GLP-1 medications were initially developed to help manage type 2 diabetes by regulating blood sugar levels. Recently, these medications have gained attention for promoting weight loss by suppressing appetite and slowing digestion, which enhances feelings of fullness (1). While they offer benefits for managing type 2 diabetes, cardiovascular disease, and kidney disease, little research has examined their effects on eating disorders. The decreased hunger cues and rapid weight loss associated with GLP-1 medications raise concerns for individuals with a history of eating disorders, those in recovery, or those at risk of developing disordered eating behaviors (2). Eating disorder specialists are also questioning the broader implications of these medications, including their influence on weight stigma, healthcare access disparities, and racial inequities in health outcomes.
Lack of Routine Screening in Primary Care
Many individuals with undiagnosed eating disorders are being prescribed GLP-1 medications, as routine screening for eating disorders is not commonly conducted in primary care settings (3,4). Specialists have observed an increase in new or worsening eating disorder symptoms among patients using these medications (3).
What Does the Research Say?
As of 2024, research on GLP-1 medications and eating disorders remains limited (1-4). Some studies suggest these medications may reduce binge eating episodes in individuals with binge eating disorder (BED) or bulimia nervosa (BN). However, these studies often have small sample sizes and focus on short-term effects (3–6 months), leaving long-term impacts unknown. The only randomized controlled trial on BED found no significant changes in eating disorder behaviors. Research on other eating disorders, such as atypical anorexia, is even more scarce. Given these limitations, no evidence-based guidelines currently exist for using GLP-1 medications in eating disorder treatment.
A 2024 literature review highlights key areas for future research, including (1):
Incorporating standard eating disorder outcome measures.
Differentiating between pathological dietary restriction (e.g., skipping meals, rapid weight loss) and non-pathological dietary restraint (e.g., reducing overeating while maintaining adequate nutrition).
Conducting long-term studies (2–5 years) to assess delayed-onset eating disorder symptoms, including rebound binge eating after discontinuation.
Investigating potential misuse of GLP-1 medications, particularly with the introduction of oral formulations.
Exploring how these medications interact with psychotherapeutic interventions, such as cognitive-behavioral therapy (CBT), to mitigate eating disorder risks.
Potential Risks (1-4)
Irregular Eating Patterns: Regular eating is essential for eating disorder recovery, but GLP-1 medications can decrease hunger and cause early satiety, making it harder to maintain consistent eating patterns.
Cognitive and Behavioral Outcomes: These medications may reinforce harmful beliefs about restricting food intake or ignoring hunger cues. Their strong association with weight loss raises concerns about misuse to further a drive for thinness. Rapid weight loss and malnutrition are known risk factors for eating disorders.
Rebound Binge Eating: Individuals with BED may initially experience fewer binge episodes due to appetite suppression. However, this effect does not address the underlying emotional and behavioral aspects of BED. If the medication is discontinued or loses effectiveness, a rebound effect may occur, leading to stronger binge episodes and reinforcing a sense of loss of control.
Weight Cycling: Limited access to GLP-1 medications or discontinuation can lead to weight cycling, which has been linked to negative health outcomes.
Potential Benefits
Management of Co-Occurring Conditions: These medications may support treatment for medical conditions such as diabetes while a patient is receiving eating disorder care.
Reduction in Binge Eating Episodes: Limited research suggests some individuals with BED may experience a temporary decrease in binge eating while using GLP-1 medications.
Considerations for Providers (4)
Dr. Kimberly Dennis, a psychiatrist specializing in eating disorders for over 20 years, emphasizes the importance of patient autonomy and individualized care. She encourages providers to adopt a collaborative, nonjudgmental approach that prioritizes the patient’s quality-of-life goals as defined by the patient, not the clinician. This approach helps reduce stigma and discrimination in healthcare settings.
Recommendations for Providers
Dr. Dennis suggests the following best practices (Dennis, 2024):
Ask all patients about recent medication changes.
Confirm whether the patient has an FDA-approved indication for GLP-1 medication.
Explore the patient’s goals and motivations for using the medication.
Provide informed consent within their scope of practice, considering the medication’s impact on all of the patient’s conditions—not just the eating disorder.
Collaborate with the patient and other healthcare providers.
Implement monitoring and more frequent follow-ups.
Given the lack of research, Dr. Dennis advises providers to rely on:
Parallel Data: Drawing insights from research on similar conditions.
Clinical Experience: Making informed decisions based on professional expertise while acknowledging and minimizing personal biases.
Patient Preferences: Respecting the patient’s lived experience and treatment goals.
Final Thoughts
GLP-1 medications present both potential benefits and risks in the context of eating disorders. Until more research is available, a cautious, patient-centered approach is essential to ensuring the best possible outcomes for individuals in recovery.
If you are a provider looking for an eating disorder dietitian, please have your patient use the Book Now link to receive compassionate care.
References
Mirch, M. C., Teigen, L. M., Kühnle, M. C., Gupta, S., Alam, M., Ben-Porath, C., & Guarda, A. S. (2023). GLP-1 receptor agonists and eating disorders: A scoping review. International Journal of Eating Disorders, 56(12), 2282–2296. https://doi.org/10.1002/eat.24109
National Eating Disorders Association. (2024). GLP-1 Receptor Agonists and Eating Disorders. Retrieved from https://www.nationaleatingdisorders.org/glp-and-eating-disorders/
Gumbrecht, J. (2024, February 26). Experts warn of potential risks as more people use weight loss drugs for eating disorders. CNN Health. Retrieved from CNN
Dennis, K. (2024). GLP-1 Medications and Disordered Eating: A Personalized, Evidence-Based Approach [PowerPoint slides]. SunCloud Health. Retrieved from SunCloud Health
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