Forums›Public Square›When your doctor doesn't believe in GLP-1 therapy — 6 month update

When your doctor doesn't believe in GLP-1 therapy — 6 month update

JennaRN Mon, Jan 20, 2025 at 6:33 PM 40 replies 2,500 viewsPage 1 of 8

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JennaRN

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Jan 20, 2025 at 6:33 PM#1

Read the primary source rather than the write-up and the two do not agree, so here is what is actually in it.

The mental-health dimension is under-measured in the trial literature and the reports here are consistent enough to take seriously. On the positive side: reduced anxiety around food, better self-image, more confidence. On the difficult side: grief for the years lost, identity disruption, relationships built around eating, and the loss of food as a coping mechanism with nothing put in its place. Rarer but real: anhedonia and emotional flatness. Regulators have started asking for validated patient-reported outcomes in this class; the existing data gap is not evidence of absence.

Where I think it is weakest: the completion rate deserves as much attention as the headline, because a large effect among those who finished is a different claim from a large effect among those enrolled.

What I am after is how people separated a drug effect from the ordinary consequences of a large deficit and disrupted sleep, because I cannot. I have searched first, so if this is covered somewhere point me at it and I will read it.

Note on sourcing:
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.

11 14Dr.KarenChen, Dr.NateNeph, PharmD_Rodriguez and 8 others

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Dr.GastroMayo

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Jan 20, 2025 at 8:07 PM#2

JennaRN said:
The mental-health dimension is under-measured in the trial literature and the reports here are consistent enough to take seriously.

JennaRN said:
...mental health should only be used alongside therapy...

I'd say therapy should be AVAILABLE to all GLP-1 patients, but requiring it as a precondition for treatment would create an access barrier.

Not everyone can afford therapy. Not everyone needs it. Some people do just fine with medication + lifestyle changes. But for those with emotional eating, body image issues, or disordered eating history, therapy is extremely valuable.

My recommendation: make mental health screening part of the initial assessment, offer therapy as a recommended adjunct, but don't gatekeep medication access behind it.

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LarryQC_SD

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Jan 20, 2025 at 9:41 PM#3

JennaRN said:
The mental-health dimension is under-measured in the trial literature and the reports here are consistent enough to take seriously.

Pushing back on JennaRN here. I would be careful about how confidently the flatness reports get attributed. Rapid weight loss, a large deficit and disrupted sleep produce low mood on their own, and separating that from a drug effect is genuinely hard.

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traveltech_sara

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Jan 20, 2025 at 11:15 PM#4

LarryQC_SD said:
I would be careful about how confidently the flatness reports get attributed.

Recovering from an eating disorder and using mental health: this is a complex situation and I want to be transparent about it.

I have a history of binge eating disorder. My psychiatrist, therapist, and prescribing doctor all collaborate on my care. The GLP-1 agonist has actually been therapeutic — it removes the biological urgency of binge impulses without relying on restriction.

This is NOT appropriate for all ED patients. Anorexia, bulimia, and restrictive EDs require different approaches. But for BED specifically, the evidence and my personal experience are positive. Always involve your mental health team.

Last edited: Jan 21, 2025 at 2:15 AM

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