An industry is prescribing weight-loss drugs to people with anorexia, devastating lives

For AJ Jasper, drugs hailed as miracles have proven nothing short of a curse. In 2024, a hard-won truce between Jasper and the anorexia he had battled, on and off, since childhood collapsed, sending him spiraling to his lowest ebb yet. He was only a few pounds below his target weight, but a stressful period compelled Jasper to seek out a new, revolutionary class of weight-loss medication. Jasper said he submitted a form to the telehealth site Hims & Hers, lying about his weight and asking for a GLP-1 prescription. He expected to speak to a doctor. For there to be more questions. Yet in about two days, the medication was at his door. “I thought that there would be roadblocks,” he told CNN from his apartment in Chicago. CNN spoke to several clinicians and eating disorder specialists reporting sharp rises in the numbers of patients with anorexia using GLP-1s, many of whom obtained them via telehealth platforms with remarkable ease. Millions of people worldwide are using the drugs to lose weight, but their omnipresence has made it difficult for some people who have anorexia to recover or to remain in recovery. Globally, about 3.9 million people have anorexia nervosa — a complex mental health and eating disorder in which people severely restrict their energy intake to lose weight — according to the latest estimates from 2023 by the University of Washington-based Institute for Health Metrics and Evaluation. A study of 436 adults with eating disorders, published in June by the University of Louisville and research institute RTI International, found that a little over 20% of those currently diagnosed with anorexia reported ever having used a GLP-1 — higher than the 15% of US adults who report using the drug at some point for weight loss. Jasper, 40, has sought treatment and stabilized and relapsed several times in the past two years. He has purchased the drugs from a number of telehealth sites, including Ro, Good Life Meds, MEDVi and Priority Meds, sometimes taking several simultaneously to maximize the effect. He’s only ever used compounded, copycat versions of name-brand drugs, as they are cheaper and come in vials rather than pre-filled pens — meaning he could administer many times the recommended dose. The nadir came in January, when Jasper’s treatment team insisted that he check into a hospital. A friend took Jasper, who, bed-bound, had become so malnourished and so underweight that he could hardly lift his head and his heart, liver and kidneys had begun to fail. “I was completely depleted,” he said. Throughout the nightmare, Jasper knew he could easily obtain what he describes as “anorexic heroin” and drop weight at a bewildering scale and speed. If one site made buying GLP-1s harder by requiring a video consultation with a clinician, he could simply use another. If a request form asked him about a history of eating disorders, he could tick “no,” and a confirmation email — arriving often within 24 hours — would inform him that the medication was already on its way. Complex rules Rules governing telehealth sites in the United States are complicated and vary state by state. All require a clinician to establish a relationship with a patient before prescribing, which can happen via a real-time video or phone call, a previous in-person meeting or through a less immediate method, like a questionnaire. Most states do not, however, allow the latter to be the sole basis of this relationship, according to the Center for Connected Health Policy. Illinois, where Jasper lives, requires, for example, optometrists to conduct in-person visits to establish a patient connection, but its rules are less explicit about how to do so for a raft of other specialties and prescription types, according to the CCHP. A spokesperson for Hims & Hers said that screening for eating disorders is a mandatory part of its prescribing process and that, as with in-person appointments, clinicians require patients to be honest about their health history. “Any answer indicating current or past disordered eating triggers additional clinical questions, closer provider review, and in many cases a referral to specialty eating disorder care off our platform,” the spokesperson said. A spokesperson for Ro said that it asks all patients to complete an intake form including questions about eating disorders. Clinicians use these details “to evaluate treatment eligibility and can, at any point, request records, require a video evaluation, or order lab testing to further understand a patient’s health,” the spokesperson said, adding that patients with a history of eating disorders are directed to “seek in-person care.” Both platforms said they regularly follow up with patients to spot problems during treatment. Jasper said he ignored any check-in emails. Telehealth platform RXPros acquired PriorityMeds earlier this year. “Patient safety and appropriate clinical oversight were central to (PriorityMeds’) processes,” a spokesperson for RXPros told CNN. MEDVi and Good Life Meds did not respond to requests for comment. Jasper has made huge leaps in recovery since January. He doesn’t want to demonize drugs that he knows are helping scores of people become healthier, nor does he want his story to be another cautionary tale. But he does want more guardrails around telehealth platforms. ‘Prescription is lax’ The Princeton Center for Eating Disorders once treated only the most severe cases of anorexia that require round-the-clock care. But the New Jersey treatment center recently introduced a program allowing patients to return home for the evening, offering more autonomy. “GLP-1 medication use has, already, in the three months this program has been open, been a major interfering factor in treatment for multiple patients,” said its director, Rebecca Boswell. She spoke of instances where patients were prescribed GLP-1s by physicians — working independently of telehealth platforms — after an in-person appointment and when an anorexia diagnosis had been well-established. Physicians uninformed about the condition have often agreed with a patient’s belief that silencing their “food noise” will help, she said. In other cases, Boswell’s patients have bought GLP-1s via telehealth sites without ever meeting a physician. Telehealth sites hit their first jackpot in the 2010s, when Viagra and other drugs for erectile dysfunction came off patent, allowing for the sale of cheaper generics. They hit another jackpot in the early 2020s, when staggering demand for GLP-1s made by pharmaceutical titans Eli Lilly and Novo Nordisk led to a global shortage and regulators in the United States temporarily permitted telehealth companies to sell compounded versions. The industry as a whole has grown rapidly over the past decade and is built on the demand for drugs targeting common conditions — and that can be accessed discreetly — such as hair loss treatments and hormone replacement therapies. During the pandemic, a relaxation of some rules governing online prescribing in the US gave companies an additional boost. But the GLP-1 opportunity “kind of came out of nowhere and no one really expected it to get this big,” said Brian Tanquilut, a senior equity analyst covering the healthcare sector at investment firm Jefferies. Some company business models are based on selling high volumes of a product, he said, making a smooth pathway to prescription necessary. “Prescription is lax,” he noted of GLP-1s, which aren’t classed as “controlled substances” by the US government — those carrying a risk of addiction or abuse — and thus less strictly regulated. “Anyone who wants it can get it, for the most part.” Last year, researchers at Yale tested that impression, creating a fake profile that attempted to obtain a GLP-1 prescription through 49 different websites. The “secret shopper” study found that 92% of websites ultimately prescribed the drugs, only 55% asked about a history of eating disorders, and 33% mandated either a video or phone call with a clinician. On average, prescriptions were issued within a day. Two were issued in five minutes or less. Researchers said the results indicated that some websites were prioritizing “quick prescriptions over comprehensive care.” Regulators are just beginning to clamp down on the industry from several angles: for rampant compounding and misleading advertising in the United States, to permissive and potentially unsafe prescribing in Australia, Britain and India. Kerri Fleming, head of service development at Beat, a British eating disorder charity, said telehealth providers often ask patients to upload photos to help verify their weight. She said some sites have introduced a “live photo” system to prevent abuse. According to Fleming, some people with anorexia have falsified their image using artificial intelligence or by submitting one of a friend or family member instead. “The clinicians that work (for many telehealth sites) are very much aware of the risks and are trying to improve practices continuously,” she said. “It’s just an ever-changing landscape that is a hard one to navigate.” Kyle Zebley, chief executive officer of the American Telemedicine Association, said the risk of misprescribing is the same across virtual and face-to-face settings when patients are trusted to report on their own problems. “A questionnaire that can be gamed with false information is a clinical governance failure, not a telehealth-specific one,” Zebley said in a statement, adding that the ATA supports “rigorous enforcement against any company or clinician cutting corners on patient safety.” A spokesperson for Eli Lilly told CNN that telehealth providers prescribing its GLP-1 medications – including Mounjaro and Zepbound – operate independently and that “they use their own clinical judgement when treating patients.” Lilly “does not promote or encourage” the use of its drugs for unapproved conditions, the spokesperson said. Mette Kruse Danielsen, a communications director for Novo Nordisk, the maker of Ozempic and Wegovy, said patient safety is a “top priority” for the company and that its products are “not approved for the treatment of eating disorders.” Pervasive use Anorexia has one of highest mortality rates of any psychiatric disorder, and clinicians told CNN that frequent GLP-1 use among patients as well as the drug’s cultural ubiquity are changing approaches to treatment. They are “part of every conversation” Tom Hildebrandt is having with anorexia patients in his clinic at the Icahn School of Medicine at New York City’s Mount Sinai, many of whom report feeling encircled by family and friends taking the drugs. One patient, he said, was offered a GLP-1 at a party. Some patients seek out GLP-1s to quiet their “food noise,” Hildebrandt said. And while there is emerging evidence that the drugs could be an effective treatment for some people with binge eating disorder or bulimia, clinicians interviewed by CNN were unanimous in their rejection of any purported therapeutic benefit for anorexia. When the body is starving, the brain will return an incessant and often distressing loop of thoughts about food, an adaptive response designed to prioritize renourishment that clinicians try to harness rather than shut down. Jasper, in Chicago, understands the risk of silencing those hunger cues. He described himself as a “walking calculator” during periods of struggle with anorexia before taking GLP-1s, incessantly tracking calories ingested and expended. But he said the drugs turned him into a “zombie.” The food obsessions, fears and even nightmares went away, but so too did Jasper’s grasp of the seriousness of his condition. “(I wasn’t) even able to fully comprehend that I was actively dying. … With the medication, I was never able to realize how malnourished I was because I wasn’t thinking about food at all,” he said. He has created a petition he hopes will attract the attention of lawmakers, urging the introduction of new safeguards around online prescribing. “It’s the wild, wild West,” said Jasper.