It’s estimated that one in eight U.S. adults has used a GLP-1 agonist medication, according to a survey from health policy research organization KFF that was released in May of 2024. While more traditionally used to treat diabetes or to prevent heart attacks and strokes in those with heart disease, they have become increasingly popular for weight loss. In fact, of those who report taking these medications, one in five (22%) were told by a doctor within the past five years that they have overweight and/or obesity.
Side note: more healthcare providers are shifting to discussing and treating overweight and obesity as disease states and saying that a person “has” these conditions rather than using those terms to refer to something a person “is.” For example, you wouldn’t say that a person is diabetes or heart disease, but rather that they have the condition.
There are many reasons someone may want or need to lose weight. Reducing disease risk, alleviating weight-related issues such as joint pain and sleep apnea and improving markers of health are a few major motivators. For example, even just five percent of weight loss has been shown to improve markers of cardiac health. GLP-1 agonists work by triggering the pancreas to produce more insulin, reducing blood sugar levels in those with Type 2 diabetes via slowing digestion. This also makes you feel more full and less inclined to eat, which is how these medications promote weight loss.
While diet and exercise have long been considered the primary interventions for weight loss—and they still are considered to be incredibly important first steps— medically assisted weight loss is becoming more commonplace. Whether you think these medications are a godsend or you think that millions of people are enthusiastically participating in a bizarre public health experiment, you can’t deny that these medications have become very popular, though they do come with an array of side effects like nausea, vomiting, diarrhea and even more serious issues such as increased heart rate , acute kidney injury and pancreatitis.
One of the things people taking them love most about these drugs is how quickly they work compared to diet and exercise alone. However, this can also present some unique challenges. For example, rapid weight loss (especially a lot of weight loss) can cause loss of muscle mass, which can lead to weakness and overall poorer metabolic health. What’s often left out of the discussion, however, is the way that losing a lot of weight may impact someone’s mental health.
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Mental health aspects of weight loss
Kate Miskevics, LMFT, therapist at LifeStance Health, says, “The mental health impacts of significant weight loss are vast and will vary from person to person, also depending on how they choose to go about achieving this weight loss. On the positive side, when approached healthily, dramatic weight loss can cause an increase in self-esteem, a great sense of accomplishment, can improve a person’s quality of life, and offer new opportunities. These factors can aid in the improvement of things like anxiety and depression.”
There can be challenges, though, Miskevics adds. ”Dramatic weight loss can stir up emotions related to feeling vulnerable and exposed, pressure to maintain a certain weight, and ultimately what may feel like an identity crisis while adjusting to a new image.”
Someone’s mental health experience also depends on whether the weight loss is gradual or sudden, she explains. “Any change in life that is rapid or sudden may have more of a ‘shock factor’ to it, and therefore may be more challenging to adjust to. Something else to consider is that losing weight quickly may offer a sense of immediate gratification, but if that plateaus after some time, the risk is that someone might begin to feel less accomplished or disappointed. Gradually losing weight can offer someone more time and space to process and adjust to their changing body. As humans, we require time to process any change, so whether the weight loss is sudden or gradual, it is important that we prepare as best as we can mentally ahead of time.”
Kim Shapira is a dietitian and author who puts a big emphasis on fostering a healthy relationship with food—and with themselves. “I always like to change the goal to not necessarily losing weight, but really having a normal relationship with food so they can maintain that weight loss. I always think the side effect of a normal relationship is not even thinking about their weight.”
However, for someone who has struggled with their weight for a long time, that may sound impossible. She shares that for people who have struggled with binge eating and emotional eating for a long time, being supported by these medications can help quiet those thoughts that lead them to overeat.
She points out, though, that even with weight loss medication in the mix, it’s still important to address those relationships and emotional needs in order to maintain healthy weight loss over time. “The most important thing for people to remember,” she says, “ is that we're more powerful than we give ourselves credit for. And so the second we can see that our mind is giving us this idea [to binge], it's up to us to train our mind. So one thing that I see is people always, when they get emotionally triggered, they get taken off of their journeys.” Mindfulness is a tool she often recommends for building awareness and reframing those thoughts.
Unique mental health challenges of weight loss medications
There are some very specific mental health aspects of weight loss medications that need to be addressed. Coping with drastic weight loss, managing side effects and adjusting to needing to be on those medications for a long time (and to afford to be on those medications for a long time) are just a few of the issues that can come up. Regaining weight loss when you stop using these medications can also take a toll, mentally, which is why having it’s recommended to incorporate nutrition and exercise counseling into a comprehensive weight loss plan even when medications are involved.
“Another unique mental health challenge that may come from the recent uprise in weight loss medication,” says Miskevics, “is related to the craze that has been surrounding Ozempic, Wegovy, etc. Using these medications specifically for weight loss has obviously been a newer trend in society, which is why we hear and see about it so frequently in the news, in popular culture, and on social media. Because of this, there is a greater chance of misinformation being spread, and greater opportunities to hear about individual experiences.”
This widespread exposure can impact expectations, she adds. “People may think that they know what to expect based off of the information they see online or on TV, but it is extremely important to do research beyond the media if considering weight loss medication. Without doing so, someone might develop unrealistic expectations or find themselves comparing their journey to someone else’s. These factors can cause mental impacts such as feeling disappointed or let down, feeling underprepared for any side effects, or generally feeling anxious if things don’t turn out as envisioned.”
Mindset tips
Before starting a weight loss journey, however long or short, with or without use of medication, Miscevics recommends, “think through mental health needs related to weight loss.” Some questions to reflect upon, either with yourself or with a provider, she shares, may include:
- What is my main intention for wanting to lose weight at this time?
- How will I respond when people start to notice or comment on my weight loss?
- How can I hold myself accountable to reach personal goals while still practicing self compassion towards myself?
Shapira encourages taking the long view. “If you aren't thinking long-term, then you're definitely not going to be successful.” If you set yourself up to feel like a failure, that’s the emotional energy you’ll continue to carry forward. She adds that a big part of why people get caught in cycles of weight loss and regain, “they forget that they're the heroes in their story and that they have the power to heal themselves.”
She encourages taking into account not just the number on the scale but other markers of success too. For example, a lack of intrusive thoughts about food, or feeling more in tune with what feels good in your body and being able to notice which emotions and situations trigger unhealthy eating behaviors so you can develop healthy coping skills. Paying attention attention to improvements in body composition and protecting against muscle loss by making sure you’re eating adequate protein and doing strength training are also important, especially if you’re on medication that may contribute to rapid weight loss.
Bri Blank, founder of Bri Healthy, lost 150 pounds over a two-year period through diet and exercise as a college student and has shared her journey of not just weight loss but weight maintenance over the past ten years. She found sharing her journey on social media to be a very positive, empowering experience and found the support she received motivating.
To take care of her mental health both during her weight loss journey and as she has maintained her weight in the decade since then, she says, “I feel like the most important thing I’ve done for my mental health is to love my body actively. I remind myself that I am blessed to have arms and they work and they are amazing and they are beautiful in their own way. That is my practice. Body dysmorphia is a real thing. When you look at yourself in the mirror, you have to go into it with a mindset of a mindset of ‘I love me.’”
She adds, “Seeing yourself at different weights can throw you for a loop. Having that active awareness of ‘I love what I see and I love me’ is the most powerful thing. “
She would encourage someone else who wants to lose a lot of weight to take it a little bit at a time. “Reframe it the best as you can to make it feel more fun and exciting instead of so heavy because it could feel really daunting. When you start to see those results, you're going to start to feel confident. Remember that it's a journey of health for yourself more than anything. Looks has to be the last thing on the list when it comes to this because it really can be so superficial in terms of the motivation when it comes to the outside, but when you're really doing it for your health.”
Arash Hashemi, co-founder of the low-carb lupini bean-based pasta Kaizen, and creator of the popular Instagram and YouTube platform, Shred Happens, lost over 100 pounds through diet and exercise and now shares healthy recipes and insights from his own weight loss journey with his audience. He says, “Adjusting my self-image was – and sometimes is — a significant challenge that caught me off guard. While the weight loss brought positive changes, reconciling the physical transformation with my self-perception was a gradual and sometimes difficult process. It requires conscious effort and patience to align my internal identity with my physical transformation.”
Supporting mental health on your weight loss journey
When working towards a weight loss goal, there are a number of ways to protect your mental health. Miskevics recommends making a plan to follow and getting whatever support team you need in place. “Do your research on the mechanism of how you will be losing weight, talk to your doctors and professionals and set your personal intention as to why you want to lose weight.” During the journey, she says, “set realistic goals to hold yourself accountable, but have some flexibility and grace with yourself if things don’t work out exactly as you want them too.”
While many people may be familiar with the concept of tracking nutritional intake and exercise, she also encourages noting your thoughts and feelings through daily journaling, ensuring you are eating healthy amounts of food and nutrients, “and not fixating too much on the weight itself, but more on how you feel along the way.”
Talking with a therapist can also offer a judgment-free space to process through your thoughts and feelings, develop coping strategies and work through challenges you might be facing, she adds.
Blank shares, “Meditation has been the most transformative thing in my life. I used to be a very reactive person, but when I’m consistent with mediation, I can take a step back, take a deep breath, and be calm.”
When asked what advice he’d give to others on a weight loss journey, Hashemi says, “Remember, it's not just about the number on the scale. Focus on how your body feels, the confidence you gain, and the overall improvement in your well-being. These are the true measures of progress and success on your journey. The scale is just a small piece of a much larger puzzle.”
He also encourages thinking long-term. “Weight loss journeys are filled with peaks and valleys, and it's easy to let impatience derail progress. We all want steady, sustained progress. However, it's crucial to remember that success often hinges on sticking through the inevitable challenging days or moments where all we want to do is throw in the towel. Sometimes, it's about making it through just the next day, or even the next hour. These small victories are ultimately the big successes we seek, over time.”
MIskevics adds that it’s important to celebrate your progress along the way and take time to appreciate your body, but to avoid putting too much pressure on yourself to keep your weight at an exact number. “Find the habits and routines that allow you to maintain what feels healthy in your life, but recognize that living moderately allows us to achieve greater balance as humans. Losing weight should be a journey that helps someone feel strong, healthy, and confident in their skin. However, keep in mind that you will never be fully defined by your image or weight, but who you are as a person. As your appearance shifts throughout your weight loss journey, don’t lose sight of the idea that your value stems from who you are at your core, how you treat others and how you choose to show up in the world.”
