; Accepted 2026 Feb 22; Issue date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13079474  PMID: 41790422 Abstract Purpose This study examined whether eating disorder (ED) psychopathology related to weight loss medication and over-the-counter weight loss supplement use over time in women. It was hypothesized that ED psychopathology at baseline would relate to the following 6-months later: (1) use of any weight loss medications or supplements; and specific use of: (2) over-the-counter weight loss supplements, (3) prescription weight loss medications, (4) glucagon-like peptide 1 (GLP-1) agonist medications used for weight loss. Methods Women in the United States were recruited for a 6-month long online study. Questionnaire data were provided, including the 7-item version of the Eating Disorder Examination Questionnaire. Results Baseline ED psychopathology was related to use of weight loss medications and supplements 6-months later, controlling for baseline use and body mass index (BMI). Analyses found greater odds of using over-the-counter weight loss supplements, prescription weight loss medications, and GLP-1 medications, at 6 months associated with higher baseline ED psychopathology, controlling for baseline weight loss medication/supplement use and BMI. Conclusion Medications such as GLP-1s can benefit chronic disease management when used appropriately but these, and other weight loss medications and supplements, may also be appealing to those with ED psychopathology to promote restriction and weight loss. ED symptom screening is important prior to, and during, medication use. These data are relevant for prescribers and suggest that evaluation of ED symptoms, especially “atypical” anorexia nervosa presentations, may be warranted among those seeking weight loss medications. Level of Evidence: Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Supplementary Information The online version contains supplementary material available at 10.1007/s40519-026-01833-9. Keywords: Weight loss medication, GLP-1 inhibitor, Weight loss supplements, Eating disorder symptoms, Longitudinal Introduction Eating disorders present concerns for psychological and physical health, including increased mortality risk [ 1 ]. Behaviors, such as restriction of intake, over-emphasis on weight and shape, and body dissatisfaction are characteristic of many eating disorders [ 2 ]. Yet, few have investigated whether the use of prescription or over-the-counter weight loss tools, which are designed to facilitate reduction of intake and make bodies smaller, may be related to ED psychopathology. This study set out to fill this gap. Weight loss medications Over the past several decades, weight loss medications have been used by millions of Americans [ 3 ]. Weight loss medications have become increasingly salient features of culture, particularly with the surging popularity of glucagon-like peptide-1 (GLP-1) agonist medications [ 4 ]. These medications can have important medical benefits for individuals with diabetes, can help reduce inflammation, mitigate kidney and heart conditions, and are effective in producing weight loss [ 5 – 7 ]. Although these medications offer life improving options for chronic disease management, they also carry potential risks for some. As such, some have raised concerns regarding prescription weight loss medications. For instance, some have cautioned that weight loss medications (GLP-1s in particular) could facilitate the development of certain eating disorders (ED), or worsen existing ED psychopathology [ 8 ]. This may be in part because they help to suppress hunger cues and promote dietary restriction [ 9 ], which could be particularly appealing to, and concerning for, individuals with anorexia nervosa spectrum presentations. They may also be perceived by individuals with ED risk factors, such as body image concerns, as a way to lose weight, despite the costs. For instance, research has found that interest in GLP-1s and willingness to tolerate associated side effects was correlated with body shame, anti-fat bias, lower body appreciation, and disordered eating behaviors [ 10 ]. In addition, epidemiological research found that oral prescription weight loss medication was misused by 25% of those who reported taking it, particularly women [ 3 ]. The existing literature, although limited, suggests that the evaluation of prescription weight loss medication and ED psychopathology is an important avenue for continued study. For instance, one recent study found that ED symptoms were more common among boys and men who reported using prescription weight loss medication [ 11 ]. However, this study did not include women, who tend to have greater odds of EDs than men [ 12 ]. In addition, Ganson et al. [ 11 ] called for future research to examine prospective relationships between ED symptoms and weight loss medication use. Relatedly, among self-identified exercisers and athletes, those who were thinking of, or had used GLP-1 medications for weight loss or physical appearance improvement, had more anxiety, depression, and body image concerns than those who were not interested [ 13 ]. Clinical evaluations are limited, however, those that have investigated the use of weight loss medications among individuals with ED histories suggest also concerns for continued study. For instance, case studies have documented problems with GLP-1 medications in patients with anorexia nervosa (AN) presentations [ 14 , 15 ]. Although prescription weight loss medications may carry risks when used inappropriately, it is also important to note that GLP-1 medications may be used for purposes other than weight management and the evidence regarding their use should be considered separately in this regard. Over-the-counter (OTC) weight loss supplements Over-the-counter (OTC) weight loss supplement use is also common [ 16 ], and has been estimated to occur in about 34% of individuals who are seeking weight reduction, particularly women [ 17 ]. They are also popular among individuals with ED risk factors, such as poor body image. For instance, a study of OTC weight loss supplement users found relatively high levels of body dissatisfaction in their sample, which was comprised of 80% women [ 18 ]. The use of OTC weight loss pills have long been associated with EDs, with research from over 35 years ago indicating that these are frequently used to dampen hunger cues and promote weight loss among individuals with EDs [ 19 ]. In addition to ED risks, there are physical health risks associated with weight loss supplements as well. Research warned that several OTC weight loss supplements have been found to contain ingredients that can cause potentially fatal cardiac events, and are easily accessed online [ 20 ]. Some deaths have been reported due to individuals taking oral compounds obtained from the internet to become leaner, or “diet pills” containing toxic ingredients [ 21 , 22 ]. However, individuals at risk for EDs may overlook factors like side effects and medical risks to obtain products they believe may help them become leaner. Unlike GLP-1 medications which have some appropriate use indications, data regarding OTC weight loss supplement use and ED psychopathology suggests a more straightforward and concerning risk profile. A survey-based study of those who were previously treated for an ED found high rates of OTC weight loss supplement use. Specifically, 64% used an OTC weight loss supplement. Their popularity among participants existed amidst high financial costs and frequent adverse side effects [ 23 ]. Longitudinal research among adolescent and young adult women found greater odds for receiving a new ED diagnosis within several years for those who reportedly used diet pills compared to those who did not [ 24 , 25 ]. The current study Thus far, research largely has not examined prescription weight loss medications and OTC supplements in the same study with regard to ED psychopathology. This warrants consideration since the line between prescription and OTC medications has become blurred with individuals directly obtaining drugs online without a prescription that would otherwise require one [ 26 , 27 ], including GLP-1 medications [ 28 ]. Also OTC supplements are often under-studied in investigations of weight loss medications despite their widespread use [ 18 ]. Given the limited scope of investigation and pressing need, previous research has called for further investigation of weight loss medication/supplement use among those with ED psychopathology [ 29 ]. The current study aims to help remedy this gap. Moreover, there are also research questions unique to the issues of prescription weight loss medication that need to be addressed within regard to ED psychopathology. For instance, researchers have noted an overall paucity of data regarding prescription weight loss medications and ED risk [ 30 ]. Further, there are no known publications examining whether ED psychopathology is related to the use of oral medications or GLP-1 injectable medications over time. This warrants consideration given the current popularity of prescription weight loss medications, particularly GLP-1s. Thus, there are several gaps in the literature that this study was designed to fill. The focus of this study was to understand whether ED psychopathology related to subsequent overall use of weight loss medication and OTC supplements, as well as individual relationships between ED psychopathology and OTC supplements, prescription oral weight loss medication, and GLP-1 medications. To do so, this study had preliminary aims of first evaluating the rates of weight loss medication and supplement use in a community sample of women over 6-months. Based on the findings from previous literature, four hypotheses were developed: Baseline ED psychopathology will predict overall combined weight loss medication and OTC supplement use 6-months later. Baseline ED psychopathology will predict OTC weight loss supplement use 6-months later. Baseline ED psychopathology will predict use of any prescription weight loss medication 6-months later. Baseline ED psychopathology will specifically predict GLP-1 weight loss medication use 6-months later. Method Participants and procedures A community-based sample of women was recruited through Prolific.com for a two-part longitudinal study. Prolific.com was chosen for this study because it allows for expedient recruitment of diverse participants from a wide geographic area, and has been shown to be a source of high quality, reliable, data in online behavioral research [ 31 , 32 ]. Prolific also includes internal checks to ensure authentic human participants are taking part in research (e.g., identity verification) [ 33 ]. The study was broadly focused on thoughts, feelings and health in women, and advertised to participants as a study on women’s health—not weight-related medications or supplements. Participants met the following inclusion criteria: living in the United States; not pregnant; and English fluency. Women who met the inclusion criteria were invited to participate in a Qualtrics survey. All participants also passed attention check items (e.g., If you are paying attention to this item, select “strongly disagree” ). Those who took part in baseline data collection were contacted approximately 6 months later to complete the follow-up survey. Participants were compensated approximately $3.00 at both baseline (T1) and 6-month follow up (T2) for survey completion. Because attrition was expected between T1 and T2 due to lack of contact with participants over the follow-up period, the study over-recruited at T1. Average age was 32.43 (SD = 6.96) years (range 18–49); 69.4% completed at least an associate’s degree. Race and ethnicity were as follows: 22.3% African American/Black; 16.5% Asian American/Pacific Islander; 7.0% Latina/Hispanic; 0.2% Native American/Alaskan Native; 5.1% More than one race/ethnicity; 48.3% White; 0.7% Other. This study was approved by the Institutional Review Board at the university where this research was conducted. Measures Body Mass Index (BMI). Participants self-reported height and weight at T1 which was used to calculate Body Mass Index (BMI) according to the Center for Disease Control and Prevention formula [ 34 ]. Weight Loss Medications and Supplements . Participants were asked “ Please select all of the following you are currently utilizing for the purposes of weight loss ” with response options: Semaglutide (e.g., Ozempic, Wegovy); Tirzepatide (e.g., Mounjaro, Zepbound); Contrave (i.e., bupropion / naltrexone); Orlistat (e.g., Alli, Xenical); Liraglutide (e.g., Saxenda); Qsymia (i.e., phentermine and topiramate); Phendimetrazine (e.g., Bontril, Melfiat); Setmelanotide (e.g., Imcivree); Other prescription oral or injection medication; Herbal or over-the-counter (OTC) supplement(s); None/Not applicable. Coding of weight loss medications and OTC supplements was performed separately for both time points based on the following procedures: Endorsement of any weight loss medication or supplement use was coded as 1 (yes); responses of none/not applicable were coded as 0. Endorsement of herbal or OTC weight loss supplements was coded as 1 (yes) and all other responses were coded as 0 (no). Endorsement of any semaglutide, tirzepatide, contrave, orlistat, liraglutide, qsymia, phendimetrazine, or other prescription oral or injection medication use was coded as 1 (yes) for prescription weight loss medication use; responses of only using herbal or OTC supplements, or none/not applicable were coded as 0 (no). Similarly, for responses at T1 and T2, endorsement of semaglutide, tirzepatide, or liraglutide was coded as 1 (yes) for GLP-1 use; any other responses were coded as 0 (no). Eating Disorder Psychopathology . At T1, participants completed the 7-item version of the Eating Disorder Examination Questionnaire (EDEQ-7) assessing ED psychopathology. The global score, a composite of all questionnaire items, was used for primary analyses. The scores from the dietary restraint, shape/weight over-evaluation, and body dissatisfaction subscales were used in exploratory analyses. Mean scores were calculated with higher scores reflecting greater ED psychopathology. This measure demonstrated internal consistency (range 0.89–0.91) similar to the full-length version of the EDEQ, with good convergent and discriminant validity [ 35 ]. Cronbach’s alpha reliability for the global score in this sample was 0.93. Background Items . Demographic information such as age, race and ethnicity, and level of education were collected at T1. Data analysis SPSS version 29 [ 36 ] was utilized for all analyses. Descriptive information was computed using means, standard deviations, correlations, and frequencies. Four separate logistic regression analyses were performed to evaluate odds at T2 of using any weight loss medications/supplements, odds of using supplements/OTC weight loss products, odds of using prescription weight loss medications, and odds of using GLP-1 medications, respectively. Each model included ED psychopathology at T1 as the predictor and controlled for T1 use of weight loss medications/supplements and BMI. Exploratory analyses were conducted for the dietary restraint, shape/weight over-evaluation, and body dissatisfaction subscales using the same procedures. An a priori power calculation in G*Power [ 37 ] determined that for a two-tailed logistic regression with p < 0.05 and a predicted odds ratio of 1.49, a sample of 155 participants would be needed to achieve 90% power. An independent samples t test and Chi square tests were used to evaluate potential differences between those who provided data for T1 and T2 compared to those who only took part in T1. Owing to small cell sizes for some response options, educational status and race and ethnicity were recoded to facilitate evaluation of T2 respondent differences. Educational status was recoded into associate’s degree or higher = 1, else = 0; Race and ethnicity was recoded into racial and ethnic minority = 1, white = 0. Missing data were also evaluated using Little’s MCAR test. Results In total, 431 women provided data at baseline and 266 (61.72%) provided data at 6-month follow up. There were no significant differences in demographic variables (i.e., age, educational status, or race and ethnicity; p > 0.05) between those who did and did not initiate T2 data collection. Little’s MCAR test determined that values for weight loss medication/supplement use, EDEQ-7 scores, and BMI were missing completely at random ( p > 0.05). Approximately 6.73% of participants ( n = 29) reported taking weight loss medications or supplements at T1. Most (82.76%; n = 24) who endorsed taking weight loss medication/supplements at T1 took one, but some took 2 ( n = 3) or 3 ( n = 2). Of those who reported taking weight loss medication/supplements at T1 over half (58.62%; n = 17) reported using OTC supplements; 62.07% ( n = 18) reported using prescription medications for the purposes of weight loss; 41.38% ( n = 12) reported using GLP-1 medications in particular for weight loss. Of the individuals taking GLP-1 medications at T1, 5 (41.6%) had BMIs below 27 kg/m 2 . The rate of weight loss medication/supplement use increased from T1 ( n = 29) to T2 ( n = 45) by 55.17%. McNemar’s paired sample chi square test further indicated that the proportion of individuals taking weight loss medication/supplements increased from T1 to T2 (Continuity Corrected X 2 = 16.45, asymptotic p < 0.001). Similar to T1, most (93.3%; n = 42) who endorsed taking medication/supplements at T2 took one; 2 participants took 2, and 1 participant reported taking 4. Among those who took a weight loss medication/supplement at T2, over half (51.1%) reported OTC supplements ( n = 23); 60% ( n = 27) reported the use of any type of prescription weight loss medication, and 40% ( n = 18) reported using GLP-1 medications in particular for weight loss, consistent with T1 distributions. Please refer to Table 1 for descriptive information about weight loss medication/supplement use, specific prescription weight loss medication use, and other study variables at T1 and T2. Table 1. Descriptive data at baseline (T1) and 6-month follow up (T2) T1 ( n = 431) T2 ( n = 266) n a % b n a % b Any weight loss medication/supplement 29 6.73 45 16.92 Any prescription weight loss medication 18 4.17 27 10.15 Any GLP-1 medication for weight loss 12 2.78 18 6.77 Semaglutide 6 1.39 11 4.14 Tirzepatide 5 1.16 7 2.63 Contrave 1 0.23 3 1.13 Liraglutide 1 0.23 0 0 Qsymia 1 0.23 2 0.75 Phendimetrazine 1 0.23 0 0 Setmelanotide 1 0.23 0 0 Other unspecified prescription oral or injection medication 2 0.46 4 1.50 Herbal or over the counter supplements 17 3.94 23 8.65 Mean SD Mean SD Global Eating Disorder Psychopathology c 3.43 1.95 2.90 1.77 Body Mass Index (kg/m 2 ) 28.72 8.09 28.98 8.45 Open in a new tab a Note that total count of individual medications will exceed size the “Any weight loss medication/supplement” subsample n at each time point since some participants used multiple options b calculated based on available total sample size at respective time point c Measured by the global score of the 7-item version of the Eating Disorders Examination Questionnaire [ 35 ] The first binary logistic regression model evaluated the likelihood of taking any weight loss medication/supplements overall at T2 based on T1 ED psychopathology, controlling for T1 BMI and T1 weight loss medication/supplement use. Model 1 was statistically significant ( X 2 (3) = 64.55, p < 0.001, Nagelkerke R 2 = 0.36). The Hosmer and Lemeshow test was not significant ( X 2 (8) = 4.55, p = 0.80), indicating the model was a good fit for the data. Higher ED psychopathology at T1 resulted in higher odds of using any form of weight loss medication/supplements at T2. The odds of using weight loss medication/supplements at T2 increased by 1.67 for every one-point increase in mean ED psychopathology, holding other variables constant. Please refer to Table 2 . Table 2. Logistic regression analyses predicting overall weight loss medication/weight loss supplement use (Model 1) and specific herbal or over-the-counter (OTC) weight loss supplement use (Model 2) at 6-month follow up ( n = 266) from baseline (T1; N = 431) variables Variables Model 1: Any weight loss medication/supplement use Model 2: Herbal or over-the-counter (OTC) weight loss supplement use B S.E Wald p Odds Ratio 95% CI (Lower) 95% CI (Upper) B S.E Wald p Odds Ratio 95% CI (Lower) 95% CI (Upper) T1 Body mass index (kg/m 2 ) 0.06 0.23 7.22 0.007 1.06 1.02 1.11 0.01 0.03 0.13 0.72 1.01 0.96 1.07 T1 Weight loss medication/supplement use 2.46 0.60 16.83 < .001 11.71 3.62 37.92 1.48 0.58 6.58 0.01 4.38 1.42 13.54 T1 Global eating disorder psychopathology a 0.51 0.13 15.51 < .001 1.67 1.29 2.15 0.40 0.15 7.05 0.008 1.49 1.11 2.00 Open in a new tab a Measured by the global score of the 7-item version of the Eating Disorders Examination Questionnaire [ 35 ] The second binary logistic regression model evaluated the likelihood of specifically taking herbal or OTC weight loss supplements at T2 based on T1 ED psychopathology, controlling for T1 BMI and T1 weight loss medication/supplement use. Model 2 was statistically significant ( X 2 (3) = 18.77, p < 0.001, Nagelkerke R 2 = 0.15). The Hosmer and Lemeshow test was not significant ( X 2 (8) = 3.96, p = 0.86), indicating the model was a good fit for the data. Higher ED psychopathology at T1 resulted in higher odds of using herbal or OTC supplements for weight loss at T2. The odds of using herbal or OTC supplements at T2 increased by 1.49 for every one-point increase in mean ED psychopathology, holding other variables constant. Please refer to Table 2 . The third binary logistic regression model evaluated the likelihood of using any prescription weight loss medications at T2 based on T1 ED psychopathology, controlling for T1 BMI and T1 weight loss medication/supplement use. Model 3 was statistically significant ( X 2 (3) = 43.07, p < 0.001, Nagelkerke R 2 = 0.32). Goodness of fit was demonstrated by the Hosmer and Lemeshow test ( X 2 (8) = 3.87, p = 0.87). Higher ED psychopathology at T1 related to a higher likelihood of prescription weight loss medication use at T2, with a 1.86 increase in the odds of prescription weight loss medication use for every one-point increase in mean ED psychopathology, holding other variables constant. Please refer to Table 3 . Table 3. Logistic regression analyses predicting any prescription weight loss medication use (Model 3) and specific GLP-1 medication use for weight loss (Model 4) at 6-month follow up ( n = 266) from baseline (T1; N = 431) variables Variables Model 3: Prescription weight loss medication use Model 4: GLP-1 medication use B S.E Wald p Odds Ratio 95% CI (Lower) 95% CI (Upper) B S.E Wald p Odds Ratio 95% CI (Lower) 95% CI (Upper) T1 Body mass index (kg/m 2 ) 0.06 0.03 4.83 0.03 1.06 1.01 1.12 0.05 0.03 2.59 0.11 1.05 0.99 1.11 T1 Weight loss medication/supplement use 1.88 0.58 10.47 0.001 6.58 2.10 20.60 2.06 0.57 13.00 < 0.001 7.85 2.56 24.06 T1 Global eating disorder psychopathology a 0.62 0.19 11.25 < 0.001 1.86 1.30 2.68 0.69 0.23 9.02 0.003 2.00 1.27 3.15 Open in a new tab a Measured by the global score of the 7-item version of the Eating Disorders Examination Questionnaire [ 35 ] The fourth binary logistic regression model evaluated the likelihood of specifically using GLP-1 medications at T2 based on T1 ED psychopathology, controlling for T1 BMI and T1 weight loss medication/supplement use. Model 4 was statistically significant ( X 2 (3) = 37.13, p < 0.001, Nagelkerke R 2 = 0.29). Again, goodness of fit was demonstrated by the Hosmer and Lemeshow test ( X 2 (8) = 5.85, p = 0.67). Higher ED psychopathology at T1 related to a higher likelihood of GLP-1 medication use at T2, with a 2.00 increase in the odds of GLP-1 use for every one-point increase in mean ED psychopathology, holding other variables constant. Please refer to Table 3 . Exploratory logistic regression models for each of the three EDEQ-7 subscales were conducted to better understand the dimensions of ED psychopathology involved in relationships with each of the outcome variables. Across the models for the dietary restraint, shape/weight over-evaluation, and body dissatisfaction subscales, results supported higher ED psychopathology relating to higher likelihood of any weight loss medication/supplement use, any prescription weight loss medication use, and GLP-1 use. Regarding OTC/supplement use, only dietary restraint and body dissatisfaction were significantly related; shape/weight over-evaluation was over the threshold for significance ( p = 0.06). Please refer to Tables 4–9 in the Supplementary Material. Discussion This study is the first to find that ED psychopathology was related to the subsequent use of weight loss medication and supplements. Results indicated that whether examined from the perspective of overall medication/supplement use, or separately for OTC supplements, prescription weight loss medications, and GLP-1 medication, their use at 6-months was related to baseline ED psychopathology for women. This expands upon previous cross-sectional work demonstrating a positive relationship between ED psychopathology and weight loss medication use in boys and men [ 11 ]. It also adds to previous longitudinal work demonstrating ED risk in relation to OTC weight loss supplements [ 24 , 25 ]. This study found that ED psychopathology at T1 related to the utilization of weight loss medications and supplements for some women at T2, suggesting that weight and shape dissatisfaction and over-evaluation of their importance may partially motivate their use. Disordered eating attitudes such as these may prompt individuals to overlook potential risks and side effects of weight loss medications and supplements. In particular, this conceptualization aligns with the work of Markey et al. [ 10 ] who found interest in using GLP-1s, and willingness to tolerate their potential side effects, was associated with disordered eating behaviors and ED correlates such as poor body image. Indeed, the current study extends this idea since ED psychopathology specifically related to subsequent prescription weight loss medication, and specifically GLP-1 use. Also, notably almost half of GLP-1 users at T1 had body sizes below the BMI defined cutoff for obesity [ 38 ], and the World Health Organization prescription guidelines reserve the use of these medications for only for individuals with obesity [ 39 ]. This study did not directly ask about reasons for using weight loss medications and supplements though, so it is possible that a variety of factors may have contributed to their use. Causal inferences cannot be made from these results. This study adds to the larger discussion in the literature regarding the relationship between ED psychopathology and weight loss medications. There are many reasons someone may seek out the medications evaluated in this study, and use of weight loss medications does not necessarily indicate ED symptoms. The increasing cultural salience of weight loss medications has stimulated dialogue on their potential applications. For instance, some have speculated that weight loss medication may be helpful in reducing some ED symptoms (e.g., binge eating) [ 40 ]. Outcome data are mixed though. Specifically, some research has found oral prescription medications are not typically effective in reducing binge eating disorder psychopathology [ 41 ] including in randomized controlled trials against a placebo [ 42 , 43 ]. However, a systematic review suggests that GLP-1 medications show promise in reducing binge eating [ 44 ]. There are no weight loss medications currently recommended for the treatment of EDs by the World Federation of Societies of Biological Psychiatry; however, topiramate (a seizure medication known to cause weight loss) is recommended for bulimia nervosa and binge eating disorder [ 45 ]. Since some individuals with ED symptoms may be prescribed medications with weight-altering properties for ED management, it is important to distinguish between motivations for using these medications in the context of ED symptoms. For instance, the implications of someone being prescribed a GLP-1 medication to manage binge eating disorder behaviors are different than someone seeking out a weight loss medication to facilitate unhealthy patterns of restriction (e.g., in an anorexia nervosa presentation). Additional research is indicated to better understand the roles that new and existing weight loss medications may play across the spectrum of ED symptom presentations. Larger body size was positively related to weight loss medication and supplement use in this study, and analyses controlled for BMI. These results hold relevance for individuals in larger bodies who may receive greater encouragement and pressure to utilize weight loss medications and supplements. ED symptoms, such as restriction, may be more often overlooked in individuals with larger bodies [ 46 ], and some with “atypical” AN may have received recommendations to lose weight [ 47 ]. Thus, the potential exists for individuals in larger bodies with “atypical” AN to be prescribed weight loss medications which may exacerbate or reinforce their ED symptoms. Further, since some have raised concerns that the popularity of GLP-1s may exacerbate fatphobia [ 48 ], it is important for future research to investigate whether weight stigma, a risk factor for EDs, is impacted by general promotion of weight loss medications, and their use. The rate of prescription weight loss medication use in this community sample of women was higher than what has been found regarding prescription weight loss medications among men [ 11 ]. This may be due to the greater scrutiny and objectification of women’s bodies that may push them toward weight loss behaviors at a higher rate [ 49 ]. Women are more frequently prescribed weight loss medication prescriptions compared to men [ 50 ], which may also factor into the different rates observed between studies. The findings from this study also suggest weight loss medications may be increasingly popular among community women, given that the rate of prescription weight loss medication use rose during the 6-month course of this study. Weight loss supplements were used alone, or in conjunction with prescription medications, by approximately half of weight loss medication/supplement users. Their rate of use among all participants at baseline indicates OTC supplements were similar to what is typically found among U.S. adults [ 51 ]. Supplements do not require a prescription, and are therefore directly accessible to customers, which may contribute to their popularity. Confidential online ordering and delivery of OTC weight loss supplements (e.g., appetite suppressants) may also appeal to individuals with ED psychopathology looking to conceal their behaviors due to shame. Weight loss supplements can contribute to ED symptom impairment [ 24 ], incur financial burden [ 23 ], and present potential health risks. For instance, in contrast to the regulatory approval that a prescription drug must receive, in the United States supplements are not automatically reviewed for effectiveness or safety by the Food & Drug Administration before marketing [ 52 ]. Previous research has warned of the dangers of weight loss supplements [ 53 ]; however, many who use them believe they are safer than prescription weight loss drugs [ 17 ]. Given the physical and psychological risks associated with weight loss supplements, some have proposed that restrictions and extra taxes on OTC weight loss pills may be considered as a form of ED prevention [ 54 ]. This study adds further evidence for concern about their use since they represented a substantial proportion of the weight loss agents used in this sample, and weight loss medication/supplement use was related to ED psychopathology. Strengths and limits This study exhibited several strengths, including a large sample and longitudinal design. This study also had limitations, including attrition between time points and a single gender sample which may limit generalizability of results. Further, this study examined global ED psychopathology, but there may be differences based on specific diagnostic ED presentations. It is possible that individuals with ED psychopathology may be more likely to initiate weight loss medications, but without assessing motivating factors for weight loss medication/supplement use, or potential medical or psychiatric co-morbidities and other confounding variables that may independently relate to the utilization of certain medications, it is not possible to know with certainty. Medication and supplement use prior to T1 was not assessed and therefore was not able to be controlled for in analyses, which suggests that full knowledge of temporal patterns is not possible through this study. This study did not assess whether medications were recommended by a medical provider, or the context through which prescription medications were obtained. It is possible that dietary restraint may be elevated in those who receive medical recommendations to lose weight and/or have attempted behavioral weight loss interventions; however, shape/weight over-evaluation and body dissatisfaction were also related to prescription weight loss medication use and GLP-1 use. This suggests that results are not driven purely by dieting behaviors, as the body dissatisfaction and shape/weight over-evaluation domains are reflective of cognitive aspects of ED psychopathology. This study also did not assess history of ED diagnoses or treatment, which help improve understanding of temporal factors regarding ED psychopathology. In addition, because the study had broad aims investigating a community sample of women, the number of participants taking weight loss medication/supplements was relatively low compared to what might be found in weight loss seeking and clinical samples. However, because the sample was comprised of a general community sample, this facilitated the ability to understand what weight loss medication/supplement use is like outside the context of specialized populations. Nonetheless, future research is needed to better understand these relationships over a longer course, in mixed gender samples, and in clinical samples. Future research is also needed to better understand weight loss medication/supplement use among individuals in larger bodies with ED symptoms, such as those with “atypical” AN or BED, including precipitants of medication use and its effects. Unique symptom presentations (e.g., “atypical” AN vs. BED) may suggest differences in whether a specific prescription may be an appropriate consideration. Future research is also needed to evaluate the effects of weight loss medication/supplement use on ED symptoms, with considerations for the spectrums of ED symptom presentations and weight loss medication options. In conclusion, this study provides support for further investigation of the role of ED psychopathology in weight loss medication and supplement use. Additional research is needed to keep abreast of the challenges and changes posed by rapid shifts in cultural attitudes toward weight loss medications and their use. Because both higher BMI and higher ED psychopathology were significantly related to weight loss medication/supplement use, this suggests the importance of examining ED psychopathology, broadly, and specific symptoms among individuals in larger bodies in conjunction with weight loss medication referrals. Screening for disordered eating attitudes and behaviors prior to prescribing weight loss medications may be indicated. Evaluation is also warranted regarding ED symptoms and concomitant weight loss medication and supplement use. What is already known on this subject? Cross-sectional research in men suggests ED psychopathology may be more common among those who use prescription weight loss medication. OTC weight loss supplements have been associated with EDs. Thus far, no research has examined the use of prescription weight loss medications, including GLP-1 medications, in women or over time in relation to ED psychopathology. What this study adds? This study found that the 6-month use of prescription weight loss medications, OTC weight loss supplements, and GLP-1 medications for weight loss was related to baseline ED psychopathology in women, after controlling for BMI and baseline weight loss medication/supplement use. Supplementary Information Below is the link to the electronic supplementary material. Supplementary material 1. (17.2KB, docx) Supplementary material 2. (17.1KB, docx) Supplementary material 3. (17.3KB, docx) Supplementary material 4. (17.2KB, docx) Supplementary material 5. (17.3KB, docx) Supplementary material 6. (17.3KB, docx) Author contributions The primary author is responsible for all aspects of the manuscript. Funding This work was supported by internal funds from The Pennsylvania State University, Abington awarded to Diane Rosenbaum. Data availability The data that support the findings of this study are available from the corresponding author upon reasonable request. Declarations Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. The Penn State University Human Research Protection Program declared this research exempt from formal IRB review based on the policies of this institution and the provisions of applicable federal regulations . Informed consent was obtained electronically from all individual participants included in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests. 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Supplementary Materials Supplementary material 1. (17.2KB, docx) Supplementary material 2. (17.1KB, docx) Supplementary material 3. (17.3KB, docx) Supplementary material 4. (17.2KB, docx) Supplementary material 5. (17.3KB, docx) Supplementary material 6. (17.3KB, docx) Data Availability Statement The data that support the findings of this study are available from the corresponding author upon reasonable request. 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