Weight Loss Is Not a Substitute for Healthcare: Part 4 - Case Study
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In part 1 we discussed the basics of substituting weight loss for healthcare and accommodation. In part 2 we discussed issues with the likelihood of achieving weight loss, even if it was appropriate to insist that higher-weight patients become thinner before accessing care (and I don’t believe it is.). In part 3, we discussed the issues with weight loss being promoted as a solution to accessibility. Today we’ll look at a real experience with this. Many facilities, including physical and mental health in-patient facilities fail to have beds, chairs, lifts, imaging equipment etc. that appropriately accommodates higher-weight people. Instead of accommodating them, currently they can simply refuse to admit them.
I recently heard from a reader who wishes to remain anonymous about an upcoming presentation at her University in which a DO, MD, and PharmD where going to present a psychiatry grand rounds about GLP-1s for weight loss for inpatient psychiatric units, including for "barriers to placement” for higher-weight patients (meaning weight limits for inpatient care.)
She asked me for some research to use during the Q&A and I’ve included that below. She described the talk like this:
Basically it ended up being a thoughtless presentation. They presented a case study as the basis of the presentation - a man with schizophrenia, who had been off and on antipsychotic meds for a long time and a lot of psych hospitalizations, each time very hard to place him in a facility due to [the lack of accommodation for his size.] And then they focused mostly on his weight fluctuations and graphed out his weight gain in relation to antipsychotics being changed in dose and type. They honed in on his weight when it hovered between 420-450lbs, which is when they started the GLP-1. When they decided to introduce the GLP-1 tirzepatide, he had recently gained 18lbs for various reasons- I think they were associating it with a change in his antipsychotic. Then they patted themselves on the back when he lost 24lbs on the GLP-1. He was not losing weight initially and they had to go up to max dose. They did not mention concurrent diabetes so they did truly use this for weight loss purposes.
Despite the 24 lbs weight loss - which is really not a significant percentage based on his weight - his BMI was still way over the requirements for most hospitals, it really did not make a difference. Then they proudly reported how they ended up getting him the appropriate size bed which is apparently special order.
This is so frustrating, but it also clearly shows the real solution here. As we discussed in part 2, there was almost no chance that tirzepatide would result in this patient losing enough weight to be accommodated. I think it’s also important to note that there is a body of research suggesting psychiatric adverse events with this class of drugs and it doesn’t seem like that was considered by the care team or discussed in this presentation.
The reader further explains:
Myself and two of my mental health colleagues commented several times in the zoom chat but they did not leave time to answer questions. I asked what the psychiatric side effect risks were, and how did they ethically rationalize this given the man's severe mental health symptoms. I also commented that the weight loss did not seem to make any difference in the premise of their presentation about him being hard to hospitalize. And I asked about the ethics related to informed consent when an individual is so impaired to be admitted to a psych hospital to start this new medication with limited research. I pointed out how he consistently stopped taking his antipsychotics -so how long did they expect he'd stay on the GLP-1 given this history alongside the fact that almost everyone eventually goes off of it and regains the weight back.
Those are all important questions and it is problematic that they weren’t answered, but I would argue that it’s actually more problematic that they had to be asked instead of being discussed as part of the presentation. I’m also concerned that their title and talk description would give people who didn’t actually make it to the talk a false impression.
While the solution can be simple (create facilities that accommodate patients of all sizes) it is also far from easy. Healthcare suffers from a combination of being vastly under-funded and/or being used as a profit center in ways that consistently and on a massive scale put profits over human life including both patients and providers.
In part 5 we’ll wrap this up by talking about what can be done to solve this issue in the short and long term so that weight loss isn’t substituted for healthcare and accommodation.
Below you’ll find the research list that raises concerns about prescribing GLP-1s to those dealing with psychiatric disorders. I’ve included brief summaries of each, and please note that the links may include weight stigma.
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More research
The Research Post
More resources
The Resource Post
*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Research List
Chen Wei , Cai Peishan , Zou Wenbin , Fu Zhiwen. 2024. Psychiatric adverse events associated with GLP-1 receptor agonists: a real-world pharmacovigilance study based on the FDA Adverse Event Reporting System database. Frontiers in Endocrinology. Volume 15 https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1330936
https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1330936/full
This is a very thorough review of the research around psychiatric disorders (though not specifically in in-patient populations) that concluded
“Still, caution is required because the adoption of general medical treatments into psychiatry (for example, insulin therapy) has sometimes led to deleterious consequences for patients. Conscious of the importance of all the above, we argue for the need of and inquisitive mechanistic and clinically applied research to inform stakeholders about the potential benefits and harms of GLP-1RAs. This should include a more accurate, scientifically sound and perhaps sober guidance of the communication between the media and the public.”
Preliminary Data Show Over One-Third of Patients With Psychiatric Diagnoses Visit ED After GLP-1 Initiation, Aislinn Antrim, Managing Editor, May 5, 2025
This is a recent article from a Psychiatric Journal that quoted a recently presented paper finding that:
“Over one-third of patients with pre-existing psychiatric diagnoses had psychiatric emergency visits within 60 days of starting GLP-1 treatment.”
Kornelius, E., Huang, JY., Lo, SC. et al. The risk of depression, anxiety, and suicidal behavior in patients with obesity on glucagon like peptide-1 receptor agonist therapy. Sci Rep 14, 24433 (2024).
https://www.nature.com/articles/s41598-024-75965-2
“After matching, the study included 162,253 case and control patients. This study showed a significant association between GLP-1 RA treatment and a 98% increased risk of any psychiatric disorders. Notably, patients on GLP-1 RAs exhibited a 195% higher risk of major depression, a 108% increased risk for anxiety, and a 106% elevated risk for suicidal behavior. “
Salvo F, Faillie J. GLP-1 Receptor Agonists and Suicidality—Caution Is Needed. JAMA Netw Open. 2024;7(8):e2423335. doi:10.1001/jamanetworkopen.2024.23335
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2822457
This is an invited commentary that offers an overview of evidence around suicidality and, to some extent, depression and summarizes:
“the position of the US FDA recommending caution continues to be reasonable. Whatever the cause, depression or suicidality are rare but extremely severe events and need to be prevented and managed as much as possible. Waiting for more precise data, GPL-1 receptor agonists, and appetite suppressants in general, should be prescribed with great caution in patients with a history of depression or suicidal attempts, while in patients with new onset of depression without other apparent precipitants, immediate discontinuation of GLP-1 receptor agonists should be considered”
Robertas Strumila, Aiste Lengvenyte, Sebastien Guillaume, Benedicte Nobile, Emilie Olie, Philippe Courtet, GLP-1 agonists and risk of suicidal thoughts and behaviours: Confound by indication once again? A narrative review, European Neuropsychopharmacology, Volume 87, 2024, Pages 29-34, https://doi.org/10.1016/j.euroneuro.2024.07.001.
https://www.sciencedirect.com/science/article/pii/S0924977X24001573
This paper, while more positive about the drugs than I think is supported by evidence, suggests a possible mechanism by which these drugs may increase suicidal thoughts and behaviors which might be helpful to ask about
“Disruptions in homeostasis from quick weight reduction can elevate cortisol and norepinephrine levels, heightening the risk for, or exacerbation of STB. Psychological factors, including unfulfilled expectations and identity changes after significant weight loss, compound these risks.”
A reminder - if studies claim that depression/anxiety/suicidality are reduced we have to ask if there was a mechanism to determine if the effect was due to the medication itself or simply due to the patient (at least temporarily) reducing the weight stigma they experience by changing their body in a culture where weight loss is celebrated?For example, were similar results seen in thin patients and/or patients who didn't lose weight? Was there another mechanism to determine causation?
Wow. That grand rounds was AWFUL! Seems like experimenting on psych patients without consent.
Reference list is an amazing resource for this psychologist. Thank you!