There have always been societal expectations regarding body size and appetite. Thinness has often been culturally associated with discipline and beauty. GLP-1 RAs can contribute to shifting societal expectations surrounding bodies. Especially among adolescents and young adults exposed to idealized body standards online, failure to achieve thinness (which is increasingly pharmacologically achievable) may become further pathologized or moralized. This may lead to the intensification of shame regarding larger bodies and increase pressure on people to medically modify themselves in pursuit of a socially idealized version of themselves.
As the GLP-1 RA market expands rapidly, so does the drugs’ off-label and nonindicated use, and multinational pharmaceutical companies anticipate major revenue growth. Excessive weight loss in individuals with normal BMI can cause malnourishment, electrolyte imbalance, and an unhealthy relationship with food. While illicit misuse of GLP-1 RAs is not yet well documented, a 2025 case report describes an adolescent girl with atypical anorexia nervosa misusing semaglutide, highlighting early signals of abuse potential in vulnerable populations.19 The novelty of this weight loss drug, coupled with the heterogeneity of data from published reports and ongoing trials, marks the uncertainty surrounding the effects of long-term use of GLP-1 RAs and raises a concern about prescribers’ limited knowledge of the dosage guidelines and the potential for GLP-1 RA abuse. In clinical practice, sparsity of research should not preclude a prescriber from using a novel treatment, particularly when many positive clinically significant outcomes have been reported. However, prescribing practices should be individualized to the patient’s presenting symptoms.
Are GLP-1 RAs saving lives daily by generating improved cardiovascular health? Absolutely. However, critical questions remain unanswered: Are GLP-1 RAs consistently addressing the patient’s symptomatology, or are they reinforcing maladaptive patterns and potential misuse? Are we optimizing patient outcomes, or feeding into the expansion of an oversaturated culture and pharmacological dependence?
Concluding Thoughts
The public discourse surrounding GLP-1 RAs reveals a compelling narrative: For many patients who have long struggled with their weight, these medications represent the first accessible intervention that addresses biological drivers of obesity rather than framing weight as a matter of willpower and moral discipline. The intense reactions to GLP-1 RAs may reflect, at least in part, discomfort with shifting obesity from a moralized condition to a medically treatable one. This shift may reduce self-blame for some patients, though it continues to raise concerns about disparities in access and the stigmatization of pharmacological assistance as “cheating.” Most clinical trials have enrolled individuals with diabetes or obesity and excluded those with preexisting psychiatric conditions, leaving the safety profile in psychiatrically vulnerable populations largely unknown. Psychiatrists and mental health clinicians should remain attentive not only to the pharmacological effects of these medications but also to their broader cultural impact on patients’ relationships with food, body image, and self-worth. As the evidence base matures, dedicated trials that include psychiatric populations will be essential to clarify both the therapeutic potential and the risks of GLP-1 RAs in the patients we treat.
Dr Suri is a psychiatry resident year 2 at BronxCare Health System in New York, New York, with interests in lifestyle psychiatry, preventive mental health, and evidence-based wellness interventions.
Dr Javaid is the current chief resident at BronxCare Health System in New York, New York, with interests in psycho-oncology, consultation-liaison psychiatry, systems of care, and resident education.
Dr Ali is a psychiatry resident year 1 at BronxCare Health System in New York, New York, with interests spanning toward a research field in psychiatry.
Dr Pathania is an outpatient psychiatrist at BronxCare Health System in New York, New York, actively involved in supervision and education of psychiatry residents.
Dr Mirhom is an assistant professor of psychiatry at Columbia University in New York, New York, a Forbes contributor, and chief well-being officer at Athletes for Hope.
Dr Gunturu is the vice chairman of education, research, and faculty development and the psychiatry residency director at BronxCare Health System in New York, New York. He is also an assistant professor of psychiatry at Icahn School of Medicine at Mount Sinai in New York, New York, and clinical associate professor at St. George’s University School of Medicine in St. George’s, Grenada.
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