A psychiatrist has warned that the use of GLP-1 (glucagon-like peptide-1) drugs, such as Ozempic, Wegovy and Mounjaro, for weight loss could, if misused, “fuel the fire” of mental illness.
The rising use of prescription drugs for weight loss can have life-changing positive effects for those who have struggled to control their weight.
However, psychiatrists warn that users should pay as much attention to the mental health impacts as to the physical transformation.
Licensed in South Africa for the treatment of type 2 diabetes and chronic weight management for people diagnosed with obesity, GLP-1 drugs are increasingly being used by otherwise healthy people for weight loss, in SA as well as globally.
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However, Dr Bavi Vythilingum, a member of the South African Society of Psychiatrists (SASOP), warns that not enough is yet known about the impact of GLP-1 drugs on brain function or underlying mental health conditions.
As a result, dramatic weight loss can have both positive and negative impacts on self-image, mood, emotions and relationships, she said, underscoring the need for mental health support on any weight loss journey.
Dr Vythilingum said the “bi-directional relationship” between weight and mental health was a heightened risk for women, with obesity raising the risk of developing depression, anxiety and other mood disorders.
In contrast, untreated depression can lead to the development of obesity disorders.
Relapsing eating disorders
Eating disorders such as anorexia and bulimia are also more prevalent among women.
“GLP-1 drugs are contraindicated 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.”
“Many cases have been reported in clinical practice where these women relapse – the drug fuels the fire of their illness,” she said.
She emphasised that GLP-1 drugs are not approved for general weight loss.
“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 an otherwise healthy person who wants to lose a few kilos, the accepted principles of diet, exercise, and a healthy lifestyle are still the most preferred route.”
Drug impact
Vythilingum said efficacy trials of GLP-1 drugs found no negative mental health impacts in the general population. They are therefore considered safe for people with type 2 diabetes and obesity.
“When prescribed appropriately, these medications have had life-changing positive effects,” she said.
However, she said, the impact of the drugs on long-term brain function, especially in people who already have mental health problems or an undiagnosed disorder, was not yet known.
In addition, the mental health impacts of the dramatic, significant weight loss brought about by the drugs are still not certain.
“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.
“This is a good outcome, since reducing obesity is linked to overall improved physical and mental health.
“However, we need to see the outcomes of more long-term studies on what GLP-1s do in healthy individuals and people with pre-existing mental illnesses, particularly those with depression and anxiety.
“Given that these disorders are so common and so widespread, and closely linked to weight issues, we need to know more about the impact of the drugs, and drug interactions, in this group,” she said.
Weight-loss stigma
Vythilingum said that some healthy people using GLP-1s simply for weight loss, rather than as prescribed for obesity or diabetes, reported positive feelings of improved self-esteem and self-mastery by feeling they were taking control of their weight and seeing positive results.
However, others reported that not only were their food cravings lessened, as the drugs are designed to do, but they also experienced numbing of emotions, lowered mood and less interest in other usually pleasurable activities.
For some, “fat-shaming” turns into “weight loss shaming”, with stigma and criticism attached to using drugs as “the easy way” to achieve weight loss rather than traditional paths of dieting and exercise.
Weight loss can also affect an individual’s relationships at work or home, as they are “seen differently,” people respond differently, and they engage in new activities they weren’t previously able to.
“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.”
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Vythilingum said the physical changes of weight loss can result in a sense of emotional disconnect – how the person feels about their body against what they see in the mirror, and in how others respond.
There are also risks of increased stress and anxiety due to internal or external pressure to maintain the results.
“All of these 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.”
“Mental health support creates a 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 said.
She added that not every person using a GLP-1 drug to lose weight would experience effects on their mental health, but “it is important to be aware so that you can respond and seek help if you do experience changes in mood and behaviour”.
