Kim Mills: 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 US. Once reserved for treating diabetes, GLP-1s are now widely available. One recent survey found that 12% of American adults have taken a GLP-1 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 effects, 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-1s 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.
Rachel Goldman, PhD: Thank you so much. I’m so excited to be here with you today and especially talking about this topic. So thank you.
Mills: Well, let’s start with a basic question. How do these GLP-1 drugs work? What’s happening in the brain and the body when people take these medications?
Goldman: 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 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 years, but now we have a name for it. So really what we’re seeing with GLP-1s 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 with diabetes. There’s also new research out related to heart disease and other things as well.
Mills: And what’s happening to people mentally as a result of taking these drugs?
Goldman: So I mean, a lot of things are happening mentally, and I think first 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 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 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 changes 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 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 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.
Mills: 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?
Goldman: Yeah, and I’m glad the way you framed that question also because some individuals are also very happy in a larger body, and that doesn’t mean that they have to lose weight. 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. 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. Or it could be the opposite. What is going on in your life right now? Is weight loss a good thing to add to the equation or not right now? So it’s kind of 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 increased 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 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 GLP-1 would be seeing a dietician and a mental health professional to help guide them and navigate this kind of really big change that’s happening in their life.
Mills: 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 healthcare providers before they start on one of these drugs—and if their doctor will even prescribe?
Goldman: 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 in 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, 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 healthcare professional about it, 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 healthcare 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-1, 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 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.
Mills: 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? Are there are some better than others.
Goldman: Sure, and that’s a tough one because I don’t think all physicians are really up on the science and the research and what’s going on with GLP-1s. 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 on 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 healthcare professional who is trained in this area and knows what they’re doing with the prescriptions. Some people kind of go up to 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, they’re FDA approved and indicated for something, and there are certain criteria for a reason. So 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 are 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 about GLP-1s every day. More research is coming out, more medications are even being developed as we speak right now. There are 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 healthcare professional that is up on the research and is trained in this area. And that might mean seeing an endocrinologist or an obesity medicine specialist.
Mills: Let’s talk about stigma. We’ve been sort of dancing around that. There’s long been weight stigma in our society, and now people are facing stigma around the GLP-1 drugs. There’s an idea that people are somehow cheating and not losing weight the right way. How can people deal with these judgments from others and even from themselves?
Goldman: Yeah, it’s so unfortunate because I think individuals experienced stigma and shame when they weren’t getting treatment, 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 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 and larger bodies, or now quote “taking the easy way out.” I don’t believe that that’s the case, which is why I said quote. 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 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. 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 healthcare team.
But what I will say is 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. 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. 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. That’s something that we see, we, it’s our appearance, but 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. 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 all these compliments, 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. 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 this, one must be on this losing weight and how to deal with all of that can be quite challenging.
Mills: 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?
Goldman: 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? We can’t make the assumption that just because they’re on a GLP-1 and they’re having high levels of depression, that that’s the link. 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 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 GLP-1s I think was maybe 3, 4, even 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 healthcare 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 weight and your social life, and maybe you’re isolating because of your weight, then maybe a GLP-1 might be a good option for you under supervision with your healthcare team. But if you were somebody that’s really struggling with depression and it’s not related to your weight, 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. So it’s really a unique individual choice, again, with you and your healthcare team to figure that out.
Mills: There’ve 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?
Goldman: Yeah, 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 dig into the research a little bit more because I remember being interviewed about it. And yes, the headline was kind of true, but kind of not true. And what I mean by that is maybe—I forget what the divorce rate in America is right now, but whatever it was, it’s not a huge number. And it was double that for bariatric surgery, but it was a small number doubled. But the headline was like: Post-bariatric surgery doubles divorce rate. Yes, but a little misleading. 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 jump 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. What comes along with—either being on a GLP-1 or bariatric 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 GLP-1 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, your health and your body, but talk about this and talk about things that might arise, right? 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?
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 into 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.
Mills: 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?
Goldman: I think so, yes. And again, we could say that about anything. Again, not to repeat myself, but to repeat myself with this medication. Hopefully people are doing the lifestyle and behavior changes with that. Other things change. So I do a type of therapy called CBT, Cognitive Behavioral 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. It’s all related. Could things change your quote “personality”? Yes and no, right? 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. You might want to change the way that you’re living your life. And that’s not a bad thing necessarily.
And again, and—or I will say also, and this goes for anybody if you’re on a GLP-1 or not, if you’re not eating enough food, there’s realness to being hangry 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 GLP-1s that aren’t getting enough food or eating regularly. So again, GLP-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. 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, 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 know what questions to ask. I supervise psychiatry residents also, and one of them had asked me one day, I have a client or a patient that’s on a GLP-1 and 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? 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? We can’t make this immediate connection that it’s just the dosage or it’s just the GLP-1.
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, as opposed to just jumping to that. And that’s where I think 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, and then having these conversations with their prescribing doctors as well.
Mills: 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?
Goldman: Yeah, such a great question. We’ve been kind of hearing about this for a while now. This question of when I get my goal weight or when I meet my goal weight, 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 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? 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 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, but kind of 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.
Mills: So cold turkey is not advised.
Goldman: Definitely not. Again, I would be very mindful of even decreasing the dosage too quickly with lots of medications. You want to 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.
Mills: Anything else you want our listeners to know about GLP-1s and psychology, physiology, anything else that you’re noticing as you work in this area?
Goldman: Yeah, I mean, I guess the main thing that I’ve really seen, 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. I like to think of it as volume. It gets a little lower in 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. It is gone. They have no cravings. They 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 meaning—even to do the CBT 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, it’s another thing to maybe talk to your doctor about if this could be right for you. And everybody’s experience is different. So I think if you know people that this is working great for people that it’s not working well for, or people that have bad side effects or you don’t 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. 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 GLP-1s also are saying, wow, I’m satisfied and I’m stopping. Whereas before, maybe they 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.
Mills: 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? When’s it going to be available?
Goldman: Yes, I really appreciate that. Thank you so much. And although it’s not about GLP-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 date is April 7, 2026. But people can find me at DrRachelNYC on social media or drrachelnyc.com. You can learn more about my book and pre-order it there as well. So thank you.
Mills: Well, Dr. Goldman, I want to thank you for joining me today. This has been very helpful.
Goldman: Awesome. Thank you so much.
Mills: You can find previous episodes of Speaking of Psychology on our website at speakingofpsychology.org 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 episodes, you can email us at speakingofpsychology@apa.org. Speaking of Psychology is produced by Lea Winerman.
Thank you for listening. For the American Psychological Association, I’m Kim Mills.
Rachel L. Goldman, PhD (aka Dr. Rachel) is a clinical psychologist, speaker, and consultant specializing in the mind–body connection. A leading expert in cognitive behavioral therapy, she focuses on stress reduction, disordered eating, and health behavior change. She is a clinical assistant professor at NYU Grossman School of Medicine and runs a private practice in New York City. Her book 
