Before prescribing glucagon-like peptide-1 (GLP-1) receptor agonists, which are used to treat diabetes and obesity, doctors should screen patients for eating disorders. This is the consensus reached by an international group of 45 experts and people with lived experience of eating disorders or GLP-1 medication use. The recommendations were published in the journal World Psychiatry.
GLP-1 medications reduce appetite, blood glucose levels, and blood pressure, slow gastric emptying, and promote weight loss. Some early studies suggested that they might reduce episodes of binge eating, but the findings remain mixed. In the most rigorously controlled study, the reduction in the frequency of binge-eating episodes was not significantly greater than with placebo, despite more substantial weight loss.
The experts reached 94.7% agreement that patients should be assessed for current or past eating disorders before starting treatment. If screening is positive, they recommend additional monitoring, consultation with a specialist, or modifying the treatment approach depending on the severity of symptoms.
In people with active eating disorders, particularly anorexia nervosa, atypical anorexia nervosa, and bulimia nervosa accompanied by severe dietary restriction or significant weight loss, the panel generally recommends avoiding GLP-1 medications. If a patient has a history of an eating disorder, they recommend exercising particular caution.
During treatment and after it is discontinued, experts recommend monitoring not only weight but also eating patterns, appetite, physical health, mood, and psychological symptoms. Particular attention should be paid to a sharply reduced appetite or unexpectedly rapid weight loss.
If symptoms of an eating disorder emerge, consultation with a specialist, additional psychological support, or discontinuation of the medication may be necessary. However, the experts emphasize that such decisions should be made on an individual basis, taking into account both the potential risks and the medical benefits of treatment.
The authors note that the evidence base is still limited: many studies have been small, short-term, or observational. They therefore call for further research into the safety of GLP-1 medications, including their effects on eating disorders and their effectiveness for binge-eating disorder.
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