Considering Glucagon-like Peptide-1 Receptor Agonists (GLP-1RAs) for Weight Loss: Insights from a Pragmatic Mixed-Methods Study of Patient Beliefs and Barriers

TL;DR

Patients considering GLP-1RA weight loss treatments face barriers like cost and uncertainty, highlighting the need for better clinician communication and support.

Contribution

This study provides new insights into patient perspectives and barriers to GLP-1RA therapy, emphasizing the role of clinicians in improving treatment uptake.

Findings

Cost and insurance coverage were the most significant barriers to initiating GLP-1RA therapy.

Patients expressed uncertainty about eligibility, long-term safety, and treatment expectations.

Life course events, particularly (peri)menopause, were commonly cited as contributors to weight gain.

Abstract

What are the main findings?
Patients expressed uncertainty about eligibility, long-term safety, and treatment expectations, underscoring the need for proactive clinician communication and shared decision-making.Cost and insurance coverage were the most significant barriers to initiating GLP-1RA therapy, with recent policy changes and FDA restrictions on compounding further limiting access.

Patients expressed uncertainty about eligibility, long-term safety, and treatment expectations, underscoring the need for proactive clinician communication and shared decision-making.

Cost and insurance coverage were the most significant barriers to initiating GLP-1RA therapy, with recent policy changes and FDA restrictions on compounding further limiting access.

What are the implications of the main findings?
Clinicians should lead conversations about GLP-1RA therapy, clarify benefits and risks, and document prior weight loss efforts to support insurance approval.Addressing cost barriers and fostering patient confidence in treatment decisions are critical to reducing disparities and improving uptake of obesity pharmacotherapy.

Clinicians should lead conversations about GLP-1RA therapy, clarify benefits and risks, and document prior weight loss efforts to support insurance approval.

Addressing cost barriers and fostering patient confidence in treatment decisions are critical to reducing disparities and improving uptake of obesity pharmacotherapy.

Background/Objective: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have received widespread attention as effective obesity treatments. However, limited research has examined the perspectives of patients contemplating GLP-1RAs. This study explored perceptions, motivations, and barriers among individuals considering GLP-1RA therapy for obesity treatment, with the goal of informing patient-centered care and enhancing clinician engagement. Methods: Adults completed surveys and interviews between June and November 2025. In this pragmatic mixed-methods study, both survey and interview questions explored perceived benefits, barriers, and decision-making processes. Qualitative data, describing themes based on the Health Belief Model, were analyzed using Dedoose (version 9.0.107), and quantitative data were analyzed using SAS (version 9.4). Participant characteristics included marital status, income, educational attainment, employment status, insurance status, age, race/ethnicity, and sex. Anticipated length on GLP-1RA medication and selected self-reported health conditions (depression, anxiety, hypertension, heart disease, back pain, joint pain), reported physical activity level, and perceived weight loss competency were also recorded. Results: Among the 31 non-diabetic participants who were considering GLP-1RA medication for weight loss, cost emerged as the most significant barrier. Life course events, particularly (peri)menopause among women over 44, were commonly cited as contributors to weight gain. Participants expressed uncertainty about eligibility, long-term safety, and treatment expectations. Communication gaps were evident, as few participants initiated discussions and clinician outreach was rare, reflecting limited awareness and discomfort around the topic. Conclusions: Findings highlight that individuals considering GLP-1RA therapy face multifaceted emotional, financial, and informational barriers. Proactive, empathetic clinician engagement, through validation of prior efforts, clear communication of risks and benefits, and correction of misconceptions, can support informed decision-making and align treatment with patient goals.

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