Speaking of Psychology - Navigating the mental health impact of GLP-1s, with Rachel Goldman, PhD

Episode Date: November 12, 2025

Over the past several years, the rise of GLP-1 drugs such as Ozempic and Wegovy has changed the conversation around weight and obesity in the U.S. Rachel Goldman, PhD, talks about how GLP-1s work; the effects they can have on mental health; what questions to ask if you’re considering trying these medications; how weight loss can shift people's relationships with their family, friends and partners; and why there’s still stigma around the use of GLP-1s and how patients can navigate that. Find Dr. Rachel's new book at When Life Happens: The Mindset Shift You Need to Manage Stress, Build Confidence, and Break Free. Learn more about your ad choices. Visit megaphone.fm/adchoices

No one goes to Hank's for his spreadsheets. They go for a darn good pizza. Lately, though, the shop's been quiet. So Hank decides to bring back the $1 slice. He asks Copilot in Microsoft Excel to look at his sales and costs to help him see if he can afford it. Co-pilot shows Hank where the money's going and which little extras make the dollar slice work.

Now, Hank has a line out the door. Hank makes the pizza. Co-Pilot handles the spreadsheets. Learn more at M365Copilot.com slash work. Over the past several years, the rise of GLP1 drugs such as OZemPEC and Wagovi has changed the conversation around weight and obesity in the U.S. Once reserved for treating diabetes, GLP1s are now widely available. One recent survey found that 12% of American adults have taken a GLP1 medication

and another 14% are interested in doing so. For many people, the drugs have been life-changing, But along with physical changes, people taking GLP-1s often need to navigate new mental health, emotional, and relationship concerns. Now mental health professionals are thinking about how best to support people through these challenges. So how do GLP-1 drugs work? What should people consider when they're deciding whether or not to take them? What affects both positive and negative might these medications have on mental health? How does weight loss affect people's relationships?

with their family, friends, and partners, why is there still stigma around the use of GLP ones and how can patients navigate and protect themselves from that stigma? Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills. My guest today is Dr. Rachel Goldman,

a licensed psychologist in private practice in New York City and a clinical assistant professor in the Department of Psychiatry at NYU. Her practice focuses on stress management, eating behaviors, obesity treatment, and health behavior change. From 2011 to 2016, she served as senior psychologist at the Center for Obesity and Weight Management at Bellevue Hospital. In addition to her clinical work, Dr. Goldman is frequently featured as a health expert in the media, including as an expert panelist with Oprah and in publications, including the New York Times, Time, and USA Today. Dr. Goldman, thank you for joining me today. Thank you so much. I'm so excited to be here with you today and especially talking about this topic.

So thank you. Well, let's start with a basic question. How do these GLP1 drugs work? What's happening in the brain and the body when people take these medications? Yeah, such a great question. So GLP-1s actually mimic a natural hormone called GLP-1, which helps regulate blood sugar levels and promotes weight loss. So now to kind of take that to easier terms, so to say, what I always hear with my clients is that it helps them feel full faster and it also decreases food noise, which is a new

term that we've been hearing for the past few years now. but it's something that probably you and I have known about or seen in individuals for many years, but now we have a name for it. So really what we're seeing with GOP ones is that individuals are getting full faster. They're decreasing cravings and this food noise, allowing them to eat less food, and that is promoting weight loss, as well as helping the diabetes. There's also new research out related to heart disease and other things as well. And what's happening to people mentally as a result of taking these drugs?

Yeah. So, I mean, a lot of things are happening mentally. And I think first, you know, I want to just mention that these medications don't work for everybody. So the things that we're going to be talking about today is kind of like what we hear most of. But I have clients that it's not really working so well for them or they have really bad side effects. So, you know, kind of just keeping that in mind. What I have really noticed, with my clients and with individuals that have really been struggling with their health and their weight for years is that these medications are giving them hope when they have lost hope. And really what I mean by that is individuals that have been struggling with these messages that we've been told for years, eat less, move more. All of a sudden, now when they are maybe eating less and moving a little more, they're seeing change. Whereas before, I think a lot of individuals that have the disease of obesity would be doing those health behavior change and trying really hard, but not seeing the results that maybe, I don't

want to assume, but maybe somebody like you or I would, right? So for some people, eating a little less and moving a little more, works for them to get healthier and or to lose weight. And for some people, that doesn't do it. There's something in their brain that's telling them. you're still hungry or is really fighting that weight change or fighting the resistance and the medications are taking that kind of that piece away. So I like to say it's putting individuals that have struggled on an even playing field with people that really haven't struggled and that maybe going to the gym a little bit more, they're able to see that success and that change.

So I think we know that there are some positive aspects. to losing weight, especially if you've been trying to do so for a long time, and then you take one of these drugs, and you see it happening and you feel better. But what are some of the negative effects on people's psyche? Yeah. So, and I'm glad the way you frames that question, also because, you know, some individuals are also very happy in a larger body, and that doesn't mean that they have to lose weight, right? So some individuals have the disease of obesity or have struggled, and this is a goal of theirs, and we know excess body fat is not healthy and can lead to other diseases down the road as well. But some individuals, they have to be mindful of their weight loss

and we don't want individuals to lose too much weight, or maybe they don't need to lose weight, and they're healthy, and they're trying to get on these medications and losing more weight. So it really depends. You know, I like to remind people, everybody is a unique individual, and everyone has their stories and their struggles. So some individuals may already be feeling kind of low and have lower mental health, maybe have depression, anxiety, things like that. And these medications aren't necessarily going to just make that go away and or could be the opposite, right?

Like what is going on in your life right now is weight loss a good thing to add to the equation or not right now, right? So it's kind of like weighing the pros and cons and thinking where somebody is mentally and with their physical health conditions. So it really depends. Most individuals that I've seen, again, I would say that they are starting to feel better mentally and physically on these medications. Most, again, I can't speak to everybody, but most people as they're losing weight and they're getting healthier and they're seeing that what they're doing is working, they get a sense of, increase self-worth, increased self-esteem, increased body image. A lot of times people start to socialize more if they were isolating before, things like that. But it could work in the

other direction as well. So some individuals might be fearful to go out and socialize and go out to dinner because maybe they're only eating such a small amount of food now. And maybe they don't want to share that with others, right? Or they're not ready to share that with others. So again, I think it really depends where individuals are and what their goals are, but it can go either way, which is why I always say in a perfect world, everybody on a GLP1 would be seeing a dietitian and a mental health professional to help guide them and navigate this kind of really big change that's happening in their life. Well, that's an interesting point, and it raises a question of how people can think through whether these medications are right for them. So what are the

questions that people should ask themselves or their health care providers before they start on one of these drugs. And if their doctor will even prescribe. Yeah. So I think the first question is, are you or have you been struggling with your health and or your weight, right? And I like to put that overall again because just being a larger body doesn't mean that you're necessarily unhealthy. So that's the first question. Are you struggling? Another thing I always say is if the thought is there, It's the same as I say about therapy, actually. If you've been thinking about maybe going for therapy, it's probably a sign. Seek it out, right?

Ask, you know, get a mental professional. Maybe you have a consult. Maybe you decide it's not for you. If you're thinking, is this right for me? Is it something I should try? That should be a signal to talk to your health care professional about it. You know, make the phone call, make the appointment. It's been on my mind.

Is this right for me? And talk that through with your doctor. because really it depends on your medical history. It depends on so many things that really just you and your health care professional together can make the best decision. Things I also like to keep in mind, though, is if somebody has a history of an eating disorder, I would actually really want to be closely monitoring that person if they decide to go on a GLP one.

Again, there is this lesser appetite that comes. along with it, which means it's working, but we don't want it to work too well either. So, you know, if you do have a history of an eating disorder, I would really recommend not only speaking to your healthcare professional, but also getting a therapist or hopefully you have a therapist that can help guide you through this as well. I would say those are the main things to first get you in the door to talk to your healthcare professional about. And then, like I said, it's really the decision is yours and your doctors.

And I really emphasize the yours and your doctors because there's a lot of messages out there. There's a lot of opinions out there. And nobody knows what is right for you and your body and your health besides you and talking with your doctor about it. And I know we're going to get to the shame and the judgments in our conversation as well. But that's why I like to emphasize that. Because if this is something that you've been struggling with, this is a treatment option that is available.

and it works for many people. Again, a lot of people have some bad side effects and things, but it works for many people. And it's something that you could totally consider and should be considered. Now, you see people in your practice who are on GLP 1 or would like to be on a GLP 1. Now, what if the physician says, I don't think you're a candidate and the patient says, I still want it? And there are places where you can get it.

what do you say to those folks? And are there safer distributors than there are some better than others? Sure. And that's, that's a tough one because, you know, I don't think all physicians are really up on the science and the research and what's going on with GOP ones. So I think some individuals or some physicians right away are just like, no, I don't think you're a candidate. I don't want you want it. And if that's the case, if you feel like your physician may just not be on board because they don't fully understand, I would actually say to seek out an obesity medicine specialist and or see an endocrinologist that really specializes in this area because not every primary care physician is going to be comfortable prescribing this. And then, of course, you have the

individuals that I would say don't really meet criteria and still want it. Right. So yes, there's places out there, unfortunately, that you can get it. But again, I would want individuals to be really seeing a health care professional who is trained in this area and knows what they're doing with the prescriptions. Some people kind of go up too quickly in the dosages and then they have worse side effects. And also with any medication, they are tested through all the clinical trials. There's research. out there, their FDA approved and indicated for something, and there's certain criteria for a reason. So, you know, whenever we hear these things of, oh, this side effect or that side effect, my question is always, well, if the people that are on the medications or ones that the medication is made for, you might not be having some of those other side effects. So to just be extra mindful of that. And yes, we are learning more, you know, about GOP ones every day, more research is coming out, more medications or even being developed as we speak. Right now, they're once a week injectables.

There's going to be daily tablets pretty soon. There's going to be weekly tablets. There's all these things in the works coming out. So we're learning more every day also. But I would really want individuals listening to go to a health care professional that is up in the research and is trained in this area. And that might need seeing an endocrinologist or an obesity medicine specialist. We're going to take a short break. When we return, I'll talk to Dr. Goldman about why there's still a stigma around GLP1 use and how patients can navigate and protect themselves from that.

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losing weight the right way. How can people do that? deal with these judgments from others and even from themselves. Yeah. It's so unfortunate because I think individuals experienced stigma and shame when they weren't getting treatment, right? And now they're experiencing stigma and shame when they are getting treatment. So it's almost like it's a no-win situation, which really sucks. And I really, you know, I hate that for my clients.

I hate that for people listening and that are experiencing that. because unfortunately we live in a world that judges. As humans, we judge, unfortunately again. We do. But we live in a world that really stigmatizes individuals in larger bodies and or now, quote, taking the easy way out. I don't believe that that's the case, which is why I said, quote. But so it's very difficult. And I don't want to sit here saying, just ignore that because it's difficult and people internalize those messages. and then experience, you know, their own shame and stigma around it as well. So a few things I want to say about that is first, yes, we live in a society, unfortunately, that I think has glorified or thrived on thinness.

And I think that's, of course, kind of where this begins and part of the problem. For years, we've all seen the magazines, the media and all of this about lose weight, lose weight, lose weight. So there's that. And because of that, individuals have internalized that and think that being thin is better. That's not necessarily the truth. You know, individuals can be in a thin or smaller body and not be healthy, just like individuals can be in a larger body and healthy or not healthy. Again, a decision for you and your health care team.

But what I will say is, A, you don't need to tell whoever you don't want to tell, whatever you decide to do when it comes to your health and your body. So we are not all out there blurting if we're on this medication or that medication when it comes to any other health condition. So why do we have to be telling people what we're doing when it comes to our weight or, again, overall theme of health? So that's one thing I'm going to say. And the unfortunate part is I often say this, but it's so true. We don't have post-it notes on our forehead telling the world what we're struggling with, right? But unfortunately, if we live in a larger body and all of a sudden lose weight or whatever body we live in and we lose weight, unfortunately, people's notice. Right.

That is one thing we notice. If I colored my hair, someone's going to notice and make a comment, right? That's something that we see. It's our appearance. But like nobody's asking what our shoe size is, right? It's our shoe size. It doesn't change. Well, sometimes it does.

But in general, it doesn't. So let's be quiet. when it comes to people's body shape and size, right? Don't comment on people's body shape and size. We don't know what people are going through. And especially because this is a psychology podcast, I'm going to say this also. Sometimes when you comment on people's body shape and size, you could be reinforcing a negative behavior, meaning somebody could be doing something unhealthy and you're like, wow,

you look amazing. And that then triggers to that person, oh, I'm going to keep doing what I'm doing. because I'm getting on these conglaments and that feels really good, but it could be really harmful and unhealthy. So first role is just don't comment on people's body, shape, and size, because we don't know what they're doing. And then I would say remind yourself that you don't have to tell people if you don't want to.

But I would say to try to get a select group of people that you can confide in or you can get support in because it's also something that you don't want to be fully doing. alone, you want to be able to talk through some of these things, maybe with loved ones, supportive friends. You want to have that in your life also to be happy for you that you are taking your health in your control and seeking treatment for something that maybe you've really been struggling with. But it's hard. I hear this from clients. I comment on it a lot in media related to, you know, this one must be on this because they're losing weight and like, you know, how to deal with all of that can be quite challenging.

So I want to talk a little more about some of the psychological effects. There have been conflicting studies about links to depression and patients on GLP-1s. Where's the research on this now? Yeah. So again, I think there's more research coming out all the time related to this. And my question always goes back to, well, what were they experiencing before? Right. Like, we can't make the assumption that just because they're on a GLP one and they're having high levels of depression, that that's the link, right? We don't know what the cause is. Many times there could be a correlation or maybe it's exacerbated or not, but we don't really know. So, you know, more research is coming out on that and now that people have been on these medications for a little bit

longer because the rise of JLQIwans, I think, was maybe three, four, even five, you know, a few years ago at this point. So we really don't know. And again, this is why it's so important that you talk to your health care professional about this. Is this right for me? If you were somebody that's really struggling with depression right now and the depression is related to your wheat and your social life and maybe you're isolating because of

your weight, then maybe a J.O.P.1 might be a good option for you. under supervision with your health care team. But if you were somebody that's really struggling with depression and it's not related to your we, not related to your social life and these other things, maybe there's other things you should be doing first to get your depression under control and well managed before you add another medication that could worsen or better the depressive symptoms, right? So it's really a unique individual choice, again, with you and your health team to figure that out. You know, there have also been news articles recently about ozempic divorce.

Is that something real? I mean, how do GLP-1s and weight loss more broadly affect people's relationships with their partners and their family and friends? Yeah, you know, it's so interesting those headlines because I remember it was a few years ago, could have even been several years ago, at this point, that there was a similar headline with bariatric surgery. And I digged into the research a little bit more because I remember being interviewed about it. And yes, the headline was like kind of true but kind of not true.

And what I mean by that is like maybe the, I forget what the divorce rate in America is right now. But whatever it was, it's like a, you know, not a huge number. And it was double that like for bariatric surgery. But it was a small number doubled. But like the headline was like post-bariatric surgery. doubles divorce rate. Like, yes, but a little misleading, right? So first, I just want to remind people, please read the articles and look at the research. Don't just read the headlines because our brain wants to, oh my God, is that going to happen to me without really understanding what's

going on. But with that being said, any change. Now, the change could be, I decide to go to the gym more, so I'm not going to be sitting at home with my partner watching TV. The change could be we're making a change and we're going to eat healthier at home and maybe my partner's on board or maybe my partner's not on board, right? So these, what comes along with either being on a a GLP1 or Bayerathic surgery also mean other changes in your life. You're not just getting surgery or you're not just taking a medication. Hopefully you're making those behavior, lifestyle changes as well. And that could impact relationships simply by just making those changes without even introducing the actual surgery or GLP1 medication.

So have I seen relationships struggle after starting one of these treatment options or after weight loss? Yes. And what I would say is my recommendation is talk to your partner about this ahead of time. Are they supportive of you doing this? I'm not saying not to do it if they're not supportive because it's your health and your body. But talk about this and talk about things that might arise, right? Like is your partner going to be on board that maybe you're, going to make a different meal for the household, or maybe you are going to want to go on evening

walks after dinner. You know, I kind of always use this example, but you have to create new rituals with your partner. If old rituals aren't going to fit in to this new lifestyle that you're trying to incorporate into your life, meaning if you used to sit on the couch and eat ice cream after dinner every night together. There's nothing wrong with that. But you might decide that you don't want to do that anymore. Or you might not crave ice cream anymore. I hear this often with people on GLP-1s. You might decide, I want to go take a walk or I want to go to the gym. Well, is that going to impact your relationship with your partner? Maybe your partner's still going to want to do that. What is that going to mean for the dynamic of the relationship and how is that going to shift?

It does not have to mean divorce, right? We don't need to jump to that. It just means better communication, getting the support, and finding new rituals that work for both of you. And I've also seen articles about something that they're calling ozempic personality, which refers to a cluster of mental health issues, including increased anxiety, depression, and a lack of interest in some of the activities you used to. enjoy. Is that another myth that needs to be busted right here? I think so. Yes. And again, we could say that about anything, right? Again, not to repeat myself, but kind of to repeat myself, with this medication, you know, hopefully people are doing the lifestyle and behavior changes. With that, other things change. So, you know, I do a type of therapy called CBT, Cognitive behavior therapy. For anyone listening that doesn't know what that is, the basic premise of it is our thoughts, emotions, and behaviors are all linked. So if we use GLP-1 medication for a moment as an example,

if you change the behavior by taking a medication and then you change other behaviors, that's going to change the way you're going to think about things, and that's going to change the way you're feeling about things. So it's all related. So could things change in your quote personality? Yes, know, right? Like, your personality isn't going to change, but you might not be as interested in, again, I don't know why I'm using ice cream as an example for everything, but you might not be as interested in going out for ice cream with your friends. You may instead be like, hey, let's go on a walk and talk and meet up instead of grabbing dessert together tonight, right? Like, you might want to change the way that you're living your life. And that's not a bad thing necessarily. And again,

And, you know, and or I will say also, and this goes for anybody, if you're on a GOP 1 or not, if you're not eating enough food, there's realness to being hungry, right? When you're hungry and you're angry and you get irritable. So these are things that I am noticing with people that are on GOP 1s that aren't getting enough food or eating regularly. So again, GOP 1s are working by also making you full faster and limiting the amount of food you're eating. I just had a client earlier today that was like, she just upped her dose and was like, I have zero appetite. And I was like, that's a problem, right? Like,

we need you to start, we need to make sure you're eating regularly. So for some people, it's a little bit forcing yourself to eat a little bit something. If any of us restrict what we're eating or we're skipping meals, we're going to get irritable. We're going to get angry. We might get depressed. We might lose joy in certain things. So again, you know, I think a lot of these headlines are making a big jumps and missing what's happening in the in-between. And again, this is why it's so important that people are being followed by individuals that are really trained in this to note what questions to ask, right? Like I supervise psychiatry residents also, and one of them had asked me one day,

you know, I have a client that's or a patient that's on a GOP1, with, they're getting really nauseous. Should I just tell them to talk to their doctor about lowering their dosage. And I was like, well, let's explore it a little bit, right? Like, what time are they taking the medication? Are they taking the medication on an empty stomach, on a full stomach? Did they drink enough water? Did they get enough sleep? Like, we can't make this immediate connection that it's just the dosage or it's just the GOP one. There's some behaviors that we can be looking at. And as a mental health professional, I'm not the prescribing physician, but I can help my clients navigate that

and then say, now I want you to go back to your prescribing doctor and let them know. I'm getting really nauseous, but I also realized I'm taking the medication on an empty stomach. Let me try this before we lower the dose, right, as opposed to just jumping to that. And that's where I think, you know, this conversation is so important that mental health providers can be doing this kind of curiosity and investigative and navigation work with our clients and guide them in then having these conversations with their prescribing doctors as well. What about people who reach their goal weight and then decide that they want to stop taking the medications? What issues might come up for them and what kinds of support might they need?

Yeah, such a great question. We've been kind of hearing about this for a while. I have this question of when I get my goal weight or when I meet my goal week, can I stop the medication? And it's kind of a difficult question to answer. But the way that I like to answer it is if you have the disease of obesity, it is a disease that has to be managed for the rest of your life. So for most people, you have to have some treatment that you are using. And I say that vaguely some treatment that you're using for the rest of your life to manage it. That could mean just lifestyle behavior change for some. It could mean a lower dose of the medication for others. We don't know. But if you are on a medication for hypertension and you all of a sudden,

your blood pressure is in the normal range, for most people, they're not just going to stop the medication, right? Like, it's working because you're on the medication. So I think that's really important for people to hear, again, if you're struggling with the disease of obesity, if you're on the medication just for weight loss and maybe didn't really get it for the reasons it's indicated for, I'm not speaking to that person, you know, in this conversation. But again, that's a conversation that needs to happen with you and your doctors. For some people, they're going down a dosage to see maybe it's more like a maintenance dose. for some, they might go down, dosing, and then try, I don't want to say doing it on their own because it didn't work before on their own, right? But kind of like figuring that out and navigating it.

But I do think it's important to remember the medication is working if you hit the goal weight. And we don't necessarily want to just now eliminate that factor because that's the treatment that's been working for you. So cold turkey is not advised. Definitely not. Again, I would be very mindful of even decreasing the dosage too quickly, like with lots of medications. You want to kind of very slowly titrate down and, again, be supervised by your prescribing physician in terms of how to do that and what that's going to look like. Anything else you want our listeners to know about GLP1s and psychology, physiology, anything else that, that, you know,

you're noticing as you work in this area? Yeah, I mean, I guess the main thing that I've really seen, you know, and we didn't really talk about it too much, but we touched on it is the food noise aspect. And I think it's really fascinating because I have clients that will start the medication. And for some, they notice a decrease in the food noise. Like, I like to think of it as like volume. Like, it gets a little lower in the volume. It's a little quieter, the chatter, the food chatter. And for some people, they're like, oh, my God, it's just gone. Like, it is gone. They have no cravings.

They, you know, don't think about food the way that they did before and they can enjoy food and on a whole new level. And I think it's really interesting because I think decreasing that food noise is actually allowing individuals to work on their relationship with food and mean even to do like the CVT work related to body image or their depression or other things. Whereas before, the food noise was so loud that it really just took up so much mental space for a lot of my patients. So I think if you're struggling with food noise, you know, it's another thing to maybe talk

to your doctor about if this could be right for you. And, you know, everybody's experience is different. So I think if you know people that this is working great for, you know people that it's not working well for, or you know people that have bad side effects or you don't, you know, go into this with an open mind and just be very mindful and try to tune in to yourself and understand what this is doing for you. Because I do think that we all live in a society that we just go, go, go, go, go, and we're ignoring a lot of the messages and signals and signs that our body is giving us, which for some people, that could even be a hunger or fullness feeling. And a lot of people

on GLB-1's also are saying, wow, like, I'm satisfied and I'm stopping. Whereas before, maybe they've never really were tuned into those hunger or fullness cues. And again, the decrease in the food noise is allowing that to happen now as well. So before we go, I just want to tell our listeners, you have a book coming out. So let's tell people what's the book? Once it's going to be available? Yes, I really appreciate that. Thank you so much. And although it's not about GOP-1s, there is a whole chapter on body image. And it is more about providing CBT tools to, people to help them decrease stress, build confidence, and break free, which is actually the subtitle of the book.

So the book is called When Life Happens, The Mindset Shift You Need to Manage Stress, Build Confidence and Break Free. It is available now, actually, for pre-order and will be released. Publication Day is April 7, 2026. But people can find me at Dr. Rachel, NYC, on social media. or Dr. Rachel NYC.com. You can learn more about my book and pre-order it there as well. So thank you.

All right. Well, Dr. Goldman, I want to thank you for joining me today. It's been very helpful. Awesome. Thank you so much. You can find previous episodes of Speaking of Psychology on our website at speakingofpsychology. Or on Apple, Spotify, YouTube, or wherever you get your podcasts. And if you like what you've heard, please follow us and leave a review.

If you have comments or ideas for future podcasts, you can eat. email us at Speaking of Psychology at APA.org. Speaking of psychology is produced by Lee Wynerman. Thank you for listening. For the American Psychological Association, I'm Kim Mills.