#504: Adult Eating Disorders in the GLP-1 Era

November 10, 2025 | By Isabel Valdez

Audio

Video

Transcript available via YouTube

Explore how GLP-1 meds can help or harm eating disorders with Dr. Laura Bridge

Show description: 

When weight-loss meds meet eating disorders: GLP-1 drugs are reshaping medicine,  but could they also be fueling disordered eating? Join Dr. Laura Bridge  as we unpack the risks, red flags, and how to keep “healthy” from turning harmful.  Also, how to approach restrictive eating disorders, bulimia, and binge eating disorder as a PCP.

Claim CME for this episode at curbsiders.vcuhealth.org!

Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME

Show Segments

• Introduction
• Defining Eating Disorders 
• Screening & Permission to Discuss 
• Clinical Approach & History Gathering 
• Treatment Framework 
• GLP-1 Contraindications
• Dr. Bridge’s Take-Home Points 

Credits

• Producer, writer, show notes, cover art and infographics: Isabel Valdez, PA-C
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Reviewer: Molly Heublein MD
• Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
• Technical Production: PodPaste
• Guest: Laura Bridge MD, FACP

Disclosures

Dr. Laura Bridge no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Adult Eating Disorders in the GLP-1 Era Pearls

1. Eating disorders occur at any BMI — screen all patients, not just those underweight, using brief and non-judgmental tools.
2. Lead with empathy and curiosity — use trauma-informed language and ask, “What does health mean to you?” to align with patient values.
3. GLP-1 medications can worsen restriction — their appetite-suppressing effects may reinforce malnutrition or blunt hunger cues.
4. Nutrition and psychotherapy are first-line — restoring meal structure and addressing body image remain core to recovery.
5. Monitor for medical complications — track vitals, electrolytes, menstrual changes, and bone health in at-risk patients.
6. Medication use depends on diagnosis — fluoxetine for bulimia; lisdexamfetamine for binge eating disorder; SSRIs only for comorbid anxiety or depression.
7. Combine meds with therapy — sustainable recovery requires addressing both physiologic appetite and psychological triggers.

Adult Eating Disorders in the GLP-1 Era – Notes

Anorexia Nervosa and Avoidant Restrictive Feeding and Eating Disorders (ARFID)

Restrictive eating disorders are characterized by malnourishment that stems from different underlying causes.  Anorexia nervosa tends to be motivated by body dissatisfaction or weight concerns while ARFID stems from a sensory driven fear of eating.  Unspecified eating disorder is the term used as one is working up the eating and feeding disorder.  Other specified feeding and eating disorder is used to classify a disorder wherein the criteria for the other eating disorders are not entirely met.  

Beyond BMI: A Non-Judgmental Approach to Screening

Dr. Bridge emphasized that screening in primary care must be practical, brief, and non-judgmental.  Don’t limit screening to just underweight patients — eating disorders exist across the BMI spectrum. Because many eating disorders are missed in outpatient medicine, even among patients presenting for metabolic or weight-related concerns, clinicians should have at least one rapid-screen tool available at the point of care to help structure the conversation and lower the threshold for referral or deeper assessment.

“Let’s talk about it…”: Patient-centered and Trauma-informed

When initiating a conversation about eating disorders, Dr. Bridge aims to establish a safe and supportive environment.  She suggests making eye contact and using the patient’s language to reflect on their request for medications that may reinforce restrictive eating patterns. Dr. Bridge recommends using the patient’s stated why to ask permission to delve further into their concerns while openly acknowledging the challenging nature of the discussion ahead. Offer the patient reassurance and support, allowing them to control the parameters of what they disclose, including when they need to pause or end the conversation. To better align with the patient and differentiate between health and weight loss, Dr. Bridge asks patients to define their health goals or their personal definition of health with the question: “What does health mean to you?” This approach helps build trust and provides insight into how to best support them.

GLP-1RA Pharmacologic Effects on Eating Disorders

Dr. Bridge cautioned that the same physiologic mechanisms of GLP-1RA—particularly appetite suppression and delayed gastric emptying—can be harmful in patients with eating disorders.  In brief, GLP-1RA (and dual GLP-1/GIP agonists) mimic the action of naturally occurring incretin hormones that enhance insulin secretion, suppress glucagon, slow gastric emptying, and promote satiety. These pharmacologic effects lead to improved glycemic control and significant weight loss, which make them effective in treating diabetes and obesity. For individuals with anorexia or restrictive eating patterns, GLP-1 medications are contraindicated because they reinforce restriction and worsen malnutrition (Kalas et al, 2025). Dr. Bridge added that in those with bulimia or binge eating disorder, they may blunt hunger cues or trigger relapse after discontinuation. Overall, our expert acknowledges that these medications have clear metabolic benefits and reminds us that these could unintentionally mimic or exacerbate disordered eating behaviors (Bartel et al, 2024).

Treatments approaches: More than just medicines

Rehabilitation and Nutrition 

Psychotherapy and nutritional therapy are the cornerstones of treatment for eating disorders and primary care providers should collaborate with psychiatrists and dieticians when they are available for care.  Cognitive-behavioral therapy helps to address body image concerns and controlling patterns that affect the patient’s impulse control and eating behaviors (Waller and Beard, 2024) .  Dr. Bridge highlights the importance of teaching mindful eating to these patients because they might not experience or be aware of hunger or fullness cues. She  emphasises nutritional rehabilitation with a dietician with the aim of normalizing and establishing three-meals a day and a snack, encouraging macronutrients and gradual increase in calories. Medical management includes monitoring for cardiometabolic changes like electrolytes changes in a patient who is actively purging with laxatives or vomiting, heart rate changes like bradycardia, or changes in menstruation pattern in patients with a uterus.  Dr. Bridge reminds us to screen with a bone density test if the patient has had amenorrhea or maintained a low weight. 

Restrictive Eating Disorders: Anorexia, ARFID

Dr. Bridge reminds us that there are no approved medications for treating restrictive eating disorders. SSRIs can be used to treat comorbid, overlapping mental health disorders such as depression or anxiety. 

Bulimia 

Fluoxetine is the only FDA-approved medication for bulimia and should be used with awareness for QT-prolongation (Constandache et al, 2023).  Because of purging, patients may develop poor dentition and edema from pseudo-Bartter syndrome. GLP-1 RA can be used with caution for treating any indicated condition so long as patients are supervised carefully for relapse. 

Binge Eating Disorder (BED)

Dr. Bridge mentions SSRIs can manage anxiety/depression in BED but aren’t a primary treatment for BED itself, because these have little impact on binge frequency. Lisdexamfetamine effectively reduces binge episodes and is FDA-approved for treating BED, and our expert reminds us to be cautious since it is an appetite suppressant (Grilo et al, 2025).  GLP-1 RAs also show promise in reducing binge frequency by increasing satiety (Radkhah et al, 2025). However, GLP-1 RAs may not address psychological triggers, risking rebound binging if discontinued without therapy (Aoun et al, 2024). A combined pharmacotherapy and psychotherapy approach is recommended for sustained BED management.

Take home points

1. Always screen for eating disorders before prescribing GLP-1 medications.
2. GLP-1 agents should not be used in active restrictive eating disorders such as anorexia or ARFID.
3. Use GLP-1s cautiously in bulimia or binge-eating disorder and only when there is a strong medical indication.
4. Take patients’ concerns seriously and trust your clinical intuition if something about their relationship with food feels off.  
5. Treat eating disorders using a multidisciplinary team including a therapist, dietitian, and medical provider.
6. Eating disorders occur at all body sizes; do not rely on weight alone to assess risk.
7. Prioritize restoring a healthy relationship with food and body signals over weight-centric outcomes.

Recommendations and Links

Books recommended by our listener, PA Madison Donnelly
Almost Anorexic	Anti-Diet
Jennifer J. Thomas and Jenni Schaefer	Christy Harrison

Goal

To enhance clinicians’ ability to recognize, evaluate, and appropriately manage chronic eating disorders in adults, particularly in the context of increasing use of GLP-1 receptor agonists for weight loss and metabolic disease.

Learning objectives

After listening to this episode listeners will…

1. Identify the clinical features and diagnostic criteria of chronic eating disorders in adults (anorexia nervosa, bulimia nervosa, and binge eating disorder).
   
2. Evaluate the risks, contraindications, and potential misuse of GLP-1 receptor agonists in patients with known or suspected eating disorders.
   
3. Integrate behavioral health, nutrition, and medical perspectives in the management of patients with coexisting metabolic disease and eating disorders.
   
4. Apply ethical and clinical judgment when considering weight-loss pharmacotherapy in patients at risk for, or currently experiencing, disordered eating.

Citation

Valdez I, Bridge L, Williams PN, Watto MF, Heublein M, “#504: Adult Eating Disorders in the GLP-1 Era”. The Curbsiders Internal Medicine Podcast. thecurbsiders.com/category/curbsiders-podcast. November 10, 2025.