Is Semaglutide Safe and Effective for People With Schizophrenia Who Want to Lose Weight?

Summary: Yes, new research shows that semaglutide is safe and effective for people with schizophrenia who want to lose weight.

Key Points:

• Studies show that people with schizophrenia are at increased of weight gain, metabolic disease, and obesity.
• The side effects of antipsychotic medications common in schizophrenia treatment include weight gain, which adds to the risk of weight gain already present for people with schizophrenia, and complicates their treatment, recovery, and overall physical health and wellbeing.
• The new generation of weight loss drugs, GLP-1 receptor agonists including semaglutide – the active agent in Ozempic – may help people with schizophrenia and obesity increase weight loss and improve metabolic markers associated with chronic diseases such as diabetes.

Addressing Weight Issues in People With Schizophrenia and Serious Mental Health Issues

Mental health professionals are aware of the problem of weight gain among people with schizophrenia and other serious mental illness, but the general public is largely unaware of this issue and the challenges it creates. There are a variety of reasons people with serious mental illness are at increased risk of gaining weight, including but not limited to:

• Self-isolation
• Sedentary lifestyle
• Decreased self-care/decreased interest in self-care/decreased acknowledgment of the need for self-care
• Low mood/low motivation
• Side effects of antipsychotic medication

A large-scale review and meta-analysis published in 2021 showed the following.

Prevalence of Obesity/Overweight Among People With Serious Mental Illness

Obesity among people with serious mental illness:

• Total: 25.9%

Obesity and overweight among people with serious mental illness:

• Combined total of 60.1%

Risk Of Obesity/Overweight: Any Serious Mental Illness, Bipolar Disorder, Schizophrenia

• Any serious mental illness:
  • Overweight: 7% increased risk
  • Obesity: 245% increased risk
• Bipolar disorder:
  • Obesity: 190% increased risk
• Schizophrenia:
  • Obesity: 295% increased risk

These studies explain the scope of the risk and the magnitude of the problem. Obesity and overweight – prevalent among people with serious mental illness – exacerbate and contribute to the following chronic conditions:

• Hypertension
• Heart disease
• Kidney and gastrointestinal diseases
• Diabetes

The question we’ll focus on for the rest of this article is this:

Can new weight loss medications with semaglutide help?

New Research on Semaglutide for People With Schizophrenia

The authors of the study “The Safety and Efficacy of Semaglutide in People With Schizophrenia Spectrum Disorders: Systematic Review and Meta-Analysis of Randomized Controlled Trials” address this question, identifying the goal of their research as follows:

“To synthesize all placebo-controlled, randomized controlled trials (RCTs) examining semaglutide and/or tirzepatide in people with SSDs.”

The research team analyzed data from three (3) studies on semaglutide including data from a total of 258 patients. They examined the nine relevant outcomes among people with schizophrenia and obesity and taking semaglutide and compared them to a control group of patients with schizophrenia and obesity who did not take semaglutide.

Here’s what they found.

Impact on Weight and Metabolic Metrics: Semaglutide Among People With Obesity, Schizophrenia

1. Body mass index: 3.58 point reduction
2. Body weight: 11.32 kg reduction
3. Diastolic blood pressure: 0.39 reduction
4. Glucose: 0.54 reduction
5. Insulin: 3.03 reduction
6. Triglycerides: 0.14 reduction
7. Hemoglobin: 0.37 reduction
8. HD lipoprotein: 0.07 increase
9. Systolic blood pressure: 2.34 reduction

Those results are both important and informative. They tell us that semaglutide is effective in reducing body mass index, weight, and critical markers associated with chronic illness and metabolic diseases like diabetes.

The research team also tracked the five relevant mental health outcomes: symptom severity, cognitive function, daily function, quality of life, and substance use.

Here’s what they found.

Impact on Mental Health: Semaglutide Among People With Obesity, Schizophrenia

1. Symptom severity: no statistically significant change
2. Cognitive function: no statistically significant change
3. Daily function: no statistically significant change
4. Quality of life: no statistically significant change
5. Substance use: no statistically significant change

The results show that semaglutide is effective in addressing weight and related health issues, and semaglutide doesn’t have a negative effect on mental health symptoms, functional capacity, and other factors associated with overall health and wellness.

But is it safe?

To answer that question, the research team recorded instances of adverse events. Here’s what they found.

Adverse Events: Semaglutide Among People With Schizophrenia and Overweight/Obesity

• Any serious adverse events: no statistically significant difference compared to semaglutide (SMG) in general population (GP)
• Abdominal pain: increased risk compared to control group, but no statistically significant difference compared to SMG in GP
• Vomiting: increased risk compared to control group, but no statistically significant difference compared to SMG in GP
• Nausea: increased risk compared to control group, but no statistically significant difference compared to SMG in GP
• Constipation: increased risk compared to control group, but no statistically significant difference compared to SMG in GP
• Diarrhea: no difference compared to control group or SMG in GP

That data tells us that semaglutide is associated with some adverse events. However, the rate and severity of those adverse events is not statistically different than the adverse events reported by people in the general population without schizophrenia or serious mental illness.

The Outcome: Positive Results for People With Schizophrenia Who Want to Lose Weight

The data from this new study shows semaglutide is effective in:

• Reducing BMI and weight in people with schizophrenia
• Improving metabolic markers associated with chronic disease

It also shows semaglutide, for people with schizophrenia:

• Doesn’t exacerbate mental health symptoms or impair quality of life
• Doesn’t increase substance use
• Is safe, with side effects similar to those reported by people who take semaglutide but don’t have schizophrenia.

Here’s how the study authors summarize their results:

“Semaglutide produces clinically meaningful improvements in weight and [health] outcomes in people with SSDs, with an adverse event profile consistent with the general population. These findings support semaglutide as a promising intervention in this population, although larger and longer trials are needed to better characterize the effect and long-term safety.”

In plain language, that’s good news for people with schizophrenia who want to lose weight. This new class of weight loss drug – pending the larger trials needed – can be effective in reducing weight and improving metabolic health for people with co-occurring schizophrenia, obesity, and overweight. This new development may help people with a sedentary lifestyle and health complications move toward a more active lifestyle, which may improve their overall health and long-term wellness.