Semaglutide delivered significant improvements in physical quality of life scores among 154 adults with schizophrenia, prediabetes, and obesity over 30 weeks, with effect sizes exceeding clinically meaningful thresholds. Roughly half of this benefit appeared mediated through weight loss, suggesting additional mechanisms contribute to physical wellbeing improvements. Mental quality of life and psychiatric symptom severity showed no meaningful changes during the trial period. This represents a notable expansion of semaglutide's therapeutic profile into psychiatric populations, who face substantially elevated metabolic disease risk and reduced life expectancy. The finding is particularly significant given that people with schizophrenia typically experience 15-20 year shorter lifespans, largely due to cardiovascular and metabolic complications. While the mental health benefits remain unclear at this timeframe, the physical improvements could meaningfully impact long-term health outcomes in this vulnerable population. However, the 30-week duration limits conclusions about sustained benefits or delayed psychiatric effects. The study's strength lies in its randomized controlled design within a well-defined psychiatric cohort, though longer trials are essential to determine whether mental health improvements emerge over time and whether physical benefits translate to reduced mortality risk.