A 45‑member expert panel urges eating disorder screening before every GLP‑1 prescription, on evidence it calls limited

A panel of 45 clinicians, researchers and people with lived experience has published the first consensus recommendations on how prescribers should handle eating disorders when they put someone on a GLP-1 medicine such as semaglutide or tirzepatide. The recommendations appeared in the journal World Psychiatry on 15 September 2026.

The core of it is short. Ask every patient about eating disorders before writing the first prescription. Keep checking during treatment, and after it stops. And in people who currently have anorexia nervosa, atypical anorexia nervosa, or bulimia nervosa with heavy dietary restriction, generally do not prescribe these drugs at all.

That last point was the only clinical recommendation the panel agreed on unanimously. Several of the research recommendations also reached 100%.

The panel agreed 100% that these drugs should generally be avoided in active anorexia and bulimia

The authors are careful about what "generally avoided" means. They write that it is not an absolute contraindication, which is the medical term for a hard rule that rules a drug out in every case. They describe it instead as risk-aware prescribing, applied with clinical judgment after looking at the person's symptoms, how severe the illness is, their nutritional state, and the rest of their care.

The panel also made a point that matters for anyone who has been told their weight rules out an eating disorder. Obesity does not preclude an eating disorder diagnosis. A person with obesity can have atypical anorexia nervosa, binge eating disorder or bulimia nervosa at the same time, and in those cases the panel says they may not be a suitable candidate for a GLP-1.

Binge eating disorder was treated differently from the rest. The panel noted that people with that diagnosis are generally at lower theoretical risk of harm from these drugs, and in some cases may be more likely to benefit. It still urged caution, because some people with binge eating disorder also restrict their eating heavily between episodes.

Screening would be a short questionnaire, asked in primary care

Agreement on screening was high. 94.7% of the panel backed assessing every patient for a current or past eating disorder before starting a GLP-1. 89.5% backed doing it with a brief tool of three to five questions rather than a long clinical interview. 94.7% said the screening belongs in every setting where these drugs are prescribed, primary care included, which is where most prescriptions now start.

The paper names existing short questionnaires that could be used, including the Eating Disorder Screen for Primary Care and the SCOFF questionnaire. It also says plainly that none of them has been validated for this specific situation, and that studies are needed to work out whether they perform well in people being considered for a GLP-1.

92.1% agreed that a positive screen should lead to something concrete: a referral to an eating disorder specialist, closer monitoring, patient education, or a change to the treatment plan, depending on how severe the symptoms are. In high-risk cases, some experts suggested holding off on starting the medicine until a fuller assessment is done.

Monitoring everyone is the recommendation panelists argued about most

84.2% agreed that everyone taking a GLP-1 should be watched for physical and psychological signs of an eating disorder, both during treatment and after stopping. The paper records why the other 15.8% objected: there is not yet enough research on how often new eating disorders actually appear after someone starts a GLP-1, and monitoring every patient would add real work for prescribers.

97.4% agreed the intensity should be scaled to the individual rather than applied evenly. The paper gives one specific signal clinicians should treat as a prompt to look closer: weight coming off faster than expected for the particular drug, which it describes as typically more than one to two pounds per week, while noting this varies from patient to patient.

86.8% agreed on what to track, including eating disorder symptoms, rate of weight loss, nutrition, hunger and fullness cues, vital signs, mood and quality of life. The paper acknowledges that list may need trimming in a busy primary care visit.

The split on requiring therapy alongside the drug was about access, not principle

81.6% agreed that people with a diagnosed eating disorder who take a GLP-1 should also receive evidence-based psychotherapy. The 18.4% who disagreed did not argue that therapy is unhelpful. They argued it should not become a gate: waits in public eating disorder services can be long, private therapy costs money, and making therapy a condition of the prescription could put the medicine out of reach for the people the recommendation is meant to protect.

Underneath the recommendations sits case-report evidence, not trial evidence

The panel is explicit that it is filling a gap rather than summarizing settled science. On the potential benefit side, small studies have reported fewer binge eating episodes in people with binge eating disorder treated with liraglutide, semaglutide or dulaglutide. But the most rigorously controlled trial to date in that group did not show a significantly greater drop in binge frequency than placebo, even though it did produce more weight loss. In bulimia nervosa, exactly one case report has been published. For tirzepatide in binge eating disorder there are no published observational or placebo-controlled studies at all, though a phase 2 randomized placebo-controlled trial is running.

On the harm side, the evidence is thinner still. Two published case reports describe people with a history of anorexia nervosa whose restrictive eating returned after starting a GLP-1. One larger signal comes from a retrospective cohort, which found that people with obesity and a prior mental health diagnosis were about twice as likely to be diagnosed with an eating disorder within two years of starting a GLP-1 than people without that history. A retrospective cohort compares groups after the fact, so it can show that two things occurred together without showing that one caused the other.

The panel points to that gap as the reason for its research recommendations, which reached 100% agreement on several items. Among them: study how often eating disorders occur in GLP-1 users compared with non-users, run proper trials of these drugs in binge eating disorder, and measure psychological outcomes in those trials rather than weight alone.