The prestigious medical journal Lancet has published a review and analysis of numerous studies done to investigate whether the popular weight loss medications classified as GLP-1s might be beneficial for those who have been previously diagnosed as suffering from an eating disorder. As the popularity of GLP-1 medications soared, health care practitioners have expressed caution about utilizing this tool for someone who has had a diagnosed eating disorder. Perhaps a treatment which can be very beneficial for most patients who wish to lose weight might cause harm in this population.
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00628-X/fulltext
To perform this study six health databases were used, allowing a review of 38 studies which had over 3,000 patients worth of data to analyze. Studies of weight loss interventions in people who were overweight or obese were included if they documented the inclusion of study subjects with eating disorders as per the validated Eating Disorder Examination Interview or the Eating Disorder Examination Questionnaire pre- and post-intervention. The weight loss interventions reviewed included behavioural weight loss programs as well as those not using medication.
The thirty-eight studies utilized had 3364 participants in total. They found that when compared with baseline scores at the beginning of the studies , disordered eating scores improved, measured at the completion of the studies, which had an average duration of 4 months. An in depth analysis showed that disordered scores improved even more in people with an eating disorder at baseline compared those without high scores.
Interpretation of the studies
Weight loss interventions consistently improved scores of disordered eating. In their totality these studies provide reassurance that weight loss interventions might not only be of no harm, but that disordered eating may improve. The research team who published this study claim that it is the largest review in this field of study. These 38 clinical trials conducted in 10 different countries and including 3364 participants were of both randomized and non-randomized clinical trials. Weight loss studies which included those with diagnosed disordered eating had not previously been subject to a meta analysis.11,12,47. They produced more statistical evidence via the size of the study, and by calculating the data needed to assess the change in eating disorder scores (EDE-Q/EDE scores), the test statistics are the most relevant in this field. Nearly 50% of the clinical trials included participants who had an eating disorder at baseline and, and their scores decreased at follow-up. Clinical trials are the most likely to provide a better estimate of treatment effect. At treatment end, there was clear and consistent evidence of a benefit of weight loss treatment. The authors claim that another strength of this meta-analysis is the use of validated eating disorder test tools,( EDE and EDE-Q). They are considered the “gold standard” in this field to assess disordered eating psychopatholog.48
The authors of this study do point out some limitations of their study. NInety percent of the subjects were female, (which is common in weight loss trials).49 Also, most studies had a short follow-up period, following their study subjects for one year or less. Weight regain was common after completion of the programs 50, and it would seem that future studies should investigate how weight regain and participation in multiple weight loss programs may affect disordered eating scores in the long-term. The median follow-up was 10 months and thus, this review does not provide evidence regarding the development of eating disorders in the longer term.
SCREENING FOR EATING DISORDERS DEEMED NOT NECESSARY
With the new treatment options such as GLP-1 medications growing in popularity, there have been calls for using screening tools to evaluate for eating disorders before weight loss programs might be recommended. There are negative consequences to this approach. Screening adds significant inconvenience and cost. And it adds time from the initial referral to the initiation of the program which could reduce the patients access to these programs. The results of this study provide a degree of reassurance that this type of screening is simply unnecessary.
It has been recognized that eating disorders involve the problem body dissatisfaction 4 that can interfere with the long term success of weight loss interventions. Individuals trying to lose weight might impose rigid rules to achieve their weight loss goal. But when their efforts to stick with difficult regimens become untenable, negative emotions and abandonment of the rules, often leading to overeating, might lead to an even more rigid weight loss regimen. This results in a cycle of over restraint and subsequent failure and the initiation of a vicious cycle of weight loss yo-yoing to occur. Overeating is a known risk factor in the development of eating disorders, and compensatory weight control behaviours may precede and lead to the development of eating disorders, 55 56 This suggests that ineffective attempts to induce weight loss could increase disordered eating symptoms.
THE SUCCESS OF GLP-1s IS KEY TO THEIR BENEFITS
Weight loss attempts that are unsuccessful may have a negative impact on mental health. Weight is often perceived as a sensitive topic to address in families as well as in doctors’ offices, and it may precipitate the avoidance of raising the subject of weight loss and the beginning of a weight loss program. 59 ,60,61,62 with the fear that difficult dietary regimens could trigger eating disorders. There is also concern in the public health area of the negative effects of “diet culture”, with the overvaluing of the thin ideal,63 particularly for young women risks the development of eating disorders.64 These concerns are in part undoubtedly due to the fear of failure of traditional weight loss programs, and historically the lack of long term effectiveness of these weight loss programs makes these fear quite valid.THE SUCCESS OF GLP-1 type medications may not only provide reassurance to those fearful of promoting an eating disorder due to a weight loss failure, but it also gives hope to the likelihood of an improvement in an existing disorder as shown by the success of GLP1s positive effects on eating disorders 65.
GLP1s HELP EATING DISORDERS
In summary this meta-analysis of 38 studies and 3,300+ people shows that for people with overweight/obesity, weight loss interventions producing successful weight loss are clearly and consistently associated with statistically significant improvement in disordered eating scores in analyses in controlled trials. The improvement in disordered eating was maintained with long term follow-up. And this improvement in eating disorders was even greater for participants with pre-existing eating disorder diagnoses.
Weight loss programs, in conclusion, if successful, with or without weight loss pharmacotherapy or psychological therapy, do not worsen eating disorders and may even improve them.
https://drsobo.com/do-the-weight-loss-drugs-wegovy-and-zepbound-help-depression-and-anxiety/
Weight Loss Drugs may Improve Depression and Anxiety
Eating disorders are associated with anxiety and depression. According to research published by Epic Research GLP-1 weight loss drugs were associated with a lower risk of being diagnosed with depression or anxiety disorders. The research involved looked at over three million diabetic patients and nearly one million non-diabetic patients taking GLP-1 medications, which is the class of drugs representing popular name brands such as Ozempic, Wegovy, Mounjaro and Zepbound in the study that was just published.This very large study involved over 3 million diabetic patients and over 900,000 non- diabetic patients who were prescribed these medications. They compared those prescribed the GLP-1 type diabetes medications to diabetics prescribed other types of medications for diabetes.To assess non diabetic patients they compared patients prescribed GLP-1 medications to patients given other weight management solutions. Semaglutide (Wegovy, Ozempic ) and Tirzepatide (Mounjaro,) both showed a mental health benefit.
