GLP-1 social media promotion for cosmetic weight loss creates a novel eating disorder onset pathway in vulnerable populations through unscreened access

The review identifies social media as a mechanism through which GLP-1 misuse reaches eating-disorder-vulnerable populations. Social media promotes GLP-1s 'for esthetic purposes' as miracle weight-loss treatments, which could trigger restrictive eating behaviors in vulnerable individuals. This creates a novel pathway distinct from traditional eating disorder onset: (1) widespread cultural framing of GLP-1s as cosmetic weight loss tools, (2) online access without medical supervision or ED screening, (3) pharmacological appetite suppression that reinforces restrictive patterns in vulnerable users. The review documents a 2025 case where a woman with childhood anorexia prescribed tirzepatide for metabolic indications reignited restrictive patterns, overexercise, and secret continued dosing after physician stopped prescription. The review explicitly calls for pre-treatment psychological assessment and screening for high-risk ED patients before initiating GLP-1s, but notes no regulatory requirement exists. This is a structural access governance failure: the same mechanism that makes GLP-1s therapeutically valuable for BED (appetite suppression) becomes harmful for restrictive EDs when deployed without screening infrastructure.