TOPLINE

In a small qualitative study of 25 young adults interviewed in South Florida, the decision to start GLP-1 weight-loss drugs reflected a mix of medical conditions, body-image goals, and the impact of relatives and social media. About 3 in 4 young adults had asked for the drug themselves, and none recalled a clinician discussing expectations beforehand. Some obtained the drugs from med spas, telehealth apps, or online sellers, and for some, cost and insurance denials played a role in their decision to seek the drugs outside conventional care.

METHODOLOGY

• Prescriptions for GLP-1-based drugs rose nearly sixfold from 2020 to 2023 among adolescents and young adults in the US, but how this group decides to start treatment, obtains the drugs, and covers the cost has been inadequately studied.
• To understand what shapes that decision, researchers interviewed 25 young adults aged 18-29 years (mean age, 22 years; 80% women) in South Florida who were taking a GLP-1-based drug for weight loss or had done so in the previous year; those who used a GLP-1-based drug only to treat diabetes were excluded.
• Interviews were conducted via Zoom between February and April 2026 and averaged approximately 40 minutes.
• Questions were guided by Andersen's Behavioral Model of Health Services Use, a widely used framework that sorts what leads people to seek care into three categories, namely predisposing factors (what makes someone inclined to seek care), enabling factors (the resources and systems that determine whether care is within reach), and need factors (health needs, whether perceived by the person or evaluated by a clinician).
• The interviews were recorded and transcribed and subsequently analyzed for common themes. The researchers looked for ideas based on the framework as well as ideas that came up naturally in participants' own words.

TAKEAWAY

• Of the 25 young adults interviewed, 19 asked for a GLP-1 drug themselves rather than having it offered to them by a clinician. Nearly all had tried exercise and diet changes first, and nearly half cited a confirmed or suspected medical condition such as polyendocrine metabolic ovarian syndrome (formerly known as polycystic ovary syndrome) that contributed to weight gain; many also cited appearance goals.
• A total of 11 participants first heard about the drugs from a relative, and several said TikTok or Instagram content prompted them to seek the drugs without seeing a clinician. None recalled a clinician discussing expectations beforehand.
• Participants got the drugs from licensed clinicians, medical spas, telehealth apps, or online sellers that required no prescription; 13 used brand-name products and 12 used compounded or unbranded versions whose source the researchers could not determine; five used Ozempic, which is approved for type 2 diabetes, even though they did not have type 2 diabetes.
• Most participants covered all or most of the cost themselves, and some said insurers denied coverage because they lacked a qualifying diagnosis.

IN PRACTICE

"[N]one of the participants recalled or described provider-mediated expectation-setting before initiation, suggesting a potential gap in counseling or in patients' retention of counseling. Initiation counseling is better understood as structured shared decision-making paired with appropriate clinical monitoring. It should cover indication and eligibility, the expected magnitude and trajectory of response, dose titration, common and clinically important adverse effects, contraindications and precautions, nutritional considerations, reproductive considerations where applicable, the expectation that treatment is likely to be long term, and the possibility of weight recurrence after discontinuation," the authors wrote.

SOURCE

The study was led by Sourav Das Gupta, Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami. It was published online in Obesity Pillars.

LIMITATIONS

Participants were recruited from South Florida, were mostly Hispanic or Latino individuals, and included many students; therefore, the findings may not apply to young adults elsewhere. All data, including insurance coverage, were self-reported and may have been subject to recall bias or social desirability effects. The team also did not collect clinical details such as BMI, dose, duration of drug use, side effects, or whether participants had stopped treatment.

DISCLOSURES

The study was supported by Florida International University. The authors declared no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.