CBT May Help You Manage Mental Health Side Effects

While taking anti-obesity medications like Ozempic and Wegovy, people may experience freedom from food noise, a shift in cravings or desires to eat, and the weight loss. However, Robyn Pashby, PhD, licensed clinical health psychologist and founder of DC Health Psychology, said pre-existing mental health challenges may also accompany use of these medications.

“Those with a history of disordered eating (such as over restriction, binge eating, emotional eating, etc.) may continue to have difficulty in changing the habits and patterns of eating that cause them distress and affect their health and weight,” she told Healthline.

This is of particular concern once these medications are no longer taken, as research shows that people most likely gain back weight that they have lost once medication is stopped.

“Therapists are trained to help a person cope with their presenting issues whether that is through talk therapy, medication use, comprehensive group programs, or other mechanisms,” said Pashby. “Finding a therapist that specializes in obesity or weight-related issues is very important for those struggling with the mental health aspect of [anti-obesity medication] use in the same way you wouldn’t see a cardiologist to help you manage a broken arm.”

New mental health concerns may arise while taking anti-obesity medications due to adverse effects from the medication. For instance, because Wegovy contains high levels of semaglutide (more than Ozempic), its label states that there is risk for the following mental health side effects:

• anxiety
• depression
• suicidal ideation and attempt

While a therapist can help manage these conditions, if you or a loved one actively have a plan and intent to harm yourself, dial 988 to reach the Suicide and Crisis Lifeline for immediate help.

Indirectly related to the medication, Pashby said people may struggle with body image concerns activated by weight change. In some cases, they may be shamed for losing weight with a drug.

This is because for decades, the idea that weight loss is a matter of self-control and discipline has contributed to the idea that ‘success’ with weight loss reflects a strong sense of self-control.

“Therefore, if a person loses weight on Ozempic or other [anti-obesity medication], it can feel like they ‘took the easy way out,’” said Pashby. “Taking the easy way out is euphemism for failure. I have seen so many people struggling with a feeling of failure if they do lose eight while using an [anti-obesity medication], similar to how one pursuing bariatric surgery may feel.”

The body positivity movement, which is an effort to combat weight-related stigma and shame, may also contribute to shame in a sense, she added. While Pashby believes it is an important and useful guidepost, she said body positivity can easily become a form of toxic positivity.

“Some clients have reported that they feel pressure to love, accept, and not try to change their bodies no matter what,” Pashby said.

In other words, taking an anti-obesity medication and enjoying the body changes that may follow can feel like a failure or a sense of giving up on body positivity.

“People can feel like they can’t win. Ashamed to live with obesity and ashamed to treat it,” she said.

Working with a therapist to address the many sources of shame that accompany weight and eating issues can help with healing.

For those who lose weight on medication, they may experience social anxiety because they aren’t comfortable with the newfound attention they receive.

“Almost all human beings struggle with self-identity and self-worth to a degree and this varies person to person but does not go away simply by achieving your ideal weight,” said Rizk.

He has witnessed patients reach or approach their goal weight but not feel the satisfaction they expected, or the support they anticipated from friends and family.

“CBT is excellent for helping a patient move forward in this situation, form coping mechanisms for these new feelings and for their new sense of self,” he said.

As social beings, Pashby said people are constantly evaluating themselves and others.

“So when people change, the world around them treats them differently. This shift can result in significant anxiety, confusion, or other concerns,” she said.

Additionally, when a person loses weight, body image doesn’t always follow accordingly, said Pashby. Some people still “see” themselves as the weight they were before.

“Some people describe it as waiting for their ‘brain to catch up’ to their body changes,” she said.

A therapist trained in body image and obesity can help people understand their body image changes as their weight changes.

“They can also help people manage the impact of changes in the way they are treated by others. Working to reduce internalized weight bias, cope with continued weight stigma, and manage anxiety that arises from societal pressures are just some of the ways a therapist can help,” said Pashby.

For people who do not respond to anti-obesity medication, she said the disappointment can be difficult to process.

“By incorporating a CBT approach alongside medication use, people are able to challenge and change unhelpful thinking or behavior patterns, address body image concerns, and navigate the emotional ups and downs that are part of long-term treatment,” said Pashby.

Therapists who conduct CBT utilize a variety of strategies to help people move forward and develop more effective coping mechanisms, said Rizk.

While a therapist will personalize these strategies to each patient, the following are some ways CBT can help a person change thinking patterns:

• Recognize distortions in thinking that are problematic and how to reevaluate them.
• Gain a better understanding of how others behave and their motivations.
• Utilize problem-solving skills to cope with challenging situations.
• Learn to become more confident in one’s abilities.

CBT may also teach a person how to change their behavioral patterns by:

• Facing their fears rather than avoiding them.
• Engaging in role playing to prepare for difficult encounters with people.
• Learning ways to calm their mind and relax their body during challenging scenarios.

While taking anti-obesity medications like Ozempic and Wegovy can provide health benefits, seeking therapy from a trained therapist while on these medications can help people manage existing mental health conditions, such as disordered eating, and new ones that may arise, such as suicidal ideation.