¹Dalhousie University/Nova Scotia Health, Psychiatry, Halifax, Canada

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for type 2 diabetes and obesity and are increasingly encountered among individuals with eating disorders (EDs) or elevated ED risk. Early and mixed evidence suggests potential benefit for binge-eating symptoms, while clinical concern persists regarding ED onset, relapse, or symptom exacerbation in susceptible patients.

Aims & Objectives: To develop expert consensus–based clinical recommendations and research priorities for GLP-1RA–based treatments in the context of EDs, balancing potential benefits with risks in the setting of limited empirical evidence.

Method: A modified three-round Delphi process convened a multidisciplinary panel (N=50) spanning diabetes/obesity/endocrinology clinicians/researchers, ED clinicians/researchers, and individuals with lived experience. Consensus was predefined as ≥70% agreement. A working group generated an initial framework, which was refined through virtual meetings, open-ended feedback, and anonymous surveys using a 4-point Likert agreement scale.

Results: Panelists achieved high overall agreement (average consensus ~92%). Consensus clinical recommendations included: (1) routine screening for current or past EDs prior to GLP-1RA initiation (≈95% agreement), (2) ongoing monitoring for physical and psychological ED indicators during and after treatment (≈84%), (3) development and dissemination of standardized educational materials for prescribers and patients (≈92%), and (4) concurrent evidence-based psychotherapy for individuals with diagnosed EDs who receive GLP-1RAs, with caution/relative contraindication emphasized for more severe restrictive or purging presentations (≈82%). Research priorities reached consensus for: epidemiologic studies on incidence/risk factors/outcomes (100%), regulatory/safety-focused research (≈92%), and rigorous clinical trials in binge-eating disorder assessing both safety and psychological outcomes (100%).

Discussion & Conclusions: These consensus recommendations provide a pragmatic framework for clinicians and researchers navigating GLP-1RA use where evidence is evolving. Key themes include proactive identification of ED vulnerability, proportionate monitoring tailored to baseline risk and clinical setting, balanced patient/provider education amid widespread public messaging, and integration of evidence-based ED treatment when GLP-1RAs are used. The agenda emphasizes epidemiologic clarification of real-world risk, stronger safety oversight in prescribing pathways, and adequately powered trials. particularly for binge-eating disorder, to resolve uncertainty and guide future guideline development.