Background: Bulimia nervosa (BN) is a severe eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, misuse of laxatives, fasting, or excessive exercise. Current treatment strategies, including cognitive-behavioral therapy (CBT) and pharmacotherapy, have limitations, with many patients not responding adequately and experiencing high relapse rates. GLP-1 receptor agonists, initially developed for type 2 diabetes mellitus (T2DM) and chronic weight management, have shown potential in regulating appetite and modifying behavior, suggesting a possible role in treating BN.
Objective: This review aims to assess the current evidence regarding the efficacy and safety of GLP-1 receptor agonists, particularly Semaglutide, in the treatment of bulimia nervosa.
Methods: A comprehensive literature search was conducted using PubMed and Google Scholar, focusing on articles published between 2014 and 2024. Studies included were clinical trials, case reports, and reviews addressing the use of GLP-1 receptor agonists in BN. The search terms included “Bulimia Nervosa,” “Semaglutide,” “GLP-1 receptor agonists,” and related terms. After screening and removing duplicates, five relevant articles were included in the qualitative synthesis.
Results: The included studies demonstrated that GLP-1 receptor agonists, such as Semaglutide, liraglutide, and dulaglutide, effectively reduced binge eating episodes and body weight in patients with BN. In a notable case report, a patient with long-standing BN experienced complete resolution of symptoms within two weeks of starting liraglutide, sustained over five years. Retrospective cohort and open-label studies also showed significant reductions in binge eating severity with GLP-1 receptor agonists compared to other anti-obesity medications. Additionally, preclinical studies suggested these agents’ potential in modulating appetite and reward pathways in the brain.
Conclusion: The evidence indicates that GLP-1 receptor agonists may be a promising alternative pharmacotherapy for bulimia nervosa, addressing both appetite regulation and behavioral aspects of the disorder. However, the current paucity of large-scale, randomized controlled trials necessitates further research to confirm these findings and establish the efficacy, safety, and optimal dosing of GLP-1 receptor agonists in the treatment of BN. The favorable psychiatric side effect profile and potential for improved patient adherence highlight the need for continued exploration of these agents in clinical practice.
Author(s) Details:
Nkechinyere M. Harry
Vinnytsia National Pirogov Medical University, Vinnytsia Oblast, Ukraine.
Kenechukwu Anona
University of Ibadan, Ibadan-200005, Nigeria.
Vivien O. Obitulata-Ugwu
University of Nigeria, College of Medicine, Ituku/Ozalla-402109, Nigeria.
Olubukola Anike Kuye
Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ago Iwoye, Nigeria.
Oluwatosin Arubuolawe
Manhattan Psychiatry Center, New York- 10035, USA.
Ibrahim L. Folorunsho
General Directorate of Health Affairs, Najran-12271, Saudi Arabia.
Adeniyi Kayode Busari
Emory University, Atlanta Georgia-, 30322, Georgia.
Chidalu Ibeneme
University of Toledo, Toledo OH- 43606, USA.
Amarachukwu Diala
Youngstown State University, Youngstown, Ohio-44555, United States.
Victory Afolabi
University of Ibadan, Ibadan-200005, Nigeria.
Gibson O. Anugwom
Menninger Department of Behavioral Science and Psychiatry, Baylor College of Medicine, Houston, Texas, Houston, USA.
Recent Global Research Developments in Treatment Obstacles for Adolescent Bulimia Nervosa
Family-Based Treatment (FBT): FBT is the leading evidence-based treatment for adolescents with eating disorders (EDs). It is recommended as the first-line treatment for medically stable patients in outpatient care [1] . FBT is based on five tenets:
Agnostic View: Therapists remain agnostic about the cause of the illness.
Non-Authoritarian Stance: Therapists avoid authoritarian approaches.
Empowerment of Parents: Parents play a crucial role in their child’s recovery.
Externalization of the Eating Disorder: The disorder is separated from the patient.
Pragmatic Approach: Focus on the here and now [1] .
Prevalence and Early Intervention: Adolescents are a target for screening and early intervention before symptoms become severe. Early intervention is associated with better treatment outcomes [2] .
Limited Evidence for BN Treatment: Unlike anorexia nervosa (AN), there is limited evidence to guide BN treatment in adolescents. Only four randomized controlled trials (RCTs) of psychological treatments and one open medication trial have been published[2] .
Challenges: Challenges associated with treating BN among youth need further exploration, and future research should address these obstacles [3] .
References
- Rienecke, R.D., Le Grange, D. The five tenets of family-based treatment for adolescent eating disorders. J Eat Disord 10, 60 (2022). https://doi.org/10.1186/s40337-022-00585-y
- Hail, L., & Le Grange, D. (2018). Bulimia nervosa in adolescents: prevalence and treatment challenges. Adolescent health, medicine and therapeutics, 11-16.
- Treating Adolescent Bulimia Nervosa
https://link.springer.com/referenceworkentry/10.1007/978-3-030-67929-3_47-1