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.
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.
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Authors: Aaron R. Keshen, Elena Koning, Kelly C. Allison, Anastassia Amaro, Sara J. Bartel, Pauline Belliveau, Lisa Boniferro, Simran Brar, Sonia Butalia, Cynthia Marie Bulik, Ariana M. Chao, Jennifer L. Couturier, Kimberly D. Dennis, Laura Dixon, Deena El-Ziftawi, Chloe Gao, Susan Gamberg, Anthony Peter Goldstone, Riccardo Dalle Grave, Anna I. Guerdjikova, Tanya M. Halliday, Margaret Hahn, Anastasia Harris, Hubertus Himmerich, William B. Horton, Monique Jericho, Brooke Langman, Amanda Lightbody, Diane Alix Klein, Laurel Mayer, Susan L McElroy, Michael Mindrum, Nicholas C. Peiper, Amanda Raffoul, Jesse Richards, Lauren M. Schaefer, JOANNA E. STEINGLASS, Valerie H. Taylor, Beverly G. Tchang, Nami Trappenberg, B. Timothy Walsh, Michael A. Weintraub, Ashley White, Susan Wnuk
Institutions: University of Pennsylvania, Karolinska Institutet, Johns Hopkins University, Dalhousie University, University of British Columbia, Imperial College London, University of North Carolina at Chapel Hill, University of Virginia, McGill University Health Centre, University of Toronto, University Health Network, University of Calgary, University of Copenhagen, University of Utah, University of Illinois Chicago, NYU Langone Health, New York University, Johns Hopkins Medicine, Hammersmith Hospital, McGill University, McMaster University, Columbia University Irving Medical Center, King's College London, Weill Cornell Medicine, Centre for Addiction and Mental Health, University of Cincinnati, University of Louisville, Casa di Cura Villa Garda, Nova Scotia Health Authority, New York State Psychiatric Institute, Sanford Research, Lindner Center of HOPE, University of Oklahoma - Tulsa