How many of your patients do you think are taking GLP-1s off-label? According to a recent study, it could be a few, at least.

The study, conducted by researchers at New York University, and published this month in Obesity, suggested that more than 1 million people may be taking GLP-1s off-label. Such a finding puts primary care providers (PCPs) front and center in an ongoing discussion about the use of these drugs for weight loss.

The issue is complicated because GLP-1s are available online without a prescription — and without the benefit of medical oversight while taking them. And PCPs are increasingly being asked about the drugs, originally approved to treat diabetes and later, obesity and overweight with certain comorbidities.

So knowing that a person can go online and get a GLP-1, what are PCPs to do?

For starters, PCPs need to be up to speed on GLP-1s for whoever asks about them and may need them medically, experts said.

“If you’re a primary care provider in 2026, you should be comfortable prescribing a GLP-1,” said Amy Sheer, MD, an internist and program director for the obesity medicine fellowship at the College of Medicine, University of Florida Health in Gainesville, Florida.

That means more than just being willing to write the prescription, Sheer and others said. Providers should be ready to counsel a patient, to educate them about risks and side effects of a GLP-1, and to monitor that person and to make sure they receive nutritional and exercise counseling.

As for patients who do not medically need them — for those whose BMI is 25 or lower — the issue is more complicated because of the widespread online availability.

“They can just go online and never have to step on a scale,” Sheer said.

The popularity — and success — of the drugs has contributed to an online frenzy unmatched in the history of medicine.

Social media influencers tout their weight loss and sometimes even describe how they change their dosing themselves. They also share how they obtain the drugs from online providers and compounding pharmacies.

Online providers are equally enthusiastic. One online provider entices by suggesting “see how much weight you can lose.”

Those interested in a GLP-1 can go online and get a drug delivered within days.

The drugs’ efficacy in treating a serious, refractory disease has contributed to the appeal. As of September 2026, the adult obesity rate in the US had dropped from a peak in of 39.9% of adult Americans in 2022 to 36.8%. The percentage of adults who report they have been diagnosed with diabetes for the first time also has declined during that time, to 12.8%.

As many as 11% of adult Americans are taking the drugs to treat obesity and overweight with certain comorbidities, such as sleep apnea and peripheral artery disease, according to a Gallup poll in July 2026.

But interest in the drugs is also linked to Americans’ obsession with weight, dieting, and appearance. Nonstop news about the drugs often adds to confusion and misinformation.

“In the same day, we’ll hear it’s the miracle drug, and then there are all these lawsuits saying they are causing everyone to be blind,” said Dan Azagury, MD, chief of bariatric surgery and director of the Weight Management Program at Stanford Medicine in Palo Alto, California. “Trying to parse through the noise is not always easy.”

For Catherine Varney, DO, obesity medicine director at UVA Health at the University of Virginia in Charlottesville, the recent study about off-label usage sowed more confusion.

She disagreed with the suggestion that PCPs are inappropriately prescribing GLP-1s. Azagury agreed.

“That’s not where the risk is,” he said. “With a primary care physician, they get treatment from people who are highly competent in their field.”

The danger, he said, is with “low-quality, low-resource providers,” Azagury said.

Varney said she was also concerned with the study’s methods because it excluded patients whose BMI was 25 or 26. Therefore, it not representative of people who have overweight — a BMI of 25 or 26 — and a comorbidity, she said.

The GLP-1s have been enormously helpful to her patients, she said.

As studies about the drugs continue to be conducted and published, primary care doctors will still be the ones on the front lines helping patients. Varney worries that confusing information could deter patients from getting the treatment they need.

“We’re not just creating a number on a scale,” she said. “We’re helping real people.”

That includes not only treating obesity and overweight but also preventing illnesses that stem from those diseases, she said.

So when patients ask about a GLP-1 for weight loss and don’t have a BMI over 25, what should PCPs do?

For starters, certain people should never be prescribed a GLP-1, the experts said. That includes people with anorexia and other disordered eating.

“That’s when the answer is ‘no, this is not a safe drug for you, and I’m not going to provide it,” Azagury said.

For other patient groups, however, the conversation is different.

Sheer said she is “not opposed to cosmetic use,” with oversight.

“They (patients) want them for a lot of different reasons,” she said. And it’s important to listen and counsel, she said.

For example, a person going through menopause may have unwanted and, to them, excessive weight gain.

“It’s not just BMI,” Sheer said. Body dysmorphia also plays a role, she said, although that leads to further discussions, the doctors said.

Is a person unhappy with their weight because they have gained significant weight as they aged, or are they unhappy with a few extra pounds they may have gained because they have become more sedentary?

“I would really advise for people to be looking at what has changed, what has led to the weight gain,” said Miranda Stieweg-Rapp, DO, assistant clinical and program director for the Obesity and Metabolic Disease Clinic at UC Davis Health in Sacramento, California. “You need to be looking at sleep, mental health, stressors. There has to be a discussion about how we’re using these medications.”

For those patients who do have obesity or overweight with comorbidities, it may be important to refer them to a specialist, she said.

When PCPs are treating patients themselves and not referring them out, it is essential to explain the risks and side effects of the GLP-1 that is prescribed.

“This is not candy, or even a vitamin. It is a drug. And you have to say, ‘it has some side effects. There are some risks,’” Azagury said.

“The other thing is that they get nutritional counseling…so they are getting the essential nutrients, protein, and fiber,” said Stieweg-Rapp.

Appetite is curbed with GLP-1s, and people often eat far less than the amount they normally consume. They need to make sure that the calories they do consume are nutrient-dense.

Those taking a GLP-1 off-label for weight loss also need to have an exercise program because of the risk for muscle loss, she said.

And they also need to know they must be compliant and continue taking the medication even after losing the weight they want to lose, if that is their goal.

“A lot of people think they can be on it a few months and then stop taking it,” she said. “What we do know is the when people stop cold-turkey, you do gain the weight back.”

Varney reported serving as a speaker and an advisory board member for Eli Lilly.  The other experts reported having no relevant disclosures.