Saxenda for binge eating disorder represents an emerging area of clinical interest, though the medication is not currently licensed for this indication in the UK. Saxenda (liraglutide 3.0 mg) is a GLP-1 receptor agonist approved by the MHRA for weight management in adults with obesity or overweight with comorbidities. Whilst preliminary research suggests potential benefits in reducing binge eating episodes, particularly in individuals with concurrent obesity, the evidence base remains limited. NICE guidelines recommend psychological interventions as first-line treatment for binge eating disorder, with pharmacological options considered only when psychological therapies have been ineffective or declined. This article examines the current evidence, regulatory considerations and treatment alternatives for individuals exploring Saxenda in the context of binge eating disorder.

Understanding Saxenda and Its Mechanism of Action

Saxenda (liraglutide 3.0 mg) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for weight management in adults with obesity or overweight with weight-related comorbidities. It is administered as a once-daily subcutaneous injection, starting at 0.6 mg and gradually increasing weekly to the maintenance dose of 3.0 mg to improve tolerability.

The primary mechanism of action involves mimicking the naturally occurring hormone GLP-1, which is released from the intestine in response to food intake. Liraglutide binds to GLP-1 receptors in multiple areas of the brain, particularly in the hypothalamus and brainstem regions involved in appetite control. This activation leads to increased feelings of satiety (fullness) and reduced hunger signals, helping individuals consume fewer calories. Additionally, Saxenda slows gastric emptying, which prolongs the sensation of fullness after meals, though this effect may diminish with continued use.

Research suggests liraglutide may also influence reward pathways in the brain that are associated with food-seeking behaviour. GLP-1 receptors are present in areas such as the nucleus accumbens and ventral tegmental area, which are involved in the reward and pleasure responses to food. By potentially modulating these pathways, Saxenda might affect the compulsive aspects of eating behaviour, though this hypothesis requires further investigation in the context of binge eating disorder.

It is important to note that Saxenda is not currently licensed by the MHRA for the treatment of binge eating disorder specifically. Its approved indication relates to weight management as part of a comprehensive lifestyle intervention programme including reduced-calorie diet and increased physical activity. Any use outside this licensed indication would be considered off-label prescribing.

Binge Eating Disorder: Clinical Features and Treatment Challenges

Binge eating disorder (BED) is the most common eating disorder in the UK, characterised by recurrent episodes of consuming large quantities of food in a discrete period, accompanied by a sense of loss of control. Unlike bulimia nervosa, individuals with BED do not regularly engage in compensatory behaviours such as purging or excessive exercise. The condition affects people across all age groups, genders and body weights, though it is frequently associated with obesity and significant psychological distress.

Clinical features include eating more rapidly than normal, eating until uncomfortably full, consuming large amounts when not physically hungry, eating alone due to embarrassment, and experiencing marked distress, guilt or shame following binge episodes. According to NICE guidelines (NG69), diagnosis requires these episodes to occur at least once weekly for three months. BED is often accompanied by comorbid conditions including depression, anxiety, type 2 diabetes and cardiovascular disease, creating a complex clinical picture that requires comprehensive assessment.

Treatment challenges are substantial and multifaceted. Psychological interventions, particularly cognitive behavioural therapy adapted for eating disorders (CBT-ED), represent the first-line treatment recommended by NICE. However, access to specialist psychological therapies remains limited across many NHS services, with waiting times often extending several months. Additionally, not all patients respond adequately to psychological interventions alone.

The relationship between BED and obesity creates additional complexity. Weight management interventions may trigger or worsen disordered eating patterns in some individuals, whilst the binge eating itself contributes to weight gain and metabolic complications. There are limited pharmacological options specifically for BED in the UK, which has led clinicians to explore whether medications licensed for obesity management, such as Saxenda, might offer benefits for individuals with both conditions.

If you're experiencing symptoms of binge eating disorder, speak to your GP who can refer you to local eating disorder services. For urgent support with severe psychological distress, contact NHS 111 or 999 in an emergency.

Current Evidence for Saxenda in Binge Eating Disorder

The evidence base for using Saxenda specifically in binge eating disorder remains limited and emerging, with no large-scale randomised controlled trials designed primarily to assess its efficacy for this indication. However, several smaller studies have explored whether GLP-1 receptor agonists might reduce binge eating behaviours, particularly in individuals with concurrent obesity.

Preliminary research suggests potential benefits in reducing binge eating frequency and severity. Some small studies have investigated liraglutide in individuals with obesity who also experience binge eating symptoms, showing modest reductions in both binge eating episodes and body weight compared to placebo over short periods (typically 12-16 weeks). Some participants receiving liraglutide reported improvements in eating disorder psychopathology scores and better control over eating behaviours. However, study samples have been relatively small (often fewer than 100 participants), and longer-term outcomes beyond 12 weeks remain uncertain.

Some research suggests that GLP-1 receptor agonists may influence the neurobiological pathways potentially underlying binge eating, including reward processing and impulse control. Early neuroimaging studies indicate that liraglutide might reduce activation in brain regions associated with food reward when participants view images of palatable foods. This suggests a potential role in addressing the reward-driven aspects of binge eating behaviour, though translating these findings into clinical practice requires caution.

Important limitations must be acknowledged. Most existing studies have focused on individuals with obesity who also experience binge eating, rather than those meeting full diagnostic criteria for binge eating disorder across all weight categories. The distinction is clinically relevant, as BED occurs in individuals of normal weight, and the risk-benefit profile of Saxenda may differ in this population. Additionally, there is no established evidence for Saxenda providing sustained remission from binge eating disorder, and the medication's effects may diminish after discontinuation. Further research with longer follow-up periods and diverse patient populations is needed before definitive conclusions can be drawn about Saxenda's role in treating BED.

Regulatory Status and Prescribing Considerations in the UK

In the UK, Saxenda is licensed by the MHRA exclusively for weight management in adults with a body mass index (BMI) of 30 kg/m² or greater, or 27 kg/m² or greater in the presence of weight-related comorbidities such as type 2 diabetes, hypertension or dyslipidaemia. It is not licensed for the treatment of binge eating disorder, meaning any prescription for this indication would constitute off-label use. Off-label prescribing is legal and sometimes clinically appropriate, but it places additional responsibilities on the prescribing clinician to ensure the patient is fully informed about the unlicensed nature of the treatment.

According to NICE guidance (NG69) on eating disorders, pharmacological interventions should not be used as the sole treatment for binge eating disorder. The guideline recommends offering an evidence-based psychological intervention as first-line treatment, with medication considered only in specific circumstances, such as when psychological treatments have been ineffective or are declined by the patient. Currently, NICE does not specifically recommend Saxenda for BED, and it does not appear in the treatment algorithms for this condition.

NHS prescribing of Saxenda is subject to local formulary restrictions and commissioning decisions by Integrated Care Boards (ICBs). NICE technology appraisal guidance (TA664) recommends liraglutide only within specialist Tier 3 weight management services under specific criteria. Treatment should only be continued if patients achieve at least 5% weight loss after 12 weeks at the maintenance dose. Private prescribing is more common, but patients should be aware that treatment requires ongoing commitment and can be costly.

Clinicians considering Saxenda for patients with binge eating disorder should conduct a comprehensive assessment including psychiatric history, current eating disorder symptoms, previous treatment responses, and the presence of contraindications. Collaborative decision-making is essential, with clear documentation of the rationale for off-label use, discussion of alternative treatments, and informed consent. Referral to or consultation with eating disorder specialists is advisable, particularly for complex cases or when diagnostic uncertainty exists. Prescribers should also consider whether addressing the binge eating disorder through evidence-based psychological interventions might be more appropriate before initiating pharmacological treatment.

Safety Profile, Side Effects and Contraindications

Gastrointestinal side effects are the most common adverse reactions associated with Saxenda, affecting the majority of users to some degree. These include nausea (experienced by approximately 40% of patients), vomiting, diarrhoea, constipation and abdominal discomfort. Symptoms are typically most pronounced during the initial titration phase and often improve with continued use, though some individuals may experience persistent symptoms that limit tolerability. For patients with binge eating disorder, these gastrointestinal effects may be particularly distressing and could potentially trigger or worsen disordered eating patterns in susceptible individuals.

More serious but less common adverse effects include acute pancreatitis, which has been reported with GLP-1 receptor agonists. Patients should be advised to seek immediate medical attention if they experience severe, persistent abdominal pain that may radiate to the back. Gallbladder disease (including cholelithiasis and cholecystitis) has been reported with Saxenda, particularly with rapid weight loss. Saxenda can also cause modest increases in heart rate and has been associated with dehydration and acute kidney injury in some cases.

According to the UK SmPC, Saxenda is contraindicated during pregnancy, breastfeeding, and in patients with hypersensitivity to liraglutide or any excipients. Animal studies have shown thyroid C-cell tumours with liraglutide, though the relevance to humans remains uncertain. Caution is advised in patients with inflammatory bowel disease, diabetic gastroparesis, and severe renal or hepatic impairment due to limited clinical experience in these populations.

Psychiatric considerations are particularly relevant when considering Saxenda for binge eating disorder. Some patients have reported mood changes, depression or suicidal ideation whilst taking liraglutide, though establishing causality is challenging given the high prevalence of mood disorders in individuals with obesity and eating disorders. Careful monitoring of mental health is essential, especially during the initial months of treatment. Patients with active suicidal ideation, severe depression or other significant psychiatric comorbidities may not be suitable candidates for Saxenda without concurrent psychiatric support.

Hypoglycaemia can occur, particularly in patients taking concomitant medications that lower blood glucose such as insulin or sulfonylureas; dose adjustments of these medications may be necessary. Patients should be educated about recognising side effects, when to seek medical advice, and the importance of gradual dose titration to minimise adverse reactions. Regular monitoring of weight, eating behaviours, mental health and tolerability should be maintained throughout treatment. Patients should report suspected side effects via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or the Yellow Card app).

Alternative and Complementary Treatment Approaches

Psychological interventions remain the cornerstone of evidence-based treatment for binge eating disorder according to NICE guidelines. Cognitive behavioural therapy adapted for eating disorders (CBT-ED) is the recommended first-line treatment, typically delivered over 16-20 sessions. CBT-ED addresses the cognitive distortions and behavioural patterns that maintain binge eating, including rigid dietary rules, negative body image and emotional eating triggers. Studies demonstrate that many patients achieve significant improvement in binge eating with CBT-ED, with benefits often maintained at long-term follow-up.

For individuals who do not respond to or cannot access CBT-ED, alternative psychological approaches include interpersonal psychotherapy (IPT) and dialectical behaviour therapy (DBT). IPT focuses on improving interpersonal relationships and communication patterns that may contribute to emotional eating, whilst DBT emphasises emotion regulation skills and distress tolerance. Both approaches have demonstrated efficacy in reducing binge eating frequency, though evidence is strongest for CBT-ED. Guided self-help programmes based on CBT principles offer a more accessible option and may be appropriate for individuals with less severe symptoms.

Pharmacological options in the UK are limited. Some medications have been studied for binge eating disorder but would be considered off-label use. Selective serotonin reuptake inhibitors (SSRIs), particularly fluoxetine at higher doses, have shown some efficacy in reducing binge eating frequency, though effects on weight are typically modest. Topiramate has also been studied but is not licensed for BED in the UK and carries significant side effect concerns including cognitive impairment and paraesthesia. Any medication should be considered as an adjunct to psychological therapy rather than a standalone treatment.

Lifestyle and supportive interventions play an important complementary role. Nutritional counselling with a registered dietitian can help establish regular eating patterns, challenge food rules and develop a more flexible approach to eating without triggering restriction-binge cycles. Structured meal planning, mindful eating practices and strategies to manage emotional triggers are valuable components of comprehensive care. Support groups, whether in-person or online, provide peer support and reduce the isolation often experienced by individuals with eating disorders. For patients with concurrent obesity, a multidisciplinary approach integrating eating disorder treatment with weight management support may be most effective, though care must be taken to avoid interventions that could exacerbate disordered eating.

Patients should be encouraged to discuss all treatment options with their GP, who can refer to local eating disorder services. Additional support is available through organisations such as Beat Eating Disorders (beateatingdisorders.org.uk). A personalised care plan addressing both the psychological and physical aspects of binge eating disorder offers the best chance of recovery.

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