More than 1.1 million U.S. adults with no documented diabetes or qualifying obesity were prescribed a GLP-1 drug such as semaglutide or tirzepatide from 2021 to 2025, according to a study published online September 22 in the journal Obesity. The prescribing rate in this group rose 15-fold, from 0.1% in 2021 to 1.5% in 2025, Medscape reported. More than a third of these patients, 35.1%, had a body mass index (BMI) in the normal range.
These are powerful medicines studied mainly in people with obesity or type 2 diabetes. For people outside those groups, the balance of benefits and risks is not well understood, a point the study's authors stressed.
Inside the 92-Million-Record Analysis
Researchers led by Dr. Babak J. Orandi of New York University used Cosmos, a database of electronic health records from health systems that use Epic software. They analyzed records from more than 92 million adults who lacked an FDA-recognized reason for GLP-1 use, meaning no diabetes and no qualifying obesity. Qualifying obesity was defined as a BMI of 30 or higher, or a BMI of 27 to under 30 with a weight-related condition.
The team tracked drugs by active ingredient rather than brand name. That captured cases in which a patient received a version of a drug approved for diabetes, which may be easier to get or cheaper, even if the goal was weight loss. To reduce misclassification, the researchers excluded patients without a recorded weight at least six months before their first prescription.
Recipients differed from non-recipients. Women made up 85.5% of recipients, compared with 54.2% of non-recipients. Recipients were also more likely to be White, to live in less socially vulnerable communities, and to have private insurance (78.0% vs. 47.8%).
Eating Disorder History Raises a Red Flag
The most concerning signal involved mental health. A history of an eating disorder was recorded in 1.8% of GLP-1 recipients, compared with 0.3% of non-recipients, a sixfold difference. The authors wrote that the drugs "may be reaching populations at higher risk of disordered eating or being used for weight control in the absence of obesity."The finding is an association; it does not show that the drugs caused disordered eating.
The overall picture was mixed. Recipients had higher rates of high blood pressure and abnormal cholesterol, although heart failure was less common than among non-recipients. That suggests some patients may have had cardiovascular risk factors even though they did not meet the documented criteria.
Dr. Andrew Kraftson, an obesity specialist at the University of Michigan, warned that doctors may not be weighing the full balance of benefits and risks, according to Yahoo News. He noted that people without obesity or diabetes were not included in the clinical trials and that possible risks include malnutrition and loss of muscle mass. A New England Journal of Medicine perspective has also flagged eating disorders as a cause for concern with these drugs.
What the Study Can and Cannot Show
This is an observational study of health records, not a clinical trial. It shows who received prescriptions, not why, and it did not measure health outcomes. Missing documentation does not always mean a missing diagnosis; some patients may have qualified before their records entered the database or before they lost weight. The study also could not capture drugs obtained outside these health systems, such as through online sellers or compounding pharmacies.
The findings fit a broader surge in use. A Gallup survey conducted in May and June found that 11% of U.S. adults were taking a GLP-1 drug for weight loss in 2026, up from 3% in 2024. Epic Research data show that GLP-1 prescriptions among U.S. adults more than quadrupled between 2021 and early 2026.
Women, people with a past or current eating disorder, and people using the drugs without close medical follow-up are among those most likely to be affected. Common side effects include nausea, vomiting, constipation, and diarrhea. Severe abdominal pain, persistent vomiting, fainting, or signs of dehydration need prompt medical care.
Anyone considering a GLP-1 for weight loss should talk with a clinician who reviews their full history, including eating patterns and mental health. Ask whether you meet the approved criteria, how long you would take the drug, and what happens if you stop. People already taking a GLP-1 should not stop without talking to their prescriber, and anyone with a history of disordered eating should share it with their prescriber.
The authors said the risks and benefits for people who use these drugs without an approved reason are unknown and merit further study.
Key Questions Answered
What did the study find? More than 1.1 million adults without documented diabetes or qualifying obesity received GLP-1 prescriptions from 2021 to 2025, and the prescribing rate in this group rose 15-fold.
How many had a normal weight? About 35.1% of these recipients had a BMI in the normal range.
Why are eating disorders a concern? Recipients were six times as likely as non-recipients to have a recorded eating disorder history. The study shows an association, not cause and effect.
Does this prove the prescriptions were unnecessary? No. Health records may miss earlier diagnoses or higher past weights, and the study did not examine why the drugs were prescribed.
Who qualifies for GLP-1 weight-loss drugs? FDA-approved weight-loss versions are for adults with a BMI of 30 or higher, or 27 or higher with a weight-related condition. Other versions are approved for type 2 diabetes.
Should I stop my GLP-1? Do not stop without talking to your prescriber. Ask whether the drug is still right for you.
Published by Medicaldaily.com
