Ziyad Al-Aly, Washington University in St. Louis

Several years ago, a little-known drug named Ozempic – previously used only to treat diabetes – emerged as a promising new drug for weight management.

The Food and Drug Administration’s approval of Ozempic in 2021 for weight loss treatment ushered in a new era for the class of drugs called glucagon-like peptide-1 agonists, or GLP-1.

Today, GLP-1 drugs, including Wegovy, Mounjaro and Zepbound, have become household names and key tools in the fight against obesity: 1 in 8 American adults say they have used a GLP-1 drug, and forecasts show that by 2030, 1 in 10 Americans will likely be using these medications.

Now, research from my lab and others suggests that GLP-1 drugs could help treat dozens of other ailments as well, including cognitive issues and addiction problems. However, my colleagues and I also found previously unidentified risks.

I am a physician-scientist and I direct a clinical epidemiology center focused on addressing public health’s most urgent questions. My team works to address critical knowledge gaps about COVID-19, long COVID, influenza, vaccines, effectiveness and risks of commonly used drugs, and more.

On Jan. 20, 2025, my team published a study of more than 2.4 million people that evaluated the risks and benefits of GLP-1 drugs across 175 possible health outcomes. We found that these drugs lowered risks of 42 health outcomes, nearly a quarter of the total that we analyzed. These include neurocognitive disorders such as Alzheimer’s disease and dementia, substance use and addiction disorders, clotting disorders and several other conditions.

Unfortunately, we also found that GLP-1 drugs come with significant side effects and increase the risk of 19 health conditions we studied, such as gastrointestinal issues, kidney stones and acute pancreatitis, in which the pancreas becomes inflamed and dysfunctional.

Cognitive benefits

One of the most important health benefits we found was that the GLP-1 drugs lowered the risk of neurodegenerative disorders, including Alzheimer’s disease and dementia. These findings align with other research, including evidence from preclinical studies showing that these drugs may reduce inflammation in the brain and enhance the brain’s ability to form and strengthen connections between its cells, improving how they communicate with one another. These effects contribute to mitigating cognitive decline.

Two other key studies have shown that patients treated with a GLP-1 drug for diabetes had a lower risk of dementia.

All of these studies strongly point to a potential therapeutic use of GLP-1 drugs in treatment of the cognitive decline. Ongoing randomized trials – the gold standard for evaluating new uses of drugs – are looking at the effects of GLP-1 drugs in early Alzheimer’s disease, with results expected later in 2025.

Curbing addiction and suicidal ideation

GLP-1 drugs have also demonstrated potential in reducing risks of several substance use disorders such as those involving alcohol, tobacco, cannabis, opioids and stimulants. This may be due to the ability of these drugs to modulate reward pathways, impulse control and inflammatory processes in the brain.

The effectiveness of GLP-1 drugs in curbing addictive behavior may explain their spectacular success in treating obesity, a chronic disease state that many have suggested is indeed a food addiction disorder.

Our study demonstrated a reduced risk of suicidal thoughts and self-harm among people using GLP-1 drugs. This finding is particularly significant given earlier reports of suicidal thoughts and self-injury in people using GLP-1 drugs. In response to those reports, the European Medicines Agency conducted a review of all available data and concluded that there was no evidence of increased risk of suicidality in people using GLP-1 drugs.

Now at least two studies, including our own, show that GLP-1 drugs actually reduce the risk of suicidality.

Other benefits

In addition to the well-documented effects of GLP-1 drugs in reducing risks of adverse cardiovascular and kidney outcomes, our study shows a significant effect in reducing risk of blood clotting as well as deep vein thrombosis and pulmonary embolism.

One puzzling finding in our study is the reduced risk of infectious diseases such as pneumonia and sepsis. Our data complements another recent study that came to a similar conclusion showing that GLP-1 drugs reduced risk of cardiovascular death and death due to infectious causes, primarily COVID-19.

This is especially important since COVID-19 is regarded as a significant cardiovascular risk factor. Whether GLP-1 drugs completely offset the increased risk of cardiovascular disease associated with COVID-19 needs to be thoroughly evaluated.

GLP-1 drugs may also be useful in treating fatty liver disease and conditions ranging from asthma to chronic obstructive pulmonary disease, sleep apnea, osteoarthritis, depression and eye disorders.

Risks and challenges

Despite their broad therapeutic potential, GLP-1 drugs are not without risks.

Gastrointestinal issues, such as nausea, vomiting, constipation and gastroesophageal reflux disease are among the most common adverse effects associated with GLP-1 drugs.

Our study also identified other risks, including low blood pressure, sleep problems, headaches, formation of kidney stones, and gall bladder disease and diseases associated with the bile ducts. We also saw increased risks of drug-induced inflammation of the kidneys and pancreas – both serious conditions that can result in long-term health problems. These findings underscore the importance of careful monitoring in people who are taking GLP-1 medications.

A significant challenge with using GLP-1 drugs is the high rates at which patients stop using them, often driven by their exorbitant cost or the emergence of adverse effects. Discontinuation can lead to rapid weight gain.

That’s a problem, because obesity is a chronic disease. GLP-1 drugs provide effective treatment but do not address the underlying causes of obesity and metabolic dysfunction. As a result, GLP-1 drugs need to be taken long term to sustain their effectiveness and prevent rebound weight gain.

In addition, many questions remain about the long-term effectiveness and risks of these drugs as well as whether there are differences between GLP-1 formulations. Addressing these questions is critical to guide clinical practice.

Ziyad Al-Aly, Clinical Epidemiologist, Washington University in St. Louis

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Kerby Goff, Rice University; Eric Silver, Penn State, and John Iceland, Penn State

The concept of Christian nationalism has taken center stage in many Americans’ minds as either the greatest threat to democracy or its only savior.

Political scientist Eric McDaniel defines Christian nationalism as the belief that the United States was founded to be a Christian nation. “In this view,” according to McDaniel, “America can be governed only by Christians, and the country’s mission is directed by a divine hand.” Why does the idea resonate with some but alarm others?

Scholars often portray Christian nationalism as rooted in a deep-seated desire to exclude non-Christians and people of color from American society. Historians point to a persistent link between racism and Christian nationalism among white Americans throughout U.S. history.

White Christians, however, are not the only ones sympathetic to Christian nationalist ideas. Nearly 40% of Black Protestants and 55% of Hispanic Protestants agree with statements such as “being Christian is an important part of being truly American.” Interestingly, over one-third of Muslims agree that the U.S. government should promote Christian moral values but not make it the official religion.

Many who reject Christian nationalism do so because it seems to privilege those white Christian Americans who would like to make conservative Christianity the United States’ official religion. Conversely, supporters argue that the future of the U.S. depends upon loyalty to God and to staying true to the country’s Christian past. They contend that since the nation’s founding, a Christian influence in government and societal institutions such as education and health care has been and remains essential to sustaining religious, political and economic stability.

While racial, religious and political tribalism appear to influence who supports and who rejects Christian nationalism, our own research suggests there are other factors at play, specifically moral differences. We set out to understand the role that different moral values play in shaping support for and opposition to Christian nationalism.

Our study drew on the most influential social science approach to understanding moral values: moral foundations theory.

Moral differences

Moral foundations theory states that humans evolved to possess six primary moral intuitions that shape moral judgments – care for the vulnerable, fairness in how people are treated, loyalty to in-groups, respect for authority, reverence for the sacred, and the safeguarding of individual liberty.

A vast amount of research finds that liberals endorse the first two foundations, care and fairness, but score lower on the rest.

Conservatives, on the other hand, tend to score equally on all six foundations. This suggests their moral judgments often involve balancing a desire to be compassionate with a desire to safeguard the stability of the social order.

Moral foundations theory has been used extensively by social scientists to study hot-button issues such as crime control, policing, vaccine resistance, immigration, same-sex marriage, abortion and more.

For example, research finds that prioritizing care for the vulnerable, which is most pronounced among liberals, is linked to reduced acceptance of police use of force. Conservatives, who also value respect for authority, often favor “law and order” even when it involves use of force.

What our research found

With moral foundations theory as our guide, we analyzed Christian nationalism using a 2021 national survey of 1,125 U.S. adults conducted by YouGov, a global opinion research organization. We measured respondents’ moral foundations with the moral foundations questionnaire, which has been used extensively by researchers across numerous academic disciplines.

To measure Christian nationalism, we asked respondents whether they agreed with six questions, such as whether the federal government should declare the United States a Christian nation, advocate Christian values, allow prayer in public schools and allow religious symbols in public spaces, to list a few.

What we found surprised us.

Support for Christian nationalism was most strongly linked to the moral foundations of loyalty, sanctity and liberty, but not to the authority foundation. We expected Christian nationalism to appeal to individuals who are enamored of authority, providing a rationale to their support for authoritarian leaders. But in our study, respect for authority did not distinguish those who supported Christian nationalism from those who opposed it.

We also found that support for Christian nationalism was linked to having a weaker fairness foundation. But it was not related to the strength of one’s care foundation.

We conclude that differences over Christian nationalism emerge not because some people care about the harm Christian nationalism could bring to non-Christian Americans, while others don’t. Rather, our findings suggest that those who support Christian nationalism do so because they are more sensitive to violations of loyalty, sanctity and liberty, and less sensitive to violations of fairness.

Our findings also revealed that support for Christian nationalism isn’t merely about racism or being ultrareligious, as critics often suggest. We accounted for endorsements of anti-Black stereotypes and religiosity. Yet, moral foundations remained the best predictors of Christian nationalist beliefs, even after taking into account these critical variables.

2 moral approaches to Christianity in the US

The Christian nationalism scale we and others have used combines several different beliefs about Christianity’s role in society. So we also examined how each of the six items in our Christian nationalism scale related to each of the six moral foundations. We found two important patterns.

First, we found that the Christian nationalist desire to bring church and state closer together was most prominent among those with strong loyalty and sanctity foundations and a weak fairness foundation. This means that people who advocate for a Christian state largely do so out of loyalty – specifically, loyalty to God – and out of a desire to adhere to God’s requirements for society, as they understand them.

In line with this, support is also linked to a desire to protect the sanctity of the nation’s Christian heritage. Those who oppose bringing church and state closer together do so out of a sense that such a union would be unfair.

Second, we found that the desire to allow prayer in schools and religious symbols in public spaces was strongest among those with pronounced liberty and sanctity moral foundations. This likely means that people who favor public religious expression, but not a union of church and state, do so because they see individual religious expression as a sacred national ideal.

All in all, our study shows that support for or opposition to Christian nationalism is not merely due to religious, political or racial identities and prejudices, as many believe, but is rather due to entrenched moral differences between the two camps.

Building solidarity through diverse moral concerns

Moral divides are not necessarily impassable. It’s possible that understanding these diverging moral concerns may help build bridges between those who are sympathetic to and those who are skeptical toward Christian nationalism.

America’s founders conceived of fairness and liberty as central to a democratic society. And these values have fueled loyalty to a robust national identity ever since.

Our research suggests that the controversy surrounding Christian nationalism is driven not by a lack of moral concern by sympathizers or critics but by their different moral priorities. We believe that understanding such differences as morally rooted can open the door for mutual understanding and productive debate.

Kerby Goff, Associate Director of Research at the Boniuk Institute for the Study and Advancement of Religious Tolerance, Rice University; Eric Silver, Professor of Sociology & Criminology, Penn State, and John Iceland, Professor of Sociology and Demography, Penn State

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Jeremy P. Shapiro, Case Western Reserve University

I began practicing psychotherapy during the Reagan administration. Thirty years went by before distress about politics became a clinical issue for any of my clients.

I remember the moment it first happened: There was a long voicemail from a distraught woman requesting therapy for anxiety and depression in reaction to the 2016 presidential election of Donald Trump. I listened twice to make sure I hadn’t missed something. I hadn’t. There were no other issues. This woman wanted therapy for political distress.

That was a new one for me and every therapist I knew. But now I see no sign of this clinical challenge abating.

Political polarization in the U.S. is at the highest level ever measured. Growing majorities of both Republicans and Democrats say they consider members of the other party to be unintelligent, dishonest and immoral.

What I’m calling political distress is a bipartisan mental health problem. It is based on a belief that, because the country is in the hands of bad leaders, awful things might happen. Many people experience intense fear about what the other side might do. Both Republicans and Democrats have experienced this anguish, but it peaks at different times for the two parties, depending on who won the last election.

We psychotherapists like to base our interventions on research-based strategies that have been vetted in clinical trials or, if not that, at least strategies grounded in the clinical expertise of master therapists who wrote classic books. There’s none of that for how to deal with political distress.

But therapists cannot tell a client in distress that future research is needed before we can help. Instead, we pull from what is known about how best to handle related issues. Here’s the advice I’m sharing with my clients who are upset about the way the world is going.

Taking a longer view

Information about American history is relevant to political distress because, psychologically, people evaluate their situations by comparing them with anchors or norms. You compare current dangers and threats with what you’ve faced and survived in the past.

A Democrat comparing today’s United States with the country a decade ago may feel gloomy. But broader comparisons can produce a more grounded, calming perspective.

The U.S. has faced major trials and tribulations over the course of its history. The country has proven itself to be a resilient democracy. Basic information about the Civil War, the Great Depression and World War II yields a sense that the present political moment is not the only perilous time our republic has ever faced.

Wisdom of the Serenity Prayer

God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

The Serenity Prayer is an effective summary of research on coping. As I discuss in my book “Finding Goldilocks,” the well-known invocation identifies two basic strategies and tells you when to use which one. People need the strength to change what can be changed and the serenity to accept what cannot. Political distress, like many stressors, calls for a combination of both tactics.

Doing what you can means funneling political anxiety into political actions, including voting, volunteering, donating money and serving as a poll worker. Can one person’s actions make a difference? They can make one person’s worth of difference. You can’t do everything, but you can do something.

In addition, taking action about a problem, even if it does not produce a solution, often reduces distress, especially if it brings you together with like-minded people.

Once you’ve done what you can, it’s important to acknowledge how much is beyond your control: The whole world doesn’t rest on your shoulders alone. Then you can in good conscience turn your attention to the good things in your own personal life.

It helps to limit your consumption of political news; past a certain point, you’re not learning anything new and just fueling your agitation.

The best things in life aren’t political

One basic tool of cognitive therapy for anxiety is asking the question, “What is the worst thing that could plausibly happen?” The purpose of this question is not to get anxious people thinking about worst-case scenarios – they’re doing that already – but to move their thought process forward to a picture of how they could survive their worst fear. This is a strangely effective form of reassurance.

Democrats believe Donald Trump’s second administration will hurt people. But with important exceptions – such as undocumented immigrants who could be deported – when many people try to picture exactly how their lives will be damaged in specific, concrete, serious ways, they usually do not come up with much.

This does not mean nothing bad will happen. It does mean you likely can cope with whatever does. While Trump’s policies might be unfortunate and even infuriating for those on the other side of the aisle, they are unlikely to be disastrous on an immediate, day-to-day level for large groups of people.

A very broad perspective will remind you that democracy is a rarity in world history. For most of civilization, people have lived in monarchies or tyrannies of some sort, and most of them managed to be OK.

I’m not suggesting that people disengage from the political world. I believe it’s important to stand up for what you believe is right. My advice is not to put on your rose-colored glasses and withdraw into your own safe space, the rest of the world be damned.

But the main sources of human well-being are family, friends, meaningful work, hobbies, the arts, nature, spirituality and acts of kindness. None of these depend on political systems. We can cope with political distress by falling back on the best things in life.

Jeremy P. Shapiro, Adjunct Assistant Professor of Psychological Sciences, Case Western Reserve University

This article is republished from The Conversation under a Creative Commons license. Read the original article.