As GLP-1 receptor agonist prescriptions continue to surge globally, a critical blind spot is emerging: the millions of adults living with subclinical or diagnosed eating disorders who may be prescribed these medications without adequate psychiatric screening. Understanding this intersection could reshape how clinicians approach obesity pharmacotherapy in a vulnerable population.
This narrative review in the Journal of Psychiatric Research maps the double-edged profile of GLP-1 receptor agonists — including semaglutide and liraglutide — in individuals with or at risk of eating disorders. On the therapeutic side, several small trials reported reductions in binge-eating episodes, likely mediated through the drugs' well-documented action on hypothalamic satiety circuits and dopaminergic reward pathways. On the adverse side, case reports document extreme appetite suppression progressing into pathological dietary restriction, alongside psychiatric sequelae including emergent anxiety and depression — in some instances severe enough to require drug discontinuation. The review also highlights that GLP-1 receptor agonists modulate mesolimbic reward signaling, a mechanism that may either attenuate compulsive eating or, in susceptible individuals, amplify restrictive and avoidant behaviors associated with anorexia nervosa and bulimia nervosa.
This review arrives at a pivotal moment. Prescribing of GLP-1 agents has expanded well beyond endocrinology into primary care and weight-management clinics, where formal psychiatric screening is rarely standard. The finding that the same appetite-suppressing mechanism that makes these drugs effective for obesity could destabilize eating behavior in at-risk individuals is not entirely surprising — appetite regulation and eating psychopathology share overlapping neurobiology — but formal evidence remains sparse and methodologically inconsistent. The review is a narrative rather than a systematic meta-analysis, limiting its evidentiary weight. Most supporting trials involved small samples and short follow-up. Still, the signal is credible enough to warrant pre-prescription psychiatric screening and ongoing monitoring, particularly as semaglutide moves into adolescent and young adult populations where eating disorders peak in prevalence. Incremental but clinically urgent.