TY - JOUR
AU - I. Mack
AU - S. Kullmann
AU - Le Morvan de Sequeira
AU - B. Klos
AU - S. Zipfel
AU - A. Birkenfeld
AU - R. Erschens
A1 - 
AB - Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) represent a major advancement in obesity treatment, offering robust efficacy in weight loss and metabolic regulation. Beyond these effects, emerging evidence indicates that GLP-1 RAs also modulate appetite, reward sensitivity, and self-regulation, domains that intersect with behavioral and psychological functioning. This review adopts a biopsychosocial perspective to examine how GLP-1 RAs interact with eating behavior, mood, identity, and self-regulation, particularly in individuals with binge eating disorder (BED) or other psychiatric comorbidities. A clinical framework is proposed to integrate pharmacotherapy with lifestyle and psychological interventions. The temporary reduction in appetite and food reward may create a "low-drive window" in which behavioral strategies such as self-monitoring or stimulus control become more effective. However, high emotional eating, mood symptoms, or identity conflicts may moderate treatment response. Given the high prevalence of psychiatric comorbidities, structured screening using tools like the Patient Health Questionnaire-9 (PHQ-9) or Binge Eating Scale (BES) is recommended. A stepped-care approach from brief digital interventions to formal psychotherapy may help address varying support needs. Crucially, weight regain after discontinuation is common. The review discusses behavioral, psychological, and social mechanisms of relapse and highlights strategies for long-term stabilization. These include emotion regulation, body image work, and maintenance-focused behavioral interventions. GLP-1 RAs should therefore be seen not as standalone treatments but as facilitators of self-directed, sustainable change within integrated care models. Future research should define composite outcomes, explore digital tools for relapse prevention, and develop adaptive pathways tailored to individual psychological profiles.
AD - Internal Medicine VI, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany. isabelle.mack@uni-tuebingen.de.; Center of Excellence in Eating Disorders (KOMET), Tübingen, Germany. isabelle.mack@uni-tuebingen.de.; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen and German Center for Diabetes Research (DZD), Tübingen, Germany.; Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany.; Internal Medicine VI, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany.; German Center for Mental Health (DZPG), Tübingen, Germany.; Center of Excellence in Eating Disorders (KOMET), Tübingen, Germany.
AN - 42068458
BT - Rev Endocr Metab Disord
C5 - Opioids & Substance Use
DA - 05/2026
DO - 10.1007/s11154-026-10047-4
DP - NLM
ET - 20260502
JF - Rev Endocr Metab Disord
LA - eng
N2 - Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) represent a major advancement in obesity treatment, offering robust efficacy in weight loss and metabolic regulation. Beyond these effects, emerging evidence indicates that GLP-1 RAs also modulate appetite, reward sensitivity, and self-regulation, domains that intersect with behavioral and psychological functioning. This review adopts a biopsychosocial perspective to examine how GLP-1 RAs interact with eating behavior, mood, identity, and self-regulation, particularly in individuals with binge eating disorder (BED) or other psychiatric comorbidities. A clinical framework is proposed to integrate pharmacotherapy with lifestyle and psychological interventions. The temporary reduction in appetite and food reward may create a "low-drive window" in which behavioral strategies such as self-monitoring or stimulus control become more effective. However, high emotional eating, mood symptoms, or identity conflicts may moderate treatment response. Given the high prevalence of psychiatric comorbidities, structured screening using tools like the Patient Health Questionnaire-9 (PHQ-9) or Binge Eating Scale (BES) is recommended. A stepped-care approach from brief digital interventions to formal psychotherapy may help address varying support needs. Crucially, weight regain after discontinuation is common. The review discusses behavioral, psychological, and social mechanisms of relapse and highlights strategies for long-term stabilization. These include emotion regulation, body image work, and maintenance-focused behavioral interventions. GLP-1 RAs should therefore be seen not as standalone treatments but as facilitators of self-directed, sustainable change within integrated care models. Future research should define composite outcomes, explore digital tools for relapse prevention, and develop adaptive pathways tailored to individual psychological profiles.
PY - 2026
SN - 1389-9155
ST - Beyond weight loss: Integrating GLP-1 RA therapies into psychological and behavioral care for obesity and binge eating disorder
T1 - Beyond weight loss: Integrating GLP-1 RA therapies into psychological and behavioral care for obesity and binge eating disorder
T2 - Rev Endocr Metab Disord
TI - Beyond weight loss: Integrating GLP-1 RA therapies into psychological and behavioral care for obesity and binge eating disorder
U1 - Opioids & Substance Use
U3 - 10.1007/s11154-026-10047-4
VO - 1389-9155
Y1 - 2026
ER -