Why GLP-1 patients need access to behavioral health support

All anyone in obesity care seems to be talking about these days is GLP-1s, which is drawing plenty of attention among benefit brokers and advisers who are talking with their employer clients about offering and managing the cost of these drugs. 

The historic weight loss, along with a high price tag, side effects, impact on lean body mass and weight regain are all hot topics. But as an eating disorder and obesity specialist, I am mystified about why we are not also talking about behavioral health — a known risk factor for and comorbidity of obesity. Those of us who have worked in obesity care for a long time know that undiagnosed or untreated behavioral health conditions are often at the heart of why obesity treatment doesn't succeed. We can (and should) do more.

Taking GLP-1s clearly can help patients lose weight, and in some instances, when they are able to keep that weight off, their mental health has been shown to improve. Studies also have estimated that fewer than 50% of those taking GLP-1s for weight loss are still taking the medications after a year, and those who discontinue may regain two-thirds of the weight lost on average. 

Read more:  Employees need more than GLP-1s to manage their weight

Obesity is associated with increased odds of mood and anxiety disorders, including more serious mental health conditions such as schizophrenia and bipolar disease. Mental health challenges in many ways impact a person's behavioral health, as well as their ability to lose weight. Stress can lead to emotional eating, which can be reduced by developing healthy coping strategies. Depression manifests as a lack of motivation and low energy, which can make exercise more difficult. Binge eating behavior can lead to over-eating and circumventing GLP-1 effects. All of these factors limit weight loss on treatment and can lead to weight regain.

Bariatric surgery has been shown to be an effective weight loss option for patients with class II or III obesity and often requires psychological assessments due to the intensive prep and post-op care required. These assessments screen for depression, anxiety, disordered eating, substance use, and other conditions that could impact weight loss or lead to serious complications. 

In addition, surgery programs want to know if patients can adhere to the diet and lifestyle requirements post-surgery. Given the expense and risks associated with the surgery, patients with significant behavioral health concerns may not be eligible. Many bariatric surgery programs also have multi-disciplinary teams including social work, nutrition and psychologists that can complement the surgical treatment with behavioral support essential for treatment success.

Read more:  It is possible for employers to balance anti-obesity GLP-1s access with costs

So, why aren't we also offering these behavioral health services to our GLP-1 patients? Even though surveys suggest one-in-eight Americans have tried GLP-1s (15 million), many patients have been largely left to figure out how to take the medication and maintain the weight loss on their own. For many, behavioral health screening and support is largely absent from GLP-1 prescriptions provided by primary care or online virtual care solutions. In my view, it's irresponsible given the need.

What should employers, their advisers and healthcare professionals be doing about this? They should be taking the lead from bariatric surgery programs and follow two essential steps to achieve positive outcomes:

●      Pre-screening for behavioral and mental health issues. There needs to be a greater level of medical oversight when considering prescribing the medication. This is an enormous challenge given the ease of access to telehealth prescribing and lack of PCP oversight.

●      Comprehensive care during usage. Simultaneous to taking GLP-1s, patients need greater access to support teams, including pharmacists, behavioral health specialists, nurses and coaches. Their goal is to combine responsible drug taking with the behavior awareness and lifestyle management essential for long-term benefit.

Read more:  Do your employees need Ozempic? How to include GLP-1s in your health plans

Some companies and healthcare providers already do behavioral health screenings before prescribing GLP-1s, but the rest of the industry – mental health and obesity organizations and physicians – need to get on board with screening and providing additional behavioral health support. If behavioral health concerns were properly addressed, I believe we would see more sustained weight loss over time.