Patients should be subject to a mandatory comprehensive medical assessment before being prescribed GLP-1 RA medications, says the group.
Australia’s peak eating disorder advocacy bodies are calling for tighter controls on new-generation weight loss medicines, as the Butterfly Foundation records an increase in callers concerned about the use of GLP-1 receptor agonists.
Because a large portion of patients are accessing these medicines via online-only telehealth clinics like Juniper or Mosh, which operate entirely outside of the MBS and mostly outside of the PBS, there is limited hard data available on the people being prescribed drugs like Ozempic (Novo Nordisk).
“The Butterfly Helpline are seeing an increase in callers from both people with an eating disorder and also their families and carers concerned about what’s happening [with GLP-1 medicines],” clinical psychologist and director of the National Eating Disorder Collaboration Dr Sarah Trobe said.
“What would happen for someone with an eating disorder, though, is they’re not going to necessarily come out and say that that’s what’s happening, because they want to be able to have access to the medication.
“What we’re relying on is the few people that are coming forward … but we’ve been concerned about this for quite a long time, because these medications are not being regulated well enough.
“Not even close to well enough.”
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Earlier this week, the ABC reported on the case of a woman who accessed GLP-1 RAs via a telehealth service even though she disclosed a history of disordered eating and mental health conditions.
Her eating disorder ultimately relapsed, resulting in a hospital admission.
Eucalyptus, the parent company of online weight loss clinic Juniper, was explicitly named as the telehealth clinic which wrote the prescription.
Eucalyptus clinical director Dr Matt Vickers told The Medical Republic that the company was committed to patient safety.
“We screen extensively for disordered eating in both our intake procedure and our phone or video consultations, and we have implemented mandatory practitioner training and auditing to support this,” he said.
Popular GLP-1 medicines like Ozempic and Mounjaro are still relatively new, as are telehealth-only clinics.
Combined, these factors have made it a uniquely slippery topic.
“A lot of the big clinical trials do actually exclude people with mental health conditions, because they need a controlled trial done,” Dr Trobe told The Medical Republic.
“But … if someone has severe depression or if someone has an eating disorder and takes a GLP-1, what are the impacts going to be?”
The Eating Disorders Alliance is calling on the government to implement greater scrutiny and regulations for doctors operating outside of the MBS, as well as mandatory comprehensive medical assessments in telehealth assessments for people seeking weight loss medicines.
“You really need to eyeball someone,” Dr Trobe said.
“You need to actually see who that person is and what their weight is, and it’s an assessment not of weight – it’s looking at the physical comorbidities, because that’s what you’re treating. You’re treating fatty liver or high blood pressure.
“Then you have an informed care team, and that’s what’s really required – a dietitian and GP is a minimum, but often having that mental health support as well [is a good idea].”
