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GLP-1s significantly reduce binge frequency in early studies. Mechanism: reduced reward response to food + slowed gastric emptying.
Phase 2 trials of semaglutide in BED show ~50-60% reduction in binge episodes at 12-16 weeks. Lisdexamfetamine remains FDA-approved standard; semaglutide may eventually compete.
Eating disorder specialists, academic obesity medicine. Off-label use growing in BED + obesity comorbid patients.
Eating disorder specialists must evaluate first — restrictive eating risk increases on GLP-1s if behavioral context is wrong. Not appropriate for anorexia or bulimia nervosa.
For BED + obesity, this is increasingly the off-label of choice. Coordinate with an eating disorder specialist.
Editorial summary. Off-label use is legal but not FDA-evaluated. Insurance typically does not cover off-label prescriptions. Not medical advice.