GLP-1s have revolutionized the weight-loss landscape, providing effective treatments that can reduce body weight by 15%-25% in patients with obesity within the first year of use.

But the GLP-1 era is characterized by a contradiction. Clinicians are witnessing a rapidly expanding population of patients using these medications alongside a substantial number of patients who could potentially benefit but are not receiving them.

The reasons underlying this gap are multifactorial, including cost and insurance coverage, as well as differences in age, sex, race, ethnicity, geography, patient preferences, clinicians’ willingness to initiate treatment, and where patients seek care.

Two new reports shed light on these issues. Taken together, they suggest that demand for GLP-1 therapy is broadening, with some patients obtaining medications through sources other than their physicians, whereas clinicians face the challenge of expanding access to the many patients who could benefit.

Large Treatment Gap

Evidation, a health-tracking app and research platform, issued a report based on survey responses collected from July 2024 through May 2026. Of 165,000 respondents, approximately 119,000 were actively trying to lose weight.

Although GLP-1 use increased from 9% to 12% during the 2-year study period, adoption was uneven. Among respondents actively trying to lose weight, 76% reported no lifetime use of prescription weight management medications. Among those who were untreated, 76% had a BMI ≥ 25, and 39% had a BMI ≥ 30.

Use was concentrated among adults aged 40-49 years and 50-59 years (17% and 19%, respectively), women (14.8% vs 8.8% of men), and higher-income individuals. Those with household incomes of ≥ $150,000 were nearly twice as likely to have used GLP-1s as those with incomes < $25,000 (16.7% vs 8.7%).

Ghazanfar Khan, MBChB, MPH, chief medical officer at Evidation, told Medscape Medical News that the findings highlighted “the unevenness in GLP-1 use across different population segments.”

Although the attention surrounding GLP-1 medications can make their use seem nearly universal, the results indicate that factors such as access, affordability, provider conversations, stigma, and patient preferences may influence who receives treatment, he said.

For clinicians, “it’s worth asking patients what they’ve tried, what they’re worried about, what barriers they face, and what kind of support they actually want,” Khan said.

Commenting for Medscape Medical News, Ivania Rizo, MD, spokesperson for The Obesity Society, said the findings reflect what she sees in clinical practice. She highlighted the report’s findings that a large treatment gap exists as well as disparities by income and gender.

However, she noted that the Evidation participants were self-selected app users and may not represent the broader US population. Weight, height, medication use, and other variables were self-reported, and the descriptive analyses did not account for factors such as insurance coverage, obesity-related complications, race and ethnicity, geography, or access to prescribers.

The report nevertheless offers important take-home messages for clinicians, said Rizo, endocrinologist and associate professor at Boston University Chobanian & Avedisian School of Medicine in Boston.

“Don’t assume that patients with obesity have already been offered effective treatment. Many are actively trying to lose weight but have never discussed medication with a clinician.” 

She also urged clinicians to normalize obesity management discussions and the full range of evidence-based treatments rather than requiring patients to repeatedly “fail” lifestyle therapy before raising potential medications.

A Success Story and a Warning

While the Evidation study highlighted the substantial proportion of people trying to lose weight who had not used GLP-1s, a new report from the Gallup National Health and Well-Being Index offered a complementary picture.

In a web-based survey of 5065 US adults conducted from May through June 2026, 11% reported currently taking a GLP-1 medication for weight loss, up from 3% in 2024, and 15% had used one at some point. Awareness of these medications has also become nearly universal, increasing from 80% in 2024 to 91% in 2026.

At the population level, increasing GLP-1 use coincided with a decline in self-reported obesity, from a peak of 39.9% in 2022 to 36.4% in 2026. The proportion of adults reporting a diabetes diagnosis remained relatively stable after years of increases.

Most current users (68%) reported using a brand-name GLP-1, whereas 19% used a compounded or custom-mixed formulation and 12% were uncertain which type they used. Similar proportions of brand-name and compounded-product users rated their medications as “effective” or “extremely effective” (74% vs 77%, respectively), although “extremely effective” was reported more often among users of compounded products (39% vs 32%).

Among current users of compounded products, 35% had switched from a brand-name product compared with 10% who switched in the opposite direction. Cost or insurance coverage was the more commonly cited reason by those switching from brand-name to compounded therapy (66% vs 34%).

Commenting on the Gallup report for Medscape Medical News, Katherine Saunders, MD, spokesperson for The Obesity Society, called it “consequential because it captures a turning point in obesity care — GLP-1 medications have moved rapidly into the mainstream.”

However, she emphasized that the self-reported observational survey could identify national trends but not establish causality or comparative effectiveness.

The findings reflected her clinical experience, Saunders said, with more patients asking about GLP-1s and more clinicians incorporating them into cardiometabolic care. Yet access remains “profoundly uneven,” often driven by insurance coverage, cost, and availability rather than clinical considerations.

She pointed to the convergence of several forces, including the “near-universal public awareness, growing recognition of obesity as a serious chronic disease, greater clinician familiarity with medical obesity treatment, and expanded pathways for obtaining medication.”

Growing demand has also fueled the use of compounded products and prescribing models that may not consistently provide the evaluation, education, monitoring, and long-term support these medications require, added Saunders, clinical professor of medicine at Weill Cornell Medicine in New York City.

She cautioned against interpreting the similar patient-reported effectiveness of brand-name and compounded products as evidence of actually comparable efficacy.

“Gallup measured perception, not pharmacology, and this wasn’t a head-to-head clinical trial,” she said. “It didn’t measure actual weight loss, health outcomes, dose, duration of treatment, adherence, or level of clinical support.”

A substantial proportion of compounded-product users had also switched because of cost or insurance coverage, “so that group may include patients who already knew they responded well to the underlying medication,” she added.

Saunders called the Gallup report “both a success story and a warning.”

It represents “tremendous progress that more people are receiving medical treatment for a serious chronic disease,” she said. “But access, prescribing quality, and comprehensive care have not kept pace with demand.”

Clinicians should remember that “a prescription is not a treatment plan,” she emphasized. GLP-1s should be prescribed as part of comprehensive, personalized care involving appropriate valuation, medication selection, dose titration, education, monitoring, and long-term support.

Expanding Access Requires a Multisector Approach

A recent position paper from the American College of Physicians (ACP) offered recommendations for policymakers increasing access to obesity treatments for adults and addressing modifiable contributors to obesity, including diet, physical activity, stigma, access to healthy food, and expanded coverage of evidence-based obesity interventions.

“Evidence-based treatments for obesity exist but are financially inaccessible to many patients because coverage is spotty,” lead author Ryan Crowley, manager of health policy at ACP, told Medscape Medical News.

Among its recommendations, the ACP authors called on “all payers, including Medicare and Medicaid, to cover evidence-based medications to manage obesity.”

Crowley emphasized that obesity “requires a multisector approach” encompassing not only clinicians but also healthcare institutions, insurers, pharmaceutical manufacturers, the food and agriculture industries, and even city planners.

“Awareness is also a crucial component,” he added. “Stigma or bias against people with obesity or larger body sizes may affect willingness to receive needed care, which could lead to preventable health problems.”

Crowley and Saunders reported no relevant financial relationships. Rizo reported being a consultant for Genentech and Novo Nordisk. 

Batya Swift Yasgur, MA, LSW, is a freelance writer with a counseling practice in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books, as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoir of two brave Afghan sisters who told her their story).