In individuals with overweight or obesity, treatment with a glucagon-like peptide-1 receptor agonist (GLP-1RA) appears to reduce binge eating severity and associated behaviours, including loss of control eating and disinhibited eating, according to a meta-analysis.
Pooled data from 25 randomized controlled trials (RCTs) showed that compared with participants allocated to the control intervention (placebo, active drug, or usual care), GLP-1RA‒treated participants had small-to-moderate reductions in binge eating severity (Hedges’ g, −0.23), disinhibited eating (Hedges’ g, −0.54), and loss of control eating (mean difference, −18.38). [EClinicalMedicine 2026;98:104007]
Results for the secondary outcomes also favoured GLP-1RAs, with moderate reductions in emotional eating scores (Hedges’ g, −0.30) and moderate increases in cognitive and dietary restraint (Hedges’ g, 0.31).
Effect sizes were larger in trials that involved participants with binge eating disorder than in trials that did not (Hedges’ g, −0.60 vs −0.27), although the difference was not significant (p=0.10).
Bias risk was rated as high or of some concern in all included RCTs, and heterogeneity was substantial.
“Our findings suggest that GLP-1RAs may be a promising adjunctive pharmacotherapy for individuals living with binge eating symptoms and obesity,” according to first author Isobel Emptage from the University College London, London, UK, and colleagues.
“While pharmacological treatments may help regulate appetite and reduce loss of control eating, sustainable recovery is likely to depend on concurrent psychological therapies, social support, and policies addressing wider determinants of disordered eating, including societal norms and structural weight bias,” Emptage and colleagues continued.
“GLP-1RAs may therefore form part of a multidisciplinary strategy integrating medical, behavioural, psychological, and community-level approaches to reduce drivers of binge eating and associated psychological distress,” they said.
However, the current evidence is preliminary, the authors cautioned. “Most included trials were at high risk of bias, funded by the pharmaceutical companies, and rarely enrolled participants with a clinical diagnosis of binge eating disorder, which substantially limits the certainty and generalizability of the findings,” they said.
Emptage and colleagues highlighted the need for independently funded RCTs—including those recruiting individuals with diagnosed binge eating disorder, incorporating longer follow-up, and measuring both psychological and metabolic outcomes—to establish the clinical role of GLP-1RAs and determine whether the observed short-term benefits translate into meaningful and sustained improvements.
Evidence from such RCTs, they said, will be particularly relevant, given the limited global guidance on pharmacological treatments for binge eating.
The 25 trials were conducted in high- or upper-middle-income settings and included 8,069 participants (median age 47.3 years, 67.5 percent female) with obesity (median BMI 35.8 kg/m2, median waist circumference 113 cm).
Ten trials included participants with diabetes or prediabetes, and only three trials actively recruited participants with a diagnosis of binge eating disorder or identified as binge eaters to specifically evaluate GLP-1RAs in binge eating.
Liraglutide was the most frequently investigated GLP-1RA (12 trials, 48 percent), followed by semaglutide (six trials, 24 percent). Retatrutide, dulaglutide, exenatide, and tirzepatide were evaluated in two trials each (8 percent), while survodutide and cagrilintide were assessed in one trial each (4 percent). Doses ranged from 0.01 to 12 mg for injectable agents administered subcutaneously once daily or once weekly, and from 14 to 50 mg for oral formulations.
Primary outcomes were binge eating behaviours and disinhibited or loss of control eating. Secondary outcomes included emotional eating, cognitive or dietary restraint, and body image concerns. Body image outcomes were not meta-analysed because only one trial reported relevant data.