GLP-1s for Binge Eating Disorder: A Different Target

Binge eating disorder isn't just about weight. It's a psychiatric condition with its own brain pathways. Here's why GLP-1s might help — and what the early research shows.

What Is Binge Eating Disorder?

Binge eating disorder (BED) is the most common eating disorder in the United States, affecting an estimated 2.8 million adults. It's characterized by:

• Recurrent episodes of eating large amounts of food rapidly
• Feeling a loss of control during episodes
• Distress, shame, or guilt afterward
• No regular purging behaviors (unlike bulimia)

BED is not the same as overeating or obesity. Many people with BED are not obese, and many people with obesity don't have BED. It's a psychiatric disorder with distinct brain circuitry — which is why appetite suppression alone doesn't necessarily treat it.

Current Treatment Landscape

Only one medication is FDA-approved for BED:

• Lisdexamfetamine (Vyvanse) — a stimulant with abuse potential, approved in 2015

Other medications used off-label include:

• Topiramate — anticonvulsant with cognitive side effects
• Antidepressants — SSRIs, with modest effects

Cognitive behavioral therapy (CBT-ED) is considered first-line treatment, but medication can help some patients.

The Semaglutide Study

In 2023, researchers published the first study directly comparing semaglutide to existing BED treatments. The results were notable.

Study Design

Researchers compared three groups of BED patients:

• Semaglutide only (n=19)
• Semaglutide + other anti-obesity medications (lisdexamfetamine or topiramate) (n=13)
• Other anti-obesity medications only (n=16)

They tracked changes in Binge Eating Scale (BES) scores — a validated measure of binge eating severity.

Patients receiving semaglutide only showed greater reductions in BES scores than those receiving lisdexamfetamine or topiramate (with or without semaglutide). Notably, adding lisdexamfetamine or topiramate to semaglutide didn't improve outcomes — semaglutide alone was best.

Why GLP-1s Might Work for BED

GLP-1 receptors are expressed in brain regions that drive compulsive eating:

• Hypothalamus — regulates hunger and satiety signals
• Nucleus accumbens — processes food reward
• Ventral tegmental area — dopamine production center

In animal models, GLP-1 receptor activation:

• Reduces hedonic (pleasure-driven) eating
• Decreases food-seeking behavior
• Modulates dopamine release in reward circuits

In humans, semaglutide has been shown to reduce "emotional eating" — which is closely linked to binge eating.

"Treatment with semaglutide is associated with a significant reduction in emotional eating, which is a known contributor to BED." — Richards et al., Obesity Pillars, 2023

The "Food Noise" Connection

Many GLP-1 users report that "food noise" — the constant mental chatter about food — decreases dramatically on the medication. For people with BED, this could be transformative.

Binge eating often starts with intrusive thoughts about food that build until they feel uncontrollable. If semaglutide quiets this mental noise, it could address BED at the level of compulsion — not just appetite.

A Systematic Review: 2024

A 2024 systematic review in the Journal of Clinical and Translational Endocrinology analyzed all available studies on GLP-1s for binge eating:

Key findings from the review:

• Small pilot studies show GLP-1s reduce binge eating, body weight, and metabolic comorbidities
• GLP-1s have a more favorable psychiatric side effect profile than current BED treatments
• Semaglutide's weekly dosing may improve adherence compared to daily liraglutide
• Larger placebo-controlled trials are needed

Meta-Analysis: 2025

A February 2025 meta-analysis in Eating and Weight Disorders pooled data from 5 studies (182 participants):

GLP-1s vs. Lisdexamfetamine

The only FDA-approved BED medication is lisdexamfetamine (Vyvanse), a stimulant. How might semaglutide compare?

The Richards study suggests semaglutide may be more effective for BED — but it's a small, open-label, retrospective study. Randomized controlled trials comparing the two directly are needed.

Should You Consider GLP-1s for BED?

The evidence is promising but preliminary:

• First-line treatment is still CBT-ED — therapy has the strongest evidence
• Only lisdexamfetamine is FDA-approved — GLP-1s are off-label for BED
• Work with an ED-informed clinician — appetite suppression can backfire in eating disorders
• Insurance won't cover GLP-1s for BED — you'd pay out of pocket

That said, if you have both obesity and BED, discussing semaglutide with your doctor could address both conditions. The early data suggests it may help the binge eating specifically — not just the weight.