A modified Delphi study published in World Psychiatry has produced consensus recommendations on how GLP-1 receptor agonists should be handled in patients with eating disorders. The headline recommendation is that clinicians screen for current and past eating disorders before starting one of these drugs.

GLP-1 receptor agonists, the class developed first for type 2 diabetes management and later expanded to obesity treatment, work by suppressing appetite. The panel's concern follows directly from that mechanism: drugs that blunt hunger and drive weight loss carry, in their view, a risk of misuse and of worsening or triggering eating disorders.

How the consensus was built

The panel comprised 45 participants, a multidisciplinary mix of experts in diabetes, obesity and eating disorders alongside people with lived experience of an eating disorder, GLP-1 use, or both. Across three Delphi rounds, recommendations had to clear a 70% consensus threshold, and the average consensus reached was 91.7%.

That is a notably high level of agreement for a field the authors themselves describe as having limited and inconsistent evidence. The Delphi method exists precisely for that gap: when trials have not answered the question, structured expert opinion is what there is.

What the panel recommends

Four clinical recommendations came out of the process: screening before initiation using a brief psychometrically validated instrument, routine monitoring of eating-disorder symptoms with intensity stratified by risk, standardized educational materials for patients and providers, and concurrent evidence-based psychotherapy for patients with eating disorders who are prescribed these drugs.

The panel also drew a line on who should generally not receive them. GLP-1 receptor agonists should generally be avoided in people with active eating disorders, particularly anorexia nervosa, atypical anorexia nervosa, and bulimia nervosa with marked dietary restraint or significant weight suppression, with caution advised in those with a past history of these conditions.

Limitations

This is consensus opinion, not trial data, and the authors are explicit that the underlying evidence remains limited and inconsistent. The preliminary efficacy reported for reducing binge eating episodes has not been settled by the kind of study the panel is asking for.

Where the field goes next

The research agenda is specific: longitudinal epidemiological studies comparing eating-disorder incidence and outcomes in GLP-1 users against non-users, regulatory work on prescribing safety, and clinical trials of safety, efficacy and psychological outcomes in binge eating disorder. Until those exist, the panel's framing is a weighing of potential benefits against risks rather than a verdict.