LIFESTYLE NEWS - GLP-1 (glucagon-like peptide-1) medications such as Ozempic, Wegovy and Mounjaro are increasingly being used for weight loss in South Africa and internationally.

The medications are licensed in South Africa for the treatment of type 2 diabetes and chronic weight management in adults living with obesity. 

However, their growing use among otherwise healthy people seeking to lose weight has prompted concerns about whether the psychological effects are receiving enough attention.

Dr Bavi Vythilingum, a member of the South African Society of Psychiatrists (SASOP), said there was still much to learn about the long-term effects of GLP-1 medications on brain function and people with underlying mental health conditions.

“When prescribed appropriately, these medications have had life-changing positive effects,” she said.

However, she cautioned that inappropriate use could have serious consequences for people with undiagnosed or existing mental health conditions.

Eating disorders a particular concern

Vythilingum said the relationship between weight and mental health was complex and could be particularly significant for women.

Obesity is associated with an increased risk of depression, anxiety and other mood disorders, while untreated depression can also contribute to weight gain and obesity.

Eating disorders, including anorexia and bulimia, are also more prevalent among women.

GLP-1 medications are contraindicated in people with anorexia and bulimia, but Vythilingum said problems could arise when a person is prescribed the medication by a healthcare provider who is unaware of an existing eating disorder, or when the medication is obtained illicitly.

She said cases had been reported in clinical practice where women with eating disorders relapsed after using GLP-1 medications.

Who should use GLP-1 medications?

Vythilingum stressed that GLP-1 medications should not be viewed as general-purpose weight-loss drugs.

She said they are licensed for weight management in adults living with obesity, with treatment generally indicated for people with a BMI of 30 or higher, or a BMI above 27 in adults with at least one weight-related comorbidity.

“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,” she said.

Clinical trials have not identified negative mental health effects among the general target population, and the medications are considered safe when appropriately prescribed for conditions such as type 2 diabetes and obesity, Vythilingum said.

Weight loss can affect mood and relationships

While significant weight loss can improve self-esteem and reduce depressive symptoms, the psychological impact is not necessarily positive for everyone.

Some people using GLP-1 medications for weight loss report improved self-esteem and a greater sense of control over their weight.

Others have reported reduced food cravings accompanied by emotional numbness, lower mood and less interest in activities they previously enjoyed.

Vythilingum said some people could also experience pressure or stigma associated with using medication to lose weight, with criticism that they had taken an “easy way” rather than relying solely on diet and exercise.

The changes can also affect personal and workplace relationships as people experience changes in how they see themselves, how others respond to them and the activities they are able to participate in.

More long-term research needed

Vythilingum said the long-term mental health effects of GLP-1 medications, particularly among healthy people and those with pre-existing depression or anxiety, required further research.

She said weight loss itself could create an emotional disconnect between how people feel about their bodies and what they see in the mirror, while pressure to maintain weight-loss results could contribute to increased stress and anxiety.

“Mind and body are intimately connected,” she said, adding that weight and weight loss involve complex emotional relationships with food, self-image and behaviour.

Mental health support can help

Vythilingum said people using GLP-1 medications should be aware of potential changes in their mood or behaviour and seek professional help if they occur.

Mental health support can provide a space for people to process the physical and emotional changes associated with significant weight loss while developing sustainable habits and routines.

“Not every person using a GLP-1 drug to lose weight would experience effects on their mental health,” she said. “But it is important to be aware so that you can respond and seek help if you do experience changes in moods and behaviour.”

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