Eating behaviors may influence how well individuals with
This multicenter, prospective observational study is published in
“Pre-treatment assessment of eating behavior patterns may help predict who will benefit most from GLP-1 receptor agonist therapy,” Daisuke Yabe, MD, PhD, professor at Kyoto University and senior author of the study,
The researchers enrolled 92 adults with T2D who were initiating GLP-1 RA therapy across 4 institutions in Japan. Participants were evaluated at baseline, 3 months, and 12 months for changes in clinical parameters such as HbA1c, body weight, and body fat percentage.1
Dietary intake was assessed using a validated Food Frequency Questionnaire, while eating behaviors were measured with the Japanese version of the Dutch Eating Behavior Questionnaire. The primary outcomes focused on improvements in glycemic control and weight reduction, while secondary analyses examined associations between eating behavior patterns and clinical response to therapy.
GLP-1 RAs led to significant improvements in metabolic outcomes over 12 months. Analysis of eating behaviors showed a sustained decrease in external eating scores, while emotional and restrained eating scores demonstrated only temporary changes. External eating refers to behavior triggered by external cues such as seeing others eat or smelling an appetizing food, whereas emotional eating is driven by negative emotions, and restrained eating is defined by conscious limiting of food intake for the purposes of weight control.
Importantly, individuals with higher baseline external eating scores achieved greater weight loss and showed a trend toward improved glycemic control, suggesting that external eating may serve as a predictive marker of treatment response. In contrast, emotional and restrained eating patterns were not significantly associated with clinical outcomes.
“One possible explanation is that emotional eating is more strongly influenced by psychological factors which may not be directly addressed by GLP-1 receptor agonist therapy,” Takehiro Kato, MD, PhD, clinical lecturer at Gifu University and second author of the study, said in the statement.2 “Individuals with prominent emotional eating tendencies may require additional behavioral or psychological support.”
However, the researchers acknowledged some limitations.1 Its observational design prevented causal conclusions, and unmeasured factors such as lifestyle or psychological status may have influenced outcomes. Additionally, eating behaviors were self-reported, introducing potential recall and social desirability bias. Furthermore, the cohort may have included highly motivated individuals, limiting generalizability to the broader patient population with T2D.
Despite these limitations, the researchers believe the study offers new insights into how eating behaviors influence GLP-1 RA therapy outcomes in individuals with T2D. The researchers also believe the study results suggest that incorporating behavioral assessments could help tailor GLP-1 RA therapy and enhance its effectiveness in clinical practice.
“While our study suggests a potential association between external eating behavior and treatment response to GLP-1 receptor agonists, these findings remain preliminary,” Yabe said in the statement.2 “Further evidence is necessary before they can be implemented in clinical practice. Should future large-scale or randomized controlled trials validate this relationship, incorporating simple behavioral assessments could become a valuable component in optimizing treatment strategies.”
References
1. Koide Y, Kato T, Hayashi M, et al. Association between eating behavior patterns and the therapeutic efficacy of GLP-1 receptor agonists in individuals with type 2 diabetes: a multicenter prospective observational study. Frontiers. Published online September 17, 2025. doi:10.3389/fcdhc.2025.1638681
2. People on Ozempic who eat to regulate emotions less likely to lose weight. Frontiers. News release. September 17, 2025. Accessed September 17, 2025.