Tirzepatide and Binge Eating Disorder: Evidence and Clinical Considerations
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Baddie
Tirzepatide (Mounjaro, Zepbound) is a dual GIP/GLP-1 receptor agonist FDA-approved for type 2 diabetes and chronic weight management, but not for binge eating disorder (BED). While its appetite-suppressing effects have generated interest in treating BED—the most common eating disorder in the United States—no randomized controlled trials have examined tirzepatide specifically for this condition. This article reviews tirzepatide's mechanism of action, current evidence, safety considerations, and appropriate clinical contexts for patients with comorbid BED and metabolic conditions, emphasizing that evidence-based psychological interventions remain first-line treatment.
Summary: Tirzepatide is not FDA-approved for binge eating disorder and lacks dedicated clinical trial evidence for this indication.
Tirzepatide is a dual GIP/GLP-1 receptor agonist approved for type 2 diabetes and obesity, not binge eating disorder.
No randomized controlled trials have specifically examined tirzepatide's efficacy for treating binge eating disorder.
Cognitive behavioral therapy remains the first-line evidence-based treatment for binge eating disorder per APA guidelines.
Off-label consideration may be appropriate only when patients have comorbid type 2 diabetes or obesity meeting treatment criteria.
Common adverse effects include gastrointestinal symptoms; boxed warning exists for thyroid C-cell tumors based on animal studies.
Multidisciplinary care with eating disorder specialists is essential when considering any pharmacological intervention for BED.
We offer compounded medications and Zepbound®. Compounded medications are prepared by licensed pharmacies and are not FDA-approved. References to Wegovy®, Ozempic®, Rybelsus®, Mounjaro®, or Saxenda®, or other GLP-1 brands, are informational only. Compounded and FDA-approved medications are not interchangeable.
Understanding Binge Eating Disorder and Current Treatment Options
Binge eating disorder (BED) is the most common eating disorder in the United States, affecting approximately 3.5% of women and 2.0% of men during their lifetime. It is characterized by recurrent episodes of consuming large quantities of food in a discrete period, accompanied by a sense of loss of control, marked distress, and absence of regular compensatory behaviors such as purging. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) defines BED as occurring at least once weekly for three months, with associated features including eating more rapidly than normal, eating until uncomfortably full, eating large amounts when not physically hungry, eating alone due to embarrassment, and feeling disgusted or guilty afterward.
Current evidence-based treatment approaches for BED include cognitive behavioral therapy (CBT), which remains the psychological intervention with the strongest evidence base according to the American Psychiatric Association Practice Guideline for Eating Disorders (2023). Interpersonal psychotherapy and dialectical behavior therapy have also shown efficacy in controlled trials. From a pharmacological perspective, lisdexamfetamine (Vyvanse) is the only FDA-approved medication specifically for moderate to severe BED in adults. This stimulant medication carries risks including cardiovascular effects and abuse potential that require monitoring.
Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline are sometimes used off-label, though evidence for their efficacy is modest. Topiramate, an anticonvulsant, has shown promise in reducing binge frequency and body weight in clinical trials but is not FDA-approved for this indication and has significant side effects including cognitive impairment and teratogenicity. Many individuals with BED also struggle with obesity, creating a complex clinical picture that requires integrated treatment addressing both the eating disorder psychopathology and metabolic health. The high prevalence of comorbid conditions including depression, anxiety, and type 2 diabetes further complicates management and underscores the need for comprehensive, multidisciplinary care approaches.
Screening tools such as the Binge Eating Disorder Screener-7 (BEDS-7) can help identify patients who may benefit from further evaluation and treatment.
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How Tirzepatide Works: Mechanism of Action and FDA Approval Status
Tirzepatide (Mounjaro, Zepbound) is a novel dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist. This first-in-class medication represents a significant advancement in incretin-based therapies. The drug activates both GIP receptors and GLP-1 receptors, which are naturally occurring hormones involved in glucose homeostasis and appetite regulation. GLP-1 receptor activation enhances glucose-dependent insulin secretion, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying. GIP receptor activation complements these effects and may contribute to metabolic benefits, though the precise mechanisms in humans are not fully understood.
The FDA approved tirzepatide under the brand name Mounjaro in May 2022 for improving glycemic control in adults with type 2 diabetes mellitus as an adjunct to diet and exercise. Subsequently, in November 2023, the FDA approved tirzepatide under the brand name Zepbound for chronic weight management in adults with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) with at least one weight-related comorbid condition, such as hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea, or cardiovascular disease.
It is important to note that tirzepatide does not currently have FDA approval for the treatment of binge eating disorder. Any use of tirzepatide for BED would be considered off-label. The medication is administered as a once-weekly subcutaneous injection, with doses ranging from 2.5 mg to 15 mg. The 2.5 mg dose is used for treatment initiation and dose escalation only, not as a maintenance dose for glycemic control. According to the FDA prescribing information, tirzepatide should not be coadministered with other GLP-1 receptor agonists. The dual agonist mechanism distinguishes tirzepatide from single GLP-1 receptor agonists like semaglutide, potentially offering enhanced metabolic effects and greater weight reduction in clinical trials.
Tirzepatide's Effects on Appetite Control and Eating Behaviors
Tirzepatide may exert significant effects on appetite regulation through multiple neurohormonal pathways. GLP-1 receptor activation in the hypothalamus and brainstem appears to reduce appetite and increase satiety signals, leading to decreased food intake. The medication slows gastric emptying, which may prolong the sensation of fullness after meals, though this effect tends to attenuate over time with continued treatment. Additionally, GLP-1 receptors in reward-processing brain regions may modulate food reward and hedonic eating behaviors, potentially affecting cravings for highly palatable foods, though these mechanisms are not fully elucidated in humans.
Clinical trial data from the SURMOUNT program demonstrate substantial reductions in body weight with tirzepatide treatment. In the SURMOUNT-1 trial published in the New England Journal of Medicine, participants with obesity but without diabetes achieved mean weight loss of 15.0% (5 mg dose), 19.5% (10 mg dose), and 20.9% (15 mg dose) at 72 weeks compared to 3.1% with placebo. In the SURPASS program for type 2 diabetes, weight loss was generally lower but still significant.
In SURMOUNT-1, participants receiving tirzepatide reported significant improvements in the Impact of Weight on Quality of Life-Lite Clinical Trials Version (IWQOL-Lite-CT) physical function domain scores compared to placebo, suggesting improvements in weight-related quality of life.
While these appetite-suppressing effects are well-documented in the context of obesity and diabetes management, the specific impact on binge eating behaviors has not been systematically studied in dedicated BED populations. The mechanisms by which tirzepatide affects appetite—particularly its influence on reward pathways and impulsivity related to food—suggest theoretical potential for reducing binge episodes. However, binge eating disorder involves complex psychological, behavioral, and neurobiological factors beyond simple appetite dysregulation, including emotional eating, stress responses, and learned behavioral patterns that may not be fully addressed by pharmacological appetite suppression alone.
Clinical Evidence: Research on Tirzepatide for Binge Eating Disorder
Currently, there are no published randomized controlled trials specifically examining tirzepatide's efficacy for treating binge eating disorder as a primary outcome. The existing clinical trial program for tirzepatide has focused on glycemic control in type 2 diabetes (SURPASS trials) and weight management in obesity (SURMOUNT trials), with binge eating behaviors not systematically assessed or reported as endpoints in these studies. Review of the SURMOUNT and SURPASS trial protocols indicates that individuals with eating disorders were generally excluded from participation, limiting direct applicability to BED populations.
Some indirect evidence may be extrapolated from studies of other GLP-1 receptor agonists in populations with eating disorders or disordered eating behaviors. A 2023 systematic review examining GLP-1 receptor agonists and eating behaviors found limited but emerging evidence that these medications may reduce food cravings and loss-of-control eating in individuals with obesity. However, these studies primarily involved single GLP-1 agonists like liraglutide and semaglutide rather than the dual GIP/GLP-1 agonist tirzepatide, and most did not include participants with formally diagnosed BED.
Anecdotal reports and case series have begun to emerge in clinical practice describing potential benefits of GLP-1-based therapies in patients with comorbid obesity and binge eating behaviors, but these observations lack the rigor of controlled trials and are subject to significant bias. The absence of dedicated research represents a critical knowledge gap, as individuals with BED were likely excluded from or underrepresented in the major tirzepatide trials.
A search of ClinicalTrials.gov reveals several ongoing studies examining GLP-1 receptor agonists in populations with disordered eating, though specific completed trials examining tirzepatide for BED are not currently available. Until such evidence becomes available, any consideration of tirzepatide for BED must be approached cautiously, recognizing the lack of established efficacy, appropriate dosing strategies, or safety data in this specific population. The complex psychopathology of BED may require integrated treatment approaches that address both biological and psychological dimensions of the disorder.
Safety Considerations and Potential Side Effects
Tirzepatide's safety profile is well-characterized from extensive clinical trial data in diabetes and obesity populations, though specific safety considerations for individuals with binge eating disorder have not been systematically evaluated. The most common adverse effects are gastrointestinal in nature and include nausea (reported in 12-29% of patients depending on dose), diarrhea (13-23%), vomiting (6-12%), constipation (6-11%), abdominal pain, and decreased appetite. These effects are typically mild to moderate in severity, occur most frequently during dose escalation, and tend to diminish over time.
More serious but less common adverse effects include acute pancreatitis, gallbladder disease (cholecystitis and cholelithiasis), acute kidney injury (usually in the context of severe gastrointestinal side effects leading to dehydration), and hypoglycemia when used in combination with insulin or insulin secretagogues. Tirzepatide carries a boxed warning regarding thyroid C-cell tumors based on rodent studies, though the relevance to humans remains uncertain. The medication is contraindicated in patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2, and in patients with severe gastrointestinal disease, including severe gastroparesis.
According to the FDA prescribing information for Zepbound, patients should be monitored for suicidal thoughts and behaviors, depression, and mood changes. Tirzepatide may reduce the absorption of oral medications due to delayed gastric emptying. Particularly important for women of reproductive potential, tirzepatide can decrease exposure to oral contraceptives; patients should use a non-oral contraceptive method or add a barrier method for 4 weeks after initiation and after each dose escalation. Tirzepatide is not recommended during pregnancy as weight loss offers no benefit and may cause fetal harm; the medication should be discontinued if pregnancy occurs.
For individuals with binge eating disorder, several specific safety concerns warrant consideration. The gastrointestinal side effects, particularly nausea and vomiting, could potentially be misinterpreted or trigger concerns in patients with a history of eating disorders. Additionally, the appetite suppression and weight loss effects, while potentially beneficial for comorbid obesity, require careful monitoring to ensure they do not precipitate restrictive eating patterns or other disordered eating behaviors.
Patients should be counseled about the importance of adequate hydration, particularly during episodes of gastrointestinal side effects. Signs of pancreatitis (severe abdominal pain radiating to the back, with or without vomiting) warrant immediate medical evaluation and discontinuation of the medication. For patients undergoing procedures requiring anesthesia, providers should consider the delayed gastric emptying effect and potential aspiration risk, with appropriate pre-procedural holding of the medication per anesthesiology guidelines.
Treatment Approaches: When to Consider Tirzepatide
Given the absence of FDA approval and limited clinical evidence for tirzepatide in binge eating disorder, any consideration of this medication for BED should be approached thoughtfully and conservatively. Tirzepatide should not be considered a first-line treatment for BED. Evidence-based psychological interventions, particularly cognitive behavioral therapy adapted for BED (CBT-BED), should remain the initial treatment approach for most patients, with or without FDA-approved pharmacotherapy such as lisdexamfetamine for moderate to severe cases, as recommended by the American Psychiatric Association Practice Guideline for Eating Disorders.
Off-label use of tirzepatide might be considered in select clinical scenarios where a patient has both binge eating disorder and comorbid conditions for which tirzepatide has established efficacy—specifically, type 2 diabetes or obesity meeting criteria for weight management therapy. In such cases, the medication would be prescribed primarily for the FDA-approved indication, with potential secondary benefits on eating behaviors monitored as an additional outcome. This approach requires comprehensive informed consent discussions about the off-label nature of BED treatment, the lack of specific evidence in this population, potential risks and benefits, available alternatives, and the importance of concurrent psychological treatment. This informed consent should be documented in the medical record.
Key considerations before initiating tirzepatide in patients with BED include:
Comprehensive psychiatric evaluation to assess eating disorder severity, comorbid mental health conditions, and treatment history
Establishment of psychological treatment (ideally specialized eating disorder therapy) as the foundation of care
Careful assessment for contraindications, including personal or family history of medullary thyroid carcinoma or MEN 2, severe gastrointestinal disease, and pregnancy
Discussion of realistic expectations, emphasizing that medication alone is unlikely to address the psychological components of BED
Development of a monitoring plan including regular assessment of binge frequency (using tools such as the BEDS-7 or binge episode logs), psychological symptoms, weight changes, and medication side effects
Referral to or consultation with an eating disorder specialist is strongly recommended when considering any pharmacological intervention for BED, particularly medications without established evidence in this population. Multidisciplinary collaboration between primary care providers, endocrinologists, psychiatrists, registered dietitians, and eating disorder specialists optimizes patient safety and treatment outcomes. Urgent referral to specialized care is warranted for patients exhibiting suicidality, severe depression, medical instability, or rapid weight loss.
Patients should be monitored closely for any worsening of eating disorder symptoms, development of restrictive eating patterns, or psychological distress related to appetite changes or weight loss. The decision to use tirzepatide in this context should be individualized, evidence-informed, and part of a comprehensive treatment plan addressing the multifaceted nature of binge eating disorder.
Frequently Asked Questions
Is tirzepatide FDA-approved for treating binge eating disorder?
No, tirzepatide is not FDA-approved for binge eating disorder. It is approved only for type 2 diabetes (Mounjaro) and chronic weight management in obesity (Zepbound), making any use for BED off-label.
What is the first-line treatment for binge eating disorder?
Cognitive behavioral therapy adapted for binge eating disorder (CBT-BED) is the first-line treatment with the strongest evidence base according to the American Psychiatric Association. Lisdexamfetamine is the only FDA-approved medication for moderate to severe BED in adults.
When might tirzepatide be considered for someone with binge eating disorder?
Tirzepatide might be considered off-label only in select patients who have both binge eating disorder and comorbid type 2 diabetes or obesity meeting criteria for weight management therapy. This requires comprehensive informed consent, concurrent psychological treatment, and monitoring by specialists familiar with eating disorders.
Editorial Note & Disclaimer
All medical content on this blog is created using reputable, evidence-based sources and is regularly reviewed for accuracy and relevance. While we strive to keep our content current with the latest research and clinical guidelines, it is intended for general informational purposes only.
This content is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a licensed healthcare provider with any medical questions or concerns. Use of this information is at your own risk, and we are not liable for any outcomes resulting from its use.
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