AJ Jasper expected someone to stop him. He has lived with anorexia since childhood, and during a relapse in 2024 he filled out a GLP-1 request on a telehealth site, lied about his weight, and waited for the follow-up questions. “I thought that there would be roadblocks,” he told CNN. The medication was at his door in about 2 days, and he says he never spoke with a doctor face to face or by phone before he was prescribed.

In the 2 years since, he has bought from several sites, sometimes taking more than one product at a time, and only ever compounded versions sold in vials, which he says let him take many times the recommended dose. In January his treatment team insisted he go to the hospital; by then he was so malnourished that his heart, liver, and kidneys had begun to fail. He has made real progress since, and he told CNN he wants more guardrails on online prescribing without demonizing drugs that are helping many people.

I'm the Chief Medical Officer of Vineyard, a telehealth obesity medicine practice, so this is my industry's story; read what follows with that in mind. My questions are about the prescribing process: what it checked, what it missed, and what responsible screening should look like.

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In obesity medicine, food noise usually means persistent, intrusive thoughts about food, and many patients on a GLP-1 describe real relief when those thoughts quiet down. In someone who is undernourished, preoccupation with food can come from a different place.

In 1944 and 1945, Ancel Keys enrolled 36 healthy conscientious objectors in months of semistarvation at the University of Minnesota. They became preoccupied with food, reading cookbooks, collecting recipes, and talking about little else, though none of them had an eating disorder. Undernutrition by itself was enough to make food hard to stop thinking about.

The eating disorder specialists CNN interviewed described that preoccupation in a starving brain as an adaptive push toward renourishment, something treatment tries to work with. Anorexia involves more than hunger, though. Intense fear of weight gain and rigid rules about eating are part of the illness, and Tom Hildebrandt of the Icahn School of Medicine at Mount Sinai told CNN that some patients seek GLP-1s to quiet their food noise. Relief from intrusive food thoughts is not evidence of recovery, and it says nothing about whether a person is eating enough. Jasper described what it looked like for him: on the drug, his food obsessions, fears, and even nightmares went away, and so did his sense of how seriously ill he was.

In a meta-analysis of 36 studies, anorexia carried a death rate almost 6 times the expected rate for people of the same age and sex, the highest of the eating disorders analyzed. The clinicians CNN interviewed were unanimous that GLP-1s have no therapeutic role in anorexia, even as researchers study them in binge eating disorder and bulimia. That evidence is still early. As I wrote last month, a small placebo-controlled trial of liraglutide in 27 adults with binge eating disorder did not show a significant advantage over placebo for reducing binge episodes, although weight loss was greater, and a pharmacy dispensing error limited the study. A small negative trial doesn't prove there is no benefit; it leaves the question open.

In July, a Yale team published a secret-shopper study in JAMA. Between August and December 2025, a researcher used a simulated patient, a 27-year-old man who met eligibility criteria, to request a GLP-1 from 49 online sellers. Of those, 45 prescribed and 34 mailed the drug. Only 27 asked about eating disorders. A video visit was required by 13 sites and a phone call by 3; the remaining sites did not require a live visit. The median time to a prescription was 1 day or less, and 9 of the 45 prescribers accepted only an upper-body photo when their own process called for a full-body or scale photo.

The study used an eligible simulated patient and did not measure clinical harm or how often an ineligible person gets a prescription, and the authors had no data on follow-up after prescribing. What it documents is the assessment itself: most sites never required a live conversation, nearly half never asked about eating disorders, and some accepted less photo evidence than they had asked for. Jasper's account fits that picture. He told CNN that when one site required a video consultation, he could use another.

How the drug is dispensed matters too. Jasper told CNN he used only compounded versions, which came in vials. Drawing doses from a multidose vial leaves room for error: in 2024 the FDA warned that patients measuring their own compounded semaglutide had injected 5 to 20 times the intended dose, and some were hospitalized. Those were accidents. Jasper's account describes something different, using the vials to take far more than prescribed on purpose. Fixed-dose pens make that harder, though no device prevents intentional misuse, and vials aren't unique to compounding: approved tirzepatide is also sold in single-dose vials.

In June, researchers at the University of Louisville and RTI International published a survey of 436 US adults with eating disorder histories. It was a nonprobability sample, recruited through other research studies, national organizations, and online outreach, and it included people in remission. Across the whole sample, 32% reported ever using a GLP-1, 22% were using one at the time, and 10% reported misuse at some point. Misuse was defined broadly: taking more or less than prescribed, raising the dose early, using it longer than prescribed, tampering with the injection device, or sharing it. It is not a count of people using the drug to restrict. Use was highest among people with binge eating disorder and lowest among those with anorexia. A sample like this shows the overlap exists; it can't establish how common it is, whether use came before or after the eating disorder, or whether the drug caused harm.

This is not only a telehealth problem. Rebecca Boswell of the Princeton Center for Eating Disorders told CNN that some of her patients received GLP-1s from physicians after in-person visits, with the anorexia diagnosis already well established, and that physicians unfamiliar with the illness often accept the idea that silencing food noise will help. The head of the American Telemedicine Association told CNN that a form someone can fill with false answers reflects a failure of clinical oversight rather than of telehealth itself. I agree, and the standards below apply in an exam room as much as online.

These are the standards I think every GLP-1 prescriber should meet. They are my clinical judgment: the studies above show where the gaps are, but none of them tested which safeguards work. A questionnaire can help identify risk, but a completed form should not be mistaken for a clinical assessment.

My position is that no one with active anorexia, including atypical anorexia, should be prescribed a GLP-1 for weight loss. The FDA labels don't list anorexia as a contraindication. A past eating disorder calls for individualized assessment, with the patient's eating disorder specialist involved when appropriate.

The evidence behind this piece is limited. CNN documented one man's experience and clinicians' reports of rising use, which can't show how often people with anorexia obtain GLP-1s, online or in person. The Yale study used an eligible patient and had no follow-up data, so it shows gaps in assessment without counting who gets through them. The survey is self-reported, and its lead author expects that to undercount use. The studies discussed here did not establish which safeguards reduce inappropriate prescribing. The USPSTF found the evidence insufficient to weigh the benefits and harms of routine eating disorder screening in people without symptoms, which is a different question from assessing someone who has asked for an appetite-suppressing drug.

For many people with obesity, quieter food noise on a GLP-1 is a real benefit. In someone with an eating disorder, it is not evidence of recovery or of adequate nutrition. Whether the visit happens online or in an exam room, the prescriber's job is to assess what the patient is actually eating, recognize restrictive symptoms at any body size, and act when follow-up raises concern.

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