Ozempic (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for type 2 diabetes mellitus. Whilst it has gained attention for its appetite-suppressing effects, Ozempic is not currently licensed by the MHRA for binge eating disorder or any eating disorder. Binge eating disorder is a complex psychiatric condition requiring evidence-based psychological interventions as first-line treatment. This article examines the limited evidence for Ozempic in binge eating, potential risks, and NHS-recommended treatment pathways aligned with NICE guidance.

What Is Ozempic and How Does It Work?

Ozempic (semaglutide) is a prescription medication licensed in the UK by the Medicines and Healthcare products Regulatory Agency (MHRA) for the treatment of type 2 diabetes mellitus. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of a naturally occurring hormone that regulates blood sugar levels and appetite.

The mechanism of action involves several physiological processes. Semaglutide stimulates insulin secretion from pancreatic beta cells in a glucose-dependent manner, meaning it only works when blood sugar levels are elevated. Simultaneously, it suppresses glucagon release, which reduces glucose production by the liver. Importantly for appetite regulation, GLP-1 receptor agonists slow gastric emptying—the rate at which food leaves the stomach—leading to prolonged feelings of fullness. They also act on appetite centres in the brain, particularly the hypothalamus, reducing hunger signals and food cravings.

Ozempic is administered as a once-weekly subcutaneous injection using a pre-filled pen device. The standard dosing schedule begins at 0.25 mg weekly for four weeks, then increases to 0.5 mg weekly, with potential escalation to 1 mg or 2 mg weekly depending on glycaemic control and tolerability. Whilst the medication has gained considerable attention for its weight loss effects—leading to the development of Wegovy (a higher-dose formulation of semaglutide specifically licensed for weight management)—Ozempic itself is not currently licensed in the UK for binge eating disorder or any eating disorder. It is also not indicated for type 1 diabetes or diabetic ketoacidosis.

Any use outside its licensed indication would be considered off-label prescribing, which requires careful clinical justification and informed patient consent. Currently, there are supply constraints for GLP-1 receptor agonists in the UK, with NHS guidance prioritising these medications for people with diabetes.

Evidence and Clinical Studies on Ozempic for Binge Eating Disorder

The evidence base for using semaglutide specifically for binge eating disorder (BED) remains limited and emerging. There is no official licence from the MHRA or European Medicines Agency (EMA) for Ozempic or any GLP-1 receptor agonist in the treatment of eating disorders. However, preliminary research has explored the potential role of these medications in addressing binge eating behaviours, primarily through their effects on appetite regulation.

Several small-scale studies and case reports have suggested that GLP-1 receptor agonists may reduce binge eating episodes in some individuals. The proposed mechanism relates to the medication's ability to enhance satiety signals and reduce food cravings. Some researchers hypothesise that these medications might potentially influence reward pathways in the brain associated with compulsive eating behaviours, though this remains speculative with limited human evidence. A small pilot study published in 2023 examined semaglutide use in adults with BED and obesity, reporting reductions in binge eating frequency alongside weight loss. However, these findings require replication in larger, randomised controlled trials before definitive conclusions can be drawn.

It is crucial to recognise that binge eating disorder is a complex psychiatric condition with psychological, behavioural, and neurobiological components. Whilst pharmacological interventions may address certain physiological aspects—such as appetite dysregulation—they do not target the underlying psychological triggers, emotional distress, or maladaptive coping mechanisms that characterise BED.

According to NICE guideline NG69, guided self-help programmes based on cognitive behavioural therapy (CBT) principles are the recommended first-line treatment for adults with binge eating disorder. Cognitive behavioural therapy adapted for eating disorders (CBT-ED) is typically offered if guided self-help is declined or proves ineffective. Medication is not recommended as first-line treatment for BED under current NICE guidance.

Potential Side Effects and Safety Considerations

Like all medications, Ozempic carries a risk of adverse effects that patients and prescribers must carefully consider. The most commonly reported side effects are gastrointestinal in nature and include nausea, vomiting, diarrhoea, constipation, and abdominal pain. These symptoms typically occur during dose escalation and often diminish over time as the body adjusts to the medication. Starting at a low dose and gradually increasing can help minimise these effects.

More serious but less common adverse effects include:

• Pancreatitis: Patients should be advised to seek immediate medical attention if they experience severe, persistent abdominal pain that may radiate to the back, as this could indicate acute pancreatitis. Semaglutide should be discontinued if pancreatitis is suspected and should not be restarted if pancreatitis is confirmed.

• Gallbladder problems: Rapid weight loss associated with GLP-1 receptor agonists may increase the risk of cholelithiasis (gallstones) and cholecystitis.

• Hypoglycaemia: Whilst semaglutide alone rarely causes low blood sugar, the risk increases when used alongside other glucose-lowering medications such as sulphonylureas or insulin.

• Diabetic retinopathy complications: People with type 2 diabetes, particularly those with pre-existing retinopathy or on insulin therapy, may experience worsening of retinopathy, especially with rapid improvement in blood glucose control.

• Thyroid concerns: Animal studies identified an increased risk of thyroid C-cell tumours. While relevance to humans remains uncertain, the UK SmPC advises caution in patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. Patients should seek medical review for any neck mass, dysphagia, dyspnoea, or persistent hoarseness.

Additional safety considerations include the risk of dehydration and acute kidney injury from gastrointestinal side effects, hypersensitivity reactions including anaphylaxis, and injection-site reactions. Semaglutide should be avoided during pregnancy and breast-feeding, and should be discontinued at least 2 months before a planned pregnancy.

Specific considerations for individuals with eating disorders include the potential for exacerbating disordered eating patterns. The appetite-suppressing effects might reinforce restrictive behaviours or complicate the psychological work needed to normalise eating patterns. Additionally, the gastrointestinal side effects could be particularly distressing for individuals with heightened anxiety around bodily sensations or digestive symptoms.

Patients should contact their GP immediately if they experience severe abdominal pain, persistent vomiting, signs of dehydration, symptoms of hypoglycaemia (trembling, sweating, confusion), or any concerning changes in mood or eating behaviours whilst taking this medication. Any suspected side effects should be reported via the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk or the Yellow Card app).

NHS Treatment Options for Binge Eating Disorder

The NHS provides evidence-based treatment pathways for binge eating disorder, guided by NICE guidelines (NG69: Eating Disorders: Recognition and Treatment). These recommendations emphasise a stepped-care approach, with psychological interventions forming the cornerstone of treatment.

First-line treatment for adults with BED consists of guided self-help programmes based on cognitive behavioural therapy (CBT) principles. These structured resources allow individuals to work through therapeutic materials with support from a trained facilitator, typically over 4-9 sessions. If guided self-help is declined, ineffective, or unavailable, NICE recommends offering a specifically adapted form of cognitive behavioural therapy (CBT-ED), typically delivered over 16–20 sessions. These psychological approaches help individuals identify triggers for binge eating, develop healthier coping strategies, challenge distorted thoughts about food and body image, and establish regular eating patterns.

Pharmacological options within NHS pathways are limited and not recommended as first-line treatment. NICE guidelines suggest considering selective serotonin reuptake inhibitors (SSRIs), particularly for patients with co-existing depression or anxiety, though evidence for their effectiveness specifically in BED is modest. Lisdexamfetamine, a medication licensed for attention deficit hyperactivity disorder, has shown efficacy in reducing binge eating episodes in some studies, but it is not licensed for BED in the UK and is not routinely recommended due to concerns about dependency and cardiovascular effects.

Access to specialist eating disorder services varies across the UK. Patients can be referred by their GP to community eating disorder teams for assessment and treatment. These multidisciplinary teams typically include psychiatrists, clinical psychologists, dietitians, and specialist nurses who can provide comprehensive care tailored to individual needs. For severe cases with medical complications (such as electrolyte imbalances, significant dehydration, or cardiovascular symptoms) or significant psychiatric comorbidity (including suicidal thoughts), more intensive support including day programmes or inpatient treatment may be necessary.

Speaking to Your GP About Ozempic and Eating Disorders

If you are considering discussing Ozempic as a potential treatment for binge eating behaviours, it is important to approach the conversation with your GP in an informed and open manner. Preparation is key: before your appointment, reflect on your eating patterns, the frequency and severity of binge episodes, any triggers you have identified, and how these behaviours impact your daily life and wellbeing.

Be prepared to discuss your complete medical history, including any previous treatment for eating disorders, mental health conditions, current medications, and relevant family history. Your GP will need this information to assess whether any pharmacological intervention would be appropriate and safe. It is worth noting that off-label prescribing of Ozempic for binge eating disorder is not routinely recommended in primary care. Current UK supply constraints also mean GLP-1 receptor agonists are being prioritised for people with diabetes.

Your doctor may explore several important considerations:

• Diagnostic clarity: Confirming whether you meet diagnostic criteria for binge eating disorder or whether other eating disorder presentations or mental health conditions are present.

• Previous treatments: Understanding what interventions you have already tried, including psychological therapies, and their outcomes.

• Underlying factors: Identifying medical conditions (such as insulin resistance or type 2 diabetes) that might influence treatment decisions.

• Referral pathways: Discussing appropriate referral to specialist eating disorder services or other mental health support.

If you have read about Ozempic online or through social media, share these sources with your GP but remain open to their clinical perspective. Evidence-based medicine requires robust research demonstrating both efficacy and safety before treatments can be recommended. Your GP will likely prioritise NICE-recommended treatments such as guided self-help based on CBT principles or referral to specialist services for CBT-ED.

Your GP's role is to ensure any intervention is in your best interests, balances potential benefits against risks, and aligns with current clinical guidelines. A collaborative approach, where you work together to identify the most appropriate treatment pathway—whether psychological therapy, specialist referral, or other interventions—offers the best opportunity for meaningful recovery from binge eating disorder.

Frequently Asked Questions