Presentation (CTI)

OBJECTIVES: Glucagon-like peptide-1 receptor agonists (GLP-1s) have demonstrated substantial and sustained weight loss in obese patients and are increasingly used. Beyond metabolic outcomes, GLP-1s have been associated in large observational studies with neutral or beneficial effects on mood, emotional-eating, and quality-of-life. Nevertheless, concerns regarding psychiatric safety-including depression, anxiety, and suicidal behavior-have been raised in post-marketing studies. Such concerns may influence prescribing behavior or patient acceptance, particularly among patients with mental health conditions (PwMHC). Understanding real-world treatment initiation patterns in this population is critical for informing clinical practice, health policy, and market-access decisions. This study evaluated GLP-1 initiation rates among patients with and without mental health conditions as a real-world indicator of potential treatment hesitancy, among physicians or patients.
METHODS: This retrospective cohort study used electronic health records (EHR) data from a large, state-mandated healthcare provider in Israel. Adults with documented obesity (BMI≥30 kg/m²) and no diagnosis of type-2 diabetes were included. Mental health conditions were identified based on documented diagnoses of depressive disorders, anxiety disorders, and indicators of suicidality. GLP-1 initiation rates during 2025 were compared between patients with and without documented mental health conditions.
RESULTS: The study included 43,030 adults with obesity, of whom 2,541 (5.9%) initiated GLP-1 therapy in 2025. The highest initiation rate was observed among patients aged 45-54 years (9.4%). Compared with patients without documented mental health conditions, PwMHC were more likely to initiate GLP-1 therapy (aOR=1.41; 95% CI: 1.30-1.54), with little variation across age groups.
CONCLUSIONS: In this large real-world cohort, PwMHC were more likely to initiate GLP-1 therapy for obesity than those without such conditions. These findings support equitable access to GLP-1 therapy across mental health subgroups and provide important real-world evidence for clinicians, payers, and policymakers evaluating the safety, uptake, and value of advanced obesity treatments.