Eating Disorder Risk and Screening in Patients Using GLP-1RAs: Lessons Learned From Metabolic and Bariatric Surgery

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for weight management. Similar to the early implementation of metabolic and bariatric surgery (MBS), little is known about how GLP-1RAs affect individuals with eating disorders (EDs) or their potential to promote, mask, or exacerbate ED psychopathology. Lacking robust empirical data directly examining associations between GLP-1RAs and ED risk, we draw on lessons from the field of MBS to summarize current critical knowledge gaps and guide clinicians, educators, researchers, and advocates on interim decision-making.

As providers working at the intersection of EDs and obesity treatment, we integrate published findings with our clinical and research expertise to identify potential ED risks associated with GLP-1RA use and identify opportunities to screen and intervene.

Initially in MBS practice, ED symptoms were underrecognized due to lack of standardized screening and monitoring protocols. Early concerns arose from patient reports and provider observations, followed by empirical and systematic research investigation leading to the development of structured assessment tools and protocols. Similar concerns are arising with GLP-1RA treatment, where changes in appetite and weight may, without prospective or ongoing screening, worsen existing or contribute to de novo ED behaviors and cognitions.

ED providers are uniquely positioned to identify and address disordered eating occurring with GLP-1RA treatment that may be overlooked by providers with less ED training and experience. We highlight opportunities for ED professionals to engage in advocacy, education, and interdisciplinary collaboration to reduce harm and promote patient wellbeing as GLP-1RA use increases.