The Hidden Dangers of GLP-1s: Eating Disorders, Compounded Meds & Mental Health (Psychiatrist Explains) | ANEW 130

In this second half of their powerful conversation, Dr. Supatra Tovar and quadruple board certified psychiatrist Dr. Vikas Gupta, founder of Wellness Psychiatry, tackle the topics that most GLP-1 discussions avoid: compounded medications, people who do not respond to GLP-1s, the explosion of disordered eating, and why a multidisciplinary, weight neutral approach is urgently needed.

Dr. Gupta begins by addressing the reality many patients face. When FDA approved GLP-1 medications are hard to access, people turn to compounding pharmacies, online prescribers, and social media dosing advice. He explains why the FDA does not endorse compounded GLP-1s, what that means for quality and safety, and the practical steps patients can take if they have relied on compounded versions in the past. Planning ahead with a prescriber, exploring manufacturer assistance programs, and maintaining a “metabolic scaffolding” of structured meals, hydration, and resistance training become essential if access changes.

They also discuss a risk that is rarely named out loud. Many people are now crowd sourcing their dose from the internet, posting syringe photos and asking strangers what to inject. Dr. Gupta underscores why dose decisions belong in a medical visit, not on a message board, and how honest conversations with a trusted clinician can protect both body and mind even when a patient has obtained medication elsewhere.

From there, the episode turns to non responders. What if you are on a GLP-1 and do not lose weight, or even gain? Dr. Gupta outlines the biological and behavioral reasons this happens, including receptor variability, dose issues, medication interactions, inflammation, thyroid function, sleep, and the way appetite suppression can quietly reduce movement and muscle. Dr. Tovar adds a deep dive into the body’s evolutionary response to restriction, explaining how aggressive calorie cuts trigger thermogenesis downshifts and “rebound” weight gain unless hunger, fullness, and nutrient quality are respected.

The heart of Part Two is an honest look at eating disorders and disordered eating in the GLP-1 era. Drawing on his work with higher levels of care, Dr. Gupta explains why GLP-1s are not appropriate in anorexia, atypical anorexia, or restrictive presentations, and why even a past history of an eating disorder should be a serious red flag. Together they explore how appetite suppression, rapid weight changes, and cultural praise for thinness can reactivate restriction, binge restrict cycles, and compulsive body checking.

Dr. Tovar highlights the role of weight stigma, comments on other people’s bodies, and the limits of BMI as a proxy for health. Both emphasize the need for Health at Every Size aligned care, screening tools like the EAT-26, and teams that include therapists, psychiatrists, and dietitians who understand eating disorders, trauma, and metabolic health.

The episode closes with Dr. Gupta’s hopeful vision for the future of psychiatry. He describes an upcoming landscape where metabolic data, genomics, microbiome s

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Transcript

Supatra: 0:00

Welcome back to the ANEW Insight podcast. We're back for the second half of our incredible interview with quadruple board certified psychiatrist and founder of Wellness Psychiatry, Dr. Vikas Gupta. Dr. Guptas gave us, oh my gosh. So much insight into some of the recommendations, some of the pitfalls, some of the worries about medicalized treatment for weight loss. Yes. So we have a lot of people who are finding their medications. They, they cannot get, or their doctor will not prescribe them the medication. And so they're going to compounding pharmacies, which we've seen kind of go through the gamut of, you know, being told that they need to shut down. Now that Novo Nordisk has a greater supply.

Vikas: 0:02

Oh, that's a, that's a great and timely question. Uh, the regulatory tightening we've seen, uh. Now it's largely about making sure, uh, the medications are safe and consistent, um, as you are aware that the compounded versions fill the real gap in the supply of these medications. But the concern was that not all of these were being produced under the same quality standards as the other FD approved products. Don't wait till your while runs out. Uh, planning ahead prevents or, uh, ab abrupt interruptions. The second I would say is to explore manufacturer access or savings programs. So like many branded uh, medications like Semaglutide or Tirzepatide, they have patient assistance pathways, especially for continuing their treat.

Supatra: 0:04

Yes. Here's something I also see is that, uh, people, when they get their medications from these compounding pharmacies, they have no idea how to manage the dose. They don't know they're posting pictures of the syringes and saying, Hey, everybody. Asking the metaverse what, what their dose should be based on their syringe.

Vikas: 0:05

So there are, uh, prescribers and doctors in the community who are, uh, prescribing compounded versions of GLP ones. Um, many of their patients are not comfortable with these injections and some of them are also providing assistance in their clinics to do this. Um. That said, um, even the prescribers and doctors, they, um, don't have firsthand knowledge of the compounded versions.

Supatra: 0:06

Yes. I think it says a lot about the pressures that people face in our society that, you know, there's so much, there's so much damage done from weight stigma and when people experience being overweight that, that the motivation to go outside of our medical providers to get something like this at the risk of their health. And so I hope people hearing this know that there's, there's other ways that we can improve our health and that your worth does not. Your weight does not equate to your worth, um, and working with a psychologist. Will be very helpful as you are pursuing your health journey, because if the only focus is on thinness, we're in big trouble. And, um, as a consequence and boost any or patch weight, sometimes the titration is too fast or going up on the dose too fast. And that can, you know, maybe result in some side effects. And because that people may want to not take the medication anymore. And sometimes the impact of, um, other medications, uh, antidepressants or beta blockers may blunt the effects of some the medications. And, uh, in turn, you know, people may lose lean muscle, the metabolism may slow down, uh, they eat less, but also move less. And this and their progress may plateau. So, um. I frame success from weight loss to metabolic re resilience, uh, focus on preserving muscle, maintaining energy, and building sustainable habits. Uh, it's not always that the medication isn't working, it's also sometimes that the body isn't adapting. And what the body will do is it will slow down thermogenesis 'cause it's trying to hold onto those juicy fat cells, um, and maintain those calories so that they can use them for, uh, you know, energy at the, you know, at, at. In terms of like in an emergency situation, the body tends to prefer, of course, carbohydrates, but we'll use fat if there's no stores available. But when we are in hormonal balance and listening to our hunger, listening to our fullness, eating, um, slowly throughout our meals, and especially eating foods that the body thrives upon, which are mainly, carbohydrates and healthy proteins, especially plant proteins and healthy fats, uh, the body then does not feel like it is in this restriction starvation mode and can utilize those nutrients more efficiently. Um, so I really want to talk about, um. Other medications. But before we do that, I would like to really delve into the topic of eating disorders and disordered eating in relation to these medications. I just recently delivered a TED Talk because I was so alarmed to see the dramatic rise in disordered eating and eating disorders, and you're actually doing some work with Montinito right now.

Vikas: 0:13

Right. So, Hmm. First of all, uh, whatever I say is not endorsed by Montinito. Uh, uh, but it's coming from my personal, uh, opinion. So, as regards to eating disorders, they present like a complex, uh, you know, overlap with the, and concern for the GLP use. Uh, so we do see patients who, um, begin to get disordered eating after they're on GLP ones because of, um, aberrant cues and perhaps, uh, decreased appetite. So I think it's very care important for the physicians to, uh, carefully and aptly, uh, acertain if there is any restrictive eating or restrictions happening outside the binging. Uh, because in that, uh, scenario and. Uh, uh, concern is for the anorexia or, uh, other specified eating disorders, um, which are atypical of like a typical binge eating scenario wherein the BMI is more than 25 and binge eating is the only presentation. So I think, uh, there is a risk balance, a risk benefit analysis that needs to be done. Uh, aside from taking a detailed history before a prescription of these medications. Um, I do, I do know that a lot of patients, um, uh, consider g uh, the weight as one of the primary, you know, assessments of how they see themselves and in terms of their body image and self image. disordered eating and eating disorders can be completely exacerbated. Um, you know, I just read a study that, you know, GLP ones are significantly associated with patterns of misuse, which could be unprescribed use, uh, intentional misapplication, other, uh, ways that, um, you know, are really disturbing for what we're seeing right now. So sometimes, uh, you know, it's, uh, obviously the GLP ones lower the appetite. So with someone who has a recovery from an eating disorder previously. but they're not satisfied with their body image. Perhaps they have a BMI of 22 or 24 and they visit, uh, uh, their, uh, online, uh, prescriber and, uh, you know, they, they don't, uh, answer honestly, uh, regarding the BMI their weight. So I think the history really needs to be thorough and uh, I have seen a lot of patients who have come in with concerns for it. Occasionally say binge eating with a higher BMI. Uh, but they've had a history of, uh, restriction previously. And, uh, because eating disorders can also evolve over time. Uh, so I think the onus is really on the doctors to, to monitor the eating, uh, with the weight and the BMI as well. So monitoring, uh, for the physical factors, the objective factors, the vitals, um, is, is critical, uh, with the use of these medications. And even when considering them. No, especially from these compounding pharmacies. So you know, it, it also speaks to the broader cultural issues that I was talking about earlier, and I think the disordered eating and eating disorders get exacerbated because people feel it's okay to comment on other people's bodies. Whether it's you're too fat or you're, oh, wow, you're thin, and either one of those comments can exacerbate disordered eating or eating disorders, and you're not even aware that you're doing that, especially if you're complimenting someone's weight loss and they're on these medications, you might be feeding into something that is going to be ultimately deadly for that person. I think yes, we need to all be working together and we need to get some more education out there on. How do we talk? Do we talk about each other's body? I, I personally have a staunch rule that we don't make comments about each other's bodies because we don't know if we are complimenting an eating disorder. No, especially from these compounding pharmacies. So you know, it, it also speaks to the broader cultural issues that I was talking about earlier, and I think the disordered eating and eating disorders get exacerbated because people feel it's okay to comment on other people's bodies. Whether it's you're too fat or you're, oh, wow, you're thin, and either one of those comments can exacerbate disordered eating or eating disorders, and you're not even aware that you're doing that, especially if you're complimenting someone's weight loss and they're on these medications, you might be feeding into something that is going to be ultimately deadly for that person. I think yes, we need to all be working together and we need to get some more education out there on. How do we talk? Do we talk about each other's body? I, I personally have a staunch rule that we don't make comments about each other's bodies because we don't know if we are complimenting an eating disorder. Absolutely. I think, uh, the movement of health at every size is picking up and there's a huge, uh, conversation around that. Uh, unfortunately it hasn't translated as such to the medical settings, which still heavily rely on like BMI as an indicator of, um, you know, health. So, um, you're absolutely right. Uh, there are very, very healthy people who are very, sometimes occasionally a very high BMI and, uh, BMI isn't, uh, or the size isn't an indicator of your physical emotional health. And it's really hard for doctors. I will, I will, you know. Be sympathetic that they don't have a lot of time. They also don't have, uh, you know, some of these measures to really help people. But there are some simple questionnaires that you can give to your clients, like the Eat 26, where you can really start to understand people's eating behaviors and I think encouraging this open, honest conversation in the office, avoiding the weight shaming and the weight stigma and really helping somebody on a more of a holistic level rather than just, here's some medication now, just go and, you know, eat high protein, low carb. Like let's get away from that and really start to look at a person individually. So also on, for patients who are on antipsychotics, which sometimes may cause weight gain. GLP's sometimes can actually help rebalance the metabolism. So, um, I also work in inpatient settings in both the, uh, the children's inpatient units. Uh, and they're being used for patients who've gained quite a bit of weight on antipsychotics, uh, to kind of counter counterbalance that. The, the brain can feel it also. So, um, some of these interactions, uh, somehow can, uh, you know, impact your, your moods, your emotions, um, and, uh, being on concurrent medications can sometimes be a concern and they need to be watched very carefully. Yeah, great question. So I think, uh. The binge eating disorder, there are some FDA approved medications for that, uh, like Vyvanse, uh, or, uh, is approved for the binge eating disorder. Sometimes we'll use Topamax and binge eating disorder, so that's another alternative. Then there can be other alternative medications that can be tried, uh, on occasion if everything else has failed and someone really has a true binge eating disorder and with a heavier set body mass. But it's not actually true binge eating disorder. It's actually binge eating in the context of restriction, which is not diagnosed as binge eating disorder, which is other specified eating disorder, and GLP ones are certainly not. It's not a strictly physiological problem. Most people who struggle have had some kind of trauma difficulties in childhood, come from abuse, maybe even from, uh, you know, poverty, uh, have some, uh, distorted views on sustenance and its need. There's so many reasons. So I would say that, you know, if you are struggling with binging, and especially if it's coming from So it is so important to talk to somebody who can help you work through these issues. A therapist, a psychologist, will be your best bet in that area. And then you can also work in a multidisciplinary approach if you really want to improve your eating. Going to somebody who's a haze, um. Aligned dietician will also help you because they will keep you away from that dieting and restrictive mentality and provide you this, the dietary, uh, education that you will need to improve your overall health, which may include your weight and it may not. One. Uh, I anticipate that personalized psychiatry will, um, meet a lot of metabolic data. There'll be a lot more genomics, microbiome testing. There'll be also a lot of variable technology that may help, uh, match treatments to emotional and metabolic profiles. Then, as you already mentioned, uh, there's a lot more, uh, uh, understanding and importance of multidisciplinary treatments. And, uh, the future really will belong to clinicians who can read both the lab values and the life stories and, uh, you know, treat, uh, patients with compassion and, uh, really, uh, utilize, uh, the precision medicine and other, uh, medical advances that might happen in the next few years. That our physical health is 100% connected to our mental health and vice versa. And if we can understand, uh, what food. You know, all these lifestyle factors can do to help or harm us. We can improve people's health. So I love to hear you say that, and I love how aligned you are with me. It's been such a pleasure to sit here with you, Vic.

Supatra: 0:33

Oh, absolutely. And I would love to have you back on here some more and pick your brain some more. 'cause you are just incredible wealth of knowledge. So you guys, oh my gosh, we were blessed today. Thank you, Vic, for coming on the podcast. I am so grateful. And thank you everyone for tuning into the ANEW Insight podcast.