GLP-1 Receptor agonist use and attempted access in individuals with and without lifetime eating disorders: The role of diagnostic history, BMI, and medication motivation

Abstract Background Glucagon-like peptide-1 receptor agonist medications (GLP-1RAs) have revolutionized management of type-2 diabetes and obesity and are increasingly widespread. In eating disorders (ED), where dietary restriction is a triggering and maintaining factor, concerns have been raised regarding risks related to GLP-1RAs. Methods We studied self-reported prescribed, unprescribed, and attempted use in 5882 individuals with various lifetime EDs compared to 1322 controls, stratified by highest lifetime body mass index (BMI) following drug indication thresholds (above 30 or above 27 with complications, e.g. hypertension). Logistic regression models using single-diagnosis- and mutually adjusted models was used, and prescription for T2D was used as a covariate to control for purely medically motivated use. Results Lifetime atypical anorexia nervosa, bulimia nervosa, and binge eating disorder were generally associated with higher engagement compared to controls. Anorexia nervosa was associated with lower engagement in participants with lifetime BMI above 30, but higher engagement in BMI strata below 30 and below 27. Sex-separated analyses suggested higher engagement in males with lifetime anorexia nervosa also in higher-weight strata. Avoidant-restrictive food intake disorder did not differ from controls on any outcome. While weight loss was the primary motivation for engagement, a notable proportion cited management of binge eating even though that is not among the approved indications. Conclusions Findings suggest that lifetime ED is associated with heightened drug-seeking and inappropriate use in some individuals, and support recent calls for increased monitoring of ED history and symptoms in relation to GLP-1RA treatment.