Effects of GLP-1 receptor agonist therapy on eating disorder risk and psychological distress in adults with Class 3 obesity

Objective: Eating disorders (ED) and psychological distress are highly prevalent in individuals with Class 3 obesity (BMI ≥ 40 kg/m²). With the increasing use of glucagon-like peptide-1 receptor agonists (GLP1-RA), concerns have emerged about the potential worsening of ED symptoms. This study aimed to compare ED risk and psychological distress in adults with Class 3 obesity: (1) between those already on GLP1-RA and those not and (2) between baseline and 12 months in individuals initiated on GLP1-RA in the program. Method: This retrospective observational cohort study included adults with Class 3 obesity enrolled in a publicly funded multidisciplinary weight management program in Sydney from January 2018 to June 2024. Participants completed the Eating Disorder Examination-Questionnaire Short (EDE-QS), Kessler Psychological Distress Scale (K10), and Depression, Anxiety and Stress Scale-21 (DASS-21) at baseline and 12-months. Results: Among 666 participants, 59 (9%) were on GLP1-RA at baseline, with no significant differences in EDE-QS, K10, or DASS-21 scores compared to those not on GLP1-RA. Of 203 participants not on a GLP1-RA at baseline and having 12-month data, 31 (15.3%) initiated GLP1-RA treatment, with the majority on semaglutide 1 mg and a mean duration of use of 7.1 ± 3.7 months. Those initiated on GLP1-RA had a significant reduction in median weight, from 131.0 (118.7–149.6) kg at baseline to 120.0 (109.2–135.3) kg at 12 months, p < 0.001. There were no statistically significant changes in EDE-QS, K10, and DASS-21 scores from baseline to 12 months, and none stopped GLP1-RA due to ED symptoms or psychological distress. Discussion: This study suggests that GLP1-RAs may not significantly worsen ED risk or psychological distress in adults with Class 3 obesity.