Incretin-Based Therapies for the Treatment of Binge Eating-A Systematic Review

Binge eating disorder (BED) is a common psychiatric condition associated with psychological and cardiometabolic morbidity. Psychotherapy remains a core treatment modality while pharmacologic agents such as lisdexamfetamine, selective-serotonin reuptake inhibitors (SSRIs), and topiramate demonstrate variable efficacy and tolerability. Incretin therapies-specifically glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 RA-originally developed for type 2 diabetes mellitus (T2DM) and obesity, are an emerging therapy of interest for BED due to their effects on satiety, appetite regulation, and reward-driven eating. This systematic review examines current data surrounding the efficacy of incretin therapies in treating BED and discusses potential mechanisms underlying their effects.

This systematic review was registered with PROSPERO (CRD42024615851) and conducted in accordance with PRISMA 2020 guidelines. Comprehensive searches were performed across MEDLINE, Embase, PsycINFO, Scopus, and Cochrane CENTRAL from inception to December 2024. Eligible studies included human trials evaluating GLP-1 RAs or dual GLP-1/GIP agonists in patients with diagnosed BED or binge eating behaviors. Data were extracted on study design, interventions, eating disorder outcomes, psychiatric symptoms, weight, and cardiometabolic measures.

Of 1125 screened records, 12 studies met inclusion criteria. Interventions studied included liraglutide, semaglutide, and dulaglutide, with sample sizes generally < 75 participants. Despite heterogeneity in study design and outcome measures, consistent reductions in binge eating behaviors were observed, reflected by improvements in Binge Eating Scale scores, reductions in binge frequency, and remission rates. GLP-1 RAs were also associated with significant reductions in body weight (-3 to -24 kg), BMI, and improvements in glycemic control among individuals with diabetes. Adverse effects were primarily gastrointestinal, with no new psychiatric safety concerns identified.

GLP-1 RAs may offer dual therapeutic benefits for BED, reducing binge eating behaviors while addressing comorbid obesity and metabolic consequences. However, available evidence is limited by small sample sizes, heterogeneous methods, and short follow-up durations. Larger randomized controlled trials using standardized diagnostic criteria and validated psychiatric measures are warranted.