A scientific review conducted by the scientists at Staten Island University Hospital, US, describes the utility of glucagon-like peptide-1 receptor agonists in reducing binge eating behaviors in individuals with binge eating disorder and bulimia nervosa.

The research is published within the Journal of Clinical and Translational Endocrinology.

Study: GLP-1 receptor agonists: A novel pharmacotherapy for binge eating (Binge eating disorder and bulimia nervosa)? A scientific review. Image Credit: Creativa Images / Shutterstock

Background

Consumption of an abnormally great amount of food inside a brief period is the first symptom of each binge eating disorder and bulimia nervosa. The estimated lifetime prevalence of binge eating disorder and bulimia nervosa worldwide is 1.9% and 1%, respectively.

Psychological and pharmacological interventions are considered the primary line of treatment for eating disorders. While psychological interventions, resembling cognitive behavioral therapy, primarily take care of emotional and behavioral elements of the disorder, pharmacological interventions mainly involve selective serotonin reuptake inhibitors to administer the symptoms.

Pharmacological medicines (topiramate and lisdexamfetamine) which can be currently approved for these eating disorders are related to opposed negative effects, resembling headache, paresthesia, sedation, and increased heart rate and blood pressure. This highlights the necessity for identifying novel pharmacological interventions.

Glucagon-like peptide-1 (GLP-1) is a hormone and neuropeptide produced within the intestine and brain. This hormone inhibits appetite, reduces food intake, reduces body weight, and stimulates glucose-dependent insulin secretion by activating GLP-1 receptors. Activation of this receptor is thought to manage normal feeding behavior and reward-driven feelings.

GLP-1 receptor agonists (GLP-1RAs) are currently used for treating type-2 diabetes and obesity due to their effects on appetite, food intake, and body weight reduction. These effects make GLP-1RAs an acceptable selection for treating binge eating disorder and bulimia nervosa.

On this systematic review, authors systematically analyzed existing literature on using GLP-1RAs in managing binge eating behaviors.

The authors screened various scientific databases to discover studies that investigated the effectiveness of GLP-1RAs in eating disorders, including binge eating disorder and bulimia nervosa.

Prevalence of eating disorder

The systematic evaluation of the chosen studies indicates that about 8% of respondents have eating disorders and three% experience recurrent episodes. Episodes mostly occur within the morning and early evening, and 40% of respondents experience lower than 4 hours of fasting beforehand.

Women (10%) are significantly more more likely to experience binge eating than men (6%). Furthermore, the prevalence of binge eating is higher amongst younger respondents aged 20 – 29 years, which decreases with increasing age.

Existing evidence indicates that eating disorders can increase the chance of diabetes, obesity, hypertension, hypertriglyceridemia, headache, back pain, and other chronic metabolic diseases.

GLP-1RA a promising intervention

Existing literature shows that GLP-1RAs work through each central and peripheral mechanisms to manage gut signals, brain appetite networks, and food preferences and cravings.

Upon detection of dietary nutrients within the gut, GLP-1 is released from the intestinal L cells and binds to its receptor. The receptor binding subsequently triggers cAMP levels, resulting in an induction in insulin secretion. Moreover, GLP-1 reduces the speed of gastric emptying and glucagon release.

Animal studies have shown that GLP-1RAs control appetite and binge eating behavior through serotonin pathways. Mechanisms deciphered in these studies indicate that the interaction between serotonin and GLP-1 within the hindbrain increases proopiomelanocortin/cocaine- and amphetamine-regulated transcript (POMC/CART) neuron activity, resulting in induction of satiety signals and suppression of neuropeptide Y/agouti-related peptide (NPY/AgRP) neuron activity, which in turn suppresses hunger.    

Activation of POMC neurons results in the discharge of alpha-melanocyte-stimulating hormone (α-MSH), which subsequently binds to the melanocortin 4 receptor within the paraventricular nucleus of the hypothalamus and triggers appetite-inhibiting signaling cascade.

These brain chemicals not directly influence the CA1 region of the ventral hippocampus, resulting in the modulation of hunger and, satiety and emotional responses to foods.

Overall, these findings indicate that GLP-1 agonism is a component of the ultimate effects of selective serotonin reuptake inhibitors and that GLP-1RA is usually a promising treatment for binge eating disorder.

Regarding tolerability, evidence indicates that GLP-1RAs are secure for non-diabetic obese patients. Nevertheless, the treatment may cause mild to moderate gastrointestinal problems, resembling nausea, vomiting, and diarrhea.  

Pharmacokinetics and therapeutic potentials of GLP-1RAs

Liraglutide (Victoza) is a fatty acid-attached GLP-1 analog (GLP-1RA) that is run through once-daily injection. It may cross the blood-brain barrier and positively influence nerve growth and protection. A randomized controlled trial conducted on obese people has shown that a 12-week treatment with Liraglutide can reduce binge eating behavior and cause weigh loss in patients with binge eating disorder.

Liraglutide has also been found to scale back food obsessions, overeating, aggression, and other repetitive behaviors in a patient with autism spectrum disorder, mental disability, and obsessive eating disorder.   

Semaglutide (Ozempic) is a long-acting GLP-1 analog with higher receptor binding ability in comparison with liraglutide. Treatment with Semaglutide (weekly dosing) has been found to scale back overeating behavior, food cravings, and preference for high-fat, high-calorie foods.    

Dulaglutide (Trulicity) is one other GLP-1 analog administered weekly. Treatment with Dulaglutide has been found to scale back binge eating frequency, body weight, body mass index, body fat percentage, and glycated hemoglobin in diabetic patients with binge eating disorder.