GLP-1 weight-loss drugs may aid binge eating, but clinicians must screen for eating disorders and monitor patients with multidisciplinary care.
Managing patients with concurrent obesity and eating disorders required balancing 2 seemingly opposing treatment goals, highlighted Gemma Sharp, PhD. Eating disorder treatment typically sought to reduce the centrality of weight, shape, and appearance to self-evaluation, whereas glucagon-like peptide-1 (GLP-1) receptor agonists used for obesity directly affected weight, a contrast that could leave patients uncertain about the treatment objective. Both approaches, Sharp said, shared the same underlying goal of improving overall physical and mental health.
Preliminary evidence suggested GLP-1s could benefit patients with binge eating disorder or binge-spectrum presentations, though Sharp noted more research was needed to determine which patients were likely to respond.1 Routine screening for eating disorders should occur whenever a GLP-1 was prescribed, she said: "doing routine screening for eating disorders when prescribing a GLP-1...should be part of routine care."2 A positive screen did not automatically preclude GLP-1 use but warranted closer monitoring by a multidisciplinary eating disorder team, including a psychologist, dietitian, general practitioner, and psychiatrist; if restrictive eating patterns emerged or existing disordered eating was exacerbated, Sharp recommended prompt reassessment.
The mechanism linking GLP-1s to reduced binge eating remained speculative. Sharp said, "it seems to potentially be something to do with impulsivity, given that we are seeing positive effects also for substance abuse." Patients with co-occurring substance use disorders reported both reduced substance use and lower binge eating frequency while on GLP-1 therapy. Sharp said clinical trials were needed to clarify how, where, and why GLP-1s might help these patients.
For screening, Sharp described the SCOFF questionnaire as a quick, validated tool but said a comprehensive clinical interview remained essential, noting that eating disorder symptoms often went undiagnosed. She recommended asking about body image distress, restrictive eating, binge-restrict cycles, compensatory behaviors, and any history of disordered eating at other life stages, since eating disorders could reemerge during periods of stress. Given that psychotropic medications also affected weight, Sharp suggested GLP-1s might have a role in managing that effect and called for further investigation into the mental health impact of GLP-1 medications themselves.
Dr Sharp is a professor and head of body image, eating, and weight disorders research at Adelaide University in Australia.
References
1. Radkhah H, Rahimipour Anaraki S, Parhizkar Roudsari P, et al.
2. Herb Neff KM, Dunford A, Goldschmidt AB, et al.
