Stigma, cost, support shape how patients live with GLP-1s

Clinical takeaway: Frame GLP-1s as a facilitator of lifestyle change, not a standalone fix, and counsel patients on what to expect from side effects and cost up front. Brief, transactional prescribing left some patients unprepared for what followed.

GLP-1 receptor agonists have reshaped obesity care, but roughly half of patients stop within a year, and most regain weight after stopping. What that experience looks like from the patient's side, especially outside of diabetes care, has been thinly documented. This study set out to fill that gap through interviews with patients taking the drugs for a range of indications, including those who had quit.

Patients consistently described a quieting of "food noise," the intrusive, compulsive pull toward eating, and framed it as restored control rather than simple appetite suppression. But they were emphatic that the drug was not a standalone fix. Many described it as a tool that made deliberate change possible: shopping, cooking, and exercising differently as weight came off. The medication opened a door; patients still had to walk through it.

That benefit came with trade-offs patients actively negotiated. Adverse effects ranged from transient nausea to symptoms severe enough to force discontinuation, and many patients tolerated considerable discomfort to keep losing weight. One reframed gastrointestinal effects as a useful signal to stop eating; another described hunting pharmacy to pharmacy through shortages. Several voiced unease about long-term dependence and what would happen if they stopped.

Stigma was common, and it tracked with indication: patients felt weight-loss use was judged as an "easy way out" in a way diabetes use was not, and some leaned on the diabetes framing to deflect it. Cost and access were recurring barriers, with patients describing the time, health literacy, and self-advocacy needed to obtain and keep the drug. Coverage tied to diabetes thresholds cut both ways, with one patient required to stop after their A1c improved, then regaining weight. Counseling quality varied widely, from clinicians who explained what to expect to brief encounters that left patients to discover side effects on their own.

This was an inductive thematic analysis of semi-structured interviews with 30 US adults, 23 currently taking a GLP-1 and 7 who had stopped.

The authors argue the findings point to a fixable gap: there are no standardized guidelines for what should be covered when starting a GLP-1. Clearer counseling on expectations, side-effect management, treatment duration, and long-term planning could improve consistency of care, and the authors raise digital support tools as one way to extend that counseling given limited physician time. They also suggest reexamining eligibility criteria anchored to diabetes thresholds, which may reinforce the perception that weight loss alone is not a legitimate reason to treat.

"Articles say there are people who would look down on you for relying on medications for weight loss. I don't really care what people think about how I lost weight. If the subject comes up, I'll shout it from the rooftops that I found it very effective," one participant said.

Source: de Vere Hunt I. JAMA Netw Open. 2026 Jun 5. Patient Experiences With GLP-1 Receptor Agonists