How significant weight loss can affect your mental health

As more and more people turn to injectable medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) to help with weight loss, they may experience similar challenges faced by patients who undergo dramatic weight changes following bariatric surgery.

Weight loss can certainly have a positive impact on mental health, but it can also have negative effects if it’s not done in a healthy way. While many assume losing significant amounts of excess weight will only improve one’s mental state, they may be surprised when depression, anxiety and other issues related to food and weight still crop up.

Often, that’s because drastic weight loss methods may influence other areas that help us maintain our quality of life and mental health.

Here are some things to look out for when losing weight and signs that you should ask for help.

Changing relationship with food

Food can bring feelings of comfort and be a way for people to escape. Some people who’ve lost weight may have previously tended to use food to cope. If they’ve lost that tool, they may not have other coping strategies to replace it. They may also feel like they’re grieving the loss of food. It’s important for people to learn sustainable, healthy ways to manage emotions and find other outlets for self-soothing.

Triggering eating disorders

It’s possible that using weight loss medications to lose weight quickly could trigger restrictive eating. This might lead to a higher risk for an eating disorder or the resurfacing of an eating disorder.

When someone experiences dramatic weight loss, they may sometimes want more weight loss and may become obsessive about the number on the scale. When weight loss starts to slow down, it can be challenging to accept. It might be easy, psychologically, to discount other areas of progress and benefits from weight loss, such as improved health. It’s important to be aware of and celebrate non-scale victories.

Also, with certain medications such as GLP-1 injectables, people may not experience hunger cues and may go all day without eating. This could increase vulnerability to binge eating. If we're not getting the nutrition that we need, that could lead to higher chances of overeating.

See our guide to weight loss for more info

Physical changes

Dramatic weight loss tends to slow metabolism. Sometimes the body adjusts and burns calories more slowly, making it more challenging to lose additional weight.

Drastic, quick weight loss can also cause loss in muscle, have an impact on our bones, or lead to nutritional deficiencies that can reveal themselves in hair loss, fatigue or poor immune function.

Further, some weight loss medications have side effects, such as gastrointestinal discomfort or fatigue, that can lead to symptoms that limit activities.

Relationship changes

Stigma and discrimination based on weight is still prevalent in our society. People may be treated differently after they lose a large amount of weight, sometimes by strangers being more kind to them, but also potentially in negative ways.

People in their social support system may not be supportive of the weight loss or accompanying increase in self-esteem or self-confidence. In the context of bariatric surgery, we see increased risk of divorce or separation.

Further, people who start to eat less or have different eating habits may feel a bit lonely or isolated when with friends at food-focused gatherings. There’s a strong social component to eating so much that it can be challenging to be unable to eat in the same way at gatherings with your friends and loved ones.

Quality of life disruptions

It is important to be mindful that these challenges can impact quality of life. For example, if you’re staying home due to side effects from medications, you may skip the gym or time for physical activity. If you’re uncomfortable at food-focused gatherings, you may back out of social events or see your supports less.

It's all about balance. While weight loss can be incredibly beneficial for health and quality of life, it’s important to try to continue to stay healthy in other areas, such as social relationships, being active and getting out of the house. Our health, well-being and quality of life comprise a number of different areas of our life that are all vital.

Should anyone avoid weight loss medications?

People interested in using weight loss medications should be screened for a history of eating disorders or a current eating disorder or eating disorder behavior. It’s important to discuss with your doctor how long an eating disorder has been in remission and how weight loss medications could pose a risk for it resurfacing. Regular follow-up is crucial to prevent recurrence.

It’s also important to ensure that any severe depression or anxiety symptoms are well-managed before taking these medications, as well as any history of addiction concerns.

Signs to watch for

If you or someone you care about is becoming obsessive about weight or food or engaging in extremely restrictive eating habits, it may be time to seek help.

Some signs:

• Thinking about weight or food is distressing
• Thoughts of weight or food are ever-present
• Thoughts of weight or food are interfering with day-to-day functioning or quality of life
• An intense fear of eating or regaining weight
• Not getting adequate nutrients
• Going all day without eating
• Skipping a lot of meals
• Low energy, passing out or hair loss due to inadequate food intake
• Denial of concerning behaviors

It’s also important to seek help if you’re experiencing significant depression, hopelessness or thoughts of wanting to harm yourself.

If you notice concerning behaviors in a loved one, try to provide support. Be open with a listening ear, and perhaps gently share some of your concerns. Let the person know you’re there to help find support if they’re interested and perhaps go to visits with them.

Avoiding pitfalls

The best way to manage these challenges is to work with a comprehensive, multidisciplinary medical team. The gold standard would include not only the medical prescriber, but also a registered dietitian to assist with nutritional needs, a behavioral health specialist to ensure mental health aspects of rapid weight loss are addressed, and an exercise physiologist to create an exercise plan to maintain muscle tone and fitness when you’re on weight loss medications. All of these providers can ultimately help support you in maintaining healthy behavior change in an individualized and sustainable way.