The effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on binge eating in patients with obesity: a systematic review and meta-analysis

Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs), widely used for weight management and type 2 diabetes, may reduce binge eating behaviours and body dissatisfaction, but there are concerns that they might increase eating restraint. We evaluated the effectiveness of GLP-1RAs for binge eating severity and related eating behaviours. Methods We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing any GLP-1RA with placebo or active comparators reporting validated measures of binge eating, disinhibited eating, and loss of control eating. We searched MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials for RCTs published from Jan 2005 to April 2026. Trials including participants with severe physical comorbidities (e.g., cancer) were excluded. Standardised mean differences (Hedges' g ) based on change-from-baseline scores or post-intervention raw mean differences ( MD ) with 95% CIs were estimated using random-effects models, with heterogeneity quantified using I 2 and τ 2 ; publication bias was not formally assessed due to the limited number of studies. Intervention effects on body image concerns were not meta-analysed due to limited data. PROSPERO: CRD42024570728. Findings Twenty five RCTs (n = 8069; ∼two-thirds female; majority White) met inclusion criteria. Compared with control conditions, participants allocated to GLP-1RAs reported moderate reductions in binge eating (n = 2106; k=9; g = −0.23 [95% CI −0.36 to −0.10]), loss of control eating (n = 362; k=5; MD = −18.38 [–23.34 to −13.43]) and eating disinhibition (n = 911; k=13; g = −0.54 [−0.90 to −0.18]); alongside lower emotional eating (n = 429; k=4; g = −0.30 [−0.51 to −0.09]) and higher cognitive or dietary restraint (n = 911; k=13; g = 0.31 [0.17–0.44]). Effects were larger in trials enrolling participants with binge eating disorder. All studies were rated as having high risk or some concerns of bias, and heterogeneity was substantial. Interpretation GLP-1RAs reduced binge eating-related behaviours and emotional eating and increased cognitive or dietary restraint, though whether restraint is pathological is unclear. Given heterogeneity and high risk of bias, adequately powered trials targeting individuals with diagnosed binge eating disorder and longer follow-up are needed to inform clinical practice. Funding Wellcome Trust and Medical Research Foundation.