Incretin-based therapies for obesity and disordered eating: optimising care in general practice

Disordered eating behaviours like binge eating, emotional eating and compulsive overeating are common in people with obesity. A systematic review of over 94 000 adults seeking obesity treatment found that 14% had a clinically diagnosed binge eating disorder, while self-reported moderate and severe binge eating affected 26% and 12%, respectively. It is important to distinguish these from classic restrictive eating disorders, which are rare (≤1%) in this population, though screening is still crucial. These findings highlight that disordered eating is a significant coexisting condition in obesity care, exacerbating weight gain, psychological distress, poor quality of life and physical health issues such as metabolic dysregulation.
General practitioners (GPs) are often the first point of contact for individuals seeking help with weight management, making them crucial in initiating effective treatment strategies. These agents may also be considered for individuals with a body mass index (BMI) of 27–30 kg/m² who have obesity-related complications. The pharmacological management of obesity has been revolutionised by the emergence of glucagon-like peptide-1 (GLP-1) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists. These medications are believed to mimic endogenous GLP-1, a hormone released in response to food intake, by binding to receptors in the pancreas, gut and brain. Their primary mechanisms for weight reduction likely involve significant appetite suppression and increased satiety through central nervous system effects. This action may reduce cravings for highly palatable foods and can increase satisfaction during eating, thereby supporting improved eating management and adherence to dietary plans. These agents also appear to reduce ‘food noise’, which is the persistent, intrusive and unwanted thoughts about food. By quietening this cognitive preoccupation, GLP-1 receptor agonists offer a significant psychological benefit beyond just appetite suppression. This multifaceted effect helps individuals better manage their weight and disordered eating.