Men and women develop obesity at similar rates, but women are far more likely to be prescribed and to use the newer GLP-1-based weight-loss drugs, and the gap is widening, recent research suggested.

A study examining the impact of the FDA’s 2021 approval of semaglutide (Wegovy) for chronic weight management on the GLP-1 usage gap between men and women in the US found similar utilization rates between the sexes prior to the approval. However, approval “was associated with a sharp increase in GLP-1 utilization…, widening sex-based differences, with female utilization significantly surpassing that of males” in subsequent years, the authors concluded.

In addition, an analysis of US prescribing data from 2020 to 2024 showed that about 3% of eligible women received semaglutide or tirzepatide for obesity compared to 1.2% of eligible men.

Does the gap result from missed diagnoses, missed referrals, marketing, stigma, patient preference, or other obstacles? All these factors likely play some role, depending on the patient and the practice, according to experts.

Missed diagnoses. “Most individuals have their height and weight measured at routine visits so BMI is usually captured,” Hemalkumar Mehta, PhD, Johns Hopkins Bloomberg School of Public Health, Baltimore, told Medscape Medical News. “What we are missing is the next step, where a high BMI becomes a documented, treatable obesity diagnosis. The data suggest women are more likely than men to get that diagnosis.”

Overall, the study found non-Hispanic Black women and Hispanic women were the most likely to be diagnosed, and non-Hispanic-Asian men were the least likely to be diagnosed. “This is important because diagnosis is the first step in the process to receive drugs for obesity,” Mehta said.

The authors of an earlier review of gender differences in obesity prevalence, comorbidities, and treatment concluded, “[w]omen, compared to men, are more likely to be diagnosed with obesity and seek and obtain all types of obesity treatment including behavioral, pharmacological, and bariatric surgery.”

Missed referrals. Data from the US and the UK showed women are more likely than men to be referred to behavioral weight-loss programs. An early US study found that physicians were more likely to encourage women with a BMI of 25 to lose weight than men with the same BMI, and indicated that women would receive more treatment referrals than men.

Similarly, general practitioners referred women nine times more often than men to community weight-loss programs, according to authors of the UK’s BWeL trial. Furthermore, when patients with obesity were randomized to a 30-second clinician endorsement and referral for weight management or to brief advice, men took effective weight-loss action less often in both arms (41.6% of men vs 60.7% of women with referral; 12.1% vs 18.3% with advice), despite the fact that the relative benefit of the intervention did not differ by sex.

Marketing and stigma. Decades of weight-loss marketing aimed at women mean “we shouldn’t be surprised if women are more likely to recognize weight-loss treatment as something intended for them,” Robyn Pashby, PhD, research assistant professor of psychology at F. Edward Hebért School of Medicine at Uniformed Services University, Bethesda, Maryland, and member of the National Board of Directors at Obesity Action Coalition, told Medscape Medical News.

“Think about the imagery, language, testimonials, and messaging associated with commercial weight-management programs — they skew toward women,” she said.

“We know that even when a service is available to everyone, its presentation can communicate who belongs there,” she added. “Men may be less likely to identify with a program that appears designed for women, even if they are interested in the underlying treatment.”

A recent small qualitative study from Anglia Ruskin University, Cambridge, UK, supports that view, noting that a recurring theme across study participants was the perception that dieting is largely a female-focused activity. Participants described dieting conversations as more commonly associated with women, often through social media and magazines, and most men said they would feel self-conscious and uncomfortable engaging in them.

Patient preferences. The Anglia Ruskin study also found that men often associated dieting with being denied the food they enjoy, and they were reluctant to commit to approaches they saw as requiring significant sacrifice.

Similarly, a recent study on shared decision-making in people with obesity and type 2 diabetes, highlighted the reluctance of some men to engage in weight loss at all. That study found that men tend to express less body dissatisfaction, be less interested in weight loss, and be less likely to seek out obesity treatment compared with women. The authors concluded, “[p]roviders should be aware of the potential presence of these beliefs and their possible impact on conversations about treatment.”

In addition, “[s]ome men may feel uncomfortable seeking help, particularly if they believe weight management is something they should accomplish independently or through willpower alone,” Pashby noted.

Health insurance. “Overall, we need a population-health focus on metabolic health and obesity treatment, but we can’t do that until we have coverage,” said Obesity Medicine Association Past President Angela Fitch, MD, founder and chief medical officer of knownwell, New York City. “It’s a horrible issue driven by capitalism, not population health,” she told Medscape Medical News.

“We can’t launch a public health campaign if we can’t offer patients treatment,” she said. “We need a standard benefit coverage of treatment for all people instead of this ‘if you can afford health [coverage], you can get it.’”

The data show that treating obesity saves the healthcare system money, especially when people have comorbidities. “If the cost of a drug is $245, like what Medicare is paying, [we] save money by treating obesity. Why can’t we do this for everyone!”

What Clinicians Can Do

Clinicians can take steps to help ensure that more men have the opportunity to receive a GLP-1 and use it, our experts agreed.

“First, close the diagnosis gap,” Mehta said. “Record men’s obesity diagnosis in the electronic health record the same way you do for women. Then start the conversation with men as routinely as you do with women.”

“Normalize that conversation,” Pashby said. Obesity should be positioned as “a chronic, treatable medical condition, rather than waiting for patients to raise concerns about their weight.” The lack of screening, diagnosis, and discussion about weight-management options is a “universal problem that reflects clinicians’ discomfort discussing weight,” she added.

“Some clinicians worry about doing it wrong (hurting feelings or saying the wrong thing) and others are too busy or overwhelmed, while still others simply do not understand or believe that obesity is a medical condition, and are still seeing it as a matter of willpower or self-control,” she said.

“If we can make seeking help feel less like an admission of failure and more like a reasonable, proactive decision about one’s health, then I would expect the statistics on who seeks and receives care will likely balance out.”

Fitch added, “[w]hether it is women or men, we should reframe all of this on health and not weight. It isn’t about what you are going to lose, but about the health you will gain.”

Indeed, a study on motivations of men with severe obesity who pursued medical management or bariatric surgery found that “The opportunity to improve health, optimize quality of life, and lengthen lifespan motivates males with severe obesity to pursue weight-loss treatments. These factors should be considered when providers educate patients about obesity treatment options and outcomes.”

After authors of a conference presentation reported that testosterone levels rose in men on GLP-1s, some people suggested that men might be motivated to lose weight by reframing treatment around testosterone and male reproductive health.

Mehta said he would be “cautious” about reframing the conversation that way, and that even if it worked, “it’s a short-term solution.” Pashby agreed: “I would be careful about trying to solve the gap by marketing GLP-1s around testosterone or masculinity. We don’t need to replace one set of body expectations with another.”

Mehta and Pashby declared having no conflicts of interest. Fitch declared serving on advisory boards for Eli Lilly, Novo Nordisk, Boehringer Ingelheim, Currax, AbbVie, Samsung Health, Metsera/Pfizer, Seca, Viking, and Zealand Pharma; speaking engagements with Eli Lilly, Novo Nordisk, Boehringer Ingelheim, Currax, Rhythm, Nestlé, Abbott, Amgen, and Wave Life Sciences; and receiving research fund from Eli Lilly, Viking, Roche/Genentech, and Structure.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.