Attitudes towards new weight management medication in people living with severe mental illness (SMI)

These monthly blog posts by the Public Mental Health Implementation Centre (PMHIC) 'Perspectives on public mental health', aim to highlight the voices of practitioners, patients, carers, and public health experts.

Welcome to this month’s blog post, by Dr Gemma D Traviss-Turner (Associate Professor in Behavioural Medicine, University of Leeds) and Dr Emily Peckham (Senior Research Fellow, Bangor University), with support from Ian Maidment (Professor of Clinical Pharmacy, Aston University), Danielle Hahn (Research Assistant, University of Sheffield), Michelle Horspool (Deputy Director, Sheffield Health & Social Care Trust), Katie Biggs (Deputy Director, CTRU, University of Sheffield), Ben (Expert by Experience) and SP Dexter (Expert by Experience).

Here, they consider the difficulties that people living with SMI have with weight management and reflect on a workshop they held with people living with SMI to discuss the new generation of weight-loss medications known as GLP-1s (glucagon-like peptide-1 inhibitors). They go on to give tips for Patient Public Involvement (PPI) from their experiences and reveal their plans to develop a weight-management intervention tailored to the needs of people living with SMI.

In this blog, they take a step towards addressing the question, could pharmacological interventions be an option alongside behavioural interventions for people living with SMI?

Addressing the problem

People living with severe mental illness (SMI) have a reduced life expectancy of 15–25 years.¹ This mortality gap is largely due to physical health conditions such as diabetes and cardiovascular disease, which are frequently associated with weight gain and can be preventable through lifestyle modification. However, people with SMI often face particular challenges to living a healthy lifestyle, including maintaining a healthy body weight.

People living with SMI are almost twice as likely to have obesity (a BMI [body mass index] of ≥30kg/m2).² Rapid weight gain is a common side effect of many medications used to treat SMI, such as antipsychotics. Current guidelines for weight management focus on behavioural lifestyle interventions as a first-line treatment. These interventions show modest reductions in weight, but people with SMI have described barriers to engaging with standard weight management interventions. They therefore require a tailored approach³, in which GLP-1s may have a beneficial role.

In recent years there has been a boom in research (and media) interest in a new generation of weight-loss medications called GLP-1 receptor agonists (glucagon-like peptide-1 receptor agonists). We therefore explored their advantages and disadvantages with a group of adults living with SMI.

What we did

The clinicians working in local NHS trusts, invited seven people (six male and one female) living with SMI to a face-to-face workshop in Sheffield. Several of whom reported repeated weight loss attempts through diet and exercise, but none had tried weight loss medication.

They had been invited by community mental health teams and PPI networks. Also present at the workshop were two researchers, a research assistant and an academic pharmacist. In the session, we presented the various options for weight management (behavioural weight management and pharmacological approaches), including the associated evidence and methods of administration for pharmacological approaches.

After a break, we took part in an interactive activity to consider the advantages and disadvantages of taking weight-loss medication. We used a blank fishbone diagram and Post-it sticky notes and spent an hour asking attendees to write down as many thoughts or opinions as they felt comfortable with. We had an open, ongoing discussion about the findings so that we could clarify anything that came up.

One of the researchers thematically organised the responses (see below). All attendees were reimbursed for their time and travel, in line with NIHR guidelines ⁴ which state that public contributors should be reimbursed £50 for tasks that equate to approximately two hours of activity.

What we found

Our patients with lived experience of SMI identified the potential advantages and disadvantages of taking weight loss medication. For a summary of the themes identified, see Figure 1.

Key advantages were related to the ease and speed of weight loss, and the suitability for some groups (those living with disability who were unable to be as physically active).

The group identified more disadvantages than advantages, such as a sense of ‘reduced agency’, significant concerns about the ‘unknown side effects’ ⁵, and that the medications might interfere with their ‘thoughts’, ‘hormones’ or ‘other drugs’.

We discussed the longevity of weight management through weight-loss medication, and it was seen as a ‘quick fix’. Participants expressed the view that pharmacological approaches used alone do not teach the ‘healthy life skills such as shopping and cooking’, which are essential for long-term weight management. People were also ‘petrified of regaining the weight’.

Several members talked about emotional and uncontrolled eating and suggested they would be likely to ‘displace the disruptive behaviour’ with something different or worse. Weight loss medication also carried a stigma, whereby people felt they would be ‘judged for taking it’ or thought of as ‘cheating’.

Figure 1 shows the full fishbones diagram as completed by the group highlighting the advantages and disadvantages of taking weight loss medication for people with SMI.

Figure 1: Fishbone diagram showing the advantages and disadvantages of taking weight loss medication, as identified by focus group participants.

Tips for successful patient and public involvement

We found there are some practical considerations that can be useful when conducting PPI with people with SMI. These include:

• choosing a neutral venue (for example a community centre rather than an NHS building) that is easily accessible by public transport,
• supporting reimbursement during the session,
• providing sandwiches and healthy refreshments, alongside tea, coffee and biscuits, is always welcomed,
• before the session, we also recommend sending the participants an agenda for the day that contains photos of the venue and of the researchers. It should also include clear directions for getting there, and the start and finish times,
• for the content of the sessions themselves, we found it better to deliver face-to-face interactive sessions with plenty of opportunities for breaks. It is important to pitch information at a suitable level, and to avoid using jargon.

What we plan to do next

We plan to use the valuable information gained from these workshops, about attitudes towards pharmacological approaches to weight loss, to apply for funding to develop a weight-management intervention. The project will be called SWIFT-SMI.

This intervention would be tailored to the needs of people with SMI and integrate a behavioural approach with medication management.

Acknowledgements

This blog was written with the involvement of experts by experience, and we thank SP Dexter and Ben for their contributions.

References

1. Burns J. Weight loss jabs study begins after reports of pancreas issues. [Online article]. BBC News: Health. 26 June 2025.
2. Fiorillo A, Sartorius N. Mortality gap and physical comorbidity of people with severe mental disorders: the public health scandal. Annals of General Psychiatry. 2021;20:52. doi: 10.1186/s12991-021-00374-y.
3. Public Health England. Severe Mental Illness (SMI) and Physical Health Inequalities: Briefing. London: Public Health England; 2018.
4. National Institute for Health Research (NIHR). (2022). NIHR Public Contributor Payment Policy. Version 4. Accessed 11 August 2025.
5. Lee C, Piernas C, Stewart C, Michalopoulou M, Hajzadeh A, Edwards R, et al. Identifying effective characteristics of behavioral weight management interventions for people with serious mental illness: A systematic review with a qualitative comparative analysis. Obesity Reviews. 2022;23:e13355. doi: 10.1111/obr.13355.