GLP-1 weight-loss drugs raise mental health concerns
1 weight-loss drugs raise mental health concerns
GLP-1 medications have become increasingly prominent in weight-management treatment, but a South African psychiatrist is urging users and healthcare professionals to consider the psychological effects that can accompany significant weight loss, particularly among people with existing or undiagnosed mental health conditions
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Dr Bavi Vythilingum, a member of the South African Society of Psychiatrists (SASOP), says there is still limited evidence about the longer-term effects of GLP-1 drugs on brain function and people with underlying psychiatric conditions
She cautions that inappropriate use could ‘fuel the fire’ of an existing mental illness
The medications, which include Ozempic, Wegovy and Mounjaro, are licensed in South Africa for type 2 diabetes and chronic weight management in adults living with obesity
Vythilingum says they can have significant benefits when prescribed appropriately, but the psychological side of treatment should not be overlooked
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Weight loss can change more than the body
The relationship between weight and mental health is complex, with changes in weight potentially affecting self-image, mood, behaviour and social relationships
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Vythilingum describes the relationship as ‘bi-directional’, noting that obesity can increase the risk of depression, anxiety and other mood disorders, while untreated depression can contribute to obesity
Eating disorders are another area of concern, particularly because anorexia and bulimia are more prevalent among women
‘GLP-1 drugs are contra-indicated in anorexia and bulimia, but the problem is when women are prescribed a GLP-1 by someone other than their mental health provider, who doesn’t know that they have a serious eating disorder, or they obtain it illicitly,’ she highlighted
She said clinical practice had produced cases in which women with eating disorders relapsed after using the medication
‘Many cases have been reported in clinical practice where these women relapse, the drug fuels the fire of their illness,’ Vythilingum said
Vythilingum stressed that GLP-1 medications should not be treated as general-purpose slimming drugs
‘They are licensed for weight loss in adults living with obesity. The criteria are very clear, they are indicated only for people with a body mass index (BMI) of 30 and above, or for adults with a BMI of >27 with at least one weight-related co-morbidity.’
For otherwise healthy people seeking to lose a relatively small amount of weight, she said established approaches remain the preferred option
‘For an otherwise healthy person who wants to lose a few kilo’s, the accepted principles of diet, exercise, healthy lifestyle are still the most preferred route.’
The concerns do not mean that GLP-1 medications are inherently harmful to mental health
Vythilingum said efficacy trials had not found negative mental health effects among the general population and that the medicines are considered safe when used within their approved target groups
‘When prescribed appropriately, these medications have had life-changing positive effects,’ she added
Weight reduction among people being treated for obesity can also have positive psychological effects, including improved self-esteem and reduced depressive symptoms
‘We know that the weight loss brought about by GLP-1 drugs in people being treated for obesity has generally positive impacts on improving self-esteem and reducing depressive symptoms,’ she said
The outstanding question, she said, concerns what longer-term use could mean for healthy people and those with pre-existing psychiatric conditions
While reduced appetite and fewer food cravings are expected effects of GLP-1 medication, Vythilingum said some people using the drugs for weight loss have described changes extending beyond eating behaviour
Some users have reported greater self-esteem and a sense of control as they see their weight change. Others, however, have described lowered mood, emotional numbness and reduced interest in activities they previously enjoyed
The experience of losing substantial weight can also alter how people perceive themselves and how others interact with them
For some users, she said, criticism around weight loss can replace the stigma previously associated with being overweight, with people facing accusations that medication represents‘the easy way’ to lose weight
Changes in appearance and physical ability can also influence relationships at home and work as people find themselves ‘seen differently’ or begin participating in activities that were previously difficult
Mental health support can form part of treatment
Vythilingum said the psychological consequences of significant weight loss should be considered alongside the physical results
‘Using the GLP-1 drugs for weight loss is not necessarily a harmful strategy in itself, but mind and body are intimately connected, and there are complex emotional layers attached to weight and weight loss and a changing emotional relationship with food.’
She highlighted that rapid physical changes could create a disconnect between how someone feels about their body and what they see in the mirror. Pressure to maintain weight-loss results may also contribute to stress and anxiety
‘These all add up to changes in thoughts about oneself and others, relationships, moods, behaviours and social interactions, all of which can benefit from the support of a mental health professional as you navigate the changes,’ she said
Mental health support could also help people establish sustainable routines and understand the emotional changes accompanying treatment
‘Mental health support creates the safe space to process and understand the changes, in combination with focusing on the physical outcomes, with treatment that focuses on both mind and body. This helps to entrench new habits, routines and behaviours, fostering stability and sustainable change,’ Vythilingum stated
Not everyone taking a GLP-1 medication for weight management will experience psychological effects, and Vythilingum emphasised that the medicines can provide substantial benefits when appropriately prescribed
Her warning centres on awareness, appropriate prescribing and the need to identify existing mental health or eating disorders before treatment begins
She added that people taking the medication should pay attention to changes in their mood and behaviour and seek professional assistance if concerning symptoms develop
‘It is important to be aware so that you can respond and seek help if you do experience changes in moods and behaviour,’ she concludes
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