Consensus-based clinical and research recommendations for use of glucagon-like peptide-1 receptor agonists in the context of eating disorders: a modified Delphi study.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs), initially developed for type 2 diabetes management and later expanded to obesity treatment, have shown preliminary efficacy in reducing binge eating episodes. However, the appetite-suppressing and weight-loss effects of GLP-1RAs raise concerns about misuse and potential exacerbation or emergence of eating disorders (EDs). Evidence remains limited and inconsistent, requiring structured, expert-informed guidance. Using a modified three-round Delphi method, a multidisciplinary panel of experts in diabetes, obesity and/or EDs, and individuals with lived experience of an ED and/or GLP-1RA use (N=45) achieved ≥70% consensus on recommendations (average consensus: 91.7%). Clinical recommendations include: a) the implementation of screening for current and historical ED before initiating GLP-1RAs, using a brief psychometrically validated instrument; b) routine monitoring of ED symptoms with intensity stratified by risk level; c) the development of standardized educational materials for patients and providers; and d) offering concurrent evidence-based psychotherapy to individuals with EDs prescribed GLP-1RAs. These medications should generally be avoided in individuals with active EDs, particularly anorexia nervosa, atypical anorexia nervosa, and bulimia nervosa with marked dietary restraint and/or significant weight suppression. Clinicians should also proceed cautiously in patients with a past history of these EDs. Research recommendations include: a) longitudinal epidemiological studies to assess the incidence, risk factors, and outcomes of EDs in individuals using GLP-1RAs compared to non-users; b) regulatory studies and policies to enhance patient safety in GLP-1RA prescribing practices; and c) clinical trials to investigate the safety, efficacy and psychological outcomes of GLP-1RAs in individuals with binge eating disorder. Overall, these consensus-based recommendations support evidence-informed practice and future research aimed at weighing potential benefits against risks of use of GLP-1RAs in ED populations.

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PubMed
Published
2026-10-01
DOI
https://doi.org/10.1002/wps.70096
Primary Topic
Eating Disorders and Behaviors
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article
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article

Consensus-based clinical and research recommendations for use of glucagon-like peptide-1 receptor agonists in the context of eating disorders: a modified Delphi study.

Anthony P. Goldstone, Michael A. Weintraub, Cynthia Marie Bulik, Sonia Butalia et al.
PubMed
Eating Disorders and Behaviors
article

Consensus-based clinical and research recommendations for use of glucagon-like peptide-1 receptor agonists in the context of eating disorders: a modified Delphi study.

Anthony P. Goldstone, Michael A. Weintraub, Cynthia Marie Bulik, Sonia Butalia, Hubertus Himmerich, B. Timothy Walsh, Ashley White, Kelly C. Allison, Ariana M. Chao, Monique Jericho, Aaron R. Keshen, William B. Horton, Margaret Hahn, Susan Gamberg, Nami Trappenberg, JOANNA E. STEINGLASS, Anastassia Amaro, Lauren M. Schaefer, Sara J. Bartel, Kimberly D. Dennis, Laurel Mayer, Amanda Raffoul, Susan Wnuk, Beverly G. Tchang, Valerie H. Taylor, Nicholas C. Peiper, Jennifer L. Couturier, Tanya M. Halliday, Anna I. Guerdjikova, Riccardo Dalle Grave, Laura Dixon, Diane Alix Klein, Jesse Richards, Elena Koning, Anastasia Harris, Simran Brar, Susan L McElroy, Brooke Langman, Amanda Lightbody, Lisa Boniferro, Pauline Belliveau, Michael Mindrum, Deena El-Ziftawi, Chloe Gao
article en

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RAs), initially developed for type 2 diabetes management and later expanded to obesity treatment, have shown preliminary efficacy in reducing binge eating episodes. However, the appetite-suppressing and weight-loss effects of GLP-1RAs raise concerns about misuse and potential exacerbation or emergence of eating disorders (EDs). Evidence remains limited and inconsistent, requiring structured, expert-informed guidance. Using a modified three-round Delphi method, a multidisciplinary panel of experts in diabetes, obesity and/or EDs, and individuals with lived experience of an ED and/or GLP-1RA use (N=45) achieved ≥70% consensus on recommendations (average consensus: 91.7%). Clinical recommendations include: a) the implementation of screening for current and historical ED before initiating GLP-1RAs, using a brief psychometrically validated instrument; b) routine monitoring of ED symptoms with intensity stratified by risk level; c) the development of standardized educational materials for patients and providers; and d) offering concurrent evidence-based psychotherapy to individuals with EDs prescribed GLP-1RAs. These medications should generally be avoided in individuals with active EDs, particularly anorexia nervosa, atypical anorexia nervosa, and bulimia nervosa with marked dietary restraint and/or significant weight suppression. Clinicians should also proceed cautiously in patients with a past history of these EDs. Research recommendations include: a) longitudinal epidemiological studies to assess the incidence, risk factors, and outcomes of EDs in individuals using GLP-1RAs compared to non-users; b) regulatory studies and policies to enhance patient safety in GLP-1RA prescribing practices; and c) clinical trials to investigate the safety, efficacy and psychological outcomes of GLP-1RAs in individuals with binge eating disorder. Overall, these consensus-based recommendations support evidence-informed practice and future research aimed at weighing potential benefits against risks of use of GLP-1RAs in ED populations.

PubMedVol. 25(3)
University of North Carolina at Chapel Hill (US), University of Copenhagen (DK), Dalhousie University (CA), University Health Network (CA), Centre for Addiction and Mental Health (CA), University of British Columbia (CA), University of Louisville (US), Johns Hopkins University (US), University of Calgary (CA), King's College London (GB), University of Toronto (CA), University of Utah (US), Columbia University Irving Medical Center (US), Johns Hopkins Medicine (US), Hammersmith Hospital (GB), McGill University Health Centre (CA), Nova Scotia Health Authority (CA), Karolinska Institutet (SE), University of Illinois Chicago (US), NYU Langone Health (US), Sanford Research (US), Casa di Cura Villa Garda (IT), Lindner Center of HOPE (US), Weill Cornell Medicine (US), New York State Psychiatric Institute, University of Oklahoma - Tulsa, Imperial College London (GB), McGill University (CA), University of Virginia (US), New York University (US), University of Cincinnati (US), University of Pennsylvania (US), McMaster University (CA)
Good health and well-being
Openalex Percentile: Top 13%
Eating Disorders and Behaviors
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