Experts urge caution prescribing GLP-1s for patients with eating disorders, highlighting motivation checks, psychoeducation, and team-based care.
Glucagon-like peptide-1 (GLP-1) receptor agonists carry particular risks for patients with a history of eating disorders, given their appetite-suppressing and gastric-emptying effects, according to Gemma Sharp, PhD. When such a patient seeks a GLP-1 prescription, clinicians should provide thorough psychoeducation about the medication and probe the patient's underlying motivations before proceeding. Sharp said, "there is a lot of psychoeducation and general health education that should be given to this patient so they know exactly what to expect from the GLP-1 and also understanding what their motivations are."
A motivational focus centered heavily on weight loss or body image distress can signal that the eating disorder itself is driving the request.1 Sharp recommended asking in detail about the eating disorder history, including whether an initial anorexia nervosa presentation has evolved into bulimia nervosa or binge eating disorder, and considering how appetite suppression and delayed gastric emptying from a GLP-1 may interact with behaviors and sensations the patient has previously experienced. She said clinicians and patients should agree in advance on a plan if the medication is judged to be perpetuating the eating disorder, including whether it would be discontinued or reduced in dose.
Sharp described an ideal multidisciplinary team for concurrent eating disorder and obesity as a psychologist, a dietitian, a primary care physician or general practitioner who often coordinates the team, a psychiatrist when other psychotropic medications are involved, and an endocrinologist, whom she considers essential for GLP-1 expertise.2 She acknowledged the cost of this wraparound care but said it is warranted because GLP-1 medications have powerful, multisystem effects.
Sharp called for eliminating a weight-stigmatizing lens in GLP-1 prescribing, saying, "if we could change one thing, it would be a weight stigmatizing lens that is sometimes applied to patients." The treatment goal, she said, should center on overall health, such as insulin regulation, rather than the number on the scale, an approach that also protects against eating disorder pathology. She credited GLP-1 medications with bringing the eating disorder and obesity fields together, reducing patient self-blame around weight, and advancing understanding that body weight reflects far more than diet and exercise alone.
Dr Sharp is the head of body image, eating, and weight disorders research at Adelaide University in Australia.
References
1. Peiper NC, Zibbell JE, LaJoie AS, et al.
2. Keshen A, Koning E, Allison KC, et al.
