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Up to 26 percent of people seeking obesity treatment have an eating disorder most were never screened for.

For patients with restrictive histories, appetite suppression feeds the disorder rather than treating it.

A New England Journal of Medicine article raised a formal concern; screening protocols haven't followed.

There are two women who could be sitting across from you right now, both on semaglutide, losing weight. One of them is, for the first time in years, free. The other one is restricting again and calling it success.

"I felt untouchable," one patient said. "Like I didn't need anything. Food was just irrelevant. And it wasn't even hard. I wasn't white-knuckling it. It just happened. For the first time, I wasn't negotiating with myself every hour. I didn't know that was possible." She lost weight, and something larger shifted with it. She wasn't just smaller but finally in control of the thing that had underwritten all the other competence. If her body was obedient, the rest of the performance could hold.

But what she felt was not relief. It was mastery, delivered by prescription, over the appetite she had spent years trying to outmaneuver. The medication was not treating her relationship with food so much as accelerating where it was already headed.

The Psychology of Control, and Why It Matters Here

Hilde Bruch, whose work on anorexia nervosa remains foundational, defined the disorder as a "struggle for control, for a sense of identity, competence, and effectiveness." For many of the women who end up on GLP-1 medications, that struggle looks nothing like failure. It looks like a career and a household held together with precision, where control over food is not compensation for what isn't working but the thing that keeps everything else working. The restriction is load-bearing.

That framework has been debated and refined over the decades, and the research is clear that not all eating disorders map onto the control model in the same way. But for many women with histories of restriction, the clinical reality is recognizable: the food behaviors are doing psychological work that has nothing to do with food.

Which is why a medication that makes not-eating effortless is........

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