Glucagon-like peptide-1 receptor agonists (GLP-1RAs), initially developed for type 2 diabetes management and later expanded to obesity treatment, have shown preliminary efficacy in reducing binge eating episodes. However, the appetite-suppressing and weight-loss effects of GLP-1RAs raise concerns about misuse and potential exacerbation or emergence of eating disorders (EDs). Evidence remains limited and inconsistent, requiring structured, expert-informed guidance. Using a modified three-round Delphi method, a multidisciplinary panel of experts in diabetes, obesity and/or EDs, and individuals with lived experience of an ED and/or GLP-1RA use (N=45) achieved ≥70% consensus on recommendations (average consensus: 91.7%). Clinical recommendations include: a) the implementation of screening for current and historical ED before initiating GLP-1RAs, using a brief psychometrically validated instrument; b) routine monitoring of ED symptoms with intensity stratified by risk level; c) the development of standardized educational materials for patients and providers; and d) offering concurrent evidence-based psychotherapy to individuals with EDs prescribed GLP-1RAs. These medications should generally be avoided in individuals with active EDs, particularly anorexia nervosa, atypical anorexia nervosa, and bulimia nervosa with marked dietary restraint and/or significant weight suppression. Clinicians should also proceed cautiously in patients with a past history of these EDs. Research recommendations include: a) longitudinal epidemiological studies to assess the incidence, risk factors, and outcomes of EDs in individuals using GLP-1RAs compared to non-users; b) regulatory studies and policies to enhance patient safety in GLP-1RA prescribing practices; and c) clinical trials to investigate the safety, efficacy and psychological outcomes of GLP-1RAs in individuals with binge eating disorder. Overall, these consensus-based recommendations support evidence-informed practice and future research aimed at weighing potential benefits against risks of use of GLP-1RAs in ED populations.
