GLP-1 Receptor Agonists in Disordered Eating: Safety Concerns and Clinical Recommendations
Gastrointestinal Adverse Effects
- The gastrointestinal adverse effects of GLP-1 receptor agonists, including nausea (40% with liraglutide), vomiting (16%), diarrhea, and constipation, could be particularly problematic in eating disorder populations where these symptoms may trigger or worsen disordered eating behaviors 1, 2
Metabolic and Nutritional Safety Concerns
- GLP-1 receptor agonists delay gastric emptying, which can impact absorption of oral medications and may worsen symptoms in patients with gastroparesis—a common comorbidity in eating disorders 1, 4
Restrictive Eating Disorders
- The appetite-suppressing effects and weight loss outcomes (14.9-20.9% body weight reduction) of GLP-1 receptor agonists directly contradict treatment goals in restrictive eating disorders 3
Critical Contraindications
- The American Gastroenterological Association recommends that GLP-1 receptor agonists be contraindicated in patients with personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 1, 3
- The American Society of Anesthesiologists recommends that GLP-1 receptor agonists be contraindicated in patients with active gastroparesis or severe gastrointestinal motility disorders 2
- The American Heart Association recommends that GLP-1 receptor agonists be contraindicated in patients with recent heart failure decompensation 5