GLP-1 Use and Appetite Control in Eating Disorders and Social-Emotional Factors Beyond Weight Loss

Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs; e.g., semaglutide, liraglutide) have reshaped treatment for higher weight and type 2 diabetes, with randomised trials demonstrating substantial and sustained effects on body weight and metabolic benefits [1]. GLP-1RAs act on central and peripheral pathways governing hunger, satiety, gastric emptying, and reward [2,3]—mechanisms that directly intersect with core features of eating behaviour and eating disorders (EDs) [4]. This convergence has prompted growing interest in how GLP-1RAs may influence appetite regulation [2,5], binge eating (characterized by loss of control and consumption of large amounts of food) and compensatory behaviours [6,7], emotion-driven eating (eating in response to negative affect rather than hunger) [8,9], and body image [10], as well as their implications for individuals with a diagnoses or those at risk for an ED [11,12].

Concurrently, safety signals and regulatory reviews have raised questions about mood changes and suicidality among some GLP-1RA users, although a causal link has not been established and available data are limited by short follow-up periods and the frequent exclusion of people with psychiatric comorbidity [13,14,15,16]. Emerging evidence also points to possible psychological pathways, such as rapid weight loss, disrupted interoceptive signals, and altered reward processing, which could increase susceptibility to mood disturbance, disordered eating, or suicidality in some individuals and therefore require closer examination [17].

Beyond individual-level mechanisms, these experiences unfold within a broader cultural discourse. Media coverage and celebrity endorsements frequently frame GLP-1RA use through the lens of diet culture and aesthetic performance, reinforcing societal preoccupations with weight loss and body image [18]. Such narratives can intensify pressures to pursue thinness, reinforce stigma, and minimize the psychological complexity of pharmacologically assisted weight loss. Issues of affordability and access are relevant background considerations, but the primary focus of this review is the psychological and ED-related implications of GLP-1RA use.

Taken together, these issues underscore the need for an integrated understanding of the psychological and behavioural implications of GLP-1RA use. Key areas of concern include how pharmacological appetite suppression affects eating patterns and hunger regulation; the potential for these medications to influence disordered eating, and body image; and the broader emotional, cognitive, and sociocultural processes that may shape user experiences. Particular attention is warranted for populations that may be more vulnerable to these effects, such as adolescents and individuals with disordered eating or body image concerns from diverse cultural and socioeconomic backgrounds.

In this review, we synthesise current evidence on the psychological effects of GLP-1RA treatment, with a particular focus on ED–related outcomes. Specifically, we (1) examine the influence of GLP-1RA use on appetite and eating behaviours, emotion regulation, mental health, body image, and sociocultural factors; (2) identify psychological and behavioural mechanisms—particularly those relevant to the development and maintenance of EDs—through which pharmacological appetite suppression may influence eating patterns, self-perception, and wellbeing; and (3) discuss conceptual, clinical, and research considerations needed to inform future investigations and guide safe, patient-centred use of GLP-1 therapies. These aims form the framework for the present narrative review.

Narrative reviews differ from systematic reviews in that they do not follow formal reporting frameworks. Instead, they allow for a broader and more interpretative synthesis of literature, without rigid inclusion or exclusion criteria, emphasizing conceptual integration over exhaustive retrieval.

This narrative review was conducted in three phases: (1) search execution, (2) screening and evaluation of relevant sources, and (3) synthesis and interpretation of key findings. Searches were conducted across major scientific databases, including PubMed, PsycINFO, Web of Science, and Google Scholar, and supplemented by manual reference checking. The search targeted studies published between 2015 and September 2025, supplemented by earlier seminal papers of theoretical or clinical importance. We made every effort to identify and include the most relevant studies available by using targeted database searches and cross-referencing within existing literature.

Search terms combined keywords related to GLP-1 and its analogues (e.g., "GLP-1 receptor agonists," "semaglutide," "liraglutide," "tirzepatide," "Ozempic," "Wegovy," "Mounjaro") with psychological and ED-related concepts (e.g., "eating behaviour," "binge eating," "anorexia nervosa," "bulimia nervosa," "body image," "emotion regulation," "mood," "mental health," "stigma," "social media"). Eligible sources included peer-reviewed empirical studies, meta-analyses, reviews, and conceptual or qualitative papers written in English, German or Spanish.

GLP-1RAs have emerged as highly effective therapies for metabolic diseases [19]. They regulate glucose metabolism by enhancing insulin secretion, suppressing glucagon release, delaying gastric emptying, and acting on the central nervous system to modulate satiation and satiety [2,20].

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [36,37] identifies several major ED categories, all of which carry substantial medical and psychological burden. AN is characterized by severe dietary restriction, low body weight, and body image disturbance, and has the highest mortality rate of any psychiatric illness due to both medical complications and suicide risk [36,37,38]. BN involves recurrent binge eating with compensatory behaviours such as vomiting or laxative misuse, leading to serious medical consequences and elevated suicidality. BED is marked by recurrent binge eating episodes without compensatory behaviours and is strongly associated with higher weight, cardiometabolic disease, and psychiatric comorbidity. Finally, Other Specified Feeding or Eating Disorders (OSFED), including atypical AN, purging disorder, night eating syndrome, and subthreshold BN and BED, carry impairment and medical risks comparable to the other EDs included in the DSM-5 [39,40].

The link between GLP-1RAs and EDs/disordered eating has received growing attention [12]. Research to date has focused primarily on binge–purge disorders, particularly BED and BN, where the evidence base is strongest. The following section will review findings for BED and BN, as well as emerging evidence on restrictive EDs such as AN.

Research suggests that GLP-1RAs reduce emotional eating in the short term. Individuals with higher weight experienced a significant decrease in emotional eating frequency after three month [58] and six months [59] of semaglutide treatment. Emotional eating refers to the consumption of food in response to negative emotions rather than physiological hunger [60] that is used as an avoidant strategy to cope with emotions [61]. GLP-1RAs reduce emotional eating by increasing satiety through the endocrine pathway or modulating reward processing in the mesolimbic reward circuitry through the neural pathway [9,62]. In a fMRI study, GLP-1RAs have been found to decrease brain responses to anticipatory food reward and increase consummatory food reward, which may reduce food craving and overeating [63].

However, there is recent evidence suggesting that the effect of GLP-1RAs on reducing emotional eating may not be long-lasting [8]. In this observational study, individuals receiving GLP-1RAs had significant reduction in emotional eating at three months post-treatment, but their emotional eating scores returned to baseline level by 12 months [8]. A possible explanation is that individuals with pre-existing high level of emotional eating may be less sensitive to GLP-1RA treatment [64]. Findings from this randomized trial suggested that higher emotional eating scores at baseline were related to less changes in brain areas regulating reward and satiety in responses to food cues after ten days of treatment [64]. Hence, emotional eating could be a vulnerability factor that hinder the treatment effects of GLP-1RAs [64]. Further research is required to study the long-term effects of GLP-1RAs in the reduction in emotional eating and whether the potential beneficial effects of GLP-1RAs on reducing emotional eating may be moderated by pre-existing risk factors such as elevated emotional eating.

While GLP-1RAs may improve emotional eating in the short term, the underlying emotion regulation deficits remain unaddressed. Emotion regulation is the process whereby individuals influence the onset, duration and intensity of emotions [65]. Deficits in emotion regulation are implicated in emotional eating [66,67,68]. Past research consistently demonstrated that emotional eating is associated with poor emotion regulation abilities [69] and reliance on maladaptive emotion regulation strategies such as suppression and avoidance [67,68,70]. The affect regulation model posits that emotional eating is a learned behaviour aiming to downregulate negative emotional states through the consumption of foods and this behaviour is maintained over time through negative reinforcement [71,72]. GLP-1RAs may reduce emotional eating, thus eating is less likely to be used to cope with stress and emotions [26].

However, little is known whether GLP-1RAs can alleviate emotion regulation deficits that drive emotional eating. When experiencing distress, individuals who take GLP-1RAs may still struggle with managing their emotions, continue to rely on maladaptive emotion regulation strategies when no adaptive strategies are available, or turn to other means to regulate emotions such as engaging in compulsive behaviours. Future research could use EMA to examine real-time changes in emotions, emotion regulation difficulties and eating behaviours during GLP-1 treatment. Furthermore, GLP-1RA treatment could be integrated with emotion regulation-focused therapies, such as Enhanced CBT [73] or Dialectical Behaviour Therapy [74,75], with dose titration aligned to therapy milestones.

Taken together, the current evidence suggests that GLP-1RAs may improve the regulation of eating behaviours, particularly emotional eating, in the short term, but no research has yet examined whether GLP-1RAs can improve the regulation of emotions. Examining mental health outcomes will provide insights into whether GLP-1RAs are associated with broader psychological benefits.

Body image is a multidimensional construct encompassing perceptual, cognitive–affective, and behavioural elements [86] and is a crucial determinant of well-being in individuals undergoing weight change. A consistent finding across ED research is that these individuals experience not only disturbance in cognitive–affective body image (e.g., dissatisfaction), but also perceptual distortions (e.g., body size overestimation) [87]. Critically, weight loss (including that which is rapid) does not automatically resolve body dissatisfaction or perceptual distortion [87]. Instead, ED patients often continue to experience a form of "phantom fat", whereby internal models of body size remain resistant to updating despite substantial physical change.

Theoretical accounts help explain this dissociation: predictive coding models suggest that self-perception, from a neuro-computational lens, arises from the integration of bottom-up sensory evidence with top-down priors (beliefs) [88]. Within this framework, distorted self-perception, such as in the case of body size overestimation in EDs, can arise when there is an overreliance on distorted priors (i.e., beliefs about one's body shape/weight; e.g., "I am fat") over bottom-up sensory evidence (e.g., seeing a thin body in the mirror or feeling one's protruding ribs) [89].

The allocentric lock hypothesis offers a complementary account, suggesting that individuals with EDs remain "locked" into maladaptive body memories that resist updating despite current (egocentric) sensory input [90]. These frameworks suggest that rapid pharmacologically induced weight loss, such as with GLP-1RA treatments, may not straightforwardly translate into improved body satisfaction: and instead, could interact with these same mechanisms, potentially destabilizing body perception or amplifying pre-existing misperception.

Empirical evidence in this domain remains scarce. One study with U.S. undergraduates (N = 225) found that greater interest in GLP-1RAs was associated with higher body shame, body surveillance, weight concerns, anti-fat bias, and disordered eating behaviours, alongside lower body appreciation and neutrality [10]. While limited by its cross-sectional, non-clinical design, the findings underscore that those most attracted to GLP-1RA treatments may be the same individuals most vulnerable to body image disturbance and disordered eating risk. Notably, higher body appreciation buffered against interest in treatment despite side effects, highlighting a potential protective factor.

Indirect evidence from EDs and body image dissatisfaction research underscores the importance of these concerns. Patients with AN and related disorders continue to overestimate body size even after significant weight change, with perceptual distortion predicting poorer prognosis. In recent decades, researchers have increasingly implicated impairments in multisensory integration—the fundamental process underlying self-perception which involves the continuous integration of sensory inputs across different modalities (e.g., exteroception [vision, touch], interoception, proprioception) [91,92]—in these disturbances [89,93].

Specifically, interoceptive dysfunction (i.e., impaired awareness of internal bodily sensations like hunger) is well documented in EDs [94] and is believed to lead to an overreliance on external (visual) cues, rendering self-perception malleable but unstable. Research involving multisensory body illusion paradigms, such as virtual full-body illusions [95], has provided experimental evidence that EDs are linked to such disturbances in multisensory integration (on the basis of greater susceptibility to illusion-induced distortions; [93]).

Extrapolating from this work, GLP-1RA-induced metabolic and interoceptive changes could exacerbate or reinforce perceptual distortions (exteroceptive-interoceptive mismatches): heightening reliance on unstable external/visual cues. From a predictive coding perspective, if "priors" about body size are rigid, bottom-up evidence (weight loss) may not suffice, and consequently, GLP-1RAs may inadvertently heighten mismatches between perception and reality.

Important gaps remain. First, no longitudinal studies have tracked body image trajectories across initiation, plateau, maintenance, or discontinuation of GLP-1RA therapy. Second, future research should examine not only cognitive-affective components of body image (e.g., self-reported body dissatisfaction, body appreciation) but also perceptual components through more objective measures (e.g., body size estimation, interoceptive awareness [heart-beat counting tasks]). Third, researchers should consider qualitative exploration of lived experience and identity shifts (e.g., "medication-enabled" vs. "self-driven" change).

Finally, future research should examine how GLP-1RA therapy intersect with interoceptive processing. Multisensory body illusion paradigms, such as virtual full-body illusions [95], offer powerful experimental tools to test how GLP-1RA users integrate interoceptive and exteroceptive cues when perceiving their body, and importantly, whether there are distortions in this domain (i.e., whether rapid weight loss recalibrates or amplifies distorted self-perception).

Social media has become a primary arena where narratives about GLP-1RA treatments are constructed and disseminated [96,97]. Hashtags such as #Ozempic, #Wegovy, and #Mounjaro frame these medications less as clinical tools and more as aesthetic enhancers, often through before/after imagery and "quick fix" discourses [98]. Counter-narratives of "cheating" or moralization also circulate, underscoring the contested identity politics of pharmacologically enabled weight loss [99]. From a body image perspective, these dynamics are particularly concerning for adolescents and individuals vulnerable to EDs, for whom appearance-focused content and transformation imagery are known to heighten social comparison, body dissatisfaction, and disordered eating risk [100,101].

Three empirical studies illustrate how digital culture surrounding GLP-1RA amplifies these dynamics. Propfe and Seifert [97] analysed over 46,000 Reddit posts, identifying off-label weight loss as the dominant theme, with limited mention of health risks. Instead, peer-to-peer discourse cantered on dosing, insurance denial, and side-effect management, highlighting both the popularity of off-label use and the absence of balanced information.

Another study examined 100 TikTok videos (#Ozempic, approximately 70 million views), finding most were consumer-generated, emphasizing personal use and weight loss. Over a third portrayed the drug positively or encouraged uptake, while very few addressed off-label use, shortages, or clinical alternatives such as bariatric surgery [96].

Finally, Fong et al. [102] compared multiple platforms, showing semaglutide content was presented almost exclusively for weight reduction, with frequent misrepresentation of mechanism, indications, and side effects. Strikingly, common gastrointestinal problems went largely unmentioned on Instagram, where female, non-medical users dominated. They also documented AI-modified "results" videos and marketing of counterfeit products under GLP-1 hashtags. Together, these studies demonstrate that digital spaces may amplify desirability while minimizing risk, with platform-specific differences in reliability (e.g., YouTube most accurate, Instagram least).

Evidence from broader ED and body image research reinforces these concerns. Studies consistently show that exposure to appearance-focused or "transformation" content on social media is linked to lower body appreciation, higher body dissatisfaction, and greater risk of disordered eating [100,101]. It is plausible that these risks may be amplified by algorithmic promotion of sensational content and the rise of AI-modified images. For example, when users are repeatedly exposed to highly idealized and artificially enhanced body images, paired with sensationalized narratives about GLP-1 "success stories", they may internalize unattainable appearance standards. Subsequently, this may fuel body dissatisfaction and drive maladaptive behaviours, such as restrictive eating or pursuing cosmetic procedures, to meet these unrealistic ideals.

Yet, important gaps remain. Most existing studies have focused on describing what is posted online, rather than testing how this content affects people. For example, it is unclear whether repeated exposure to TikTok "before-and-after" videos or AI-enhanced transformation images directly increases body dissatisfaction or motivates interest in GLP-1RA use. Future research should therefore consider combining large-scale social listening with controlled experiments: for example, where participants are exposed to different types of GLP-1 content (e.g., risk-focused vs. transformation-focused) to examine causal effects on body image, self-perception, and disordered eating risk. Finally, qualitative work is also needed to capture the lived experiences of users, such as how they negotiate online narratives of "quick fixes" versus "cheating" or how reliance on medication shapes their sense of identity.

At a policy level, action is required to address misleading and potentially harmful content. Platforms could be mandated to regulate promotional claims, flag or remove fake/false GLP-1RA advertisements, and provide users with clear disclaimers when AI-modified images are used (e.g., in weight loss videos). Without such measures, digital culture may continue to amplify misinformation, normalize risky off-label use, and exacerbate body image vulnerabilities, particularly among adolescents and individuals already prone to body image and eating disturbances.

Weight stigma is another important issue in the conversation around GLP-1RA drugs. On the surface, these medications may help to reduce individual blame by framing higher weight as a medical condition. However, GLP-1RAs may also reinforce and perpetuate stigma in new ways, such as people being seen as "taking the easy way out," or the judgment that weight regain after stopping treatment signals "failure." These issues are not only personal, but also layered and intersectional, shaped by gender, race, and socioeconomic status.

The emerging empirical literature provides valuable but limited insights. Post and Persky [103] showed that individuals who lost weight with GLP-1RAs were judged more negatively than those who used diet/exercise, mainly due to stronger beliefs that these individuals were taking a shortcut. These negative judgments applied to both larger-bodied and lean women, though lean women were sometimes judged even more strongly. Somewhat similarly, Post et al. [104] found that GLP-1RA users were evaluated more negatively due to downward social comparison processes. Interestingly, diet/exercise narratives were not without problems either, as they sometimes led observers to report more harmful thoughts about their own eating and exercising, highlighting the broader effects of weight loss messaging.

Bachmakova et al. [105] extended this by showing that weight loss through diet/exercise was viewed as the most effortful and praiseworthy, while Ozempic use was seen as least effortful, least admirable, and less tied to meaningful personal change. Even when combined with lifestyle changes, Ozempic use reduced how much others thought someone had "really changed." Finally, Tomiyama [106] offered a commentary highlighting the ambivalence within psychology and medicine about whether these drugs are a step forward or a step back for reducing stigma.

Taken together, these studies suggest that GLP-1RA users may face a "double-edged sword". On the one hand, they are criticized for not working hard enough, while on the other hand, traditional lifestyle approaches also carry stigma and can trigger unhealthy comparison. What is missing, however, is research on lived experience: that is, how people using GLP-1RAs feel about themselves, how stigma plays out in everyday life and healthcare, and how affordability and access create new divides.

Future work should consider extending beyond experimental studies predominately involving quantitative assessments, to qualitative and longitudinal studies, such as those capturing how GLP-1RA users navigate stigma across contexts (e.g., in clinical, workplace, and digital contexts), and over time.

Attention should be given to structural stigma, including that surrounding affordability, which risks positioning GLP-1RAs as interventions "only for the rich". Intersectional analyses are also important, given that certain gender and racial minority groups (e.g., women and people of colour), as well as lower-socioeconomic status groups may be disproportionately stigmatized or excluded. Unless these issues are addressed, the social stigma surrounding GLP-1RAs may undermine the benefits that these drugs could bring. The next section explores these sociocultural and equity-related dimensions in greater depth, examining how stigma, access, and representation shape both the clinical and psychological impact of GLP-1RA use.

Direct-to-consumer prices of GLP-1RAs remain prohibitively high in most countries. In the United States, monthly costs typically range from USD 500–1200 (up to ~USD 9000 annually) when not covered by insurance [107], while in Australia, private prescriptions for weight loss commonly cost AUD 130–600 per month [108,109]. Similar or higher prices are reported for newer agents such as tirzepatide, with monthly costs between AUD 345–645 [110]. These figures indicate that, without subsidy or insurance coverage, GLP-1RAs remain largely affordable only to wealthier individuals.

This financial barrier is particularly troubling given that higher weight disproportionately affects people from lower socioeconomic backgrounds [111]. In high-income countries, lower income, education, and occupational status are consistently linked with higher weight rates, while in low- and middle-income countries overweightness is rising fastest among disadvantaged groups as food environments and urban lifestyles change [112,113]. Thus, individuals with higher weight are often the very groups least able to afford these medications.

The result is a risk of entrenching a two-tiered system in which affluent or well-insured individuals access advanced pharmacological weight loss treatments, while disadvantaged groups remain excluded or reliant on less resourced interventions. This raises the critical question of whether GLP-1RAs are becoming "treatments only for the rich." Without deliberate strategies such as subsidies, tiered pricing, or public health benefit schemes, the drugs may inadvertently deepen health inequities and reinforce structural stigma, particularly for those already marginalized by race, gender, or socioeconomic disadvantage.

The increasing prescription of GLP-1RAs beyond adults with higher weight and type 2 diabetes highlights important questions about safety, developmental impacts, and equity of access. Two groups stand out: adolescents and young adults, and populations affected by racial, ethnic, and socioeconomic disparities.

Our review has shown that GLP-1RA usage exert effects across multiple domains that extend well beyond appetite regulation. Evidence (see Table 1) suggests potential benefits such as reduced cravings, improvements in emotion regulation, and decreases in binge eating, alongside broader impacts on body image and QoL. At the same time, uncertainties remain regarding long-term neural changes, risks in individuals with restrictive EDs, and broader mental health effects—including suicidality, mood, and anxiety—as well as the sociocultural consequences of use, such as stigma and inequities in access. These complexities highlight the importance of careful clinical oversight and the need for further research to clarify both the benefits and risks of GLP-1RA treatment across diverse populations.

Figure 1 provides a conceptual model of the biological, psychological, and social pathways linking GLP-1RA use to eating- and mental health–related outcomes. This figure outlines how GLP-1RAs exert effects across multiple domains. At the biological level, GLP-1RAs modulate appetite, satiety, and reward pathways, which are interdependent and jointly influence downstream processes. These biological changes extend into psychological domains, including eating behaviours, emotion regulation, and body image, each of which is known to play a central role in ED risk and maintenance. Alterations in these domains can contribute to clinical outcomes such as disordered eating and EDs and mental health difficulties. These outcomes are presented as bidirectionally related, reflecting evidence that disordered eating both arises from and contributes to mental health problems. Importantly, the figure highlights that stigma and inequality permeate all stages of this pathway, shaping access to treatment, amplifying psychological vulnerabilities, and influencing both the risks and benefits associated with GLP-1RA use. Taken together, the model illustrates the need to conceptualise GLP-1RA therapy within a biopsychosocial framework, emphasising the interplay between biological mechanisms, psychological processes, and social context in determining outcomes.

Building on the emerging evidence, it is critical to translate research findings into clinical practice and consider how psychological effects of GLP-1RA use can be assessed, monitored, and managed. While these agents offer metabolic and behavioural benefits, their influence on mood, eating behaviours, identity, and stigma means that careful psychological oversight must be embedded in treatment pathways.

Although empirical research remains limited, clinicians are already encountering patients using GLP-1RAs in routine practice, making preliminary guidance essential despite the absence of formal evidence-based guidelines. The recommendations outlined below are therefore informed by existing knowledge of EDs and associated psychological constructs, known pharmacological effects, and the small but growing body of observational evidence.

Prior to initiating therapy, clinicians should conduct comprehensive psychiatric and behavioural assessments to establish baseline vulnerabilities. These assessments should screen for mood and anxiety symptoms, suicidality, and disordered eating, while also eliciting information on compensatory strategies, body image concerns, and emotion regulation patterns. Because GLP-1RAs directly alter hunger and satiety, it is useful to explore patients' sensitivity to internal cues of hunger and fullness, as these may shape adaptation once appetite suppression begins.

Once treatment is underway, ongoing monitoring becomes essential. Follow-up consultations should evaluate changes in eating behaviours, mood, and suicidal ideation, with heightened vigilance during dose escalations or reductions, which appear to be periods of greater vulnerability [15]. Individuals with a history of weight suppression, rapid weight loss, or restrictive eating may be particularly sensitive to psychological destabilization during treatment and may require closer monitoring. Tracking changes in interoceptive awareness can also help identify emerging difficulties with hunger, fullness, or emotional regulation that may complicate nutritional and psychological management. Multidisciplinary collaboration between prescribers, psychologists, psychiatrists, and dietitians is especially important to ensure early detection of adverse effects and prompt referral where needed.

In addition to psychological monitoring, it is essential to recognize that GLP-1RAs should not be used as stand-alone interventions. Because these medications substantially alter hunger, satiety, and eating patterns [2,3], structured nutritional support is often necessary to maintain adequate intake and prevent the reinforcement of restrictive eating. Collaboration with dietitians and psych dietitians can help patients adapt to reduced appetite, develop sustainable eating routines, and address maladaptive beliefs or emotions related to food. Embedding GLP-1RA treatment within a coordinated multidisciplinary model—combining medical oversight, psychological care, and specialized nutritional guidance—reduces clinical risk and provides a stronger foundation for long-term wellbeing.

Attention must also be paid to the psychosocial meanings of GLP-1RA use. Rapid, medically assisted weight loss can trigger internal conflict and intensify exposure to stigma, particularly as cultural narratives often frame pharmacological treatment as "cheating" or "taking the easy way out" [103,105]. Clinicians can help reframe GLP-1RA treatment as a legitimate medical intervention, provide psychoeducation, and draw on compassion-focused approaches to counter shame and self-criticism. Peer networks or group-based interventions may offer valuable normalization and support, while individual therapy can focus on developing communication strategies and resilience against unsolicited judgments or harmful social comparison [99]. These psychosocial experiences have direct clinical consequences, as stigma-related shame may reduce adherence to nutritional recommendations, and social comparison may intensify compensatory restriction or excessive exercise. Helping patients explore these pressures explicitly in therapy can reduce risk escalation.

A further clinical priority is the prevention and management of disordered eating. Appetite suppression may inadvertently reinforce restrictive behaviours, while discontinuation or dose reduction can precipitate reactive bingeing. Regular screening for maladaptive food rules, compensatory behaviours, or binge urges is therefore essential [6,11]. Appetite suppression can also validate unhelpful beliefs about the "benefits" of not eating, particularly among individuals with perfectionistic or obsessional traits, making early cognitive intervention important. When such difficulties emerge, targeted psychological interventions such as enhanced CBT (CBT-E, [135,136]) can be effective in challenging distorted beliefs about weight, shape, and food. Collaboration with dietitians is recommended to support balanced eating patterns that meet nutritional needs despite reduced appetite, while mindful or intuitive eating practices may be cautiously adapted to account for altered satiety signals. In cases where oral intake becomes insufficient, structured meal plans or higher-energy liquid supplements may be needed to maintain adequate nutrition.

Because many patients rely on food for emotion regulation, appetite suppression may leave them vulnerable to emotional distress. Clinicians should therefore introduce alternative coping strategies through skills-based interventions, such as dialectical behaviour therapy [75], acceptance and commitment therapy, or mindfulness practices, which strengthen emotion regulation and psychological flexibility. Systematic mood tracking is advisable, as evidence suggests GLP-1RAs may have both beneficial and adverse effects on mood and cognition [17,77]. Clinicians should also inform patients that emotional blunting or affective dysregulation may arise as secondary effects of appetite suppression, which may require additional psychological support or medication review.

Given the ongoing uncertainty regarding associations between GLP-1RAs and suicidality, direct inquiry into suicidal thoughts or behaviours should form part of every assessment. Structured safety planning and urgent referral may be necessary when risk is identified, particularly around treatment initiation or dose changes, when psychological destabilization is most likely [13,16].

Special consideration is also required for young adults and people from diverse ethnic/cultural backgrounds. Young adults have been found to be especially vulnerable to body image concerns [137], and peer pressure surrounding weight loss [138], making it important to address identity formation and self-esteem alongside physical health goals. For individuals from different cultural and ethnic groups, perceptions of weight, health, and pharmacological treatment may vary widely, and stigma can intersect with cultural expectations and healthcare inequities. Clinicians should therefore adopt a culturally responsive approach, exploring how GLP-1RA use aligns with patients' values and lived experiences, while remaining sensitive to mistrust in medical systems and disparities in access. Incorporating culturally adapted psychoeducation, engaging family or community supports where appropriate and ensuring inclusivity in treatment models can help safeguard psychological wellbeing and promote equitable care. Co-developing treatment goals that explicitly balance weight-related outcomes with psychological safety can further enhance engagement among diverse patient groups.

Taken together, these implications highlight the importance of integrating psychological assessment and care into GLP-1RA treatment. By reframing therapy to reduce stigma, actively preventing disordered eating, supporting emotion regulation, monitoring suicidality, and tailoring care to developmental and cultural contexts, clinicians can ensure that pharmacological innovation is matched with psychological safeguards, thereby maximizing both safety and long-term benefit. Although these recommendations remain preliminary due to limited evidence, they reflect current clinical realities and aim to support practitioners until more definitive guidance is available.

In conclusion, GLP-1RAs show clear promise in improving metabolic outcomes and short-term eating regulation, but their broader psychological effects remain insufficiently understood. Current findings highlight both potential benefits and serious risks across eating behaviour, mood, body image, stigma, and equity of access. Yet most studies are short-term, narrowly sampled, and methodologically limited. Without robust longitudinal data in diverse populations, we cannot know whether these drugs provide a safe and sustainable solution—or whether early gains mask long-term harms. Until such evidence emerges, GLP-1RAs must be approached with caution: integrated into multidisciplinary care with rigorous monitoring, psychological support, and policies that address inequities, while remaining alert to the possibility that today's promise could become tomorrow's problem.