Nine in Ten Eligible Adolescents Receive Neither GLP-1 Medication nor Bariatric Surgery, Study Finds
Key Takeaways:
- Among more than 1.4 million adolescents in the United States who met guideline-based eligibility criteria for metabolic and bariatric surgery, 90.4 per cent had received neither surgery nor a GLP-1 medication by the fourth quarter of 2025.
- GLP-1 prescribing rose 35-fold between early 2017 and the end of 2025, while bariatric surgery rates fell by about 29 per cent after peaking in 2022 – a decline that coincided with FDA approval of semaglutide for adolescents with obesity.
- Adolescents with private insurance were prescribed GLP-1 medications at rates 2.4 times higher than those who were uninsured or self-paying, raising concerns that newer obesity medications could be widening existing inequities in care.
New treatments, limited reach
Powerful new anti-obesity medications have arrived, and evidence supporting metabolic and bariatric surgery for adolescents continues to grow. Yet the vast majority of teenagers who are eligible for these treatments are receiving neither, according to a new study from Ann & Robert H. Lurie Children’s Hospital of Chicago, published in JAMA Pediatrics.
The research set out to examine how two major advances in the care of adolescents living with obesity relate to one another.
“The motivation behind our paper was to look at the relationship between two exciting developments in the treatment of obesity in adolescence. The first is long-term evidence for the safety and efficacy of bariatric surgery in adolescents, and the other is FDA approval of GLP-1s in this age group,” said John B. Rode, MD, MS, first author of the study and a fourth-year resident physician at Lurie Children’s.
How the study was conducted
The investigators analysed electronic health records from more than 1.4 million adolescents in the United States who met guideline-based eligibility criteria for metabolic and bariatric surgery between 2017 and 2025.
Across that period, they tracked the use of bariatric surgery alongside prescribing of GLP-1 medications, including semaglutide and liraglutide. Use of GLP-1s increased dramatically during the study period, while rates of bariatric surgery began to decline following the approval of semaglutide for adolescents with obesity in late 2022.
Bariatric surgery rises, then declines
Use of bariatric surgery among eligible adolescents increased steadily from 2017 through 2022, reaching a peak of 189 procedures per 100,000 eligible teenagers. After that point, the trend reversed.
“Our study found that while bariatric surgery use increased between 2017 and 2022, it subsequently decreased about 29 percent through the end of 2025,” Dr. Rode said. “This decline coincided with the FDA approval of semaglutide for adolescents aged 12 or older with obesity.”
GLP-1 prescribing increases 35-fold
Over the same period, prescriptions for GLP-1 medications increased sharply. Overall prescribing rates rose from 301 prescriptions per 100,000 eligible adolescents in early 2017 to 10,676 per 100,000 by the end of 2025 – a 35-fold increase.
Prescribing rates were highest among adolescents with the most severe obesity.
Most eligible adolescents receive neither treatment
Despite the sharp rise in GLP-1 prescribing, both treatments reached only a small fraction of the adolescents who qualified for them. Among the 1.4 million adolescents eligible for bariatric surgery, less than 1 per cent underwent surgery during the study period, while 4.6 per cent received at least one GLP-1 prescription.
By the fourth quarter of 2025, more than 1.29 million eligible adolescents – 90.4 per cent of the study population – had received neither treatment.
“We found that nine out of 10 adolescents who qualified for bariatric surgery received neither treatment throughout the whole study period between 2017 and 2025,” Dr. Rode said. “Our findings suggest that even though we’ve developed safe and effective treatments for obesity in adolescents, the data indicate that those who qualify likely don’t have access to these treatments.”
Insurance status and unequal access
Dr. Rode and his collaborators also identified disparities in access to GLP-1 medications. By late 2025, adolescents with private insurance were prescribed GLP-1 medications at rates 2.4 times higher than those who were uninsured or self-paying, and at modestly higher rates than those with public insurance.
Bariatric surgery rates, by contrast, were similar across insurance groups.
According to Dr. Rode, the findings raise concerns that newer obesity medications could be widening existing inequities in care.
Supporting young people living with obesity
The study points to a gap between the treatments now available for adolescents living with obesity and the number of eligible young people who actually receive them. For healthcare professionals who work with children, young people and their families, keeping pace with a fast-moving evidence base is an important part of helping to close that gap.
With GLP-1 prescribing rising 35-fold over the study period, these medications are becoming an increasingly prominent part of obesity care. Supporting clinicians to prescribe them safely and confidently – from selecting the right treatment and initiation through to titration and managing side effects – is the focus of professional training such as the College of Contemporary Health’s GLP-1RAs in Practice: Prescribing, a CPD-accredited online short course.
Questions for future research
The authors say more work is needed to understand both how GLP-1 medications will reshape obesity care and why so few eligible adolescents are receiving evidence-based treatment.
“As rates of childhood obesity continue to rise, further research is needed to understand how GLP-1s might change the landscape of obesity care, including the potential complementary role with metabolic and bariatric surgery,” Dr. Rode said. “Most importantly, further research is necessary to understand the reasons behind this lack of access to evidence-based treatments, to make sure that patients receive the care that they need.”
Authorship and funding
Justin Ryder, PhD, Vice Chair of Research for the Department of Surgery at Lurie Children’s and Associate Professor of Surgery and Pediatrics at Northwestern University Feinberg School of Medicine, was the senior author on the study.
The study was supported by the National Cancer Institute under award T32CA247801.
CCH insight
GLP-1 prescribing among eligible adolescents rose 35-fold in this study, yet nine in ten received neither a GLP-1 medication nor bariatric surgery, and access to GLP-1s varied by insurance status. For healthcare professionals supporting people living with obesity, the findings are a reminder of how quickly treatment options are changing – and how much depends on those options reaching the people who qualify for them.
CCH’s GLP-1RAs in Practice: Prescribing CPD short course (2 CPD hours, fully online, CPD-accredited) equips prescribers to use these medications well – from selecting the right treatment and initiation through to titration and side-effect management.
Source: JAMA Pediatrics
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Major Weight Loss Alters Brain Structure in People With Obesity, One-Year Study Finds
Key Takeaways:
- Adults with obesity who lost at least 40% of their excess weight over one year showed greater increases in subcortical grey matter volume than those who lost less, alongside significant improvements in blood sugar control, cholesterol, liver enzymes and inflammation.
- Greater excess weight loss was associated with reductions in cortical and subcortical T1 relaxation times, a possible marker of improved grey matter tissue health, although the between-group difference in subcortical volume did not survive correction for multiple comparisons.
- Cognitive performance did not differ significantly between groups after one year, and the researchers say longer, larger studies are needed to establish whether early structural brain changes lead to measurable cognitive benefits.
Weight loss and the brain: a growing question
People with obesity who lost at least 40% of their excess weight over one year showed measurable gains in brain structure, particularly in subcortical grey matter volume, according to a prospective cohort study conducted at New York University Grossman School of Medicine’s Brain, Obesity & Diabetes Laboratory. These changes were accompanied by substantial improvements in blood sugar control, cholesterol and inflammation.
The findings, published in Obesity Science & Practice, arrive at a time when the use of weight-loss medications in the United States doubled from 0.76 million to 1.51 million users between 2017 and 2024. As more people undergo major weight loss, understanding how it affects the brain has become an increasingly urgent question.
How the study was designed
The study enrolled 84 adults with obesity from weight-loss programmes at NYU Langone Medical Center and NYU Langone Brooklyn between 2018 and 2023. Each participant was followed for approximately one year, with identical evaluations carried out at baseline and at follow-up.
Participants were aged between 33 and 59 and had body mass index (BMI) values between 30 and 50 kg/m², with diagnoses of type 2 diabetes, prediabetes or insulin resistance. Rather than randomising participants to a specific treatment, the researchers categorised them after the fact according to how much weight they lost. In total, 54 people who achieved 40% or greater excess weight loss formed the weight-loss group, while 30 people who lost less than this threshold formed the non-weight-loss group.
Excess weight was calculated as the difference between each participant’s actual weight and the weight corresponding to a BMI of 25 kg/m². On average, the weight-loss group lost 64.39% of their excess weight and 23.62% of their total body weight, falling from a mean of 245.42 pounds at baseline to 186.51 pounds at follow-up. By comparison, the non-weight-loss group lost an average of 9.71% of excess weight and 3.38% of total body weight.
Treatment approaches varied considerably. Across the overall cohort, 57 participants underwent bariatric surgery, mostly sleeve gastrectomy, while 27 received behavioural or medical interventions. A total of 25 participants used GLP-1 receptor agonists as adjunctive therapy across both approaches.
Comparing the two groups at baseline
At the start of the study, the two groups were closely matched. They did not differ significantly in age, education, socioeconomic status, weight, waist circumference or the prevalence of metabolic syndrome, which affected 83.3% of the non-weight-loss group and 68.5% of the weight-loss group. Around three-quarters of the cohort were female, reflecting the clinical population seeking obesity treatment.
A small number of baseline differences emerged, with the weight-loss group showing higher BMI, LDL cholesterol, cholesterol ratio and alanine aminotransferase (ALT). However, most of these differences disappeared after adjustment for multiple comparisons, leaving only LDL cholesterol and ALT statistically distinct between the groups.
Assessments and brain imaging
Each participant underwent a physical examination, fasting blood tests, a five-sample oral glucose tolerance test, cognitive testing and a standardised 3T MRI session that included a structural MP2RAGE scan.
The researchers processed the images using FreeSurfer software, measuring regional brain volumes and generating quantitative T1 maps, a technique sensitive to changes in tissue. They paid particular attention to regions vulnerable to Alzheimer’s disease, including the inferior parietal and inferior temporal cortices, the posterior cingulate cortex and the hippocampus. These areas were selected because they are sensitive to the metabolic, vascular and inflammatory insults that are also common in obesity.
Marked improvements in metabolic health
The metabolic results were striking. Compared with the non-weight-loss group, participants who lost the most weight showed significantly greater reductions in BMI, waist circumference, HbA1c, fasting glucose, fasting insulin, HOMA-IR and C-reactive protein. They also showed improved insulin sensitivity, measured by QUICKI and ISI, a healthier lipid profile with higher HDL and lower LDL cholesterol, and improved liver enzymes. Most of these effects remained significant after correction for multiple comparisons.
At follow-up, the prevalence of metabolic syndrome was significantly lower in the weight-loss group than in the non-weight-loss group. Blood pressure, however, did not change significantly between groups, probably because many participants were already taking antihypertensive medications at baseline.
For healthcare professionals supporting people living with obesity and related metabolic conditions such as type 2 diabetes and insulin resistance, findings like these highlight the wide-ranging benefits of effective weight management. CCH’s Obesity Essentials course offers a grounding in supporting people living with obesity, helping clinicians place evidence like this in the context of everyday practice.
Changes in brain structure
The brain findings were more nuanced. The clearest signal appeared in subcortical grey matter volume. After adjusting for age and the interval between scans, the weight-loss group showed significantly greater increases in subcortical grey matter than the non-weight-loss group, and this effect persisted when T1 relaxation time was added as a covariate.
Within the weight-loss group, subcortical grey matter increased significantly over the year, while the non-weight-loss group showed a significant decline in the composite volume of Alzheimer’s-vulnerable regions. However, the between-group difference in subcortical volume did not survive correction for multiple comparisons, and the researchers stress that the within-group changes in Alzheimer’s-vulnerable regions should be regarded as preliminary.
T1 relaxometry offers further evidence
T1 relaxometry provided a second line of evidence. Longer T1 relaxation times are generally interpreted as a marker of tissue damage. In this study, higher percentage excess weight loss was associated with greater reductions, indicating improvements, in both cortical and subcortical T1 relaxation values. This aligns with earlier findings in adolescents with obesity.
Taken together, the authors write, the results suggest that weight loss is associated with improvements in the volume and possibly the health of grey matter, particularly in subcortical regions. This is consistent with existing literature showing that higher BMI is linked to grey matter atrophy.
No clear effect on cognition yet
Cognition told a different story. Cognitive performance did not differ between the groups at baseline or at follow-up. Although the weight-loss group showed numerically greater improvements in memory composite scores, these did not reach statistical significance and were highly variable.
The authors suggest that a one-year follow-up may be too short for subtle structural changes to translate into measurable cognitive benefits, and that detecting such effects is likely to require larger, adequately powered cohorts with longer follow-up periods.
Limitations and next steps
The study has several important limitations. It was non-randomised, and group assignment was determined post hoc based on weight loss, meaning unmeasured confounding cannot be fully ruled out. The modest sample size prevented subgroup analyses, including any examination of sex-dependent effects, and the one-year follow-up was designed to capture short-term changes rather than long-term trajectories.
The researchers note that longer studies will be needed to determine whether weight loss alters the course of cognitive decline and neurodegenerative risk, and whether the structural brain changes observed precede measurable cognitive benefits.
Even so, the parallel improvements in peripheral metabolic markers and central neuroimaging measures raise the possibility that weight loss may influence neurobiological pathways relevant to neurodegenerative risk before cognitive changes emerge. According to the authors, this provides a rationale for extended follow-up to test the durability and functional significance of these early structural signals.
CCH insight
Weight loss in this study was achieved through a range of approaches, from bariatric surgery to behavioural and medical interventions, and the benefits extended well beyond the scales. Obesity Essentials from The College of Contemporary Health helps healthcare professionals build the knowledge and confidence to support people living with obesity across these different pathways.
Explore Obesity Essentials and enrol today →
Source: Obesity Science & Practice
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Study Finds Higher Rates of Nail Detachment Among People Taking GLP-1 Medications
Key Takeaways:
- In a study of 1,904 people across four countries, nail detachment was reported by 39 per cent of people taking GLP-1 medications, compared with 9 per cent of people with type 2 diabetes or obesity who had never taken them, although around half of those taking the drugs reported nail problems before treatment began.
- The study was cross-sectional and based on self-reported symptoms, so it shows an association rather than proving that GLP-1 medications cause nail changes.
- Dermatologists describe the changes as frequent and usually benign, and advise people who notice nail, hair or scalp changes to speak with their doctor rather than stop treatment on their own.
A new question for people starting GLP-1 treatment
When a person begins a new medication and notices a change in their body, a natural question often follows: is the drug responsible? Changes to the nails can prompt exactly that question.
In a new study, researchers set out to investigate whether nail problems are more common among people taking GLP-1 medications, which are used to treat obesity and type 2 diabetes. Their analysis of 1,904 people across four countries found a notable difference.
Nail detachment was reported by 39 per cent of people taking GLP-1 medications, compared with 9 per cent of people with type 2 diabetes or obesity who had never taken the drugs. However, around half of the people taking the medications reported having nail problems before their treatment began.
The findings were presented at the European Academy of Dermatology and Venereology (EADV) Congress 2026 in Vienna.
How the study was designed
The researchers compared 575 people taking GLP-1 medications with 1,329 people with type 2 diabetes or obesity who had never used them. Participants were recruited across France, the United States, Brazil and Mexico.
According to an EADV press release, 66 per cent of people taking GLP-1 medications reported at least one nail disorder, compared with 53 per cent of the control group. Nail discolouration was reported by 46 per cent of people taking the medications, compared with 17 per cent of controls.
“Our findings show a clear association, but they also underline an important point,” says study author Charles Taïeb, the managing director of the European Market Maintenance Assessment.
“Not everything that happens during GLP-1 treatment is necessarily caused by the treatment itself.”
Why the findings cannot prove cause and effect
The study relied on participants describing their own symptoms. It was cross-sectional, meaning it captured participants’ experiences at a single point in time rather than following them through treatment with standardised dermatological examinations. As a result, it cannot establish that the medications caused the changes reported.
The extent of the nail detachment described in the study is also unclear. The researchers have not specified whether the term covers partial separation from the nail bed, complete nail loss, or both. The information currently available also does not distinguish between fingernails and toenails.
Understanding nail detachment
In general, separation of the nail plate from its bed is known as onycholysis. DermNet explains that it can affect the fingers or toes and has several possible causes, including injury, skin disease and infection. However, this general background does not establish which conditions participants in this particular study experienced.
The 39 per cent figure should therefore not be interpreted as evidence that nearly four in ten people taking GLP-1 medications lost their nails completely. Nor does it estimate the likelihood that a person newly starting the medication will develop the problem.
Accounting for other factors
When analysing the results, the researchers accounted for dermatological conditions and nutritional deficiencies. Some of the associations weakened as a result, but nail detachment and discolouration remained around two to three times more frequent among people taking GLP-1 medications, according to the press release.
The exact adjusted estimates and confidence intervals have not been provided. Without them, the precision of these comparisons cannot be assessed from the announcement alone.
The team also examined the role of weight loss. Differences remained statistically significant when the analysis focused only on participants who had lost weight, suggesting that weight loss alone may not explain the findings. Even so, this does not demonstrate a direct effect of the medications on the nails.
Hair and scalp symptoms
A companion study involving the same participants looked at hair and scalp symptoms, adding to growing interest in possible links between GLP-1 pathways and hair loss.
Unusual hair loss was reported by 50 per cent of people taking GLP-1 medications, compared with 34 per cent of controls. Reduced hair volume or density affected 42 per cent of people taking the medications, compared with 19 per cent of controls.
Among people taking the medications, hair loss was usually accompanied by scalp symptoms such as itching, redness or scaling.
Study author and dermatologist Bruno Halioua, from the Société Française des Sciences Humaines sur la Peau (SFSHP), suggests that this pattern could go beyond the hair shedding typically seen after rapid weight loss and may involve inflammation.
Because the hair findings came from the same group of people, they do not independently replicate the nail results. Instead, they offer another perspective on the symptoms reported within this sample. Whether similar patterns appear in other populations, and how often problems begin after treatment starts, remain questions for future research.
Important limitations to consider
The press release does not identify which GLP-1 medications participants were taking, nor does it provide results for any specific drug. The findings therefore cannot establish a nail effect linked to any single medication.
The release cites conference presentations as the sources for both studies and does not reference a published paper reporting them.
The nail study was conducted with institutional support from DUCRAY Laboratories, part of the Pierre Fabre Group, which develops dermatological and hair care products.
What comes next
The researchers now plan to follow patients from the start of their treatment. Standardised dermatological examinations and biological monitoring could help to establish when changes develop, what contributes to them, and whether they are reversible.
For healthcare professionals, findings like these highlight the value of asking about skin, hair and nail changes during routine reviews, and of recording any pre-existing problems before treatment begins. The College of Contemporary Health’s GLP-1RA Therapy: The Complete Programme course is designed for clinicians who prescribe GLP-1 receptor agonists and support people throughout their treatment.
Advice for people noticing changes
Halioua describes the changes as frequent and usually benign. For people who notice nail changes, hair loss, or an itchy or red scalp, his advice is to discuss these symptoms with their doctor rather than stopping treatment themselves.
CCH insight
As GLP-1 receptor agonists become more widely used, people taking them are increasingly likely to raise questions about side effects, including changes to their nails, hair and skin. Feeling confident in discussing these concerns, recognising what may be linked to treatment, and encouraging people to continue the conversation rather than stop their medication are all key parts of good care.
Our GLP-1RA Therapy: The Complete Programme course helps healthcare professionals build the knowledge and confidence to prescribe and support people on GLP-1RA therapy safely and effectively.
Explore GLP-1RA Therapy: The Complete Programme →
Source: European Academy of Dermatology and Venereology (EADV) Congress 2026
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Mounjaro May Switch On the Body’s Calorie-Burning Brown Fat, Mouse Study Suggests
Key Takeaways:
- A study in mice found that tirzepatide (Mounjaro) activates brown adipose tissue, a type of fat that specialises in using energy, and that this effect cannot be explained by reduced food intake alone.
- Unlike earlier drug-based attempts to activate brown fat, which were often hampered by side effects affecting the heart, tirzepatide shows cardiovascular benefits.
- The researchers stress that the findings come from mice and need to be confirmed in humans, but suggest they could pave the way for more personalised obesity treatment based on a person’s overall metabolic status.
Looking beyond appetite suppression
Tirzepatide has become an important treatment for obesity and related conditions such as type 2 diabetes, yet scientists are still working to understand exactly how it acts on the body. New research in mice now suggests that the drug may improve metabolism directly by activating brown adipose tissue, a form of fat that specialises in using energy rather than storing it.
According to the research team, the findings offer fresh insight into how tirzepatide works and could help shape the development of broader treatments for obesity and other metabolic disorders.
The study was led by Marion Peyrou, a Ramón y Cajal researcher at the Faculty of Biology and the Institute of Biomedicine of the University of Barcelona (IBUB), the Sant Joan de Déu Research Institute (IRSJD) and the CIBER in Physiopathology of Obesity and Nutrition (CIBEROBN).
A drug that targets two hormone receptors
Tirzepatide, the active ingredient in Mounjaro (also marketed as Zepbound), is approved for weight management in adults living with obesity, or with overweight alongside related health conditions. It is also approved for treating type 2 diabetes mellitus that is poorly controlled.
What sets tirzepatide apart from some other obesity medications is that it acts on the receptors for two hormonal factors at once: glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). This dual mechanism can lead to substantial weight loss, largely because the drug reduces how much a person eats.
For healthcare professionals supporting people who are prescribed tirzepatide and similar medicines, understanding these mechanisms is becoming increasingly relevant to everyday practice – an area explored in The College of Contemporary Health’s GLP-1RAs in Focus CPD course.
The researchers set out to establish whether tirzepatide also brings about metabolic changes that cannot simply be attributed to eating less.
How the study was designed
To answer this question, the team examined how the drug affected different fat deposits in an experimental mouse model, as this kind of detailed tissue analysis cannot readily be carried out in humans. Mice with obesity, which had been fed a high-fat diet, were treated with tirzepatide.
The researchers then compared these animals with a second group of mice that did not receive the drug but were given exactly the same amount of food. By matching food intake in this way, the scientists were able to separate the changes caused directly by tirzepatide from those that resulted from consuming fewer calories.
Tirzepatide activates brown fat
The analysis showed that tirzepatide activated brown adipose tissue. White adipose tissue mainly stores fat and tends to build up in people living with obesity, whereas brown fat specialises in using energy and “burning” the calories obtained from food.
“This activation is associated with an increased capacity to burn metabolic energy and with the production of batokines by brown adipose tissue, molecules that are beneficial for metabolism,” says Marion Peyrou.
The finding suggests that tirzepatide may influence metabolism in ways that go beyond the weight loss brought about by appetite suppression and reduced food intake.
“This drug not only reduces body weight, but also has beneficial effects on metabolism. Active brown adipose tissue ‘burns’ glucose and fat within the body, which would contribute to its positive effect not only in reducing body weight, but also in lowering blood glucose and fat levels, and improving metabolism,” the researcher points out.
Avoiding the pitfalls of earlier approaches
Scientists have long regarded brown fat activation as a potentially valuable strategy for treating obesity and other metabolic diseases. However, previous attempts to activate brown adipose tissue using drugs have frequently been unsuccessful because of unwanted side effects, particularly those affecting the heart.
“Tirzepatide, although it activates brown adipose tissue, does not have these negative effects; on the contrary, it shows cardiovascular benefits. If our findings are confirmed in humans, it would reinforce the importance of developing therapeutic strategies that not only reduce food intake but also increase energy expenditure and brown fat activation,” explains the researcher.
The results support the view that obesity treatments may be more effective when they act on several physiological processes at once, rather than focusing on appetite alone.
“This could help improve weight control and reduce associated disorders, such as type 2 diabetes and other metabolic disorders,” she adds.
Towards more personalised obesity treatment
A clearer understanding of how tirzepatide works could also influence how medicines in this class are prescribed in future.
“Identifying which patient profiles could benefit most, for example those with more compromised energy expenditure, would open the door to more personalised medicine, based not only on appetite or weight control, but also on overall metabolic status,” she emphasises.
Caution needed before applying the findings to people
The researchers are clear that because the findings come from mice, it cannot yet be assumed that tirzepatide acts in the same way in humans. Metabolism can differ considerably between the two species, as can the distribution of fat tissue and the way each responds to medications.
“As this is a study conducted on mice, we must be cautious, as there may be significant differences between species in terms of metabolism regulation, adipose tissue distribution and response to drugs. Therefore, we need more clinical evidence on the action of these drugs on fat in humans,” concludes Peyrou.
CCH insight
It is important to continue to unravel the multitude of mechanisms by which GLP-1 medications deliver their benefits, so his is very interesting research. However, as the authors noted, just because the drug acts in this way in mice, it does not mean it will do the same in humans. It is also important to note that humans have no more than a tenth the amount of brown fat, in relative terms, compared with mice. So even if this mechanism is true in humans, it may have a much smaller effect.
As research continues to reveal how dual GIP/GLP-1 receptor agonists such as tirzepatide act on the body – from appetite regulation to potential effects on energy expenditure – healthcare professionals need a confident, up-to-date understanding of these medicines to support the people in their care. The College of Contemporary Health’s GLP-1RAs in Focus CPD course offers a practical grounding in how these therapies work and how they fit into modern obesity and diabetes care.
Source: Biomedicine & Pharmacotherapy
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Greater Weight Loss, More Side Effects: What GLP-1 RAs Mean for Women
Key Takeaways:
- Real-world studies show women treated with GLP-1 receptor agonists (GLP-1 RAs) report side effects such as headache, vomiting and dizziness more often than men, even though placebo-controlled trials suggest similar rates in both sexes.
- Women tend to lose more weight on GLP-1 RAs than men, while improvements in blood sugar control are comparable, possibly due to higher drug exposure, stronger suppression of food-motivated behaviours and interactions between GLP-1 signalling and oestrogen.
- The authors call for mandatory sex- and ethnicity-stratified trial reporting, more research across every stage of women’s lives, and equitable global access to genuine GLP-1 RAs, as nearly 80% of eligible adults live in low- and middle-income countries where access remains minimal.
A call to action on GLP-1 RA use in women
The second of a Series of papers presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Milan, Italy (28 September – 2 October), and published in The Lancet Obstetrics, Gynaecology & Women’s Health, examines the wide-ranging issues surrounding GLP-1 RA use in women.
The authors, including Professor Paul Franks of Lund University and Helsingborg Hospital, Helsingborg, Sweden, and Professor Claire Meek of the Leicester Diabetes Research Centre and Leicester NIHR Biomedical Research Centre, Leicester, UK, alongside colleagues, issue a call to action to strengthen the evidence base for GLP-1 RA use in women worldwide.
The global burden of obesity among women
The prevalence of obesity is estimated to be slightly higher among women than among men, and this difference varies according to socioeconomic status. A recent analysis by the Global Burden of Disease group estimated that, in 2021, the global prevalence of overweight or obesity was 46.7% in females and 43.4% in males. Projections for 2050 rise to 60.3% and 57.4%, respectively.
This gender gap is more pronounced in low- and middle-income countries (LMICs), with the largest gaps seen in sub-Saharan Africa and south Asia. By contrast, men in high-income countries can have higher prevalence rates. The trend is likely to continue in the coming decades and is linked to socioeconomic inequalities, highlighting how broader social barriers disproportionately affect women in many regions of the world.
Why women may lose more weight on GLP-1 RAs
Weight loss with GLP-1 RAs is greater in women than in men, yet improvements in blood sugar control are comparable between the sexes. Several mechanisms could explain this greater weight-loss efficacy in women:
- Higher systemic drug exposure has been observed in women, even after adjusting for body mass.
- Women treated with GLP-1 RAs may experience enhanced suppression of food-motivated behaviours and greater inhibition of palatable food intake.
- Pre-clinical studies have highlighted possible interactions between GLP-1 signalling and oestrogen.
Side effects and weight regain
Real-world studies comparing adverse event rates in women and men treated with these medications have found a higher overall frequency of reported side effects among women, including increased rates of headache, vomiting and dizziness. This contrasts with placebo-controlled trials, which suggest similar rates in both sexes. The authors therefore stress that more studies are needed to quantify side-effect profiles in women and to develop strategies to mitigate them.
It is also well established that weight can be regained rapidly after GLP-1 RA treatment is stopped. Regaining fat without regaining additional muscle raises concerns about longer-term health and physical function in women, and further research is needed to ensure these powerful medications support women’s wellbeing over the long term.
Mental health and psychiatric safety
Trial data to date support the overall psychiatric safety profile of GLP-1 RAs, while reinforcing the importance of individualised risk assessment. Careful, routine screening for depression, anxiety and eating disorders is recommended for people of both sexes, both before treatment begins and during follow-up.
For healthcare professionals prescribing or supporting people on these medications, The College of Contemporary Health’s GLP-1RAs in Focus course offers a grounding in GLP-1 receptor agonist therapy, helping clinicians approach treatment decisions, monitoring and patient conversations with confidence.
Affordability and access in low- and middle-income countries
Independent manufacturing estimates suggest that semaglutide, for example, could be produced for less than $1 per month’s supply in oral form and $5 per month as an injection. However, recent analyses across 99 countries indicate that nearly 80% of adults who meet clinical eligibility criteria for GLP-1 RAs live in LMICs, where access remains minimal. In many of these settings, retail prices exceed $90 per month, placing treatment beyond the reach of women who rely on publicly funded care or out-of-pocket payments.
Diverse populations and polyendocrine metabolic ovarian syndrome
The paper explores multiple areas in which GLP-1 RAs affect women’s health, and highlights the need for further research in each. For example, many women with type 2 diabetes in LMICs are lean, and the BMI threshold at which type 2 diabetes begins to develop is often lower than for people of European ancestry. As a result, significant weight loss could have a more pronounced impact on these women.
Polyendocrine metabolic ovarian syndrome (PMOS; formerly polycystic ovary syndrome) affects around 12% of women worldwide, with the highest rates in the eastern Mediterranean region and south-east Asia. Although weight loss leads to various health improvements in women with PMOS, GLP-1 RAs are not generally available or centrally funded for PMOS in most healthcare systems.
Research priorities across women’s lives
The authors conclude that extensive research into GLP-1 RA use in women is needed across a range of domains, including:
- mental health and eating disorders
- contraception, fertility and polyendocrine metabolic ovarian syndrome
- optimising pre-pregnancy health
- preventing complications
- safety during pregnancy and breastfeeding
- optimising health and body composition during menopause
- optimising cardiovascular health and preventing multimorbidity
- frailty and healthy ageing
The authors’ call to action
In their call to action, the authors say:
- “Women face the highest burden of obesity and its related complications, and should have access to high-quality, equitable, multidisciplinary obesity care worldwide”
- “Sex-stratified and ethnicity-stratified reporting of clinical trials related to GLP-1 receptor agonist use should be mandatory to facilitate future meta-analyses”
- “As the main users of GLP-1 receptor agonists and incretin-based therapies, women’s care should be guided by high-quality studies assessing their treatment’s efficacy and safety, specifically in conditions affecting women (eg, before, during, and after pregnancy)”
- “Existing access pathways to GLP-1 receptor agonists disadvantage women – to maximise the treatment’s benefits, companies, health-care funders, research funders, insurers, and policy makers should promote equitable access to high-quality, genuine GLP-1 RAs for women worldwide”
The authors conclude: “Tackling the global challenges in access to GLP-1 receptor agonists provides substantial opportunities to improve women’s health internationally. However, achieving equitable access will require coordinated action to strengthen supply chains, enhance regulatory vigilance against falsified and compounded products, and embrace innovative therapies – such as oral agents – that are stable, scalable, and potentially more affordable…Advancing women-centred obesity care demands targeted research, including trials inclusive of diverse ethnic groups, women of reproductive age, and LMIC populations, alongside women-focused cost-effectiveness and implementation studies.”
CCH insight
This study highlights one of the biggest global challenges of obesity medicine – how to get obesity medications to the people who need them most, especially in low- and middle- income countries (LMICs). The emergence of GLP-1RAs in pill form should be a major development in this area, both in terms of bringing the price down and making the drugs more accessible as refrigeration is not required. Another positive step would be to produce these drugs generically or with compulsory licensing to bring prices down in LMICs.
As GLP-1 RAs become central to obesity and diabetes care, understanding how they affect different groups, including women at different life stages, is increasingly important for safe, effective prescribing. Build your knowledge with our GLP-1RAs in Focus CPD course.
Explore GLP-1RAs in Focus – Why Drugs Like Ozempic Work →
Source: European Association for the Study of Diabetes
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AI Analysis of 400,000 Reddit Posts Reveals Underreported Side Effects of GLP-1 Medications
Key Takeaways:
- University of Pennsylvania researchers used artificial intelligence to analyse more than 400,000 Reddit posts from nearly 70,000 users discussing semaglutide and tirzepatide, identifying symptoms that may be underrepresented in clinical trials and official regulatory information.
- Reproductive symptoms, including menstrual irregularities, and changes in body temperature, such as chills and hot flashes, emerged as signals particularly worth investigating, alongside fatigue, which was the second most frequently reported complaint.
- The findings show associations in what people discussed online, not proof that GLP-1 medications cause these symptoms, but the researchers suggest “computational social listening” could become a fast, early detection system for emerging drug safety concerns.
Listening to patients at scale
Artificial intelligence is offering researchers a new way to hear what patients are saying about widely used GLP-1 medications. After analysing more than 400,000 Reddit posts, a team at the University of Pennsylvania identified several symptoms reported by people using semaglutide (Ozempic, Wegovy and Rybelsus) and tirzepatide (Mounjaro and Zepbound) that may not be fully reflected in clinical trials or official regulatory information.
The study, recently published in Nature Health, examined more than five years of posts from nearly 70,000 Reddit users. Two categories of symptoms stood out as particularly deserving of further investigation: reproductive symptoms, including changes to menstrual cycles, and problems relating to body temperature, such as chills and hot flashes.
Importantly, the findings do not establish that the medications caused these symptoms. Rather, the researchers say that this vast collection of spontaneous patient reports may reveal signals that merit closer examination.
“Some of the side effects we found, like nausea, are well known, and that shows that the method is picking up a real signal,” says Sharath Chandra Guntuku, Research Associate Professor in Computer and Information Science (CIS) at Penn Engineering and the study’s senior author. “The underreported symptoms are leads that came from patients themselves, unprompted, and clinicians could potentially pay attention to them.”
What patients report outside clinical trials
Clinical trials are designed to determine whether treatments work and to identify significant safety problems. However, they cannot necessarily capture every symptom that matters to patients once a medication is being used by a much larger and more varied population.
“Clinical trials generally identify the most dangerous side effects of drugs,” adds Lyle Ungar, Professor in CIS and a co-author on the study. “But they can fail to find what symptoms patients are most concerned about; even though social media is not necessarily representative, a large collection of posts may reflect additional concerns.”
This distinction is an important one. The study identified associations in what people discussed online, not evidence that GLP-1 medications were responsible for those experiences.
“We can’t say that GLP-1s are actually causing these symptoms,” notes Neil Sehgal, the study’s first author and a doctoral student in CIS advised by Guntuku and Ungar. “But nearly 4% of the Reddit users in our sample reported menstrual irregularities, which would be even higher in a female-only sample. We think that’s a signal worth investigating.”
Using social media as an early health signal
The idea of mining online conversations for clues about drug safety predates the current AI boom. In 2011, Ungar took part in one of the earliest efforts to use content created by internet users to identify possible adverse effects of medications.
Social media can capture experiences that patients discuss with one another but may never formally report to a doctor, drug manufacturer or regulator.
“Online patient communities work a lot like a neighborhood grapevine,” says Ungar. “People who are living with these medications are swapping notes with each other in real time, sharing experiences that rarely make it into a doctor’s office visit or an official report.”
Since then, online patient communities have grown enormously. This has made social media a potentially valuable source for understanding how medications affect people in everyday life, although gaining access to platform data has become more difficult.
The researchers emphasise that traditional clinical research remains essential, but online conversations can provide information far more quickly when millions of people begin using a medication.
“Clinical trials are the gold standard, but by design, they are slow,” says Guntuku. “This is not a replacement for trials, but it can move much faster, and that speed matters when a drug goes from niche to mainstream almost overnight.”
How AI makes large-scale analysis possible
One of the biggest obstacles to this kind of research has always been scale.
Guntuku describes the approach as “computational social listening”, which uses computational methods to identify patterns across large collections of online conversations about health.
Patients, however, rarely describe their symptoms using standardised medical terminology. One person might describe feeling unusually cold, another might mention constant chills, while a clinician could categorise both experiences using a specific medical term.
Researchers therefore need a way to translate everyday language into standardised categories. One important reference is the Medical Dictionary for Regulatory Activities (MedDRA), which provides terminology widely used to classify medical conditions, symptoms and adverse events.
Previously, matching vast numbers of informal social media posts to standardised medical terminology required an enormous amount of work, limiting how much data researchers could realistically analyse.
Large language models such as GPT and Gemini are changing that, allowing researchers to process and categorise huge volumes of text more quickly and consistently.
“Large language models have made it possible to do this kind of analysis much faster with a level of standardization that could be difficult to achieve before,” says Sehgal.
Unexpected symptoms emerge from 400,000 posts
The researchers stress that Reddit users do not represent the wider population of people taking GLP-1 medications. Reddit users tend to be younger, are more likely to be male and are disproportionately based in the United States.
Despite this limitation, the analysis produced a reassuring sign that the approach was detecting genuine patterns: many of the symptoms discussed by Reddit users closely matched the already known effects of semaglutide and tirzepatide.
Around 44% of users included in the study described at least one side effect. Gastrointestinal problems were the most common, consistent with the nausea and other digestive issues already associated with these medications.
More intriguing were symptoms that appeared frequently enough to attract the researchers’ attention but may not be as well represented in current drug labels or conventional adverse event reports:
- Reproductive symptoms: nearly 4% of users who reported side effects described reproductive symptoms, including changes to menstruation such as bleeding between periods, heavy bleeding and irregular menstrual cycles.
- Body temperature changes: users described chills, feeling unusually cold, hot flashes and symptoms resembling a fever.
- Fatigue: this was the second most frequently reported complaint in the Reddit data, even though relatively few clinical trials reported fatigue often enough for it to meet established reporting thresholds.
For healthcare professionals prescribing or supporting people using these medications, findings like these are a reminder of the value of asking open questions about how patients are feeling, beyond the side effects most commonly discussed. Clinicians wishing to build confidence in this area may find The College of Contemporary Health’s GLP-1RAs in Focus CPD course a useful way to deepen their understanding of these therapies and the conversations that surround them.
Why menstrual and temperature changes are of interest
One possible reason these reports caught the researchers’ attention involves the hypothalamus, a small but vitally important region of the brain. Among its many roles, the hypothalamus helps regulate hunger, hormones, reproduction and body temperature.
“These drugs are thought to work by engaging part of the brain called the hypothalamus, which helps regulate a wide variety of hormones,” says Jena Shaw Tronieri, Senior Research Investigator at Penn’s Center for Weight and Eating Disorders and a co-author of the study. “That doesn’t mean the medications are necessarily causing these symptoms, but it could suggest that reports of menstrual changes and body temperature fluctuations are worth studying more systematically.”
The researchers are not suggesting that this biological link proves GLP-1 medications are responsible. Instead, it provides a further reason to test these patient-reported patterns more rigorously through controlled research.
Turning online conversations into research leads
For now, the team hopes the results will encourage scientists and clinicians to pay closer attention to the symptoms that patients repeatedly discuss online.
“They’re clearly on patients’ minds, and that’s worth paying attention to,” says Sehgal.
The researchers also plan to extend their analysis beyond Reddit and beyond English-language communities. Doing so could help determine whether the same patterns emerge among different groups of people and across different social media platforms.
“We don’t really know yet whether what we’re seeing on Reddit reflects the experience of GLP-1 users globally, or whether it’s particular to the kind of person who posts on Reddit in the United States,” Ungar says.
An early warning system for emerging health concerns
In the longer term, rapid AI analysis of online patient conversations could become an early detection system for emerging health concerns involving medications, supplements and wellness products.
This could be especially valuable for substances that gain popularity online faster than conventional research can keep pace. Loosely regulated or unregulated products, including injectable peptides, can spread rapidly through communities on Reddit, TikTok and other platforms, meaning that discussions among users may offer some of the earliest indications of unexpected effects.
“The whole point of this kind of approach is that it can move quickly, and that’s exactly when it’s most valuable,” says Guntuku.
The study was conducted at the University of Pennsylvania School of Engineering and Applied Science. The authors report no outside funding. Tronieri reports receiving an investigator-initiated grant, on behalf of the University of Pennsylvania, from Novo Nordisk, and receiving consulting fees from Currax Pharmaceuticals, LLC. The other authors report no conflicts of interest.
CCH insight
As more people use GLP-1 medications, healthcare professionals are increasingly hearing about experiences that go beyond the most familiar side effects. Understanding how these therapies work, and how to have informed, supportive conversations with patients about what they are experiencing, is becoming an essential part of practice.
GLP-1RAs in Focus from The College of Contemporary Health is designed to help healthcare professionals strengthen their knowledge of GLP-1 receptor agonists and support patients with confidence.
Explore GLP-1RAs in Focus today →
Source: University of Pennsylvania School of Engineering and Applied Science
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GLP-1 Medications Linked to Nutritional Deficiencies in Children and Young People, Study Finds
Key Takeaways:
- Nearly one in six children and young people (16.8%) prescribed GLP-1 medications for weight loss, prediabetes or type 2 diabetes were diagnosed with a nutritional deficiency within the first year of treatment, with vitamin D deficiency the most common (12.4%).
- Only 5% of patients received nutritional counselling within 30 days of starting a GLP-1 medication, and fewer than 25% received it within six months.
- Researchers are calling for proactive nutritional management from the outset of GLP-1 treatment in children, rather than waiting until a deficiency is diagnosed.
Nutritional risks during a critical stage of development
Children and young people prescribed GLP-1 medications for weight loss, prediabetes or type 2 diabetes are at risk of developing nutritional deficiencies, according to new research from scientists at Northwestern University and Ann & Robert H. Lurie Children’s Hospital of Chicago. The study found that nutritional deficiencies were diagnosed in nearly one in six patients (16.8%) within the first year of treatment.
Vitamin D deficiency was the most frequently identified, affecting 12.4% of children within one year of starting GLP-1 treatment.
The findings were recently published in the journal Childhood Obesity, in a study titled “Nutritional Deficiencies, Complications, and Nutrition Therapy/Counseling in Pediatric Patients Using GLP-1 Receptor Agonists.”
Why adolescence matters
The study’s senior author, Justin Ryder, associate professor of surgery and paediatrics at Northwestern University Feinberg School of Medicine and vice chair of research for the department of surgery at Lurie Children’s, emphasised the importance of understanding these risks as GLP-1 use in younger patients grows.
“As appropriate pediatric use of GLP-1s becomes more widespread, we need to understand the risks during periods of rapid growth and pubertal development,” said Ryder. “Nutrients such as vitamin D, iron and calcium are of particular concern during adolescence, when deficiencies may have lasting implications for skeletal health and overall development.”
A significant gap in nutritional support
Despite these risks, the research revealed that very few children received nutritional support after beginning treatment.
“Nutritional support needs to play a critical role once treatment with a GLP-1 medication is initiated,” he said. “In our study, however, we found that only 5% of patients received nutritional counseling within 30 days of GLP-1 treatment and less than 25% received nutritional counseling within 6 months.”
The gap highlights the need for healthcare professionals working with children and young people living with obesity to consider nutrition as an integral part of care from the moment treatment begins. Clinicians looking to strengthen their understanding in this area may find structured training, such as The College of Contemporary Health’s Childhood Obesity Essentials course, a valuable way to build confidence in supporting this patient group.
How the study was conducted
The researchers analysed national administrative claims data from 2017 to 2022, covering more than 100 million patients. From this dataset, they identified 2,031 young people aged 10–17 years who were using GLP-1 medications, met continuous enrolment criteria and had no prior diagnosis of a nutritional deficiency.
Within this sample, the most commonly prescribed GLP-1 medications were:
- Liraglutide (78.6%)
- Dulaglutide (10.4%)
- Semaglutide (9.1%)
A call for proactive nutritional management
The research team hopes the findings will encourage a shift towards preventive nutritional care for children and young people receiving GLP-1 treatment.
“We hope that our study findings bring much-needed recognition to the importance of proactive nutritional management when GLP-1s are prescribed to children, as opposed to waiting until a nutritional deficiency is diagnosed,” Ryder said. “Knowing the risks, we are in a much better position to prevent harm to children treated with GLP-1s during a pivotal period in their lives.”
Funding for the study was provided by Abbott.
CCH insight
As GLP-1 medications become more widely used in younger patients, healthcare professionals need the knowledge and skills to support children and young people living with obesity safely and holistically, including their nutritional needs during growth and development. Our Childhood Obesity Essentials CPD course is designed to help clinicians deliver confident, evidence-informed care for this patient group.
Explore Childhood Obesity Essentials and enrol today →
Source: Northwestern University
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Beyond the Scales: New Research Asks Whether GLP-1 Medications Change Daily Life
Key Takeaways:
- A new National Bureau of Economic Research working paper found little evidence that GLP-1 medications produced measurable changes in mental health, self-rated health, employment or marital status among adults living with diabetes.
- Apparent differences between people taking the medications and those who were not largely disappeared once researchers followed the same individuals over time, suggesting the gaps reflected who takes these drugs rather than what the drugs do.
- The findings do not call the clinical value of GLP-1 medications into question: improved glycaemic control, weight loss and better physical health remain the clearest measurable benefits.
A familiar class of medicines, a less familiar question
GLP-1 medications such as Ozempic have reshaped the treatment of Type 2 diabetes. For many people, they help bring blood sugar under control, lower cardiovascular risk and produce substantial weight loss. Those outcomes are now supported by a large and growing body of clinical evidence, and they have made this class of medicines one of the most closely watched developments in contemporary healthcare.
What remains far less certain is whether those physical health improvements ripple outwards into the rest of a person’s life. Do they translate into better mental health? More stable employment? Stronger or more enduring relationships? Researchers are only beginning to test those assumptions, and the answers matter well beyond the consulting room.
What the researchers set out to examine
A new National Bureau of Economic Research working paper takes up precisely that question. The study was conducted by Robert Kaestner, an economist and research professor at the University of Chicago Harris School of Public Policy, alongside co-author Cuiping Schiman.
Among adults with diabetes, the researchers found little evidence that using GLP-1 medications produced measurable changes in mental health, self-rated health, employment or marital status.
“We know these drugs improve health outcomes, and there’s been a great deal of research documenting those benefits,” said Kaestner, a research professor. “What hadn’t really been examined was whether those improvements extended into other parts of people’s lives.”
Why the question matters for coverage decisions
The issue is becoming increasingly important as insurers and government programmes weigh up whether to broaden access to GLP-1 medications. The medical case is already well documented. What is far less clear is whether these treatments also generate social or economic gains that might strengthen the argument for wider coverage.
That distinction is not merely academic. If GLP-1 medications were shown to help people return to work, sustain relationships or experience meaningful improvements in psychological wellbeing, the calculation around funding and eligibility would look rather different. If they do not, decisions will continue to rest primarily on the clinical evidence.
How the study was designed
To investigate, Kaestner and Schiman drew on more than ten years of data from the Medical Expenditure Panel Survey, a nationally representative survey. Their analysis focused on adults with diabetes between 2012 and 2023.
Crucially, the researchers did not rely solely on comparing people who used GLP-1 medications with those who did not. Instead, they followed the same individuals over time. This within-person approach allowed them to observe whether a person’s circumstances actually changed after starting treatment, rather than simply noting how two different groups of people happened to differ.
The team examined several indicators of wellbeing, including symptoms of depression, psychological distress, self-rated health, employment and marital status.
At first glance, people taking GLP-1 medications did appear to differ from those who were not, particularly in relation to employment and marriage. Those differences, however, mostly disappeared once the researchers tracked changes within the same individuals over time.
That pattern points to an important interpretive lesson. The original gaps may well have reflected differences between the kinds of people who take GLP-1 medications and those who do not, rather than any effect caused by the medications themselves. It is a distinction that is easy to lose in headline findings, and one that clinicians are increasingly being asked to explain to the people in their care.
Few measurable changes outside physical health
The results held steady across different time horizons. Whether the researchers looked at people after roughly one year of GLP-1 use or followed them across a longer two-year period, the picture was much the same. In both cases, they found little evidence that taking the medications led to meaningful changes in the broader life outcomes they measured.
Kaestner was careful to stress that this is not the same as proving GLP-1 medications have no effects beyond physical health. Some changes may simply be more subtle, or harder to capture with the measures available.
“We measured outcomes like whether someone became employed or unemployed, whether they got married or divorced, and standard indicators of mental health,” he said. “Those are important measures, but they don’t necessarily capture changes in self-esteem, relationship quality, or other day-to-day experiences.”
In other words, the study was well placed to detect large, discrete shifts in a person’s circumstances. It was less able to register the quieter changes that people themselves often describe as the most significant: feeling more confident, moving through the world with greater ease, or relating differently to food and to other people.
The medical benefits remain well established
The researchers were equally clear that their findings do not undermine the medical value of GLP-1 medications. For adults with diabetes, Kaestner noted, the clearest measurable benefits remain those already demonstrated in clinical research, including improved glycaemic control, weight loss and better physical health.
This is the balance clinicians are increasingly asked to strike in practice: conveying genuine confidence in the clinical evidence while setting realistic expectations about what a medication can and cannot be expected to change. Practitioners looking to strengthen that footing often turn to structured CPD, such as the College of Contemporary Health’s GLP-1RAs in Focus short course, which examines the evidence base underpinning this class of medicines and how it translates into everyday clinical conversations.
A young and expanding field of research
As GLP-1 medications are prescribed more widely beyond diabetes, and become increasingly common in weight management, researchers will have far more opportunity to test whether broader social effects emerge in other populations or over longer follow-up periods.
“This is still a very new area of research,” he said. “As use continues to grow, understanding these broader consequences will become increasingly important for patients, clinicians, and policymakers alike.”
For now, the evidence suggests a more measured conclusion than the surrounding public conversation often implies. GLP-1 medications can meaningfully change a person’s physical health. Whether, and how, they change a person’s life is a question the research is only starting to ask.
CCH insight
Supporting people prescribed GLP-1 receptor agonists calls for a clear grasp of the evidence, including its limits. GLP-1RAs in Focus, a CPD-accredited short course from the College of Contemporary Health, is designed for healthcare professionals who want a confident, evidence-informed foundation in this rapidly developing area.
Source: University of Chicago Harris School of Public Policy
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Weight Bias at Work: What New GLP-1 Research Reveals About Women’s Employment Prospects
Key Takeaways:
- Women who were unemployed when they started GLP-1 medications saw their employment rate rise by nearly 27 percentage points over 18 months, according to a 2026 NBER working paper.
- The gains appeared only among women entering the workforce – those already employed saw no rise in pay or promotion, pointing to perception rather than capability.
- The findings echo long-standing evidence on the financial cost of weight bias, from documented pay gaps to hiring professionals’ judgements based on photographs alone.
A new way to measure an old problem
For years, economists have documented what they call the “obesity penalty” – the social and financial disadvantages people can face because of their weight. It has been a difficult phenomenon to measure cleanly, because the factors that shape someone’s body weight also tend to shape their income, health and opportunities.
The rapid uptake of GLP-1 medications has given researchers something closer to a natural experiment. When large numbers of people begin treatment within a short window, and others who want the same treatment have not yet been able to start, it becomes possible to compare two otherwise similar groups and observe what changes.
That is the approach taken in a 2026 working paper published by the National Bureau of Economic Research, in which Harvard economist Rebecca Diamond examined what happened to women’s employment after they began taking GLP-1 medications.
What the researchers did
Diamond looked at survey data from around 15,000 people. She compared women who had started taking GLP-1 medications with similar women who wanted to take them but had not yet started. The two groups were matched on factors including income, race, body mass index and overall health, so that the comparison was not simply between people in very different circumstances to begin with.
The design matters. Because the comparison group consisted of women who also wanted the medications, the study is less vulnerable to the criticism that people who seek treatment are systematically different in motivation from those who do not.
The result that stands out
Among women who were unemployed at the point they began treatment, the employment rate rose by nearly 27 percentage points over the following 18 months, compared with the matched group who had not yet started.
To put that figure in context, it is a larger gap than the difference in employment between American women with a high school diploma and those holding a university degree. In other words, an 18-month change in body weight was associated with a bigger shift in employment than several years of formal education.
The research does not suggest that losing weight made these women more intelligent, more capable or better qualified for work. Nothing about their skills, experience or credentials changed. What the study raises is a different and more uncomfortable question: whether a change in appearance alters how women are perceived by employers.
Changes beyond the workplace
The effects were not confined to employment. The study also found that single women taking GLP-1 medications were nearly 29 percentage points more likely to get married or move in with a partner than similar women who had not started treatment.
Taken together, the employment and partnership findings describe something broader than a labour market effect. They describe a shift in social response.
The financial cost of weight bias
GLP-1 medications have moved quickly into the mainstream. In 2026, 11% of US adults said they were currently taking one to lose weight, up from just 3% in 2024, according to Gallup.
But the question of how weight shapes women’s working lives long predates the current wave of prescribing. Research was already pointing in this direction well before GLP-1 medications entered the cultural conversation.
What hiring professionals saw
A report from Fairygodboss, an employer review site for women, offered a particularly troubling look at how appearance can shape hiring decisions. In one study, hiring professionals were shown images of women with different body types and asked to evaluate them.
The woman pictured at the highest body weight was judged far more harshly than the others. Twenty percent of respondents described her as “lazy”, a label applied less frequently to every other woman pictured. Just 18% said she appeared to have leadership potential, while 21% described her as “unprofessional”.
These are judgements made on the basis of a photograph alone, with no information about experience, qualifications or performance.
Earnings gaps documented long before GLP-1 medications arrived
The pay data tells a similar story. In 2011, the Federal Reserve Bank of St Louis cited research finding that white women living with overweight earned about 4.5% less than white women whose BMI fell within what researchers classified as the normal range. White women living with obesity earned nearly 12% less.
Two caveats are important here. Those figures were specific to white women and do not apply to everyone. They also say nothing about anyone’s value, ability or contribution. What they suggest is that weight-related bias was already showing up in some women’s pay long before GLP-1 medications became widely available.
When appearance pays
The argument that appearance carries an economic premium is not new, and it is sometimes made bluntly. Codie Sanchez, CEO and founder of Contrarian Thinking, has said that women who wear makeup to work earn about 30% more on average than women who do not.
“Pretty privilege is very real,” she said on an episode of The Burnouts Podcast. “And you can either say ‘That’s not fair, so I’m not doing it.’ or you can win.”
Sanchez acknowledged that the advantage is unfair, but argued that women should use it rather than ignore it. “If it’s going to make me more money to paint my face, clown me up,” she said.
Diamond’s findings suggest weight bias may operate along similar lines. The women who benefited most were those seeking to enter the workforce, where first impressions carry disproportionate weight and where an employer’s judgement is formed quickly and on limited information. For women already in a job, whose managers had direct evidence of their performance, the effect disappeared.
Why this matters in clinical practice
For healthcare professionals, findings like these complicate the consultation room. People starting GLP-1 medications may be motivated by clinical goals, social goals, economic goals, or some mixture of all three, and those motivations shape expectations, adherence and how someone responds if treatment is paused or stopped.
Understanding the pharmacology well enough to have that conversation credibly is increasingly part of everyday practice rather than a specialist concern. Building that grounding is the focus of professional training such as the College of Contemporary Health’s GLP-1RAs in Focus – Why Drugs Like Ozempic Work, a CPD-accredited online short course covering GLP-1 physiology and pharmacology for prescribers and non-prescribers alike.
An uncomfortable conclusion
Losing weight does not make a person more intelligent, more capable, harder working or better qualified for a job. But it may change how other people perceive them.
That is precisely what makes Diamond’s findings difficult to sit with. If some women gain access to more opportunities after losing weight while their underlying abilities remain exactly the same, then the economic benefit is not really a benefit at all. It is a measure of how heavily appearance still shapes the way women are perceived and treated – and of how much value has been withheld from them beforehand.
The medication changed the response. It did not change the woman.
CCH insight
Findings like these are a reminder that GLP-1 medications carry social and economic weight as well as clinical effect – and that patients arrive at the consultation with motivations shaped by far more than a treatment target. CCH’s GLP-1RAs in Focus – Why Drugs Like Ozempic Work CPD short course (2 CPD hours, fully online, CPD-accredited) builds the foundation in GLP-1 physiology and pharmacology that healthcare professionals need to explain the science clearly, set realistic expectations and contribute confidently to treatment discussions, whether or not they prescribe.
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People with Obesity Tend to Move Less After Starting GLP-1 Medications, Study Finds
Key Takeaways:
- Daily step counts and moderate-to-vigorous activity both dropped after adults with obesity started a GLP-1 receptor agonist, with no sign that weight loss prompted people to move more.
- Because these medications strip away lean muscle as well as fat, staying active matters for protecting strength and long-term health rather than being an optional extra.
- This is the first large study to draw on data from wearable fitness trackers in adults taking GLP-1 medications, and its authors argue for targeted support that builds activity in alongside treatment.
A counterintuitive picture of how people move
It is tempting to assume that as the weight comes off, people naturally become more active. New findings suggest the opposite may be closer to the truth. Adults with obesity who were losing weight on glucagon-like peptide-1 (GLP-1) receptor agonist medications significantly reduced their physical activity, according to a study being presented on Saturday at ENDO 2026, the Endocrine Society’s annual meeting in Chicago, Illinois.
That matters because activity is one of the main safeguards against an unwanted side effect of these treatments. GLP-1 receptor agonists such as semaglutide, liraglutide, dulaglutide and tirzepatide reduce not only fat but also lean muscle mass. This makes physical activity essential for preserving strength and long-term health, according to study lead Sajana Maharjan, M.D., of HSHS St. John’s Hospital in Springfield, Illinois.
How the study was carried out
The work was a retrospective pre–post cohort study, meaning researchers compared the same individuals before and after they started treatment. It drew on data from the National Institutes of Health’s All of Us Research Program, which links participants’ electronic health records with their Fitbit activity data, allowing the team to track real-world movement rather than relying on self-reported habits.
Among the 1,950 adults with obesity who started a GLP-1 medication, researchers studied 753 people who had enough wearable-device data for analysis. The cohort was predominantly female, at 78.6 per cent, with a mean age of 52.7 years.
For each person, the researchers compared physical activity before and after treatment began, focusing on two measures: daily step counts and minutes of moderate-to-vigorous physical activity (MVPA).
Steps and active minutes both fell
The direction of travel was clear. On average, daily steps decreased from 5,047 to 4,487 per day, while MVPA minutes fell from 28 to 22 per day after people began a GLP-1 receptor agonist medication.
Crucially, the study found no evidence that weight loss from these medications led to increased physical activity. The expected rebound in movement simply did not appear in the data.
Who saw the biggest changes
The decline was not evenly spread. The largest drops were seen in men and in people living with joint or muscle pain. By contrast, factors such as age, heart failure or a prior stroke did not change the results, suggesting the pattern held across a fairly broad range of circumstances.
Why activity cannot be an afterthought
For Dr Maharjan, the practical message is that exercise needs to be designed into treatment rather than left to chance:
“While many assume that weight loss leads naturally to increased physical activity, our study suggests otherwise. The findings in our study reinforce that exercise cannot be optional for people taking these medications. People need targeted interventions that encourage physical activity alongside medication for obesity.”
Given that GLP-1 receptor agonists reduce lean muscle alongside fat, a fall in activity could compound the loss of strength, making structured support for movement an important part of care rather than a nice-to-have.
A first for wearable-data research
The study stands out for its method as much as its findings. It is the first large study analysing data from wearable fitness trackers among adults taking GLP-1 receptor agonists, offering a more objective window into everyday behaviour than questionnaires alone can provide. As these medications become more widely used, that kind of real-world evidence is likely to shape how clinicians and patients approach physical activity during treatment.
CCH insights:
This is a very interesting study, but it throws up more questions than answers. Firstly, were any of the participants receiving diet and lifestyle advice as they are supposed to? GLP-1 medications are designed as an adjunct to such advice, but these results suggest it was probably lacking from these patients’ treatment. Another question, of course, is why did physical activity drop? Further research is needed to understand what is the underlying reason for these results. But most importantly, this study is a reminder that GLP-1 therapy is not just about taking the medication, it requires diet and lifestyle advice and ongoing support and monitoring.
Source: Endocrine Society
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