Eating Disorders in the GLP-1 Era: A Spotlight on Emerging Clinical Risks, Research Gaps, and Practice Priorities

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and related incretin-based medications are rapidly changing the treatment landscape for type 2 diabetes, obesity, cardiovascular risk reduction, and weight management. Their effects on appetite, satiety, gastrointestinal function, reward-related eating, and weight loss place them in direct contact with core psychological and behavioral domains of eating disorders. This Spotlight article argues that the eating disorders field urgently needs a coordinated clinical and research agenda for the GLP-1 era.

We synthesize emerging clinical concerns and early evidence regarding GLP-1 RA use in populations with binge eating, bulimic symptoms, restrictive eating, body image disturbance, weight stigma exposure, and histories of eating disorders. We focus on unresolved questions rather than providing a systematic review.

GLP-1 RAs may hold therapeutic promise for some individuals with binge eating disorder or loss-of-control eating, but the same mechanisms that reduce appetite and food preoccupation may also reinforce restriction, avoidance of regular eating, compulsive weight control, and relapse in vulnerable individuals. Current prescribing pathways often lack systematic eating disorder screening, multidisciplinary monitoring, and guidance on how to distinguish medically appropriate appetite modulation from emerging or worsening eating disorder psychopathology.

We propose six priorities: routine eating disorder screening before and during GLP-1 RA treatment; risk stratification; development of validated monitoring tools for GLP-1-related eating disorder risk; discontinuation planning; integration of lived experience in guideline development; and communication strategies that reduce weight stigma while supporting metabolic health.