The Current State of Using GLP-1 agonists for People with Eating Disorders

On first pass, the use of GLP-1 medications for eating disorders was doubtful at best. How could medications meant to suppress appetite and lead to weight loss cause anything but worsening symptoms or relapse?

Over time, this new class of medications has proven to be useful in eating disorder treatment when used judiciously. Following the original guidelines of ramping up to high doses quickly leads to significant worsening of eating disorders, but there seems to be a place for using GLP-1 agonists in some cases.

The most effective use has been for people with binge eating disorder or compulsive overeating. Low doses of this class of medication can curb binge urges and change the hormonal control over metabolism that helps manage urges and cravings. For some people, hunger and fullness cues are more acute on these medications, and the endless need for larger amounts of certain foods is more limited.

It’s crucial to know that many people with these eating disorders have limited or no response to GLP-1’s so the effect is far from a panacea. In addition, there is no way to predict who will respond to the medications and who won’t.

There is much less information using these medications for other people with eating disorders. It is possible that the GLP-1’s can change thoughts about food which may have longer lasting effects on eating disorders, but the risk is also very high that even a low dose of them could lead to relapse. As of now, there is little evidence to even consider these medications for any other eating disorders.

Even for people with binge eating or compulsive overeating, the risk is high that the medications will lead to food restriction and only flame the desire to lose weight by increasing the dose.

The only people I have seen do well on GLP-1’s long-term already have done a lot of work in recovery. They have normalized eating, learned about hunger and fullness and neutralized eating disorder thoughts. For this cohort, the medications help ease persistent urges and food thoughts.

People who haven’t done much work in recovery struggle to eat enough and tend to push for higher doses to seemingly cure their disorder. Instead, they end up with side effects, need to stop the medication and are typically end up in a worse mental and physical place in recovery.

The GLP-1 agonists have opened doors to a possible metabolic cause for some eating disorders. Time and further research will elucidate these connections. Replacing eating disorder treatment with these medications is dangerous and likely to only worsen the illness and delay any true recovery.