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.

Joshua Lott for CNN/Phone photo courtesy AJ Jasper

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.

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.

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.”

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.

If you or someone you know is struggling with an eating disorder, help is available. In the United States, call the National Alliance for Eating Disorders’ helpline for free on 1-866-662-1235. A list of international directories is provided on eatingdisorderhope.com .

对于 AJ Jasper 来说，那些被誉为奇迹的药物最终却被证明是一种诅咒。

2024年，贾斯珀与他自幼便时断时续对抗的厌食症之间来之不易的和平彻底破裂，他跌入了人生的最低谷。他当时只比目标体重轻几磅，但一段压力巨大的时期迫使贾斯珀去寻找一种新型的、革命性的减肥药物。

贾斯珀说他向远程医疗网站Hims & Hers提交了一份表格，谎报了自己的体重，并要求开具GLP-1处方。他以为会和医生通话，结果却被问了更多问题。

然而，大约两天后，药品就送到了他家门口。

“我以为会遇到阻碍，”他在芝加哥的公寓里告诉 CNN。

CNN采访了几位临床医生和饮食失调专家，他们报告称，使用GLP-1的厌食症患者人数急剧上升，其中许多患者通过远程医疗平台非常轻松地获得了这些药物。

全世界有数百万人正在使用这些药物减肥，但这些药物的普遍存在使得一些患有厌食症的人难以康复或保持康复状态。

据华盛顿大学健康指标与评估研究所（IHME）2023年的最新估计，全球约有390万人患有神经性厌食症——一种复杂的精神健康和饮食障碍，患者会严重限制能量摄入以减轻体重。路易斯维尔大学和RTI国际研究机构于6月发表的一项针对436名饮食障碍成年人的研究发现，目前被诊断患有神经性厌食症的患者中，略高于20%的人曾使用过GLP-1受体激动剂——这一比例高于美国成年人中曾使用该药物减肥的比例（15%）。

40岁的贾斯珀在过去两年里多次寻求治疗，病情也曾稳定过几次，但随后又复发。他从多家远程医疗网站购买药物，包括Ro、Good Life Meds、MEDVi和Priority Meds，有时为了追求最佳疗效，他会同时服用多种药物。他只使用仿制药，因为这些仿制药价格更低，而且是小瓶装的，而不是预填充的注射笔——这意味着他可以服用远超推荐剂量的药物。

最危急的时刻出现在一月份，当时贾斯珀的治疗团队坚持让他住院。一位朋友把贾斯珀接了过去，他卧床不起，营养不良，体重严重不足，几乎抬不起头，心脏、肝脏和肾脏都开始衰竭。

“我当时筋疲力尽，”他说。

CNN摄影师Joshua Lott拍摄/手机照片由AJ Jasper提供

在整个噩梦中，贾斯珀知道他可以轻易获得他所说的“厌食症海洛因”，并以惊人的速度和规模减轻体重。

如果某个网站要求购买GLP-1药物必须通过视频咨询医生，从而增加了购买难度，他完全可以换个网站。如果申请表询问他是否有饮食失调史，他可以勾选“否”，然后通常会在24小时内收到确认邮件，告知他药物已在运送途中。

美国远程医疗网站的管理规则很复杂，而且各州的规定也不尽相同。

所有这些规定都要求临床医生在开处方前与患者建立医患关系，这种关系可以通过实时视频或电话沟通、之前的面谈，或者通过问卷调查等不太直接的方式建立。然而，据互联健康政策中心称，大多数州不允许仅以问卷调查作为建立医患关系的唯一依据。

据 CCHP 称，例如，Jasper 居住的伊利诺伊州要求验光师进行面对面拜访以建立与患者的联系，但对于其他许多专科和处方类型，该州的规定则不太明确。

Hims & Hers 的一位发言人表示，饮食失调筛查是其处方流程的强制性部分，并且与面对面就诊一样，临床医生要求患者如实告知其健康史。

发言人表示：“任何表明目前或过去存在饮食失调的回答都会引发额外的临床问题、更仔细的医护人员审查，并且在许多情况下，还会将患者转诊到我们平台之外的专门饮食失调治疗机构。”

Ro 的一位发言人表示，该机构要求所有患者填写一份入院登记表，其中包括有关饮食失调的问题。这位发言人说，临床医生会利用这些信息“评估患者是否符合治疗条件，并可随时要求查阅病历、进行视频评估或安排实验室检查，以进一步了解患者的健康状况”。他还补充说，有饮食失调病史的患者会被建议“寻求面对面治疗”。

两个平台都表示会定期与患者联系，以便在治疗过程中发现问题。贾斯珀说他忽略了所有回访邮件。

远程医疗平台 RXPros 于今年早些时候收购了 PriorityMeds。RXPros 的一位发言人告诉 CNN：“患者安全和适当的临床监督是（PriorityMeds）流程的核心。”

MEDVi 和 Good Life Meds 没有回应置评请求。

自一月份以来，贾斯珀的康复取得了巨大进步。他不想妖魔化那些他知道正在帮助许多人恢复健康的药物，也不想让自己的故事成为又一个警示故事。但他确实希望远程医疗平台能有更多监管措施。

普林斯顿饮食失调症中心过去只治疗需要全天候护理的最严重厌食症病例。但这家位于新泽西州的治疗中心最近推出了一项新计划，允许患者晚上回家，从而赋予他们更大的自主权。

“在该项目启动的三个月里，GLP-1 药物的使用已经成为多名患者治疗的主要干扰因素，”该项目负责人 Rebecca Boswell 说。

她提到，有些医生在面诊后，在确诊厌食症的情况下，独立于远程医疗平台，给患者开了GLP-1类药物。她说，对这种疾病不了解的医生往往会认同患者的观点，认为抑制“进食信号”会有帮助。

在其他情况下，博斯韦尔的患者通过远程医疗网站购买了 GLP-1，而从未见过医生。

远程医疗网站在 2010 年代迎来了第一个重大突破，当时伟哥和其他治疗勃起功能障碍的药物专利到期，使得价格更低的仿制药得以销售。

2020 年代初，他们又一次获得了巨大的成功。当时，制药巨头礼来和诺和诺德生产的 GLP-1 药物需求激增，导致全球短缺，美国监管机构暂时允许远程医疗公司销售复方制剂。

过去十年，整个医药行业发展迅猛，其增长动力源于市场对治疗常见疾病且可隐秘获取的药物的需求，例如脱发治疗和激素替代疗法。疫情期间，美国放宽了部分在线处方规定，进一步推动了医药公司的发展。

但杰富瑞投资公司负责医疗保健行业的资深股票分析师布莱恩·坦奎鲁特表示，GLP-1的机遇“几乎是横空出世，没人预料到它会发展到如此规模”。他指出，一些公司的商业模式依赖于产品的大量销售，因此，确保处方流程顺畅至关重要。

他指出，GLP-1类药物的处方管理“很宽松”，这类药物并未被美国政府列为“管制药物”（即具有成瘾或滥用风险的药物），因此监管也相对宽松。“基本上，任何想要的人都能得到它。”

去年，耶鲁大学的研究人员测试了这种印象，他们创建了一个虚假个人资料，试图通过 49 个不同的网站获得 GLP-1 处方。

这项“神秘顾客”调查发现，92%的网站最终会开具处方药，只有55%的网站会询问患者的饮食失调史，33%的网站会要求患者与临床医生进行视频或电话咨询。平均而言，处方会在一天内开出。其中两张处方在五分钟或更短时间内就开出了。

研究人员表示，结果表明一些网站优先考虑“快速开处方，而不是全面的护理”。

监管机构正开始从多个方面对该行业进行整顿：在美国，该行业存在猖獗的配药和误导性广告；在澳大利亚、英国和印度，该行业存在宽松且可能不安全的处方行为。

英国饮食失调症慈善机构Beat的服务发展主管凯瑞·弗莱明表示，远程医疗服务提供商经常要求患者上传照片以验证体重。她说，一些网站已经引入了“实时照片”系统来防止滥用。弗莱明指出，一些厌食症患者会使用人工智能伪造照片，或者提交朋友或家人的照片。

她说：“（许多远程医疗机构的）临床医生非常清楚其中的风险，并一直在努力改进操作流程。但这确实是一个瞬息万变、难以驾驭的领域。”

美国远程医疗协会首席执行官凯尔·泽布利表示，当信任患者能够报告自己的问题时，无论是在虚拟环境中还是面对面环境中，误诊的风险都是相同的。

“一份可以被虚假信息操纵的问卷是临床治理的失败，而不是远程医疗特有的失败，”泽布利在一份声明中表示，并补充说，美国远程医疗协会支持“对任何在患者安全方面偷工减料的公司或临床医生进行严格执法”。

礼来公司发言人告诉CNN，开具其GLP-1类药物（包括Mounjaro和Zepbound）的远程医疗服务提供商独立运营，“他们在治疗患者时会运用自己的临床判断”。该发言人表示，礼来“不推广或鼓励”将其药物用于未经批准的适应症。

诺和诺德公司（Ozempic 和 Wegovy 的生产商）的通讯总监梅特·克鲁斯·丹尼尔森表示，患者安全是公司的“首要任务”，并且其产品“尚未获准用于治疗饮食失调症”。

厌食症是所有精神疾病中死亡率最高的疾病之一，临床医生告诉 CNN，患者频繁使用 GLP-1 以及该药物在文化上的普遍性正在改变治疗方法。

在纽约西奈山伊坎医学院的诊所里，汤姆·希尔德布兰特与厌食症患者进行的每一次谈话中，他们都离不开这些药物。许多患者表示，他们感觉身边的家人和朋友都在服用这些药物。希尔德布兰特说，有一位患者甚至在一次聚会上被人递上了GLP-1。

希尔德布兰特表示，一些患者寻求GLP-1类药物来抑制“进食冲动”。虽然有初步证据表明，这类药物可能对某些暴食症或贪食症患者有效，但接受CNN采访的临床医生一致否认其对厌食症有任何治疗作用。

当身体处于饥饿状态时，大脑会不断地、常常令人痛苦地循环思考食物，这是一种适应性反应，旨在优先补充营养，临床医生试图利用这种反应而不是将其关闭。

身在芝加哥的贾斯珀深知抑制饥饿信号的风险。在服用GLP-1类药物之前，他曾饱受厌食症的折磨，那时他就像个“行走的计算器”，不停地记录着摄入和消耗的卡路里。但他表示，药物让他变成了“行尸走肉”。对食物的执念、恐惧甚至噩梦都消失了，但贾斯珀对自身病情严重性的认识也随之丧失。

“（我）甚至无法完全理解自己正在走向死亡……由于药物的作用，我根本意识不到自己营养不良，因为我完全没有想到食物，”他说。

他发起了一项请愿活动，希望引起立法者的关注，敦促对在线处方引入新的保障措施。

“这里简直就是狂野的西部，”贾斯珀说道。

如果您或您认识的人正在与饮食失调作斗争，请不要担心，您可以寻求帮助。在美国，您可以拨打全国饮食失调联盟 (NAME) 的免费热线 1-866-662-1235。您也可以访问 eatingdisorderhope.com 网站，查看国际相关机构的联系方式。