Rapid weight‑loss drugs like GLP‑1s are changing lives — and health care — but there’s an often‑overlooked psychological cost. In this interview, Thomas Rutledge, PhD. explains the “neglected psychology” that can follow dramatic, fast body changes: phantom obesity, body image mismatch, and emotional and social consequences similar to those seen after bariatric or cosmetic surgery.Jeffrey Snyder, Broadcast Retirement NetworkWell, Dr. Rutledge, it’s great to meet you. Thanks for joining us in the program this morning.Thomas Rutledge, PhD., UC San DiegoI appreciate the invitation.Jeffrey Snyder, Broadcast Retirement NetworkYou know, you can’t go anywhere on a streaming platform without getting some ad about Wacovia or Zempic or some other weight loss drug. A lot of people are now taking them. A lot of people are focused on losing weight.But, doctor, there is a dark side or an unintended side to the weight loss.Thomas Rutledge, PhD., UC San DiegoThere is indeed. There’s, I think, what you could call a neglected psychology side. Well, as you say, yes, we’re kind of entering a whole new world.It’s very exciting. Opportunities that were restricted to things like thoracic surgery in the past are now becoming available to tens of millions of people with far fewer barriers. But most of the emphasis, most of the advertising, of course, is on the weight loss, the metabolic health benefits, the transformative health effects, and those are very real.But what they fail to provide much attention to is there’s a human being on the inside of that rapid transformation. And we don’t necessarily have a lot of experience with how the mind and the emotions react when a person is going through such dramatic change in a short period of time.Jeffrey Snyder, Broadcast Retirement NetworkYou know, I remember The Biggest Loser. That was a big show. And there was a follow-up documentary, I don’t know, five, 10, 15, 20 years later.There were a lot of psychological barriers that these individuals covered. Now we can have weight loss in a few months. I think that was like a game show where people would exercise, and over six to 12 months, they would lose the weight.Now you can lose it almost instantaneously. What’s the mind-body connection? As you said, that’s probably pretty overlooked, but our mind, our mental health is just as important as our overall health.Thomas Rutledge, PhD., UC San DiegoRight, and most people think that they’re sort of two sides of the same coin. But in fact, even though they are closely related, there definitely can be a gap that the mind kind of evolved for to give us a sense of stability about who we are. And when you think about most people’s life experiences, when they’ve had physical changes, when their body has changed in some way, think about aging, for example.It happens slowly, gradually, over the course of years and even decades. And this has been true throughout human history. It’s relatively rare to have dramatic, sudden physical changes.So the brain sort of evolved to give you a stable sense of self. And then it’s only in the majority, really in the last few decades, where we’ve developed cosmetic surgeries, bariatric surgeries, GOP medicines, things where all of a sudden, almost out of nowhere, within a few months, or even sometimes a few weeks, depending upon the procedure, a person can have these dramatic physical transformations. And it does show that there can be this gap, this mismatch between how the brain sees and experiences the body, and how the body might grow to be.And so phantom obesity is really just an example of that. The body can be very different objectively on the scale, clothing sizes, how other people see you. And yet you might still see and experience your old pre-weight loss body.Jeffrey Snyder, Broadcast Retirement NetworkYeah, and I’m thinking about body dysmorphia. Again, I am not a clinician, I’m just a layperson. But of course, we get bombarded by news and information all the time.But you could lose all the weight, doctor, but still think that you’re out of shape and you don’t look good, right? I mean, you could go through this process, but still have this perception that, oh, I got a little bit over here, I gotta get that off, or maybe I need some liposuction, or something else, right? So there’s that perception that really isn’t grounded in reality.Thomas Rutledge, PhD., UC San DiegoIt often lags behind. And there’s many examples of it. So phantom obesity is really just one example of many flavors in which this can show up.Most people, for example, have heard of what’s called phantom limb, where a person might lose a hand or a foot for an accident, and yet might have a very strong psychological and even sort of visual experience that that limb still exists. They know it’s not there. They can see it.Their doctors can see it, but they can feel it, experience it. Similarly, after cosmetic surgeries, a person can have their face, their nose, their eyes changed in some meaningful way, but it might take months for them to still see it. You mentioned body dysmorphia.There’s people who engage in activities like bodybuilding, where they might gain a lot of muscle, but still see themselves as much smaller and thinner. So once again, this phenomenon, this gap between the mind and the body can show up in many different ways.Jeffrey Snyder, Broadcast Retirement NetworkSo if I’m prescribing this medication, I’m a primary care physician, should I make a recommendation that you, the individual who’s receiving that device and receiving the medication, they should sit down and get some counseling because to prepare themselves during and after what they’re gonna look like, I mean, is that what’s necessary here to make sure that you don’t regress, that your mental health doesn’t suffer as a result of this big change?Because you have this, sorry, you have this anticipation, this expectation, but maybe you’re, mentally, you’re not in alignment.Thomas Rutledge, PhD., UC San DiegoMy professional opinion is absolutely, and this is grounded in, say, I’ve spent about 20 years working with bariatric surgery, and anyone who’s been through bariatric surgery knows that psychology evaluation and education has been part of that process since the 1990s. So very early on, say 30 plus years ago, kind of the collective field recognized that bariatric surgery is way more than just a physical procedure, that there is profound emotional, psychiatric, social effects, and that building psychology into that process is really important. I’m hoping that as the GOP revolution goes on here, that this will play out in a similar way.Because on one hand, you can say, well, yes, the simplest solution is simply to have the medical provider offer that support, that education, but that’s often unrealistic. You just can’t expect prescribers that will have the knowledge, the time, the frequency of the visits. So ideally, we would, over time, develop a process, at least in my humble professional opinion, that mirrors in many ways the bariatric process, where psychology is kind of built in right from the get-go, and then there can be some education up front and some resources that are provided for people who need it.Jeffrey Snyder, Broadcast Retirement NetworkYeah, I would tend to agree, not being a clinician, not having a dog in the hunt, so to speak, if I was going through that process, for really any, even if I had a disease, say like cancer or a heart disease or something that required surgery or some type of intervention, I’d wanna sit down with someone, along with my loved ones, to make sure that I was processing things correctly. Because the emotions often can get skewed during these type of events. But Doctor, are you a little bit more optimistic, though?Because I feel like mental health has really taken, become more of a, you know, more of an important topic these days. I mean, I go to my primary care physician, they ask me about my mental health. So does that lead you to have a little bit more optimism when it comes to this GLP-1 revolution that we’re undergoing?Thomas Rutledge, PhD., UC San DiegoI think you make a good point, and I’m hopeful that what you say is true, that kind of there’s been a constellation of stars over the past few years, where the stigma about mental health treatment has lowered. So I think there’s a larger percentage of people who are willing to engage in those conversations than before. And then plus, with the advances in technology, it’s easier to access those kinds of treatments.It doesn’t require going to a psychotherapist’s office or seeing a psychiatrist, that you can do things remotely. Obviously, AI will be adopting some mental health outlets and can provide education and support, at least on some level. But I think there will also be a growing number of opportunities, as well as lowering stigma.And the combination of those could be really useful for the much larger percentage of the population that’s going to be using GLP medicines compared to, say, old-fashioned bariatric surgery.Jeffrey Snyder, Broadcast Retirement NetworkAnd GLP-1s, my understanding is some of these are covered by insurance. But mental health treatments, most insurance companies, want to get your reaction to this, or at least my correction to this, I think most insurance companies recognize, as well, that mental health is important. So as you’re getting approved for GLP-1 or some type of surgery related to your weight, you probably could look up whether or not you can get counseling.Thomas Rutledge, PhD., UC San DiegoThat’s right. For example, in the bariatric surgery world, insurance companies even formally require a person go through a psychological evaluation. So they don’t require therapy or ongoing treatment or anything to that degree.But the insurance companies themselves have seen the data and said, hey, we need to make this policy. And so that actually came from the insurance companies rather than from the clinicians or the patient populations. And again, I know there’s all kinds of insurance complications.Money is the primary elephant in the room when it comes to people getting GLPs these days. But yeah, but I’m hoping, again, as the science continues to evolve, that we will be developing these policies that are friendly to patients that are using them and the clinicians prescribing them and the insurance companies that might be footing part of the bill to sort of formally build in at least some kind of a psychology piece.Jeffrey Snyder, Broadcast Retirement NetworkYeah, well, I think people often, we often overlook things that we’re not familiar with. The emotional and psychological impacts is just one of those things. Dr. Rutledge, we’re gonna have to leave it there. Great article, great piece. And look, we look forward to having you back on the program again very soon, sir.Thomas Rutledge, PhD., UC San DiegoAgain, thank you for the opportunity.
