Before Starting a GLP-1 Medication: Mental Health Questions to Consider First

The decision to start a GLP-1 may feel straightforward, but the mental health considerations behind that choice are often more complex.

Key Takeaways

• Before starting a GLP-1 medication, it’s important to understand your current relationship with your body and food, especially if weight loss is the primary goal.
• A history of dieting, restrictive eating, or eating disorders can influence how someone responds to a GLP-1, making additional support and careful consideration essential.
• Weight loss goals can shift over time, particularly for individuals with perfectionistic tendencies, making it important to set clear, grounded expectations from the start.
• GLP-1 medications may also impact mental health, including mood, anxiety, and emotional regulation, which should be part of the decision-making process.

Most conversations about GLP-1 medications focus on weight loss.

But according to therapist Ashley Terry, at Willamette Wellness Center in Milwaukie, OR – whose work is grounded in the Health at Every Size (HAES) approach – weight loss is only part of the picture. There are important mental and emotional factors that deserve just as much attention before deciding to start.

“Encouraging people to explore their relationship with their body and their relationship with food is a really important starting point,” she explains.

How Your Relationship With Food and Body Image Impacts GLP-1 Decisions

For individuals considering a GLP-1 primarily for weight loss, Terry emphasizes the importance of pausing before taking action.

How do you currently feel about your body? What has your relationship with food been like over time?

These questions may feel simple, but they often reveal patterns shaped over years—sometimes decades—by family, culture, and societal messaging.

“There’s no one in the world who hasn’t been impacted by external factors,” Terry notes, pointing to influences like family dynamics, cultural expectations, and social media.

Understanding how those influences have shaped your beliefs can be an important part of the decision-making process.

GLP-1 Medications and Eating Disorder History: What to Consider

For individuals with a history of restrictive eating, yo-yo dieting, or eating disorders, Terry encourages a more cautious and supported approach.

A GLP-1 medication may introduce new challenges, particularly around maintaining recovery progress.

“It can lead to challenges with sustaining any previous progress made toward recovery,” she explains.

That doesn’t mean someone can’t explore their options—but it does mean the decision deserves more time, support, and conversation with trusted professionals.

Why Weight Loss Goals Can Shift on GLP-1 Medications

Another dynamic Terry sees in her work is what she describes as a shifting target.

A person may begin with a clear goal, for example, losing a certain amount of weight. But once that goal is reached, it can quietly change.

“They get 40 pounds lighter, and then it becomes, ‘I could do another 20,’” she says.

This is especially common for individuals with more perfectionistic tendencies, in which progress can feel rewarding but also difficult to stop.

Without clearly defined, grounded goals from the start, it becomes easy to keep moving the finish line.

How GLP-1 Medications Can Affect Mental Health

Terry also highlights the importance of understanding how a GLP-1 may intersect with mental health.

There is emerging evidence, she notes, that some individuals experience increased anxiety or depression symptoms while taking these medications.

Even beyond the effects of medication, changes in appetite and nutrition can affect mood and emotional regulation.

For individuals already navigating anxiety or depression, this is an important part of the conversation to have with a provider before starting.

Go deeper: A new era of weight loss: Mental health effects of GLP-1 drugs, from the American Psychological Association.

Why Starting a GLP-1 Is More Than a Physical Decision

It can be easy to think of a GLP-1 as a straightforward medical decision.

But as Terry’s perspective makes clear, it’s also deeply connected to how someone relates to their body, their habits, and their lived experience.

A more supportive starting point may not be “Will this help me lose weight?”

Instead, it may sound more like:

• What is my relationship with my body right now?
• What am I hoping will change?
• What kind of support do I have in place?

Because the medication is only one part of the picture. Understanding the rest can shape not just the outcome—but the experience of getting there.

Ashley Terry, LPC, LMHC, CADC I, is a therapist specializing in eating disorders and body image work, with extensive experience using the Health at Every Size (HAES) model. She has held leadership roles at Providence St. Vincent’s Eating Disorder Treatment Program and Monte Nido’s Portland Adult Residential Program, where she helped integrate HAES into treatment. Ashley continues her training through ongoing education and is an active member of the Columbia River Eating Disorder Network.