OBJECTIVES: This study aims to evaluate whether the incidence of eating disorders (ED) post-treatment with GLP-1A (glucagon-like peptide-1 agonists) differs among patients with and without pre-existing mental health conditions (including but not limited to, borderline personality disorder and bipolar disorder). GLP-1A medications, known for inducing insulin production and aiding in weight loss, often result in reduced appetite as a side effect. Understanding this correlation is crucial, especially given the rising use of GLP-1A in weight management, as a cost-effective alternative to insulin₁.

METHODS: The TriNetX federated network was utilized to identify overweight – defined by high BMI or ICD-10 code - individuals treated with GLP-1A medications between 2022 and 2023. The study focused on patients who transitioned to normal weight after receiving GLP-1A treatment, dividing them into two cohorts: those with prior mental health diagnosis and those without. To prevent confounding, the cohorts were propensity score matched based on sex, race, ethnicity, age, thyroid conditions, and diabetes type.

RESULTS: The study discovered significant difference (p<0.0001) in incidence of ED (anorexia, bulimia, or binge eating disorder) diagnosed post-GLP-1A treatment between the cohorts. Specifically, 1.23% of patients with prior mental health history (384 patients) and 0.51% without (160 patients) were diagnosed with an ED within two years of treatment, indicating relative risk of 2. Notably, anorexia was the most prevalent ED in the cohort of patients with a mental health history (201 patients), accounting for a significant cumulative incidence of the ED diagnoses (1.275%).

CONCLUSIONS: Findings suggest that overweight patients with pre-existing mental health conditions are more susceptible to developing eating disorders following GLP-1A treatment compared to those without mental health history. This observation highlights need for further research into implications of GLP-1A medication use in individuals with pre-existing mental health conditions, particularly regarding impact on ED development, which may have substantial economic benefits if addressed proactively₂.