In recent years, the increasing use of glucagon-like peptide 1 (GLP-1) receptor agonists and the rise in bariatric surgeries have heightened concerns regarding the psychological effects of weight loss. While these treatments offer significant metabolic benefits, experts caution that individuals with a history of psychiatric disorders, low self-esteem, or heightened emotional vulnerability may experience rapid weight loss as a significant trigger due to neurobiological and hormonal changes. Emotional factors are often influenced by the social environment.
Hormonal Adaptations
Significant weight loss triggers hormonal and neurobiological adaptations that affect emotional regulation. GLP-1 agonists, such as semaglutide and liraglutide, cross the blood-brain barrier and modulate brain regions related to appetite and rewards.
In contrast, bariatric surgery alters the secretion of peripheral hormones, including ghrelin, GLP-1, peptide YY, leptin, and insulin, which can indirectly affect the dopaminergic and serotonergic systems.
According to Fernanda Martins de Albuquerque, PhD, from the Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Brazil, these changes are generally beneficial but can negatively affect mood in emotionally fragile individuals, particularly due to changes in cortisol and central neurotransmitters.
Moreover, rapid weight loss activates the hypothalamic-pituitary-adrenal axis, promoting continuous cortisol release, which is associated with a higher risk for depression and suicide. As highlighted by Eduardo Perin, psychiatrist at the Federal University of São Paulo, São Paulo, Brazil, these neuroendocrine changes can precipitate emotional decompensation, especially in the initial months of treatment, when clinical instability is more pronounced.
However, emotional impact is not solely caused by physiological factors. Rebuilding one’s self-image after weight loss can lead to frustration, particularly when patient expectations are not met, or when difficulties arise in adapting to a new body. This effect can be intensified by exposure to social media, which reinforces unrealistic aesthetic standards and encourages harmful comparisons.
According to Perin, this pressure undermines the self-perception of the body and fuels frustration, particularly in individuals with low self-esteem, who may impose unattainable or unsustainable expectations on themselves in the long term.
Compulsive Behaviors
Another fundamental aspect is the interruption of compulsive behaviors that previously served as emotional regulation strategies, such as eating in response to stress. After bariatric surgery, there is an observed increase in the risk of replacing binge eating, for instance, with the onset or intensification of alcohol use, reinforcing the importance of structured psychological monitoring during the postoperative period. This has not been observed with the use of GLP-1 agonists.
According to a study published in JAMA Psychiatry, adults with alcohol use disorder treated with semaglutide showed a significant reduction in alcohol consumption and cravings.
Findings
A meta-analysis involving more than 660,000 patients who underwent bariatric surgery revealed an approximately twofold increased risk for suicide compared with individuals who did not undergo surgery. Although this increase is significant, it should be interpreted with caution as the absolute risk remains low.
In addition to the obvious benefits of controlling type 2 diabetes, hypertension, and dyslipidemia, bariatric surgery improves the quality of life and life expectancy. However, in terms of mental health, studies show greater vulnerability in the postoperative period, with an increased risk for depressive relapses, the emergence of compulsive behaviors, and difficulty adapting to a new body image, especially in patients with a history of psychiatric disorders.
In the case of GLP-1 agonists, a study published in JAMA Psychiatry found no increased risk for suicide or self-harm, with a rate of 0.04 cases per 100 person-years and no statistically significant difference in the placebo group. Nevertheless, experts recommend caution; rare adverse events, such as behavioral or mood changes, may not be observed in short studies, which reinforces the need for close long-term monitoring, particularly in patients at a higher risk for psychiatric disorders.
In contrast, weight loss achieved solely through physical activity consistently has positive effects on mental health. A systematic review and meta-analysis published in Journal of Affective Disorders demonstrated that higher levels of physical activity are associated with reduced suicidal ideation in various age groups. Regular exercise contributes to weight loss, improves mood, reduces depression and anxiety symptoms, and promotes better sleep quality, which are essential factors for emotional protection.
Despite the potential risks in certain scenarios, numerous studies have confirmed the safety profile of GLP-1 agonists and the effectiveness of bariatric surgery in specific populations. However, it is important to remember that GLP-1 agonists are relatively new medications and that their phase 3 studies were conducted under controlled conditions, often excluding individuals with a history of psychiatric disorders. Therefore, only large-scale and new, more specific studies will fully elucidate the safety profiles of these population groups.
Thus, according to de Albuquerque, for mentally vulnerable patients, it is essential to maintain heightened clinical attention with support from multidisciplinary teams capable of early identification of psychological distress and ensuring a comprehensive therapeutic approach.
de Albuquerque and Perin reported having no relevant conflicts of interest.
https://www.medscape.com/viewarticle/rapid-weight-loss-can-trigger-emotional-turmoil-2025a1000bik
