GLP-1s are finally silencing food noise for some binge eaters—and fueling disordered eating in others

What is binge eating disorder, and why has it been so hard to treat?

Binge eating disorder (BED) is more than the occasional episode of overeating. It involves regularly feeling out of control of what and how you eat—eating when you’re not physically hungry and until you’re uncomfortably full. The diagnostic criteria for BED requires a person to have at least one binge per week for at least three months, accompanied by marked distress over the behavior.

BED “is intolerable food noise. The inability to stop eating kind of takes over your life,” says Joanne Dushay, M.D., an endocrinologist at Beth Israel Deaconess/Harvard who specializes in obesity medicine.

The first-line treatment for BED is cognitive behavioral therapy (CBT), which helps to identify and challenge dysfunctional thought and behavior patterns. That might look like digging into the thoughts, feelings, and habits that tend to trigger a binge, and finding different ways to manage those emotions or interrupt certain behaviors. CBT is often paired with dialectical behavioral therapy (DBT), which teaches you how to accept inevitable setbacks, Cromer says.

But talk therapy alone doesn’t work for everyone, and there is currently only one FDA-approved medication for BED: lisdexamfetamine (Vyvanse), a stimulant also approved for ADHD that can suppress your appetite. A 2025 study of 141 people with BED found that 70.2 percent of people treated with a combination of therapy and Vyvanse went into remission, making it almost twice as effective as medication or therapy alone; 96 percent saw a reduction in binge episodes. But stimulants aren’t well tolerated in everyone, so doctors can prescribe several other drugs—including antidepressants as well as GLP-1s—off-label for BED.

Part of the treatment challenge for BED is that many people are never officially diagnosed in the first place. Some healthcare providers dismiss BED behaviors in people with a normal BMI, Dr. Cody Stanford says. And patients rarely divulge their binge eating behaviors due to feelings of guilt and shame.

Before starting his GLP-1 (Zepbound), Owens’ weight frequently yo-yoed. Life stressors derailed his progress, and the weight always came back. Though he’d seen multiple therapists for anxiety and depression over the years and even discussed his weight, no one ever brought up his eating behaviors. He’s sure he would have been diagnosed with BED if he’d “had the courage” to bring up his binges, but he never did.

Even for those who do receive a diagnosis, relief isn’t necessarily waiting on the other side. While the combination of CBT and Vyvanse work really well for some people, they don’t for others. “We see a lot of patients that are very frustrated by that, who feel stuck,” says Lauren Newman, a registered dietician and certified eating disorders specialist who focuses on disordered eating and diabetes care. That frustration has led both patients and clinicians to look beyond the existing toolkit and increasingly toward a newer class of drugs.

How GLP-1s work—and how they could help with BED

Many people assume these drugs simply work by suppressing appetite, but “it’s so much more” than that, Newman says. GLP-1 medications simulate the GLP-1 hormone that’s naturally produced in the small intestine and has receptors throughout the body—including, notably, the brain.

Both the naturally-occurring hormone and the medication enhance your body’s appetite and satiety signals in response to eating, while also slowing gastric emptying (the amount of time it takes food to pass through your digestive system) so you feel fuller for longer. They also act on the brain’s reward circuits, including those involved with eating, which is one of the mechanisms that may decrease interest in alcohol.

For someone who consistently feels out of control around food and ignores their body’s satiety cues, GLP-1s could help diminish the “reward-like” quality of a binge while making their fullness louder and harder to ignore. Dr. Dushay describes one patient with BED who went grocery shopping for every meal because otherwise he would eat any food in his kitchen. Since starting a GLP-1, he can fill his pantry because he knows what it’s like to feel full and is able to stop eating.

“Countless” patients have expressed relief to Newman after starting GLP-1s, with sentiments like: “This is what everybody else feels like, isn’t it? That’s what I was trying to do all these years, and nothing was helping me actually get there.”

The cost and side effects to consider

Since GLP-1s aren’t approved to treat BED, people who don’t have an FDA-approved comorbidity (like obesity, type 2 diabetes, or obstructive sleep apnea) can’t get insurance coverage and have to pay out of pocket (anywhere from a few hundred dollars with manufacturer coupons to over one thousand dollars). Even some patients who do meet the criteria often find that their plans won’t cover the full cost of these high-price medications.

That’s led to another trend that worries health care providers: the growing number of people accessing lower-cost GLP-1s through online compounding pharmacies. That can be “dangerous,” says Dr. Dushay, since there’s no way to verify that the meds actually contain their advertised dosage and ingredients. This route also typically comes with even less medical oversight.

Side effects from a GLP-1 can range from mild to serious, which is why provider oversight is so important. Nausea and loss of appetite are common—especially when the dosage is increased too quickly—which can cause people to eat less without recognizing they’re at risk for malnutrition. Other common side effects include diarrhea, constipation, headache, fatigue, and dizziness, among others. Possible serious adverse reactions listed in the prescribing information for these medications include pancreatitis, gallbladder disease, hypoglycemia, kidney problems linked to dehydration, and severe gastrointestinal reactions.

The limited research on GLP-1s and eating disorders

While there’s no direct evidence that GLP-1s treat BED yet, observational studies do show that they reduce binge eating behaviors even when people don’t lose weight. That suggests the drug may “reduce the drive to binge, not merely suppress appetite,” Dr. Cody Stanford says.

A 2025 meta-analysis looked at five studies on GLP-1s for people with eating disorders and found that people with BED taking a GLP-1 showed a reduction in binge eating symptoms and lost significantly more weight compared to control groups. These are promising results, but the study’s authors note that more research is needed, and “clinicians must also consider potential adverse effects, evaluate the cost-effectiveness of these medications for each patient, and closely monitor for any improvement or worsening of eating disorders and related side effects.”

That hesitation is shared by the National Eating Disorder Association (NEDA), who published an opinion paper on GLP-1s and eating disorders in 2024, stating: “While there is some evidence that GLP-1’s can decrease the number of binge eating episodes for those with BED, little is known about the long term physical and psychological impact on those with eating disorders.”

How GLP-1s could also fuel eating disorders

The same mechanisms that make these medications helpful for some could make them harmful for others. For example, the appetite suppression and weight loss effects of a GLP-1 could be particularly attractive to someone dealing with anorexia nervosa, who generally restricts their food intake and has an intense fear of gaining weight. Similarly, someone with bulimia nervosa could misuse a GLP-1 in the same way they might turn to self-induced vomiting, laxatives, or excessive exercise to compensate for binge eating behaviors. And, unfortunately, experts are already seeing this play out.

Newman says she’s seen people use GLP-1s as an appetite suppressant to fuel a restrictive eating disorder. One of Dr. Cody Stanford’s patients with BED developed bulimia nervosa after starting GLP-1s: Instead of being deterred when she experienced side effects like severe nausea and vomiting, she viewed that as “helpful” for her weight loss.

Restrictive eating patterns are in fact a significant trigger for developing BED in the first place, Cromer says. And research shows there can be crossover between different eating disorders, which means that someone might struggle with binge eating while also having a history of or predisposition for anorexia nervosa or bulimia nervosa. While a GLP-1 might help their binge eating behaviors, it could also be gas on the fire of other disordered eating habits.

The pitfalls of screening and self-reporting

Having a history of an eating disorder doesn’t preclude you from using a GLP-1, but experts stress that practitioners should be screening all patients for the potential for recurrence or misuse and closely monitoring them to flag any worsening eating disorder symptoms. This would include things like:

• Excessive calorie restriction
• Rapid and extreme weight loss
• Compulsive weighing or calorie counting
• Mood changes
• Body dysmorphia
• Signs of misuse, like skipping meals or taking pride in eating as few calories as possible

There are currently no national screening guidelines for eating disorder misuse specific to GLP-1s, Dr. Cody Stanford says. But doctors should use standard questionnaires to screen all patients for restrictive eating disorders, which are both common and underdiagnosed in higher-weight people. That opportunity is often missed. “This is one of the most significant gaps in clinical care,” she says.

Unfortunately, not all doctors are familiar with eating disorder screening guidelines. What’s more, patients aren’t always fully transparent with their responses. Some are ashamed or believe their behaviors aren’t “severe enough” to constitute an eating disorder; others may minimize an eating disorder to get or keep access to medication. Once people start taking GLP-1s, Dr. Dushay has seen some people hide side effects from their providers because they’re afraid of regaining the weight they’ve lost—for example, assuming that belly pain severe enough to be a medical emergency is normal, since “everyone says these medications are kind of rough.”

Warning signs that a GLP-1 is making your relationship with food worse, not better

Dr. Cody Stanford says the onus should be on healthcare providers to monitor patients’ eating patterns and help them recognize if they’re veering into disordered eating territory. But if you’re taking a GLP-1, it’s worth knowing what that looks like so you can flag concerns to your doctor.

Warning signs you should bring up to a healthcare practitioner include:

• Not experiencing any hunger and fullness cues at all
• Persistent nausea, vomiting, or diarrhea beyond the initial titration period
• Rapid weight loss (more than 1% of body weight per week after the first four weeks)
• Cold intolerance, hair loss, or dry skin, which can be signs of undernutrition
• Eating fewer than two meals per day, or skipping meals regularly
• Consciously using medication to avoid food
• Eating only to take medication, or avoiding medication days to eat more freely
• Feeling excessively preoccupied with food or the way your body looks
• Anxiety about eating
• Guilt after eating
• Black and white restrictive thinking about food (labeling foods as “good” or “bad”)
• Rigid rules about timing, amount, or type of foods you’ll eat
• Fear of eating specific foods that you previously enjoyed
• Avoidance of social eating situations
• Secrecy: hiding your medication or eating habits from friends and family, feeling hesitant to discuss side effects with your practitioner, or lying to get access to the medication

If you notice any of these symptoms, it’s important to check in with your healthcare provider and/or a mental health provider. If you haven’t previously spoken with a mental health professional about your eating habits but you’re noticing some of these behaviors, now would be a good time to find a provider.

What GLP-1s can't do—and where therapy comes in

Just because food noise is quieted doesn’t mean an eating disorder is gone. Even for patients who are finding relief from BED on a GLP-1, experts caution against relying on medication alone to treat this eating disorder.

BED isn’t a lack of willpower—it’s a mental health concern, and medication alone “can tend to be a band-aid,” Cromer says. GLP-1s don’t address the emotional triggers, the shame, and the patterns that developed over years. “The drug itself is not a cure-all,” she says, noting that if you stop taking it your symptoms will likely come back.

While it’s possible that someone who is using a GLP-1 to supplement their work in therapy may develop coping strategies to help them avoid a recurrence of BED if they stop the medication, there isn’t enough research yet to know whether these drugs can be a short-term solution. “I don’t know that we have a scientific consensus around that right now,” Newman says. “The experience that I’ve had with my patients points me to think there is something more physiological, neurobiological going on that the medication addresses.”

People who binge as a coping mechanism may also find that anxiety gets worse once appetite is suppressed. One patient found herself “eating through the medication,” says Newman: She craved the emotional comfort “and hadn’t done enough therapy to find other ways of navigating that.”

In some cases, people are forced to stop GLP-1s because of intolerable side effects—and when their appetite and body size shift dramatically, they feel dysregulated and bingeing behaviors may “come back in full force,” Newman says. “It fuels that cycle where they’re bouncing back and forth between extremes. That can be quite scary and then contribute to even more disordered patterns.”

Working with a therapist and a registered dietician can help you learn:

• What triggers your binges
• How to navigate the urge to binge (on or off the medication)
• How to develop a healthier relationship with food
• How to spot and navigate any restrictive behaviors

“That’s what the drug can’t do,” Cromer says.

What to know if you’re struggling with binge eating and considering a GLP-1

Whether a GLP-1 makes sense for you is a highly nuanced and personal decision—one that depends on your history with food, your mental health, your other treatment options, and your goals. That’s why the first step should be an honest conversation with a trusted healthcare provider. That might be your primary care doctor or a mental health professional.

If you have a history of restriction, purging, or misusing medications or other behaviors in the service of losing weight, experts believe that taking a GLP-1 might be especially risky. NEDA cautions that for people with active eating disorders or a history of disordered eating, these drugs “can be harmful when not used for their intended purpose, when inadequately monitored or monitored by clinicians without eating disorder expertise, or when used for weight loss motivated by weight stigma.”

That doesn’t mean GLP-1s are automatically off the table, but it does mean that this decision warrants extra care, specialist input, and close monitoring throughout. Dr. Cody Stanford has seen “dramatic reductions” in binge frequency when people start taking GLP-1s: Some patients stop bingeing entirely within a couple of months of beginning treatment. Others, however, don’t respond or “develop problematic side effects that interfere with eating patterns in different ways,” she says.

Whether you use a GLP-1 or not, working with a therapist is strongly recommended to treat BED. Look for providers who specialize in eating disorders, like someone who is a certified eating disorder specialist (CEDS). They can bring a targeted expertise that is often missed in primary care conversations.

“There’s a lot of misinformation, a lot of false science out there when it comes to eating and eating disorders. So going to someone who is trained in that, specializes in it, and is going to promote evidence-based scientific interventions and treatment recommendations is critical,” Cromer says.

With so much still unknown about the role that GLP-1s can play in eating disorders, it’s important to find providers you trust and feel comfortable checking in with. Ideally your care team includes a prescribing physician alongside a mental health provider and a registered dietitian, who can offer personalized guidance to support your overall wellness—both physical and mental.

“I think where some people can go wrong is [thinking], ‘Well, the food noise has been reduced, so I’m fixed,’” Cromer says. “Medication is helpful. But we know from research that medication and psychotherapy tend to produce the best outcomes for acute and long-term wellness.”