GLP-1 Medications in Binge Eating: A Positive Signal

A positive signal, but not a clear effect in binge eating disorder

STUDY: Emptage I et al, eClinicalMedicine 2026

STUDY TYPE: Systematic review and meta-analysis of randomized controlled trials

FUNDING: Wellcome Trust and Medical Research Foundation

Background

GLP-1 receptor agonists like liraglutide and semaglutide are approved for weight loss in obesity. Whether they reduce binge eating, or just trade it for a different eating problem, hasn’t been settled.

The Study

• Pooled data from 25 randomized trials (8069 participants, about two-thirds female, mostly White) comparing a GLP-1 receptor agonist, usually liraglutide or semaglutide, against placebo or an active comparator in people with overweight or obesity, some with diabetes.
• Only 3 of the 25 trials specifically recruited patients with diagnosed binge eating disorder; most enrolled general weight-management populations and measured binge eating as a secondary outcome.

Results

First, the skeptical view. Only one small trial tested a GLP-1RA (liraglutide) against placebo, and it was negative on the primary outcome. The patients lost weight, as expected, but binging did not go down.

But if we broaden the view to binge eating as a behavior, not a disorder, across these 25 trials, there is a positive signal. GLP-1RAs produced a moderate reduction in symptoms (effect size 0.50). The benefits were larger in the subset of trials that enrolled diagnosed binge eating disorder, but those were small trials (prone to large effects) and several did not use a placebo control.

Dietary and cognitive restraint, deliberate efforts to limit intake, improved, and it’s unclear whether that reflects healthier self-control or the rigid restriction that can itself feed disordered eating.

Limitations

This is not proof of efficacy in binge eating disorder. A weight loss drug may not address the cognitive problems behind that binging, such as impulsivity and executive function. But it does suggest a benefit for other types of binging.

Twelve of the 25 trials were rated high risk of bias, and none were rated low risk.

Practice Implications

1. GLP-1 RAs may be beneficial for obesity with binge eating.
2. Here’s an update on how to use them in psychiatry from the Carlat Report.

—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report

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