TOPLINE
Among more than 92 million US adults without a documented diabetes or obesity diagnosis, prescribing of GLP-1 receptor agonists rose 15-fold from 2021 to 2025. Over a third of recipients had a normal BMI, and most were women, White, and privately insured. They were also six times more likely to have a history of eating disorders than non-recipients.
METHODOLOGY
- Public fascination with GLP-1 drugs has grown well beyond their original use for diabetes; roughly 1 in 8 US adults now say they’ve tried one, often chasing weight loss rather than a diagnosed medical need.
- Using electronic health records from the Cosmos database spanning 2021 to 2025, researchers examined patients who were being prescribed GLP-1 receptor agonists outside their approved uses and how that pattern changed over time.
- They analyzed records from more than 92 million Americans lacking an FDA-recognized reason for GLP-1 use — meaning no diabetes and no qualifying obesity (BMI ≥30, or BMI 27 to < 30 with a related comorbidity).
- The team specifically tracked these drugs by active ingredient instead of brand name: a patient without a qualifying diagnosis might still get a prescription for the diabetes-labeled version of the drug because it’s easier to obtain or costs less, even if their actual goal is weight loss. Sorting by compound rather than brand let the researchers catch those cases too.
- To guard against misclassifying patients, the researchers set a cutoff: if a patient didn’t have a documented weight from at least six months prior to their first prescription, they were left out of the analysis entirely.
TAKEAWAY
- Between 2021 and 2025, more than 1.1 million adults without a qualifying diagnosis were prescribed a GLP-1 drug; the prescribing rate rose 15-fold (from 0.1% to 1.5%) over that period. More than a third (35.1%) of these recipients had a normal BMI.
- Compared with non-recipients, GLP-1 recipients were more often women (85.5% vs 54.2%) and White (60.0% vs 51.0%) and had a higher median BMI (25.9 vs 24.5).
- The clinical profile of GLP-1 recipients was mixed. Compared with non-recipients, recipients had higher rates of hypertension (32.5% vs 23.5%) and dyslipidemia (6.8% vs 2.9%) but a lower rate of heart failure (2.6% vs 4.5%).
- GLP-1 recipients were six times as likely to have a history of eating disorders as non-recipients (1.8% vs 0.3%). They were more likely to live in the least vulnerable neighborhoods (as measured by the Social Vulnerability Index) and far more likely to have private insurance (78.0% vs 47.8%).
IN PRACTICE
“[T]hese patterns suggest that GLP-1 receptor agonists may be reaching populations at higher risk of disordered eating or being used for weight control in the absence of obesity,” the authors wrote.
“The risk-benefit profile for those using GLP-1 receptor agonists in the absence of an FDA-approved indication is unknown and merits additional study,” they added.
SOURCE
The study was led by Babak J. Orandi, New York University, New York. It was published online on September 22 in Obesity.
LIMITATIONS
Missing documentation doesn’t always mean a missing diagnosis — some patients may have qualified before joining Cosmos or before losing weight. Prescriptions filled outside Cosmos or via compounded versions of these drugs weren’t captured. Most eating disorder diagnoses were logged without a specific subtype, so the researchers couldn’t determine which kinds were most tied to off-label use.
DISCLOSURES
The authors reported no specific funding for the study. Some authors reported receiving grants, honoraria, support for attending meetings, participation on advisory boards, consulting relationships, and other ties with multiple pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
