Authors
Babak J Orandi, Leila Yan, Macey L Levan, Holly F Lofton, Karan R Chhabra, Christine J Ren-Fielding, S Ali Husain, Mara A McAdams-DeMarco, Dorry L Segev, Michal A Mankowski, Allan B Massie
Published in
Obesity (Silver Spring, Md.). Sep 22, 2026. Epub Sep 22, 2026.
Abstract
This study evaluated temporal trends and patient characteristics associated with glucagon-like peptide-1 (GLP-1) receptor agonist prescribing among US adults without an apparent FDA-approved indication.
This retrospective cohort study used Cosmos electronic health records (01/2021-12/2025). Adults prescribed liraglutide, semaglutide, or tirzepatide without a documented indication (type 2 diabetes or obesity with qualifying comorbidities) were included. Patients without a recorded weight ≥ 6 months prior to first prescription were excluded. Demographic and clinical characteristics were compared using t-tests and χ2 tests.
Among 92,415,648 adults without an apparent FDA-approved indication, 1,133,953 (1.2%) were prescribed GLP-1 receptor agonists. Prescribing increased from 0.1% in 2021 to 1.5% in 2025 (15-fold). Recipients had higher median BMI (25.9 vs. 24.5 kg/m2) and were more often female (85.5%) and White (60.0%). Hypertension and dyslipidemia were more common, while coronary artery disease and heart failure were less prevalent. Notably, 35.1% had normal BMI; eating disorders were more frequent (1.8% vs. 0.3%). GLP-1 receptor agonist use was associated with lower social vulnerability and private insurance.
GLP-1 receptor agonist prescribing without an apparent FDA-approved indication has increased rapidly and disproportionately involves socioeconomically advantaged populations, including individuals without obesity. The risk-benefit profile in these populations remains uncertain.
PMID:
42768905
Bibliographic data and abstract were imported from PubMed on 22 Sep 2026.
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