This is an exclusive BHB+ story

Often hailed as a miracle drug, GLP-1 medications have been used to treat everything from diabetes to substance use disorders. But now an unlikely group of providers might be incorporating these medications into care.

Eating disorder providers are exploring their potential to help patients with binge eating and bulimia nervosa—marking a significant shift in a field traditionally cautious about medication interventions.

Still, GLP-1s have historically troubled eating disorder treatment experts, who have expressed concerns that the drugs could worsen or re-trigger eating disorders.

And while major players in the industry are excited about potential new treatments for eating disorders, many remain relatively wary of GLP-1s as treatment tools and await more substantial data. If research continues to recommend the drugs as treatments, the industry could be cleaved into two divisions: those who will prescribe GLP-1s and those who will not.

New tools to treat eating disorders are urgently needed. Remission rates among patients with eating disorders are estimated to be as low as 29%.

“GLP-1s might offer therapeutic benefits for certain eating disorders, particularly binge eating disorder (BED),” Dr. Brad Smith, chief medical officer of Accanto Health, told Behavioral Health Business. “Given that there are limited numbers of drugs with indications for the treatment of eating disorders, progress in this area of medicine would be welcome. At the same time, we need medications that are effective without possibly contributing to [the] worsening of the condition. We are watching the evolution of these drugs with great interest and curiosity.”

St. Paul, Minnesota-based Accanto was formed in 2021 through the merger of The Emily Program and Veritas Collaborative. It is also the parent company of Gather Behavioral Health. The companies offer a full continuum of care for children, adolescents and adults. Private equity firm Vestar has invested in the company.

GLP-1’s potential to treat binge eating disorders lies in the drugs’ ability to stabilize blood sugar and reduce the drive to overeat, Smith said. The drugs may also address health concerns that are attributed to higher weights, which may lead to feelings of guilt and shame about eating patterns and bodies.

Still, GLP-1s have a potential dark side. Because the drugs suppress appetite and diminish hunger cues, they can lead to “prolonged periods of food avoidance,” Smith said. This could increase the risk of disordered eating and, combined with rapid weight loss, could reinforce unhealthy weight control practices, especially in people predisposed to eating disorders.

Need for data

These dangers mean that eating disorder treatment providers are waiting on additional research to illuminate the role GLP-1s could play in the industry.

“The research is just not there,” Cara Bohon, senior vice president of clinical excellence at virtual eating disorder treatment provider Equip, told BHB. “There’s never been a randomized clinical trial of it against an existing evidence-based treatment for binge eating disorder. There have been a couple of trials where they looked at it against a weight loss intervention, but a weight loss intervention is not an eating disorder intervention, so it’s not going to be the right comparison group. … As of right now, there’s no evidence that is super compelling to me to say, ‘Yes, this is our future.’”

San Diego-based Equip provides telehealth eating disorder treatment for adults and young people. The provider has raised a total of $110 million in funding.

Studies that have been conducted show promise for GLP-1 medications as eating disorder treatment tools and suggest that the drugs have more favorable psychiatric side effects than other treatment options.

“However, rigorous clinical trials are needed to firmly establish efficacy, dosing, safety, and comparative effectiveness before considering GLP-1RAs a viable novel approach,” the authors of an article published in the Journal of Clinical and Translational Endocrinology wrote.

Using GLP-1s to treat eating disorders would require a cost-benefit analysis of the benefits of reducing symptoms with the risks of emphasizing weight loss as under a patient’s control, according to Bohon. For her, and other experts interviewed by BHB, more long-term evidence is needed to demonstrate that the medications are more beneficial than other tools currently in providers’ toolboxes.

Taking sides

While interested in further research, at least one industry leader has already established an idea of where she will stand on the issue of GLP-1s.

“I personally am unlikely to prescribe it as a treatment for an eating disorder, working with people who are on the medications,” Dr. Wendy Oliver-Pyatt, co-founder and CEO of Within Health and Galen Hope, told BHB.

Galen Hope is an in-person eating disorder and mental health treatment provider with two locations in southeast Florida. Miami-based Within Health is a 100% virtual eating disorder treatment company offering group and individual therapy sessions that operates in 41 states, according to its site.

Among the reasons Oliver-Pyatt cites for her wariness of GLP-1s is an oversimplification of binge eating disorder. People can assume that those suffering from binge eating disorder are just eating too much, she said.

“Binge eating disorder patients, though, in reality, tend to be very, very restrictive,” Oliver-Pyatt said. “If we want to overly simplify it and say, ‘Okay, people with binge eating disorder binge less if they take a GLP-1,’ yes. But the problem is, you haven’t really treated the underlying problem. … I don’t think that GLP-1s solve the problem of a person with [binge eating disorder], because it really is a biopsychosocial condition, and you have to hit all domains.”

Oliver-Pyatt predicts GLP-1s could cause a rift in the eating disorder treatment industry: one side views the medications as a viable sole treatment for binge eating disorders, and the other is resistant to prescribing the drug as a front-line treatment.

Some providers’ desire to treat eating disorders with GLP-1s will stem from a desire to help people with an extremely difficult-to-treat condition, Oliver-Pyatt said.

“It’s a really hard condition to treat,” she said. “Our costs have gone up 7%, 8%, 9%. Our reimbursements have not gone up 7%, 8%, 9%. It’s really a tough thing to address psychiatrically, psychologically. Most people doing eating disorder treatment are just really good human beings, and we may or may not always agree.”

Divisions in the eating disorder treatment industry are nothing new, however.

“There actually already is a divide in the eating disorder space of providers who simultaneously treat eating disorders and also provide weight loss interventions,” Bohon said.

While GLP-1s could further divide an already fractured industry, providers told BHB they will continue to treat patients who are currently taking the drugs without judgment.

“I’m going to embrace every patient that I possibly can to try to help them, and I’m not going to shun them,” Oliver-Pyatt said. “I remember when we first started getting patients [taking GLP-1s] in the doors like, ‘Oh, what am I going to do?’ We are just struck with these predicaments and dilemmas at all times. But if you always put the patient first, and you use a biopsychosocial model with great diligence, then you’re going to sort through it.”