Volume 223 - Issue 7
The role of GLP‐1 receptor agonists in the management of obesity: risks and opportunities for the Australian health care system
Author: Patrick GM Bolton
Med J Aust 2025; 223 (7): 379-379. || doi: 10.5694/mja2.70044
Published online: 6 October 2025
Published online: 6 October 2025
Comment
To the Editor:
The recent perspective by Kanellis and colleagues1 describes important tensions arising between health outcomes, funding and equity of access in the context of glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) in Australia.
People with significant mental illness are a population of particular importance in this regard. Members of this population die at least 20 years younger than other Australians.2 Mental illness and its treatment with antipsychotic medications put them at high risk of obesity and related health problems. This is one of two major contributors to their additional risk, alongside tobacco use. People with significant mental illness are at a high risk of socio‐economic disadvantage with related challenges accessing general medical services.3
There is emerging evidence that GLP‐1 RAs have the same place in the management of obesity in people with significant mental illness as they do in the general population.4 Funding and equity considerations make the question of access of people with significant mental illness to these medicines more acute.
There is an existing recommendation that metformin is co‐prescribed with antipsychotic medications to mitigate cardiometabolic risk irrespective of glycaemic status.5 Further research is required to determine the role of GLP‐1 RAs in this space.
Competing interests
Patrick Bolton is a complex care physician funded by New South Wales Health. His interests include the application of glucagon‐like peptide‐1 receptor agonists for weight loss in people with mental illness.
Author contributions:
Bolton PGM: Conceptualization, writing – original draft, writing – review and editing.
References
- Kanellis C, Williams K, Holt DQ, et al. The role of GLP‐1 receptor agonists in the management of obesity: risks and opportunities for the Australian health care system. Med J Aust 2025; 222: 118‐121. https://www.mja.com.au/journal/2025/222/3/role‐glp‐1‐receptor‐agonists‐management‐obesity‐risks‐and‐opportunities#
- Calder RV, Dunbar JA, de Courten MP. The Being Equally Well national policy roadmap: providing better physical health care and supporting longer lives for people living with serious mental illness. Med J Aust 2022; 217 (Suppl 7): S3‐S6. https://www.mja.com.au/journal/2022/217/7/being‐equally‐well‐ending‐neglect‐physical‐health‐people‐serious‐mental‐illness
- Farrer LM, Walker J, Harrison C, Banfield M. Primary care access for mental illness in Australia: patterns of access to general practice from 2006 to 2016. PLoS One 2018; 13: e0198400.
- Bak M, Campforts B, Domen P, et al. Glucagon‐like peptide agonists for weight management in antipsychotic‐induced weight gain: a systematic review and meta‐analysis. Acta Psychiatr Scand 2024; 150: 516‐529.
- Fitzgerald I, O'Connell J, Keating D, et al. Metformin in the management of antipsychotic‐induced weight gain in adults with psychosis: development of the first evidence‐based guideline using GRADE methodology. Evid Based Ment Health 2022; 25: 15‐22.