The dual role of GLP-1 receptor agonists in weight management and eating disorders: Potential benefits and risks

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as effective therapies for type 2 diabetes mellitus (T2DM) and obesity, as they improve glycaemic control, promote weight loss and modulate metabolic processes. However, their potent appetite-suppressing effects pose a complex challenge in patients with or at risk of eating disorders (EDs). This narrative review examines the dual role of GLP-1RAs in weight management and in the development or exacerbation of EDs, such as binge eating disorder (BED) and bulimia nervosa (BN). GLP-1RAs have been reported to reduce binge-eating episodes in some trials, but evidence is limited and often inconsistent due to small sample sizes. Conversely, psychiatric adverse effects - including anxiety, depression and disordered eating behaviours - have been observed, raising concerns about the use of these medications in individuals susceptible to EDs. There are case reports of extreme appetite suppression, pathological dietary restriction and psychiatric complications with GLP-1RA therapy, sometimes necessitating discontinuation. Moreover, GLP-1RAs influence brain reward pathways, which may further complicate their impact on eating behaviours. Although these drugs hold promise for mitigating certain ED symptoms, this review highlights the need for caution when prescribing GLP-1RAs to patients with disordered eating and calls for further research to delineate their benefits and risks in this population.