TOPLINE

Perceived competence — patients’ confidence in their own ability to manage their weight — emerged as the single strongest psychosocial marker of GLP-1 treatment success, distinguishing groups more reliably than motivation, cravings, stress, or self-monitoring. Patients with increased confidence described greater self-efficacy, including consistent strategy use and a sense of behavioral control, while patients with less confidence reported greater behavioral struggle — a pattern researchers say supports embedding brief confidence screening into routine GLP-1 care.

METHODOLOGY

• Researchers conducted an explanatory convergent mixed-methods study of 141 adults (mean age, 45 years; 61% women) from June to October 2025, examining participants’ perspectives on GLP-1s for weight loss across six groups.
• Eligible participants were adults aged ≥ 18 years, with no history of pancreatitis, type 2 diabetes, bariatric surgery, or a personal or family history of multiple endocrine neoplasia type 2 or medullary thyroid carcinoma.
• Each participant completed a survey and a semi-structured phone interview, tailored to their stage: considering use (group 1), less than 3 months on therapy (group 2), at least 3 months on therapy without achieving their weight-loss goal (group 3), at least 3 months on therapy who had achieved their weight-loss goal (group 4), discontinued without achieving their goal (group 5), and discontinued after achieving their goal (group 6).
• Psychosocial and behavioral domains, including physical activity, sleepiness, stress, depression, motivation, perceived competence, eating behaviors and cravings, self-monitoring, number of chronic conditions, and pain, were assessed using standard questionnaires and compared across groups.
• In-depth qualitative interviews (approximately 10-20 per group) added context on safety, concerns, lifestyle changes, social norms, side effects, motivations, reasons for discontinuation, and experiences before, during, and after medication use.

TAKEAWAY

• Participants on GLP-1s for at least 3 months (groups 3 and 4), regardless of goal attainment, showed stronger psychosocial profiles, including higher perceived competence, greater intrinsic motivation, fewer food cravings, and more consistent self-monitoring than other groups.
• Groups 1 and 5 displayed vulnerabilities related to low competence and motivation. Group 6 showed a mixed profile, with higher physical activity and self-monitoring but elevated stress and poorer sleep. Group 2 participants showed a fairly average psychosocial profile, with only minor deviations across domains. 
• After statistical adjustment, perceived competence was the only significant differentiator across groups — lower among participants considering use (z, -3.15; q = .0347) and higher among those on therapy for at least 3 months who had achieved their goals (z, 4.44; q < .001). All other between-group differences were descriptive.
• Qualitative interviews reinforced the quantitative patterns: Participants with higher perceived competence expressed strong confidence and mastery of new habits, whereas those with lower competence described persistent self-doubt and age-related challenges with losing weight.

IN PRACTICE

“Embedding a brief cravings/competence/autonomy screener into routine GLP-1 care, paired with nurse or dietitian follow-ups, represents a pragmatic, scalable strategy that is supported by behavioral obesity and GLP-1 literature,” the authors of the study wrote.

“Our findings underscore the importance of recognizing where individuals are in their weight-loss journey with GLP-1s and tailoring behavioral support to their specific psychosocial needs. Heterogeneity within and across groups suggests that a one-size-fits-all approach,” they added.

SOURCE

The study was led by Jane A. McElroy, University of Missouri, Columbia. It was published online in Obesity.

LIMITATIONS

The quantitative analyses were limited by relatively small group sizes. A small number of participants used compounded GLP‑1s, which may have introduced more varied experiences and limited generalizability to FDA-approved drugs. The sample was too small to test for sex differences, and most participants were White and had private insurance. Finally, the cross-sectional design prevented conclusions about the directionality of associations between psychosocial characteristics and weight-loss outcomes.

DISCLOSURES

The authors did not report any funding. One author disclosed receiving an honorarium from PeerView ECHO type 2 diabetes and continuous glucose monitoring teaching supplies from FreeStyle Libre, DexCom, and EverSense.

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