Eating Disorders and GLP-1 RAs

Eating disorders are serious, complex and potentially life-threatening mental illnesses. They are characterised by disturbances in behaviours, thoughts and feelings towards body weight and shape, and/or food and eating. Eating disorders do not discriminate and can occur in any person, at any stage of their life.

Eating disorders are common and increasing in prevalence with more than 1.1 million Australians estimated to be experiencing an eating disorder in 2023 (1). People who are of higher weight are at higher risk of experiencing an eating disorder or disordered eating behaviours (e.g., binge eating, self-induced vomiting) (2, 3). For further information on eating disorders and people with higher weight can be found on here.

What are GLP-1 RAs?

Glucagon-like peptide-1receptor agonists (GLP-1 RAs), such as semaglutide (Ozempic), are medications originally developed to treat type 2 diabetes. GLP-1 RAs stabilise blood glucose by stimulating insulin production and supressing glucagon production. They also slow gastric emptying and affect appetite-regulating pathways in the brain, which can increase feelings of fullness and reduce food intake in some people (4). As a result, people taking GLP-1 RA medications often lose weight (5), however, weight loss plateaus over time and the weight is often regained after stopping the medication, with individuals typically regaining two‐thirds of the weight loss (6). GLP-1 RAs are now being used as an approved or off-label treatment for weight loss (7) 

The relationship between GLP-1 RAs and eating disorders

There is limited research available to help researchers and clinicians to understand the relationships between GLP-1 RAs and eating disorders (9). However, it is thought that GLP-1 RAs may negatively impact eating disorder symptomology and treatment in the following ways:

• Rates of disordered eating are notably higher among people seeking weight loss treatments (10), and dieting is an established risk factor for the development of eating disorders (11). Therefore, rates of disordered eating may be high among individuals seeking treatment with GLP-1 RAs, and the increased satiety and decreased hunger associated with GLP-1 RA medications may led to dietary restriction, increasing the risk of developing an eating disorder in vulnerable individuals.
• Despite the high rates of eating disorders among people with higher weight, this group is more likely to be recommended weight loss interventions as a result of weight stigma. This focus on weight loss and erasing the desire to eat may exacerbate eating disorder symptoms
• Between 12%-40% of people with type 2 diabetes also have an eating disorder, the most common of which is BED (12). Therefore, a significant number of people who are prescribed GLP-1 RAs to manage their diabetes may also be experiencing an eating disorder.
• There is limited research on the long-term effects of GLP-1 RAs. It is unclear how sustained use of these medications may impact eating disorders, body image and psychological wellbeing over time.
• The potential interactions between GLP-1 RAs and eating disorder treatments such as psychotherapy or nutritional therapy are also not well understood

What do we know about using GLP-1 RAs to treat eating disorders?

• At this point in time, there is not sufficient evidence to suggest that GLP-1 RAs help reduce eating disorder symptoms. GLP-1 RAs are not approved for the treatment of eating disorders.  Evidence-based treatments for eating disorders are available and primarily include psychological therapies. Please read the Management of eating disorders for people with higher weight: clinical practice guideline for further information on evidence-based treatment for people experiencing eating disorders and are of higher weight.
• A recent systematic review (8) investigated whether GLP-1 RAs are an effective treatment for BED. Results showed that individuals with BED treated with a GLP-1 RA showed a significant reduction in binge eating symptoms. However, sample sizes were small (N = 34-70 participants), and most participants had a BMI >30 limiting confidence in generalising these findings to other individuals experiencing BED with diverse weights. The studies included also had short follow-up periods, and did not assess whether GLP-1 RAs impacted other eating disorder symptoms such as dietary restraint or body dissatisfaction. Importantly, as GLP-1 RAs do not address the underlying causes of binge eating, once individuals stop taking these medications, binge eating symptoms are likely to return.
• Further research evaluating the safety and efficacy of GLP-1 RAs in diverse eating disorder samples is needed.

Potential risks for people experiencing or at risk of eating disorders

For someone experiencing or at risk of an eating disorder, the use of GLP-1 RAs carries several potential risks as outlined below.

Psychological risks

Triggering disordered eating behaviours: If GLP-1 RA's are ceased, weight is often regained. This may cause feelings of psychological distress and pressure to maintain the weight loss (as perpetuated by weight stigma), leading people to engage in disordered eating behaviours to control their weight, potentially triggering an eating disorder.

Dietary restriction: Dietary restriction is a maintaining factor of eating disorders. Using GLP-1 RAs may decrease hunger and increase satiety which can lead to dietary restriction. This may be reinforced by a reduced interest in eating from potential negative side effects of the medication including nausea, vomiting and diarrhoea.

Triggering binge eating: Binge eating can be a physiological response to energy restriction. Due to their appetite suppressant effects, GLP-1 RAs can increase restriction and could contribute to binge eating.

Interference with eating disorder treatment: A core component of eating disorder treatment typically involves eating in a regular way including three meals and two-to-three snacks each day. GLP-1 RAs impact a person’s levels of hunger and fullness, as well as potentially causing side-effects such as nausea, abdominal pain, and vomiting. This may hinder a person’s ability to eat regularly and disrupt therapeutic progress.

Psychological side effects: Most research has investigated the physiological adverse effects of GLP-1 RAs, with limited research investigating psychiatric complications arising from GLP-1 RA use. This is important as other weight loss interventions, such as bariatric surgery, have been associated with significant psychiatric complications such as eating disorders, depression, anxiety, dissatisfaction with weight loss expectations not being met, and body image disturbances resulting from excess skin due to significant weight loss (13)

Psychosocial risks

Reinforcement of weight stigma: People at risk of or experiencing eating disorders who are of higher weight and have been prescribed GLP-1 RAs for the purpose of weight reduction and not for blood sugar regulation or treatment of a medical condition reinforces weight stigma for the individual. This has serious adverse impacts on the lives, health and treatment seeking of people with higher weight.

Physical risks

Medical complications: People experiencing eating disorders are at risk of medical complications such as electrolyte imbalances, cardiac issues, and gastrointestinal problems. It is unclear how GLP-1 RAs may impact these potential complications. Monitoring by a medical practitioner is crucial for people engaging in disordered eating behaviours who are taking or have been recommended to take a GLP-1 RA, should be closely monitored by a medical practitioner.

Potential for misuse: In some cases, people engaging in disordered eating behaviours may misuse GLP-1 RAs in an attempt to control their weight or compensate for food intake. This can lead to dangerous health consequences. It is essential that people experiencing an eating disorder and are using GLP-1 RAs are monitored by a medical practitioner.

Information for people seeking weight loss treatments

If you are experiencing or have a history of body image concerns, disordered eating behaviours, or an eating disorder, and are speaking with your health practitioner about potentially commencing GLP-1 RAs:

• Let your prescribing doctor know that you are experiencing or have a history of body image concerns, disordered eating behaviours, or an eating disorder.
• Understand that this medication will not change your relationship with your body. If you are experiencing body image concerns, discuss this with your care team. It may be recommended that you seek mental health support to address the body image concerns.
• Understand that this medication is not an eating disorder treatment. If you are experiencing an eating disorder or disordered eating behaviours, you should discuss this with your care team. This will support your team to determine if this medication is right for you and if additional medical and/or mental health treatment is required

Getting help

If you think that you or someone you care about has an eating disorder, it is important to seek help immediately. The earlier you seek help the closer you are to recovery. Your GP is a good ‘first base’ to seek support and access eating disorders treatment. To find help in your local area go to NEDC Support and Services.

Additionally, call the Butterfly National Helpline (1800 33 4673) for support from trained counsellors and more information on available services.

References 

1.     Deloitte Access Economics. Paying the price, second edition. The economic and social impact of eating disorders in Australia [Internet]. Butterfly Foundation; 2024 [cited 2024 Mar 25]. Available from: https://butterfly.org.au/wp-content/uploads/2024/03/Paying-the-Price-Second-Edition-25-March-2024.pdf

2.     Duncan AE, Ziobrowski HN, Nicol G. The prevalence of past 12-month and lifetime DSM-IV eating disorders by BMI category in US men and women. Eur Eat Disord Rev. 2017;25(3):165–71. doi: 10.1002/erv.2503.

3.     Nightingale BA, Cassin SE. Disordered eating among individuals with excess weight: A review of recent research. Curr Obes Rep. 2019;8(2):112–27. doi: 10.1007/s13679-019-00333-5.

4.     Ard J, Fitch A, Fruh S, Herman L. Weight loss and maintenance related to the mechanism of action of glucagon-like peptide 1 receptor agonists. Adv Ther. 2021 Jun;38(6):2821-39.

5.     Singh S, Wright Jr EE, Kwan AY, Thompson JC, Syed IA, Korol EE, Waser NA, Yu MB, Juneja R. Glucagon-like peptide-1 receptor agonists compared with basal insulins for the treatment of type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Obes Metab. 2017 Feb;19(2):228-38.

6.     Wilding JP, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, Lingvay I, McGowan BM, Oral TK, Rosenstock J, Wadden TA. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022 Aug;24(8):1553-64.

7.     Jastreboff AM, Kushner RF. New frontiers in obesity treatment: GLP-1 and nascent nutrient-stimulated hormone-based therapeutics. Annu Rev Med. 2023 Jan 27;74(1):125-39.

8.     Radkhah H, Rahimipour Anaraki S, Parhizkar Roudsari P, et al. The impact of glucagon-like peptide-1 (GLP-1) agonists in the treatment of eating disorders: a systematic review and meta-analysis. Eat Weight Disord. 2025;30:10. doi: 10.1007/s40519-025-01720-9.

9.     Bartel S, McElroy SL, Levangie D, Keshen A. Use of glucagon-like peptide-1 receptor agonists in eating disorder populations. Int J Eat Disord. 2024 Feb;57(2):286-93. doi: 10.1002/eat.24109.

10.  Mitchell JE, King WC, Courcoulas A, Dakin G, Elder K, Engel S, Flum D, Kalarchian M, Khandelwal S, Pender J, Pories W, Wolfe B. Eating behavior and eating disorders in adults before bariatric surgery. Int J Eat Disord. 2015 Mar;48(2):215-22. doi: 10.1002/eat.22275.

11.  Pehlivan MJ, Okada M, Miskovic-Wheatley J, Barakat S, Touyz S, Simpson SJ, Griffiths K, Holmes A, Maguire S. Eating disorder risk among Australian youth starting a diet in the community. Appetite. 2024 Dec 1;203:107685.

12.  Herpertz S, Albus C, Lichtblau K, Köhle K, Mann K, Senf W. Relationship of weight and eating disorders in type 2 diabetic patients: a multicenter study. Int J Eat Disord. 2000;28(1):68-77.

13. Francois Z, Rizvi A. Psychiatric complications of bariatric surgery [Updated 2024 May 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK604208/