GLP-1s Are Treating a Diagnosis. Who’s Treating the Patient?

 I see this pattern often enough in my current caseload that it no longer surprises me: a patient on tirzepatide or semaglutide, eating one meal a day. Their hair is thinning. They’re losing muscle along with the weight. And underneath it all, they’re dreading what happens if the number on the scale starts climbing again. 

It rarely enters into the conversation at their medical visits, not because no one cares but because nutrition and disordered eating screening usually fall outside a typical follow-up appointment. 

This isn’t a rare or extreme case. It’s routine.

That’s the gap I want to talk about. GLP-1 receptor agonists have moved into mainstream prescribing faster than the infrastructure to support patients taking them has caught up. By the time a patient like this ends up in front of me, their nutrition guidance has usually come from an online influencer or a generic diet handout not specific to GLP-1s at all.

Appetite Suppression Becomes Undernutrition 

Some patients taking these medications consume fewer than 800 kcal/d in the early stages of treatment, often without realizing it because appetite suppression outpaces their own awareness of how little they’re eating. 

Sustained undereating at that level isn’t a side issue. Inadequate nutritional intake can contribute to lean mass loss and micronutrient deficiency and make adherence harder to sustain over time, all of which can work against the actual treatment goal.

A 2025 cross-sectional study found measurable gaps in nutrient intake among GLP-1 users. The dietitians surveyed in that research described a lack of structured nutrition education for these patients, similar to what dietitians saw in the early years of bariatric surgery before comprehensive dietary support became standard practice. 

We’ve been here before, and we already know what can help close that gap.

Overlooking Eating Disorder Risk 

Eating disorder risk is the piece of this that gets the least attention. 

A 2026 JAMA Psychiatry study found GLP-1 use was highest among people with binge eating disorder, at just over half, and was reported by roughly 42% of those with atypical anorexia nervosa. 

A 2026 rapid review of 25 studies similarly noted that eating disorder outcomes were rarely tracked in GLP-1 research to begin with, so the true scope of the risk remains unclear. A recent New England Journal of Medicine Perspective noted that “worrisome signals have emerged” regarding GLP-1s and disordered eating, an issue the field is only beginning to take seriously.

Here’s what concerns me in practice. A medication that suppresses appetite can look, on the surface, like straightforward, welcome relief. But it can just as easily be feeding a fear of weight regain or creating a pattern of restriction where none existed before.

That’s exactly the kind of pattern a registered dietitian is trained to catch, and exactly why nutrition support shouldn’t wait until a patient brings it up.

I’m not arguing against GLP-1s. I’m arguing that we treat them like the powerful intervention they are, with real support built around them, rather than just a prescription and a follow-up check-in on the scale.

Build Support Into the Prescription 

At the time of prescribing, ask what the patient hopes will change beyond the scale. Say plainly that you’ll be tracking more than weight. And refer the patient to a registered dietitian right then, not later. 

A joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society already recommends nutrition and lifestyle support as part of standard GLP-1 care, and many patients have insurance coverage for these services without realizing it.

There’s no standard eating disorder screen built into GLP-1 prescribing yet. Until there is, the SCOFF questionnaire is one option: five questions, validated in primary care, with no specialized training required. Consider using it at the start and again at intervals.

And whether or not you use a formal screen, ask patients what they actually ate yesterday. It tells you more than the scale does.

The patient I described at the start wasn’t hiding anything. It just hadn’t come up. 

Anne Wilfong, RDN, LD, CEDS, is a registered dietitian and certified eating disorder specialist in Austin, Texas, where she works with clients managing GLP-1 therapy, disordered eating, and other nutrition concerns. 

https://www.medscape.com/viewarticle/glp-1s-are-treating-diagnosis-whos-treating-patient-2026a1000y9q