As GLP-1 drugs reach more patients, experts are confronting difficult questions about appetite suppression, eating-disorder risk, and how clinicians should monitor people who may be vulnerable.
Recently, in the journal World Psychiatry, a group of researchers presented expert-informed clinical and research recommendations for the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in people with eating disorders.
Early studies of the drugs have reported reductions in binge eating and eating-disorder psychopathology, mainly among people with binge-eating disorder. But findings have been mixed, and the most rigorously controlled trial did not find a greater reduction in binge frequency than placebo, despite producing greater weight loss.
Evidence remains limited, with most studies being case reports, pilot trials, or retrospective studies with small sample sizes or limited long-term follow-up. Reports of relapse or emergence of eating disorders have also raised safety concerns.
For their study, the researchers used an adapted three-round Delphi process to develop consensus-based clinical and research recommendations tied to GLP-1RA use in eating-disorder contexts.
Consensus was defined as at least 70% agreement, consistent with commonly recommended Delphi thresholds. The Nova Scotia Health research ethics board reviewed the project and granted an exemption from full ethics review.
A purposively selected core research team of 12 members was expanded to a 45-member panel through snowball sampling. The panel comprised 16 clinicians or researchers specialising in diabetes, obesity, or endocrinology; 22 clinicians or researchers specialising in eating disorders; and seven individuals with lived experience of an eating disorder and/or GLP-1RA use.
Lived-experience representatives were recruited through social media.
The core team held two virtual meetings in January and February 2025 to identify themes using recent literature. Seven areas were incorporated into the initial structure: eating-disorder screening, educational materials, symptom monitoring, concurrent non-pharmacological treatment, epidemiological research, regulation and patient safety, and clinical trials for binge eating disorder.
Panel members attended one or more of three virtual meetings in June 2025 to provide verbal feedback, followed by anonymous written feedback. Recommendations were then circulated in an anonymous online survey in August 2025.
Participants rated statements using a four-point Likert scale and provided comments. Agreement percentages and qualitative feedback were used to refine the recommendations before final panel review.
Study results
The multidisciplinary panel of 45 participants achieved at least 70% consensus on the recommendations, with an average consensus of 91.7%. For clinical care, 94.7% agreed that clinicians should assess every individual for a current or previous eating disorder before initiating a GLP-1RA. An 89.5% consensus supported a brief three-to-five-question screening instrument addressing eating disorders, previous disorders, and risk factors like weight or shape concerns and restrictive behaviours.
Screening was supported in prescribing settings, including primary care, by 94.7% of participants. Positive screens were considered to warrant specialist referral, increased monitoring, education, or treatment modification, depending on symptom severity, with 92.1% agreement.
The panel reached 100% consensus that GLP-1RAs should generally be avoided in people with active eating disorders, particularly anorexia nervosa, atypical anorexia nervosa, and bulimia nervosa accompanied by marked dietary restraint and/or significant weight suppression.
It also recommended caution among people with a previous history of these disorders. The recommendation was not considered an absolute contraindication for every eating-disorder presentation.
For monitoring, 84.2% supported monitoring physical and psychological signs of eating disorders during treatment and after discontinuation. Monitoring intensity should be individualised according to baseline screening and emerging concerns, they suggested, such as extreme appetite loss or unexpectedly rapid weight loss; this recommendation received 97.4% consensus.
Monitoring domains included eating-disorder psychopathology, weight-loss rate, nutrition, hunger and satiety, physical health measures, mood, and quality of life, with 86.8% agreement.
If symptoms emerged, 92.1% supported psycho-education, specialist referral, or consideration of GLP-1RA discontinuation, depending on symptom type and severity. Any decision to discontinue treatment should be individualised and collaborative, balancing emerging eating-disorder symptoms against the potential medical benefits of continued GLP-1RA use.
The panel also supported standardised educational materials for prescribers and patients, with 92.1% consensus. Recommended approaches included evidence-based resources, provider quick guides and training, accessible patient materials, social-media communication, dietary psycho-education, and harm-reduction strategies for remote prescribing.
Concurrent evidence-based psychotherapy for individuals with diagnosed eating disorders receiving GLP-1RAs received 81.6% agreement. Examples included cognitive behavioural therapy and dialectical behaviour therapy for full-threshold disorders, while guided self-help, group therapy, telehealth, or dietician counselling were suggested within stepped care for people at risk or with sub-threshold symptoms.
The recommendation to compare eating-disorder incidence, risk factors, and outcomes among GLP-1RA users and non-users received 100% consensus. Longitudinal cohorts, case-control studies, and electronic medical record (EMR) reviews also received 100% consensus.
Validation of brief screening tools received 97.4% agreement, while neuroimaging and genetic studies received 89.5%.
Regulatory studies and policies addressing patient safety received 91.9% consensus.
Proposed areas included a national outcome register, which received 73.7% consensus, an evaluation of telehealth and compounded prescribing, an analysis of Internet and social media trends, and referral guidelines.
Clinical trials examining GLP-1RA safety, efficacy, and psychological outcomes in binge eating disorder received 100% consensus. Trial designs were recommended to assess binge frequency, “food noise”, restrictive eating, physiological and laboratory measures, psychological mechanisms, neurobiological effects, comparisons with other medications, and combination with evidence-based psychotherapy.
Conclusion
The modified Delphi process generated expert-informed recommendations addressing GLP-1RA use in eating-disorder contexts. The recommendations focused on screening before treatment, individualised monitoring during and after treatment, standardised education, and concurrent evidence-based psychotherapy for people with diagnosed eating disorders receiving these medications.
Research priorities included epidemiological studies, validation of screening tools, regulatory and patient safety investigations, and clinical trials for binge eating disorder. The authors acknowledged limitations, including incomplete representation of all experts, varying panel participation, the absence of a standardised Delphi consensus threshold, and limited applicability across all clinical scenarios.
The recommendations are expected to evolve as additional evidence becomes available. Further research is needed to clarify benefits, risks, incidence, and long-term outcomes.
Study details
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
Aaron Keshen, Elena Koning, Kelly Allison et al
Published in World Psychiatry on 15 September 2026-09-22
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 standardised 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.
See more from MedicalBrief archives:
Doctors reminded to flag side effects of GLP-1 agonists
UK medical schools fail to provide adequate training on eating disorders
‘Bulk and cut’ dieting linked to eating disorders – Canadian study