GLP-1 Medications and Eating Disorders: What New Research Recommendations Get Right (and Where They Fall Short)

A new Delphi consensus study on GLP-1RAs and eating disorders offers much-needed clinical guidance – but it’s missing a critical voice in the room.

If you work anywhere near the intersection of GLP-1 medications and eating disorders, you’ve probably felt the same thing I have for years. The stark lack of evidence-based guidance on GLP-1 utilization in individuals with past or current EDs and this topic is one of the things we discussed in my 2-part GLP-1 workshop series this past summer.

Two days ago, that started to change. A significant piece of research was published in the Journal of World Psychiatry: 

“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.“ 

**It is an open-access article, which you can find here. 

While the paper offers recommendations for both research and clinical practice, I am going to summarize and respond to the recommendations focused on clinical practice. There is so much I could discuss, critique, and respond to, but am choosing to selectively highlight just a couple of points. But first, I’ll break down the research for you.

Summary of the GLP-1 and Eating Disorders Research

A panel of 45 eating disorder and diabetes/*besity/endocrinology clinicians and researchers, alongside seven individuals with lived experience, participated in an iterative consensus-building process from January through August 2025. Known as a Delphi study, this approach is used when empirical evidence is limited but clinical decisions still need to be made, systematically gathering and refining expert and lived-experience perspectives to develop consensus recommendations.

The Delphi method is a legitimate research approach and a particularly useful one in scenarios like this, where we have little to no empirical evidence and a high need for clinical guidance. But Delphi studies also come with an obvious vulnerability: the resulting consensus is shaped by who is invited to the table. And I couldn’t help but notice who appears to be missing from this one. 

Among the 45 authors, I could not identify a single registered dietitian nutritionist. From my vantage point, this omission inevitably shaped the perspectives represented in the consensus process and, ultimately, the recommendations that emerged from it. This is a point I’ll be coming back to.

The image below highlights the 7 topics utilized to shape the initial framework for the working group, the 4 high-level clinical recommendations developed by the team, alongside a clear statement regarding when these medications should be avoided in the context of ED diagnoses.

*Image generated with ChatGPT (OpenAI), 2026

There is a lot in this research I agree with

I am in full agreement with: screening for eating disorders prior to prescribing a GLP-1, ongoing monitoring, education for patients and providers, and referrals to specialized treatment when indicated. I also think the authors do a nice job of acknowledging the work still required for these recommendations to become not only realized, but actually useful and effective in clinical practice.

My gripes are mostly about what’s missing. And without a doubt, they are shaped by my role as a dietitian.

I want to focus on two key issues: the role of the nutrition professional and the very complicated question of how we distinguish “disordered” eating from the intended effects of a medication that, by design, can create the conditions for disordered behaviors.

1. Where are the Registered Dietitian Nutritionists (RDNs)? 

The role of the RDN should be featured and utilized far more prominently. While I’m grateful we received a single mention, it was minor enough that you could easily miss it.

GLP-1 medications significantly alter appetite, digestion, food intake, and metabolism. This is quite literally our wheelhouse. Our extensive training prepares us to assess and treat issues related to nutrition, appetite, digestion, and metabolism and to understand how these systems interact.

In my not-so-humble opinion, anyone prescribed these medications, eating disorder or not, would ideally have the careful eye and excellent care of an RDN. And nowhere is this more important than in eating disorder treatment, where multidisciplinary care that includes a nutrition professional is foundational. It is our job to assess nutritional adequacy, identify concerning changes in eating patterns, and help discern the very gray area between what may be driven by ED pathology, medication effects, medical needs, or some combination of all three.

The lack of meaningful inclusion of nutrition professionals in these recommendations seems reflective of who was missing from the research process itself.

And then there is this recommendation from the authors:

“Provide psychoeducation on best practice dietary guidelines to prevent maladaptive restrictive behaviors, and on expected GLP-1RA effects that could increase risk of disordered eating, such as appetite suppression.”

Who is best suited to do exactly this, you ask??

I’ll give you one guess.

When does the intended effect become an eating disorder concern?

This brings me to my second critique: 

2. I don’t think the recommendations in the research meaningfully grapple with the central conundrum at hand.

The authors recommend monitoring nutrition, hunger and satiety, ED psychopathology, and weight-loss rate, while distinguishing expected medication effects from potentially pathological changes. But that distinction is precisely where things get complicated.

These medications are designed to reduce appetite signaling and often make eating harder to accomplish. So how do we screen for restrictive or disordered eating when reduced appetite and food intake may be understood as evidence that the medication is “working”? 

When does an intended medication effect cross over into an eating disorder behavior? And who gets to decide?

I want to be clear that I hold a lot of nuance here. For some people, these medications may support more balanced eating, physiological homeostasis, and a more regulated experience of appetite. For others, they can create conditions in which restriction and other problematic behaviors become remarkably easy to access, reinforce, and even celebrate.

That gray area deserves far more attention. In fact, I think it is one of the central clinical challenges facing those of us working at the intersection of GLP-1 medications and eating disorders.

This research on GLP-1s and eating disorders is a beginning

There is much more to say, and I sincerely hope the conversation continues. I want to extend a big-hearted thank you to everyone involved in this research, including the individuals who contributed their lived experience. This work represents an essential first step toward building a world in which GLP-1 medications for weight loss and eating disorders can coexist as safely as possible.

For the nutrition professionals here who want to dig more deeply into the research on nutritional strategies for GLP-1RA treatment, I’ve pulled together some resources below.

 

 

If you want to go deeper on this, I hosted a 2-part GLP-1 & Eating Disorders workshop series live this past July and August, and it’s now available as a self-study – covering a lot of this same territory: the screening questions, the gray areas, the “is this working as intended or is this an ED behavior” conundrum. 

Check it out here →  marciRD.teachable.com/p/glp1-workshop

 

RESOURCES: 

• **Keshen, A., Koning, E., Allison, K. C., Amaro, A., Bartel, S., Belliveau, P., Boniferro, L., Brar, S., Butalia, S., Bulik, C. M., Chao, A. M., Couturier, J., Dennis, K., Dixon, L., El-Ziftawi, D., Gao, C., Gamberg, S., Goldstone, A. P., Dalle Grave, R., Guerdjikova, A. I., … Wnuk, S. (2026). 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. World psychiatry : official journal of the World Psychiatric Association (WPA), 25(3), 465–474. https://doi.org/10.1002/wps.70096
• Almandoz JP, Wadden TA, Tewksbury C et al. Nutritional considerations with anti-obesity medications. Obesity 2024;32:1613-31.
• Al-Najim W, Raposo A, BinMowyna MN et al. Unintended consequences of obesity pharmacotherapy: a nutritional approach to ensuring better patient outcomes. Nutrients 2025;17:1934.
• Gentinetta S, Sottotetti F, Manuelli M et al. Dietary recommendations for the management of gastrointestinal symptoms in patients treated with GLP-1 receptor agonist. Diabetes Metab Syndr Obes 2024;17:4817-24.
• Mozaffarian D, Agarwal M, Aggarwal M et al. Nutritional priorities to support GLP-1 therapy for obesity: a joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and the Obesity Society. Obesity 2025;33:1475-503.