Worried about an anorexic relative.

Do you know which type of prescription drugs she has been using? If GLP-1s, I can offer something. I recently switched from one medical loss provider to another, from one clinic to another. I won't go into detail about why I changed, as the thread is not about me, but I just mention that I am simply thrilled to be in the care of the new doctor. He is a young guy, literally younger than my son (I looked him up on LinkedIn and figured out his age), with a research background, and his own views on how to use GLP-1 drugs. He does not up the dose every 4 weeks, unlike most other providers. He only ups if really necessary, and not often. He cites clinical studies showing that rapid titration led to muscle loss. Losing weight slowly is much better.

I can look up these studies and give you some material to cite. You can offer that you were thrilled to see the niece lose weight, but also learned about the differing approaches to drug titration, and are worried that the niece might have lost weight too rapidly, and suggest that she, at the very least, stop titrating up and concentrate on weight-bearing exercise to build muscle and bone and on resistance training to grow other muscles. Does she eat enough protein? Does she know her protein intake guidelines, which depend on her height and body frame?

There is the expression "Ozempic face" to describe what happens when people lose weight too fast and do not bother to eat enough protein and engage in regular resistance training while losing.

But if your niece has lost her weight on, essentially, prescription amphetamines, then all the above doesn't apply. And I am afraid that her becoming an anorexic essentially and not realizing that she overdid it points to the amphetamine route. Qsymia is the name of the drug. It can erase the appetite due to the amphetamine component, change the taste perception and make food aversive to the patient due to the Topamax component, and cause psychiatric side effects in people already prone to depression. Including very bad psychiatric side effects. If I were the regulator, I would not approve this drug.

Maybe an inquiry from you, prefaced with how impressed you are with the weight loss, before you delve into how you are concerned about overdoing it, and then going into a conversation about muscle, bone, and protein, won't be perceived as intrusive.

Another thing I learned from this wonderful new doctor of mine is that rapid weight loss is more likely to lead to weight regain. One needs to build muscle and bone to prevent weight regain. Say, you read it someplace and decided to share this important warning with the niece, not to comment negatively on her gaunt face and emaciated appearance, but by way of first congratulating her on her success and then suggesting that now that she has lost all that weight, she should focus on preventing regain (same stuff, resistance training, weight bearing exercise, protein, calcium, vitamin D3).

Nothing can be done with her having already lost an excessive amount of weight, but you might be able to intervene before she loses even more. If she is truly anorexic, such rational arguments might not work, though. If she simply went overboard with an effective prescription and lacked proper medical counseling that would have warned her about the dangers of going overboard, you might have an opportunity to intervene.

For your own information, if you have a NYT subscription, here is an absolutely haunting article: Should Patients Be Allowed to Die From Anorexia?
Treatment wasn’t helping her anorexia, so doctors allowed her to stop — no matter the consequences. But is a “palliative” approach to mental illness really ethical? The article is very long.

I have anorexia and might give some insight.

A lot of people with an eating disorder history (regardless of whether AN, BN, BED, or OSFED) are tricking their doctors (especially now that there is availability with telehealth) or illegally getting access to GLP1s and developing or relapsing into anorexia (generally seen in the unrecovered ED world as the "desired ED").

Anorexia is not a normal disorder where you realize how much you suffer from it and want to get better. You're usually screaming at yourself to just lose another few pounds and stop, and then you get there and then it's "well I can go lower" so you do. You might KNOW your pain, fatigue, brain fog, and food noise can all be fixed if you just start eating again, but the thought of doing so is unbearable until you reach your breaking point and decide for yourself to recover.

Do you know what prescription it is and how she is getting it? If she has in-person appointments to get refills obviously a doctor is going to see the weight loss got excessive and should discontinue it.