Tag Archives: GLP-1 RA

“GLP-1 Receptor Agonists and Eating Disorders — Cause for Concern”

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A Banks. N Engl J Med 2026;394:1665-1667. GLP-1 Receptor Agonists and Eating Disorders — Cause for Concern.

An excerpt:

Constraining the growth of the global obesity epidemic would have clear benefits at the individual and population levels. Use of GLP-1 drugs has been linked in some patients to improved cardiovascular outcomes, a reduced risk of kidney disease, a reduced desire to drink alcohol, and potentially protective effects against neurodegenerative diseases. It is therefore easy to understand the substantial interest in investing in the development of these products and the optimism about their public health effects.

Nonetheless, some worrisome signals have emerged…The proportion of GLP-1 receptor agonist prescriptions that were written for people without diabetes, obesity, or overweight increased from 4.5% in 2018 to 17% in 2023…1

There is also compelling preliminary evidence suggesting that the use of these drugs could exacerbate and lead to new diagnoses of restrictive eating disorders, including anorexia nervosa…3 Lifetime prevalence of anorexia nervosa is as high as 6.3% in women and 0.3% in men,4 and the risk of death from any cause among people with anorexia nervosa is more than five times as high as that in the general population…5

Nutrient deficiencies, electrolyte abnormalities, orthostatic hypotension, osteopenia, sarcopenia, thinning hair, and other signs of malnutrition have been observed [in users of GLP-1 agents], and the effects of long-term use are still largely unknown…

The cumulative incidence of new eating-disorder diagnoses (most commonly anorexia nervosa) in the full study population was 1.275%…3 this proportion translates to more than 420,000 people who could develop a related eating disorder with long-term use.

Physicians, trialists, regulators, policymakers, and drug developers are unprepared for this coming wave.

My take: GLP-1 RAs are not for everybody; they will likely contribute to eating disorders in many patients.

GLP-1 RAs also have been associated with a higher risk of Nonarteritic Anterior Ischemic Optic Neuropathy (aka ‘eye stroke’) in approximately in 1 in 10,000 recipients. One reference: JAMA Ophthalmology. 2026;144;(3):259-264. New-Onset Nonarteritic Anterior Ischemic Optic Neuropathy and Initiators of Semaglutide in US Veterans With Type 2 Diabetes

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Trail to Mt Fitz Roy (Argentina)

Two Pediatric MASLD Publications: Call for Action and Use of GLP-1 RAs

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P Hartmann et al. Hepatology 2025; 82: 1341-1351. Call to action—Pediatric MASLD requires immediate attention to curb health crisis

  • “Pediatric MASLD is still perceived as an indolent condition by many patients, families, and clinicians. In this Call to Action, we aim to raise awareness of pediatric MASLD as a public health crisis. Herein, we describe insufficient screening and disease staging practices, and a lack of accurate non-invasive tests and effective pharmacotherapy, both stemming from a paucity of multicenter clinical trials in pediatric MASLD.”
  • “GLP-1 RAs have not been formally investigated in pediatric MASLD.”
Advocacy Steps Recommended by Authors

R Schenker et al. JPGN Reports. 2025;1–6. Open Access! Preliminary evidence of improved liver biomarkers in adolescents with obesity and suspected metabolic dysfunction‐associated steatotic liver disease treated with semaglutide: A case series

This was a retrospective study with 5 Latino adolescents obesity and MASLD who received semaglutide for at least 3 months. The range of BMI at the start of treatment was between 51 and 68.

Key findings:

  • There were clinically significant reductions in liver enzymes and APRI, a noninvasive marker of fibrosis. Specifically, mean ALT decreased by 38.4 IU/L (p < 0.01), mean AST decreased by 21.0 IU/L (p < 0.01), and mean APRI decreased by 0.128 (p = 0.01)
  • All 5 patients experienced weight loss with drop in BMI% from 2.3% to 14.2%

My take: This small study is consistent with others that show GLP1 RAs are likely to be an important tool for patients with MASLD. Current recommendations support use mainly in patients with comorbidities including obesity and T2DM.

Other pediatric studies:

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The Risks and Absolute Risks of GLP-1 RAs and Gastrointestinal Adverse Events

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C-H Chiang et al. Gastroenterol 2025; 169: 1268-1281. Glucagon-Like Peptide-1 Receptor Agonists and Gastrointestinal Adverse Events: A Systematic Review and Meta-Analysis

With the widespread adoption of GLP-1 RAs, there have been increasing reports of adverse effects. This systematic review/meta-analysis (with 55 randomized controlled trials involving 106,395 participants) more fully describes the likelihood of GI adverse events.

Key findings:

  • GLP-1RAs increased the risk of cholelithiasis (risk ratio [RR], 1.46; 95% CI, 1.09–1.97; 2 more cases per 1000) and probably increased the risk of GERD (RR, 2.19; 95% CI, 1.48–3.25; 4 more cases per 1000) compared with placebo
  • GLP-1RAs probably have little or no effect on the risk of other gastrointestinal or biliary events

Figures 2 & 3 use a Forest plot to look at a large number of potential adverse gastrointestinal/biliary events. For example, cholecystitis and cholangitis had increased RR at 1.17 and 1.54 respectively. However neither reached statistical significance.

My take: GLP-1 RAs definitely cause adverse gastrointestinal effects, especially nausea, vomiting, diarrhea, bloating and reduced appetite. More severe adverse effects are quite uncommon and are unlikely to influence the decision to use these medications.

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