{"paper_id":"d60eb22b-4269-46de-bd02-81899108ce3f","body_text":"1 \n \nPrevalence of use and interest in using glucagon-like peptide-1 receptor \nagonists for weight loss: a population study in Great Britain \n \nSarah E. Jackson1, Jamie Brown1, Clare Llewellyn1, Oliver Mytton2, Lion Shahab1 \n \n1 Department of Behavioural Science and Health, University College London, UK  \n2 Institute for Child Health, University College London, UK \n \nCorresponding author: Dr Sarah Jackson, Department of Behavioural Science and Health, \nUniversity College London, 1-19 Torrington Place, London WC1E 7HB, UK. s.e.jackson@ucl.ac.uk \n+44 (0)207 679 8312 \n \nNumber of tables: 2  \nNumber of figures: 1 \nNumber of supplementary files: 1  \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \nNOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.\n\n2 \n \nAbstract \nObjectives: To assess the prevalence of glucagon-like peptide-1 receptor agonist (GLP-1RA) use \nand interest in using medications for weight loss among adults in Great Britain. \nDesign: Nationally-representative household survey, January-March 2025. \nSetting: Great Britain. \nParticipants: 5,893 adults (≥ 18y). \nMain outcome measures: Participants were asked whether they had used medication in the past \nyear to manage type 2 diabetes (excluding insulin), reduce the risk of heart disease, or support \nweight loss and, if so, whether they had used five specific GLP1-RAs. Those who had not used \nmedication to support weight loss in the past year were asked how likely they would be to consider \ndoing so in the next year. Estimates were reported stratified by participant characteristics and \nextrapolated to the national population. \nResults: Overall, 2.9% [2.4-3.4%] – ~1.6 million adults – reported using a GLP-1RA to support \nweight loss in the past year, with 1.7% [1.4-2.1%] (~910,000 adults) using them exclusively for this \npurpose. The majority of those who used them exclusively for weight loss (91.4% [85.6-97.2%]) \nreported using GLP-1RAs that are licensed for this purpose in Great Britain, most commonly \nMounjaro (tirzepatide; 80.2% [71.9-88.6%]). Of those who had not used weight-loss medication in \nthe past year, 6.5% [5.7-7.3%] (~3.3 million adults) expressed an interest in doing so in the next \nyear. Use and interest were more prevalent among women, people in mid-life, and those reporting \npast-month psychological distress. Interest was also higher among people facing greater \nsocioeconomic disadvantage, including those in financial difficulty or unemployed due to long-term \nillness or disability. \nConclusions: In the first quarter of 2025, 4.2 million adults in Great Britain – nearly one in ten – \neither had recently used a GLP-1RA to support weight loss or were interested in doing so in the \nnear future. A substantial minority reported using a type of GLP-1RA that was not licensed for \nweight management, suggesting off-label use. Interest was particularly high among less \nadvantaged socioeconomic groups, while use was similar across groups, highlighting the \nimportance of addressing equity in access. These findings underscore the need to monitor who is \naccessing these medications and to ensure their safe, appropriate, and equitable provision. \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n3 \n \nRegistration: The study protocol and analysis plan were pre-registered on Open Science \nFramework (https://osf.io/r2whq/). \n \nKey words: semaglutide, liraglutide, tirzepatide, Ozempic, Wegovy, Saxenda, Mounjaro \n \nIntroduction \nThe high prevalence of obesity in Great Britain presents significant public health challenges, \nincreasing the risk of chronic diseases and placing a substantial burden on the National Health \nService (NHS).1,2 Advancements in pharmacotherapy, particularly glucagon-like peptide-1 receptor \nagonists (GLP-1RAs), have emerged as a promising tool for weight management. Originally \ndeveloped and increasingly used for the treatment of type 2 diabetes, these medications have \nproven highly effective in promoting weight loss, at least during treatment,3–5 sparking widespread \npublic interest. They also have cardio-protective effects, reducing the risks of heart attack, stroke, \nand cardiovascular mortality\n6,7 and may help to reduce substance use disorders (e.g., alcohol and \ntobacco use),8 but safety of long-term use is currently uncertain.9 Relatively little is known about the \ncurrent prevalence of the use of GLP-1RA medications in Great Britain,10 potential future demand, \nand how interest and usage patterns vary across different population subgroups. Understanding \nthese factors is important for informing healthcare planning and resource allocation, promoting \npatient safety, and addressing health inequalities.11 \nIn the UK, several GLP-1RA medications are available, including semaglutide, liraglutide, \ndulaglutide, exenatide, and lixisenatide. These are supplied under various brand names, some of \nwhich have more than one indication (see \n12 for a summary). In addition, tirzepatide is a GLP-1RA \ncombined with glucose-dependent insulinotropic polypeptide receptor agonist. GLP-1RA products \ncurrently licensed for weight loss in the UK – Saxenda (liraglutide), Wegovy (semaglutide), and \nMounjaro (tirzepatide) – are licensed by the Medicines and Healthcare products Regulatory Agency \nfor patients who (i) have obesity (body mass index [BMI] \n≥ 30 kg/m²) or (ii) have a BMI in the \noverweight range (BMI ≥ 27 kg/m²) plus weight-related comorbidities, such as cardiovascular \ndisease.12 Clinical guidelines from the National Institute for Health and Care Excellence (NICE),13 \nmaking recommendations to the NHS to ensure value for money, set higher threshold for use. \nNICE recommend tirzepatide and semaglutide for patients with at least one weight-related \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n4 \n \ncomorbidity and a BMI ≥ 35 kg/m² (or BMI ≥ 30 kg/m² and who meet the criteria for referral to \nspecialist weight management services, for semaglutide only) and liraglutide for patients with a BMI \n≥ 35 kg/m², non-diabetic hyperglycaemia, and a high risk of cardiovascular disease. In England this \nwould equate to 3.4 million being eligible for the medications on the NHS.14 Given concerns about \ncost and resources pressure on the NHS, the NHS in England plans a phased roll out, offering the \ndrugs to 220,000 people between 2025 and 2028.14   \nPublic interest in, and use of, GLP-1RAs for weight loss is growing rapidly. In the United States, a \npoll conducted in May 2024 (n=1,479) found that 6% of adults were currently using a GLP-1RA and \n12% had ever used one.15 Among those who reported ever taking the drugs, most (61%) said they \ntook them to manage a chronic condition such as diabetes or heart disease, but around four in ten \n(38%) said they took them solely to lose weight.15 Similarly, demand for these medications in the \nUK appears to be high, with concern that the NHS is struggling to manage demand for weight-loss \ndrugs.\n16 Prescribing data show sharp increases in prescription of semaglutide and tirzepatide \nacross NHS GP practices in England in 2024-25.17,18 A December 2024 poll (n=2,161) found that \n22% of UK adults would use a GLP-1RA weight-loss drug if it were available on prescription \nthrough the NHS,\n19 although many of these may not be eligible according to NICE guidelines. Of \nthose surveyed, 5% had personally taken a GLP-1RA, while 9% knew friends or family members \nwho had used one.\n19  \nDespite the growing interest in these medications, there is also concern about their misuse. \nAnecdotal evidence and adverse drug reaction reports suggest some people are using GLP-1RAs \noutside of licensed indications,\n12 potentially posing health risks. Additionally, gastrointestinal side \neffects (e.g., nausea, vomiting, diarrhoea, and constipation) are common,3,5 serious adverse effects \n(e.g. pancreatitis) have been reported,11 and some people who use GLP-1RAs experience \nmalnutrition,20–23 further raising safety considerations. As these medications become more widely \nused, it is essential to monitor their usage trends and to understand who is using them. With some \npeople accessing these medications outside of the NHS, traditional systems for understanding \nusage (e.g., NHS prescribing data, Clinical Practice Research Datalink) cannot be relied upon to \nprovide accurate estimates. Triangulation with nationally-representative surveys is important for \nproviding a complete picture.  \nGender differences may play a role in the demand for and usage of GLP-1RA medications. Severe \nobesity (BMI \n≥ 40) is more prevalent among women than men (4% vs. 2% among adults in England \nin 2022)2 and women are more likely to seek and receive medical treatment for weight loss,24 so \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n5 \n \nthey may be prescribed these drugs at higher rates than men. Additionally, societal pressures \nrelated to body image and weight management disproportionately affect women,25 which could \nfurther drive interest in GLP-1RAs within this group.  \nEquity of access to these medications is another important factor.26 In the UK poll, just 8% said they \nwould use these medications for weight loss if they had to pay for them privately, compared with \nthe 22% who would take them if provided on prescription by the NHS.19 Given it currently costs in \nthe region of £200 per month to obtain these drugs privately,19 those with the financial means may \nhave greater access to treatment, potentially exacerbating health inequalities. This is particularly \nconcerning as obesity is more prevalent among socioeconomically disadvantaged groups, \nparticularly among women, according to area level deprivation and household income.\n27,28 \nGiven the rising public interest, potential supply challenges, and safety concerns, this study aimed \nto assess the current prevalence of GLP-1RA use and level of interest in using these medications \nfor weight loss among the adult population in Great Britain. We also explored differences between \nkey population subgroups. A comprehensive understanding of these factors can help to inform \nhealthcare policy, ensure equitable access to treatment, and safeguard patient wellbeing. \n \nMethods \nPre-registration \nThe study protocol and analysis plan were pre-registered on Open Science Framework \n(https://osf.io/r2whq/). \nDesign \nData were collected via the Smoking Toolkit Study, a monthly cross-sectional survey of a \nrepresentative sample of adults (≥ 16 years) in Great Britain (i.e., England, Scotland and Wales). \nThe methods have been described in detail elsewhere.29–31 Briefly, the study uses a hybrid of \nrandom probability and simple quota sampling to select a new sample of approximately 2,450 \nadults each month. Data are collected through telephone interviews. Sample weights are calculated \nusing raking to match the population in Great Britain. This profile is determined each month by \ncombining data from the UK Census, the Office for National Statistics mid-year estimates, and the \nannual National Readership Survey.29 Comparisons with other national surveys and sales data \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n6 \n \nindicate the survey achieves nationally representative estimates of key sociodemographic \nvariables.29 \nBetween January and March 2025, all participants aged ≥ 18 years in England and ~50% in Wales \nand Scotland were asked additional questions on past-year use of GLP-1RAs and interest in using \nthem for weight loss. This study analysed these data. \nMeasures \nPast-year use of GLP-1RAs and GLP1-RA compounds (i.e., tirzepatide) was assessed with two \nquestions. The first asked: ‘In the last 12 months have you taken any medication to help you with \nany of the following, or not?’ Participants were asked to indicate all that applied from the following \nresponse options: (a) medication for type 2 diabetes, excluding insulin, to help manage your blood \nsugar levels; (b) medication to lower the risk of heart disease; (c) medication to support weight loss \n/ reduce food cravings; (d) I have not taken medication for any of these reasons. They could also \nrespond that they could not remember. Those who reported using medication (i.e., responded a, b, \nor c) were then asked: ‘In the last 12 months, which, if any, of the following types of medication \nhave you taken [for type 2 diabetes/to lower the risk of heart disease/for weight loss]?’ (a) Saxenda, \ncontaining liraglutide; (b) Ozempic, containing semaglutide; (c) Wegovy, containing semaglutide; \n(d) Mounjaro, containing tirzepatide; (e) Rybelsus, containing semaglutide; (f) another type of \nmedication. Participants were asked to select all that applied. They could also respond that they did \nnot know. Those who responded to one of the named GLP-1RA, i.e. responses (a) to (e), to the \nsecond question were considered to have used a GLP-1RA. \nInterest in using medication for weight loss was assessed among those who did not report using \nmedication for weight loss in the past year (i.e., responded a, b, or d to the first question) with the \nquestion: ‘In the next 12 months, how likely, if at all, are you to consider using a weight loss \nmedication to help you lose weight?’ Response options were: (a) very likely, (b) fairly likely, (c) not \nvery likely, (d) not at all likely, (e) I don’t need to lose weight. Participants could also respond that \nthey did not know. We provided descriptive data for all response options. For some analyses, we \ndichotomised responses to a or b (likely to consider) vs. all other responses including don’t know. \nWe captured a range of sociodemographic characteristics. Gender was self-reported as man, \nwoman, or in another way; the latter group was excluded from analyses by gender due to low \nnumbers. Age was analysed as a continuous variable. Ethnicity was categorised as white vs. \nminority ethnic group. Occupational social grade was categorised using National Readership \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n7 \n \nSurvey classifications32 as ABC1 (includes managerial, professional, and upper supervisory \noccupations) and C2DE (includes manual routine, semi-routine, lower supervisory, state pension, \nand long-term unemployed). Financial situation was assessed with the question: ‘How well would \nyou say you yourself are managing financially these days? Would you say you are (a) living \ncomfortably; (b) doing alright; (c) just about getting by; (d) finding it quite difficult; or (e) finding it \nvery difficult?’.33 Health-related economic inactivity was operationalised as participants reporting \nthat they are ‘not in paid work because of long-term illness or disability’, in response to a question \nasking which of a list of different working statuses applies to them. \nWe also recorded information on participants’ health-related behaviours and mental health. \nSmoking status was categorised as current, former, or never smoker. Level of alcohol consumption \nwas assessed with the Alcohol Use Disorders Identification Test—consumption (AUDIT-C; possible \nrange=0-12) and analysed as a continuous variable. As a general guide, AUDIT-C scores ≥ 5 \nindicate drinking at increasing or higher-risk levels (i.e., levels that increase someone’s risk of \nharm).34 Psychological distress was assessed using the Kessler Psychological Distress Scale (K6), \nwhich measures non-specific psychological distress in the past month (possible range=0-24).35,36 \nWe categorised K6 scores as ‘no/low distress’ (0-4) or ‘moderate/severe distress’ (≥ 5).35,37 History \nof eating disorders was assessed with the question: ‘Since the age of 16, which of the following, if \nany, has a doctor or health professional ever told you that you had…?’ Responses were \ndichotomised to distinguish between those who responded ‘an eating disorder’ and those who did \nnot. Due to limited availability of funding, the question assessing eating disorders was only included \nin one of the three survey waves (February 2025), so analyses of this variable were restricted to \nthose surveyed in this wave. \nStatistical analysis \nData were analysed using R v.4.4.1. All analyses used weighted data. Missing data were handled \nusing multiple imputation by chained equations. We imputed missing values under the assumption \nof missing at random, using the mice package. Five imputed datasets were generated. The \nimputation models included all variables used in the analysis (except history of eating disorders, \ngiven it was only assessed in one wave; the imputation process was repeated separately for this \nwave of data to provide complete data for analyses involving this variable). Analyses were \nconducted separately on each imputed dataset and results were combined across imputations \nusing Rubin’s rules\n38 to account for within- and between-imputation variance. Results were reported \nas pooled estimates and confidence intervals (CIs). \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n8 \n \nWe estimated proportions (with 95% CIs) of adults who reported having used GLP-1RAs in the past \nyear (a) for any reason, (b) to manage type 2 diabetes, (c) to reduce the risk of heart disease, (d) to \nsupport weight loss, and (e) exclusively to support weight loss (i.e., not also to manage type 2 \ndiabetes or to reduce the risk of heart disease). We also reported these prevalence estimates \nstratified by the specific medication used. Among adults who reported having used a GLP-1RA for \nweight loss in the past year (at all, and exclusively for weight loss), we estimated the proportion \nwho used a medication licensed for weight loss in Great Britain (Saxenda, Wegovy, or Mounjaro). \nAmong adults who had not used a medication for weight loss in the past year, we estimated the \nproportion who would be likely to consider using a weight-loss medication in the next year. We \napplied these proportions to the most recent (2023) mid-year population estimates for Great \nBritain\n39 to approximate the number of adults using these medications in 2024 and the number who \nwould be interested in using them in the next year. \nTo explore differences in (i) past-year use of GLP-1RAs to support weight loss and (ii) interest in \nusing a weight-loss medication in the next year between population subgroups, we estimated these \nproportions stratified by gender, age, ethnicity, occupational social grade, financial situation, health-\nrelated economic inactivity, smoking status, alcohol consumption, past-month distress, and history \nof eating disorders. We also examined proportions within intersections of gender and each other \nvariable (results are reported in the Supplementary File). Age and level of alcohol consumption \nwere analysed as continuous variables, modelled non-linearly using restricted cubic splines (with \nthree knots placed at the 5, 50, and 95% percentiles) to allow for flexible associations without \narbitrary categorisation. Estimates for continuous variables were predicted from unadjusted logistic \nregression models that tested the association of age/level of alcohol consumption with each \noutcome. We reported estimates for selected ages (18, 25, 35, 45, 55, 65, and 75) and AUDIT-C \nscores (0, 3, 5, 8, 11) as an illustrative example of differences across ages and levels of alcohol \nconsumption. We also ran logistic regression models to analyse associations between each \nparticipant characteristic and these two outcomes, adjusted for age and gender (or just age, for \ngender-stratified analyses). \n \nResults \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n9 \n \nA total of 5,893 participants were invited to complete the GLP-1RA survey module, of whom 5,260 \n(89.3%) consented. Characteristics of the total eligible sample and those who consented are shown \nin Table S1 alongside imputed data. \nPrevalence of GLP-1RA use \nOverall, 4.5% of participants reported using a GLP-1RA in the past year for any reason; 2.9% \nreported using them to support weight loss, with 1.7% using them exclusively for weight loss (i.e., \nnot also for type 2 diabetes or heart disease; Table 1). When extrapolated to the national \npopulation, these figures suggest that approximately 1.6 million adults in Great Britain were using \nGLP-1RAs to support weight loss in early 2025 (53.7 million adults x 2.9%), of whom 910,000 were \nusing them exclusively for weight loss (53.7 million x 1.7%). \nThere were some subgroup differences in the use of GLP-1RAs to support weight loss (Table 2). \nPrevalence was more than twice as high among women than men (4.0% vs. 1.7%; OR=2.40 [1.62–\n3.56]) – with an even greater difference in the proportion using them exclusively for weight loss \n(2.8% [70.0% of female users] vs. 0.6% [35.3% of male users]; OR=4.44 [2.43–8.15]). There was a \nnon-linear (inverted U-shaped) association with age, with the highest prevalence of use of GLP-\n1RAs to support weight loss among those in mid-life (e.g., 4.2% among those aged 45 and 55) and \nlower prevalence in early adulthood (e.g., 1.2% among those aged 18) and later life (e.g., 1.5% \namong those aged 75). Prevalence was also higher among those who reported moderate/severe \npsychological distress (3.7% vs. 2.4% among those reporting no/low distress; OR=1.62 [1.13–\n2.32]). It also appeared to be higher among those who reported a history of eating disorders (4.4% \nvs. 2.1% among those who did not; OR=2.12 [0.69–6.53]), but there was substantial imprecision in \nthe estimate for this comparison given information on eating disorders was only collected in one of \nthe three survey waves and only a small proportion (4.2%) reported having received a diagnosis \n(Table S1). There were no notable overall differences by ethnicity, socioeconomic markers, \nsmoking status, or level of alcohol consumption. However, among men, prevalence appeared to be \nhigher among those from less advantaged socioeconomic groups (i.e., those from occupational \nsocial grades C2DE, those finding it difficult to manage financially, and those not in work due to \nlong-term illness or disability), whereas prevalence was more similar or showed the opposite \npattern among women (Table S2).  \nTypes of GLP-1RAs being used \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n10 \n \nThe most commonly used GLP-1RA was Mounjaro (tirzepatide; 2.3%), followed by Ozempic \n(semaglutide; 1.3%), Wegovy (semaglutide; 0.8%), Rybelsus (semaglutide; 0.6%), and Saxenda \n(liraglutide; 0.4%; Table 1). Of note, Mounjaro was most commonly used to support weight loss; it \nwas three times more prevalent for this reason than the next most popular GLP-1RA (2.0% vs. \nWegovy at 0.6%; Table 1). \nAmong those who used a GLP-1RA for weight loss in the past year, 85.0% [79.3–90.7%] used a \nmedication licensed for weight loss in Great Britain – 69.5% [62.0–67.0%] reported using Mounjaro, \n20.0% [12.9–27.0%] Wegovy, and 3.3% [0.0–6.8%] Saxenda (note that participants could select \nmultiple medications, so these values sum to more than the total; 19.4% [12.7–26.1%] of those who \nreported using GLP-1RAs for any reason reported using more than one GLP-1RA – 0.7% [0.5–\n1.0%] of all participants). Among those who used a GLP-1RA exclusively for weight loss, those \nnumbers were 91.4% [85.6–97.2%], 80.2% [71.9–88.6%], 21.4% [12.4–30.3%], and 0.9% [0.0–\n2.6%], respectively. \nInterest in using weight-loss medications \nAmong participants who had not used a GLP-1RA or other medication for weight loss in the past \nyear (96.0% [95.5–96.6%] of the sample), 6.5% [5.7–7.3%] said they would be likely to consider \nusing a weight-loss medication in the next year (2.5% [2.1–3.0%] very likely and 4.0% [3.4–4.6%] \nfairly likely; Figure 1). This is approximately 3.3 million adults in Great Britain (53.7 million adults x \n96.0% not used medication to support weight loss in the past year x 6.5%), of whom around 1.3 \nmillion (53.7 million x 96.0% x 2.5%) are very likely to consider it. \nInterest in using weight-loss medications differed according to participant characteristics (Table 2). \nSome of these differences mirrored patterns observed for past-year use of GLP-1RAs for weight \nloss. The proportion who said they would be likely to consider using weight-loss medications in the \nnext year was higher among women than men (8.9% vs. 5.1%; OR=1.85 [1.44–2.38]; Figure 1), \nthose in mid-life (e.g., 9.7% among those aged 45 vs. 5.5% and 3.2% among those aged 18 and \n75, respectively), and those who reported moderate/severe psychological distress (10.0% vs. 5.2% \namong those reporting no/low distress; OR=1.81 [1.40–2.35]). It also appeared to be higher among \nthose who reported a history of eating disorders (13.2% vs. 7.3% among those who did not; \nOR=1.59 [0.66-3.82]), but again, there was substantial imprecision.  \nThere were also some subgroup differences that were not observed for past-year use (Table 2). \nInterest in using weight-loss medications in the next year was higher among those in less \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n11 \n \nfavourable financial situations (e.g., 11.7% among those who reported finding it very difficult to \nmanage financially vs. 4.5% among those living comfortably; OR=2.01 [1.16–3.48]) and among \nthose who were not in work due to long-term illness or disability (13.4% vs. 6.7% of those not in this \nsituation; OR=1.85 [1.19–2.88]). It also appeared to be slightly higher among those from minority \nethnic groups (9.6% vs. 6.6% among white participants; OR=1.30 [0.91–1.86]), but this difference \nwas uncertain. There were no notable differences by occupational social grade, smoking status, or \nlevel of alcohol consumption. \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n12 \n \nTable 1. Past-year use of GLP-1 receptor agonists among adults (≥ 18y) in Great Britain \n  Prevalence, % [95% CI] \nGLP-1RA used in past year \nAuthorised \nindication(s)1 \nFor any \nreason \nTo manage \ntype 2 \ndiabetes \nTo reduce the \nrisk of heart \ndisease \nTo support \nweight loss \nExclusively to \nsupport \nweight loss \n       \nAny GLP-1RA listed below - 4.5 [3.8–5.1] 1.7 [1.3–2.0] 1.6 [1.3–2.0] 2.9 [2.4–3.4] 1.7 [1.4–2.1] \nSaxenda, containing liraglutide WL 0.4 [0.2–0.5] 0.2 [0.0–0.3] 0.1 [0.0–0.3] 0.1 [0.0–0.2] 0.0 [0.0–0.0] \nWegovy, containing semaglutide WL, CRR 0.8 [0.5–1.0] 0.2 [0.1–0.3] 0.3 [0.1–0.5] 0.6 [0.3–0.8] 0.4 [0.2–0.5] \nMounjaro, containing tirzepatide WL, T2D 2.3 [1.9–2.7] 0.6 [0.4–0.9] 0.7 [0.4–0.9] 2.0 [1.6–2.4] 1.4 [1.1–1.7] \nOzempic, containing semaglutide T2D 1.3 [0.9–1.7] 0.6 [0.4–0.9] 0.6 [0.3–0.9] 0.5 [0.3–0.7] 0.2 [0.1–0.3] \nRybelsus, containing semaglutide T2D 0.6 [0.3–0.8] 0.5 [0.3–0.7] 0.3 [0.1–0.4] 0.3 [0.2–0.5] 0.1 [0.0–0.1] \n       \nCI, confidence interval. GLP-1RA, glucagon-like peptide-1 receptor agonist. \n1 Authorised indications for use in the UK.12 WL, weight loss. CRR, cardiovascular risk reduction. T2D, type 2 diabetes. \nData shown are weighted estimates of the proportion (with 95% CI) of adults in Great Britain reporting past-year use of different GLP-\n1RAs, overall (i.e., for any reason) and stratified by the reason for use. Note that reasons are not mutually exclusive, except \n‘exclusively to support weight loss’, which excludes participants reporting use for any other reason.  \nEstimates stratified by gender are provided in Table S3. \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n13 \n \nTable 2. Use of GLP-1 receptor agonists to support weight loss, and interest in using weight-loss \nmedication, by participant characteristics \n Used GLP-1RAs to support \nweight loss in the past year1 \n Interested in using weight-loss \nmedication in the next year2 \n % [95% CI] OR [95% CI]3  % [95% CI] OR [95% CI]3 \n      \nGender      \n   Man 1.7 [1.1–2.3] Ref  5.1 [4.2–6.1] Ref \n   Woman 4.0 [3.2–4.8] 2.40 [1.62–3.56]  8.9 [7.7–10.1] 1.85 [1.44–2.38] \n      \nAge (years)4      \n   18 1.2 [0.7–2.1] Ref  5.5 [3.8–7.9] Ref \n   25 1.8 [1.2–2.7] 1.53 [1.31–1.74]  6.8 [5.3–8.6] 1.26 [1.11–1.40] \n   35 3.1 [2.4–3.9] 2.64 [2.03–3.26]  8.7 [7.5–10.0] 1.67 [1.30–2.04] \n   45 4.2 [3.4–5.3] 3.74 [2.64–4.85]  9.7 [8.4–11.3] 1.91 [1.35–2.46] \n   55 4.2 [3.4–5.2] 3.71 [2.42–4.99]  8.6 [7.3–10.1] 1.66 [1.07–2.25] \n   65 2.9 [2.2–3.7] 2.46 [1.46–3.46]  5.8 [4.8–6.9] 1.07 [0.58–1.56] \n   75 1.5 [1–2.4] 1.27 [0.51–2.03]  3.2 [2.4–4.4] 0.57 [0.12–1.02] \n      \nEthnicity      \n   White 2.9 [2.4–3.4] Ref  6.6 [5.8–7.4] Ref \n   Minority ethnic group 2.9 [1.5–4.2] 1.05 [0.64–1.73]  9.6 [7.0–12.3] 1.30 [0.91–1.86] \n      \nOccupational social grade      \n   ABC1 (more advantaged) 3.1 [2.5–3.7] Ref  6.8 [5.9–7.8] Ref \n   C2DE (less advantaged) 2.6 [1.7–3.4] 0.85 [0.57–1.27]  7.4 [6.0–8.7] 1.09 [0.84–1.41] \n      \nFinancial situation      \n   Living comfortably 2.9 [2.1–3.7] Ref  4.5 [3.4–5.7] Ref \n   Doing alright 2.6 [1.8–3.4] 0.88 [0.57–1.34]  6.4 [5.1–7.7] 1.26 [0.89–1.78] \n   Just about getting by 2.9 [1.8–4.1] 0.99 [0.61–1.62]  8.7 [7.0–10.5] 1.98 [1.40–2.80] \n   Finding it quite difficult 3.3 [1.5–5.1] 1.11 [0.58–2.12]  9.6 [6.6–12.6] 2.02 [1.28–3.19] \n   Finding it very difficult 3.7 [1.2–6.3] 1.17 [0.55–2.50]  11.7 [7.6–15.7] 2.01 [1.16–3.48] \n      \nEconomically inactive due to \nlong-term illness or disability \n     \n   No 2.8 [2.3–3.3] Ref  6.7 [5.9–7.5] Ref \n   Yes 4.3 [1.7–6.9] 1.26 [0.66–2.43]  13.4 [9.1–17.7] 1.85 [1.19–2.88] \n      \nSmoking status      \n   Never 2.6 [2.0–3.3] Ref  6.4 [5.4–7.4] Ref \n   Former 3.6 [2.6–4.5] 1.35 [0.92–1.97]  8.1 [6.5–9.6] 1.26 [0.93–1.71] \n   Current 2.4 [1.2–3.7] 0.87 [0.48–1.56]  7.5 [5.3–9.6] 1.09 [0.76–1.56] \n      \nTable continues on next page. \n  \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n14 \n \nTable 2. continued \n Used GLP-1RAs to support \nweight loss in the past year1 \n Interested in using weight-loss \nmedication in the next year2 \n % [95% CI] OR [95% CI]3  % [95% CI] OR [95% CI]3 \n      \nLevel of alcohol consumption \n(AUDIT-C)5 \n     \n   0 3.2 [2.4–4.3] Ref  8.3 [7.0–9.9] Ref \n   3 2.5 [2.0–3.3] 0.79 [0.41–1.17]  6.0 [5.0–7.2] 0.76 [0.49–1.02] \n   5 2.5 [1.9–3.3] 0.82 [0.39–1.26]  5.9 [4.9–7.1] 0.77 [0.46–1.07] \n   8 3.0 [2.2–4.1] 1.12 [0.66–1.58]  7.4 [6.0–9.0] 0.99 [0.64–1.33] \n   11 3.9 [2.0–7.4] 1.67 [0.92–2.42]  10.0 [6.6–14.8] 1.40 [0.81–1.99] \n      \nPast-month psychological \ndistress \n     \n   None/low 2.4 [1.8–2.9] Ref  5.2 [4.3–6.1] Ref \n   Moderate/severe 3.7 [2.8–4.6] 1.62 [1.13–2.32]  10.0 [8.5–11.4] 1.81 [1.40–2.35] \n      \nHistory of eating disorders6      \n   No 2.1 [1.4–2.9] Ref  7.3 [5.8–8.7] Ref \n   Yes 4.4 [0.1–8.8] 2.12 [0.69–6.53]  13.2 [4.0–22.4] 1.59 [0.66–3.82] \n      \nCI, confidence interval. OR, odds ratio. \n1 Among adults in Great Britain. \n2 Among those who had not used a GLP-1RA or other medication for weight loss in the past year.  \n3 Adjusted for age and gender (analyses by age are adjusted for gender only and analyses by \ngender are adjusted for age only). \n4 Predicted estimates from logistic regression models with age modelled using restricted cubic \nsplines. Note that the models used to derive these estimates included data from participants of all \nages, not only those who were aged exactly 16, 25, 35, 45, 55, or 65 years. \n5 Predicted estimates from logistic regression models with AUDIT-C score modelled using restricted \ncubic splines. Note that the models used to derive these estimates included data from all \nparticipants who provided data on AUDIT-C, not only those who scored exactly 0, 3, 5, 8, or 11. \n6 History of eating disorders was only assessed in February 2025; analyses were restricted to participants \nsurveyed in this wave. \nEstimates stratified by gender are provided in Table S2 (use in the past year) and Table S4 (interest). \n \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n15 \n \n \nFigure 1. Interest in using weight-loss medication among adults (≥ 18y) in Great Britain who have \nnot done so in the past year, overall and by gender \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n16 \n \nDiscussion \nOur data suggest that in the first quarter of 2025, 4.9 million adults in Great Britain – nearly one \nin ten – either had recently used medication to support weight loss or were interested in doing \nso in the near future. Of these, approximately 1.6 million adults used GLP-1RAs for weight \nmanagement, with 910,000 (~60%) using them exclusively for this purpose. The majority \nreported using GLP-1RAs that are licensed for weight loss in Great Britain, most commonly \nMounjaro (tirzepatide). Use and interest were more prevalent among women, people in mid-life, \nand those reporting past-month psychological distress, and also appeared higher among those \nwith a history of eating disorders. Interest was also higher among people facing greater \nsocioeconomic disadvantage, including those in financial difficulty or unable to work due to long-\nterm illness or disability. \nThese data provide important insights into the emerging landscape of GLP-1RA use and \npotential future demand in Great Britain. The substantial level of current use, combined with \neven greater levels of interest, highlights growing public awareness of pharmacological options \nfor weight management. However, the gap between interest and current use suggests there \nmay be unmet demand. However, in the absence of data on people’s underlying medical risk \nfactors, it is not possible to understand the extent to which this reflects ‘true’ medical need, e.g. \nmeeting either current NICE criteria for weight loss medication or a lower threshold at which \nhealth benefits outweigh the harms. While the numbers we estimate are for Great Britain as a \nwhole, it is noteworthy that the number using these medications for weight loss far exceeds the \ninitial expectation for NHS England to provide treatment for 220,000 people in the first three \nyears, which is likely to have important consequences for NHS budgets, although our estimate \nis less than the number eligible according to NICE guidelines (3.4 million).\n14 Part of the \ndiscrepancy may reflect prescribing outside the NHS. It is unclear to what extent this use may \nbe driven by health concerns – and falls within either NICE recommendations or licensed use – \nor desire to lose weight for other reasons. Nonetheless, this trend is consistent with broader \nsocietal shifts towards medicalised approaches to managing obesity11,40 and points to a need for \nhealthcare systems and policymakers to decide how best to manage a continued surge in \ndemand. \nConsistent with previous studies showing greater uptake of weight-loss treatments among \nwomen,\n24 we observed higher use and interest among women than men. This may reflect a \ncombination of factors, including greater social pressures on women regarding body image and \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n17 \n \nweight,25 as well as gender differences in healthcare-seeking behaviour.41 Women have much \nhigher prevalence of severe obesity than men,2 and are typically more likely to engage with \nhealth (and preventive) services,42 engage with weight management services and discuss \nweight loss with healthcare professionals,24 which may facilitate greater access to emerging \ntreatments like GLP-1RAs. \nWe also identified socioeconomic patterns. Although current use of GLP-1RAs for weight loss \nwas relatively consistent across socioeconomic groups, this did vary by gender. Among men, \nuse was more common in less advantaged groups, while among women, use was relatively \nconsistent across socioeconomic strata. This may reflect higher prevalence of obesity-related \nmetabolic comorbidities among men compared to women, which may also be socially \npatterned.\n43,44 For men, from a health inequalities perspective it is encouraging that uptake is \nhigher among people from less advantaged groups. It is also unusual for the adoption of an \nexpensive new medication or new medical technology, and this finding warrants further scrutiny \nand exploration. For women, one possible explanation is that women may be more likely than \nmen to access GLP-1RAs through private routes, which often require substantial out-of-pocket \ncosts\n19 and may be less accessible to those with fewer financial resources. Further research is \nneeded to explore these findings more fully.  \nInterest in future use was higher among those experiencing financial hardship or unemployment \ndue to long-term illness or disability. The greater interest among groups disproportionately \naffected by severe obesity2,45 and its related comorbidities may reflect a recognition of the \npotential health benefits of weight-loss medications for these people.27,28 It may also reflect a \nlack of perceived viable alternatives to lose weight: lifestyle interventions for weight \nmanagement (even very intensive, well-designed, multicomponent ones) have a very modest \nimpact on weight loss.46,47  \nUse of GLP-1RAs for weight loss and interest in future use were also higher among those \nexperiencing psychological distress and those reporting a history of eating disorders. This may \nreflect the well-documented bidirectional relationship between mental health conditions – such \nas depression, anxiety, and binge eating disorder – and obesity.48,49 Mental health disorders are \nalso more prevalent among women,50 which may contribute to observed gender differences in \nGLP-1RA use and interest. Individuals with higher levels of psychological distress may be more \nvulnerable to weight-related stigma or internalised weight bias,\n51 leading to greater concern \nabout appearance and heightened motivation to seek pharmacological interventions. Greater \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n18 \n \nbody shame, weight concerns, anti-fat bias, and disordered eating behaviours have all been \nlinked to greater interest in using GLP-1RAs.52 However, the direction of these associations is \nunclear and may be bidirectional. Emerging evidence has raised concerns about potential \nadverse mental health effects associated with GLP-1RA use, including increased psychological \ndistress or suicidal ideation in some users, although data are currently limited and \ninconclusive.\n53,54 These patterns highlight the importance of further research to better \nunderstand the relationship between mental health and both actual and intended use of GLP-\n1RAs for weight management. \nAnother notable finding is the substantial proportion of past-year users who reported using GLP-\n1RAs that are not licensed for weight loss (15.0% of all those who reported using a GLP-1RA to \nsupport weight loss; 8.6% of those reporting use exclusively for weight loss), indicating off-label \nprescribing55 or procurement through non-medical channels.56,57 This may highlight potential \nissues in prescribing practices, patient understanding, and/or regulatory oversight. Some off-\nlabel prescribing should be expected: in the UK, liraglutide has an indication for weight loss \nonly, but NICE guidelines list it as a treatment option for type 2 diabetes.\n58 While off-license \nprescribing can be common in some areas of medicine,59 it can also pose safety risks60 – \nparticularly when medications are accessed without appropriate clinical supervision. There are \nconcerns about GLP1-RA being purchased without a prescription through unregulated or illicit \nchannels, with very light medical supervision or being used outside their licensed use (i.e. at \nlower BMI). Further work is needed, but this data raises further questions about their actual use \nand whether appropriate safety standards are in place and being adhered to. Depending on how \nthese medications are being accessed, public health messaging warning of the potential harms \nof purchasing online or from other non-medical outlets may also be helpful. \nThe rising demand for GLP-1RAs to support weight loss presents significant challenges for \nhealthcare systems such as the NHS. Responding to this demand safely and equitably, while \nfocusing on those with medical need, will require difficult decisions about access, prioritisation, \nand resource allocation. These discussions are already underway and have led to a new \nproposition about how to identify those with clinical need who would benefit most from these \ndrugs, although this is not without controversy.\n61,62 Although widespread adoption of GLP-1RAs \nhas the potential to improve population health by reducing obesity-related diseases, the \nfinancial implications are considerable. These medications are expensive,\n11 are likely to require \nlong-term use, and scaling up provision could place a heavy burden on NHS budgets already \nstrained by the management of chronic conditions and recent structural reorganisations.63 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n19 \n \nEqually the majority of the population thought they were not interested in using the medications, \nand while attitudes may change, as with other medical interventions this might suggest limits on \npublic willingness to use them. While GLP-1RAs are generally considered cost-effective for \ntreating obesity in targeted populations,64–66 alternative strategies – such as expanding bariatric \nsurgery access, enhancing lifestyle intervention programmes, pharmaceutical management of \ncardiometabolic comorbidities, or population-level policies should also be considered. These \nmay not yet have achieved an equivalent scale of impact compared to GLP-1RAs, but some \nhave not been tried at scale or with the intensity that is required, but may offer more cost-\neffective, long lasting or equitable solutions.\n11 Policymakers will need to balance the benefits of \nincreasing GLP-1RA access against broader public health investments, which have been slow \nto be implemented (e.g., advertising and product promotion restrictions\n63 that are not yet in \nplace, and which have been further delayed). Furthermore, it will be essential to ensure that \naccess is equitable, clinically justified, and aligned with evidence-based guidelines to prevent \nwidening health inequalities or encouraging inappropriate prescribing. In addition, there is a \nneed to ensure these medications remain available to those who need them for reasons other \nthan weight loss (over a third of users in 2024, according to our data; ~1.5 million people). \nA key strength of this study is the relatively large, nationally representative sample. In addition, \nthe inclusion of demographic, socioeconomic, and psychological factors provides a detailed \npicture of patterns of use and potential demand within different population subgroups. There \nwere also several limitations. All data were self-reported and relied on recall of the past year, \nintroducing scope for bias. Given the cross-sectional nature of the study, we were unable to \ndisentangle directional associations with time-varying sample characteristics and may have \nbeen unable to detect some such associations. For example, while we did not observe an \nassociation between alcohol consumption and past-year use of GLP-1RAs, it is possible that \nthose who used these medications initially had higher consumption but experienced reductions \nin alcohol consumption between initiating medication use and completing the survey.\n8 Due to \nlimited availability of funding for the GLP-1RA survey items, we were unable to collect more \ndetailed information about how and why people were accessing these medications. No data \nwere available on height and weight, so we were unable to explore differences by BMI status, \nand cannot make assessments about the appropriateness of use against medical criteria for \nuse. We also did not ask specifically about all GLP-1RAs licensed in the UK, which may have \nresulted in incomplete information on the types of medications used and caused us to \nunderestimate the overall prevalence of use. Further research is needed to explore the source \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n20 \n \nof GLP-1RAs (e.g. NHS, private prescription in person, post/internet with a prescription, \npost/internet with no formal prescription) and to assess the appropriateness of use (i.e., the \nextent to which people who are using these drugs for weight loss fall within the indications of the \nNICE guidelines). Regularly including these types of questions in a representative, repeat cross-\nsectional household survey like the Smoking Toolkit Study would offer insights into how \npopulation-level use of, and demand for, GLP-1RA medications for weight loss is evolving over \ntime. Qualitative research is also important for a richer understanding of people’s experiences of \naccessing and using these medications. \nIn conclusion, this study highlights substantial demand for GLP-1RAs to support weight loss in \nGreat Britain. As drugs become more available, equitable access to these treatments should be \nprioritised to meet the needs of all population groups, particularly those who may face barriers \nto access despite high interest. At the same time, healthcare systems must be prepared for the \npotential pressures on capacity and budgets. To support safe, effective, and equitable use, \nthere is a clear need for regular, population-level monitoring – not only of the prevalence and \npatterns of use, but also of access, appropriateness, health outcomes, and broader system \nimpacts. Such surveillance will be essential to inform responsive healthcare planning, guide and \nevaluate policy decisions, and ensure that these treatments deliver sustainable benefits without \nwidening health inequalities or overburdening healthcare resources. \n  \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n21 \n \nReferences \n1  NHS Digital. Statistics on Obesity, Physical Activity and Diet, England 2021. \n2021https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-\nphysical-activity-and-diet/england-2021/part-1-obesity-related-hospital-admissions \n(accessed 10 Mar2025). \n2  NHS Digital. Health Survey for England, 2022 Part 2. 2024https://digital.nhs.uk/data-and-\ninformation/publications/statistical/health-survey-for-england/2022-part-2/adult-overweight-\nand-obesity (accessed 10 Mar2025). \n3  Pan X-H, Tan B, Chin YH, Lee ECZ, Kong G, Chong B et al. Efficacy and safety of \ntirzepatide, GLP-1 receptor agonists, and other weight loss drugs in overweight and obesity: \na network meta-analysis. Obesity 2024; 32: 840–856. \n4  Wong HJ, Sim B, Teo YH, Teo YN, Chan MY, Yeo LLL et al. Efficacy of GLP-1 Receptor \nAgonists on Weight Loss, BMI, and Waist Circumference for Patients With Obesity or \nOverweight: A Systematic Review, Meta-analysis, and Meta-regression of 47 Randomized \nControlled Trials. Diabetes Care 2025; 48: 292–300. \n5  Guo H, Yang J, Huang J, Xu L, Lv Y, Wang Y et al. Comparative efficacy and safety of GLP-\n1 receptor agonists for weight reduction: A model-based meta-analysis of placebo-controlled \ntrials. Obes Pillars 2025; 13: 100162. \n6  Lincoff AM, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, Esbjerg S et al. \nSemaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med \n2023; 389: 2221–2232. \n7  Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA et al. Semaglutide and \nCardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2016; 375: 1834–\n1844. \n8  Martinelli S, Mazzotta A, Longaroni M, Petrucciani N. Potential role of glucagon-like peptide-\n1 (GLP-1) receptor agonists in substance use disorder: A systematic review of randomized \ntrials. Drug Alcohol Depend 2024; 264: 112424. \n9  Thomsen RW, Mailhac A, Løhde JB, Pottegård A. Real-world evidence on the utilization, \nclinical and comparative effectiveness, and adverse effects of newer GLP-1RA-based \nweight-loss therapies. Diabetes Obes Metab 2025; 27: 66–88. \n10  Sridhar D. We know so little about taking weight-loss drugs without prescription – is it really \nworth it? The Guardian. \n2025.https://www.theguardian.com/commentisfree/2025/feb/25/weight-loss-drugs-without-\nprescription (accessed 4 Mar2025). \n11  Mytton OT, Head V, Reckless I. Public health perspective on new weight loss medications. \nBMJ 2024; 384: q196. \n12  Medicines and Healthcare products Regulatory Agency. GLP-1 receptor agonists: reminder \nof the potential side effects and to be aware of the potential for misuse. GOV.UK. 24 Oct \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n22 \n \n24.https://www.gov.uk/drug-safety-update/glp-1-receptor-agonists-reminder-of-the-potential-\nside-effects-and-to-be-aware-of-the-potential-for-misuse (accessed 4 Mar2025). \n13  National Institute for Health and Care Excellence. Overweight and obesity management | \nNICE guideline | NG246. 2025.https://www.nice.org.uk/guidance/ng246/chapter/Medicines-\nand-surgery (accessed 21 May2025). \n14  NHS England. Interim commissioning guidance: Implementation of the NICE Technology \nAppraisal TA1026 and the NICE funding variation for tirzepatide (Mounjaro®) for the \nmanagement of obesity. 2025https://www.england.nhs.uk/publication/interim-\ncommissioning-guidance-implementation-of-the-nice-technology-appraisal-ta1026-and-the-\nnice-funding-variation-for-tirzepatide-mounjaro-for-the-management-of-obesity/ (accessed \n15 May2025). \n15  Poll: 1 in 8 Adults Say They’ve Taken a GLP-1 Drug, Including 4 in 10 of Those with \nDiabetes and 1 in 4 of Those with Heart Disease. KFF. 2024.https://www.kff.org/health-\ncosts/press-release/poll-1-in-8-adults-say-theyve-taken-a-glp-1-drug-including-4-in-10-of-\nthose-with-diabetes-and-1-in-4-of-those-with-heart-disease/ (accessed 4 Mar2025). \n16  Correspondent PK Health. NHS struggling to cope with ‘overwhelming’ weight-loss drug \ndemand. 2024.https://www.thetimes.com/uk/healthcare/article/nhs-weight-loss-drugs-\nmounjaro-ozempic-jq9n825pn (accessed 4 Mar2025). \n17  Semaglutide (British National Formulary code 0601023AW). OpenPrescribing. \nhttps://openprescribing.net/chemical/0601023AW/ (accessed 27 Mar2025). \n18  Tirzepatide (British National Formulary code 0601023AZ). OpenPrescribing. \nhttps://openprescribing.net/chemical/0601023AZ/ (accessed 27 Mar2025). \n19  Campbell D, editor DCH policy. One in five Britons would use weight-loss drug if free on \nNHS, poll reveals. The Guardian. \n2024.https://www.theguardian.com/society/2024/dec/28/one-in-five-britons-weight-loss-\ndrug-free-nhs-poll (accessed 4 Mar2025). \n20  Sheth K, Garza E, Saju A, Nazir N, Agarwal A. Wernicke Encephalopathy Associated With \nSemaglutide Use. Cureus; 16: e61783. \n21  Ali SA, Khadra M, Sitto M, Graifman M, Gietzen J. S4686 Semaglutide’s Hidden Perils: A \nRare Case of Malnutrition and Wernicke Encephalopathy. Off J Am Coll Gastroenterol ACG \n2024; 119: S2964. \n22  Sharma N, Vura NVRK, Shweikeh F, Ramirez-Osoria LC, Chakinala RC, Sharma AN. \nS4690 Semaglutide-Linked Dry Beriberi: A Rare Adverse Reaction. Off J Am Coll \nGastroenterol ACG 2024; 119: S2967. \n23  Foster S, Kyle A. From Weight Loss to Neurological Deficits: A Case of Wernicke’s \nEncephalopathy Stemming From Prescription Weight Loss Medication. EM Resid. \n2023.https://www.emra.org/emresident/article/wernicke-july-2023 (accessed 27 Mar2025). \n24  Cooper AJ, Gupta SR, Moustafa AF, Chao AM. Sex/Gender Differences in Obesity \nPrevalence, Comorbidities, and Treatment. Curr Obes Rep 2021; 10: 458–466. \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n23 \n \n25  Murnen SK, Don BP. Body image and gender roles. In: Encyclopedia of body image and \nhuman appearance. Academic Press: San Diego, 2012, pp 128–134. \n26  Dellgren JL, Persad G, Emanuel EJ. International coverage of GLP-1 receptor agonists: a \nreview and ethical analysis of discordant approaches. The Lancet 2024; 404: 902–906. \n27  Stiebahl S. Obesity statistics. 2025.https://commonslibrary.parliament.uk/research-\nbriefings/sn03336/ (accessed 10 Mar2025). \n28  El-Sayed AM, Scarborough P, Galea S. Unevenly distributed: a systematic review of the \nhealth literature about socioeconomic inequalities in adult obesity in the United Kingdom. \nBMC Public Health 2012; 12: 18. \n29  Fidler JA, Shahab L, West O, Jarvis MJ, McEwen A, Stapleton JA et al. ‘The smoking toolkit \nstudy’: a national study of smoking and smoking cessation in England. BMC Public Health \n2011; 11: 479. \n30  Kock L, Shahab L, Moore G, Beard E, Bauld L, Reid G et al. Protocol for expansion of an \nexisting national monthly survey of smoking behaviour and alcohol use in England to \nScotland and Wales: The Smoking and Alcohol Toolkit Study. Wellcome Open Res 2021; 6: \n67. \n31  Jackson SE, Tattan-Birch H, Shahab L, Brown J. Trends in long term vaping among adults \nin England, 2013-23: population based study. BMJ 2024; 386: e079016. \n32  National Readership Survey. Social grade - definitions and discriminatory power. \n2007.http:// www.nrs.co.uk/lifestyle.html (accessed 1 Oct2012). \n33  Downward P, Rasciute S, Kumar H. Health, subjective financial situation and well-being: a \nlongitudinal observational study. Health Qual Life Outcomes 2020; 18: 203. \n34  Rumpf H-J, Hapke U, Meyer C, John U. Screening for alcohol use disorders and at-risk \ndrinking in the general population: psychometric performance of three questionnaires. \nAlcohol Alcohol 2002; 37: 261–268. \n35  Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand S-LT et al. Short \nscreening scales to monitor population prevalences and trends in non-specific psychological \ndistress. Psychol Med 2002; 32: 959–976. \n36  Kessler RC, Green JG, Gruber MJ, Sampson NA, Bromet E, Cuitan M et al. Screening for \nserious mental illness in the general population with the K6 screening scale: results from the \nWHO World Mental Health (WMH) survey initiative. Int J Methods Psychiatr Res 2010; 19: \n4–22. \n37  Prochaska JJ, Sung H-Y, Max W, Shi Y, Ong M. Validity study of the K6 scale as a measure \nof moderate mental distress based on mental health treatment need and utilization. Int J \nMethods Psychiatr Res 2012; 21: 88–97. \n38  Rubin DB. Multiple imputation. In: Flexible Imputation of Missing Data, Second Edition. \nChapman and Hall/CRC, 2018. \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n24 \n \n39  Office for National Statistics. Population estimates for the UK, England, Wales, Scotland, \nand Northern Ireland: mid-2022. \n2024.https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/popul\nationestimates/bulletins/annualmidyearpopulationestimates/mid2022 (accessed 2 \nMay2024). \n40  ROSE G. Sick Individuals and Sick Populations. Int J Epidemiol 1985; 14: 32–38. \n41  Wang Y, Hunt K, Nazareth I, Freemantle N, Petersen I. Do men consult less than women? \nAn analysis of routinely collected UK general practice data. BMJ Open 2013; 3: e003320. \n42  Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender Differences in the \nUtilization of Health Care Services. J Fam Pract 2000; 49: 147–152. \n43  Koceva A, Herman R, Janez A, Rakusa M, Jensterle M. Sex- and Gender-Related \nDifferences in Obesity: From Pathophysiological Mechanisms to Clinical Implications. Int J \nMol Sci 2024; 25: 7342. \n44  The Health Foundation. Inequalities in life expectancy and healthy life expectancy. \n2025.https://www.health.org.uk/evidence-hub/health-inequalities/inequalities-in-life-\nexpectancy-and-healthy-life-expectancy (accessed 27 May2025). \n45  Booth HP, Charlton J, Gulliford MC. Socioeconomic inequality in morbid obesity with body \nmass index more than 40   kg/m2 in the United States and England. SSM - Popul Health \n2017; 3: 172–178. \n46  Singh N, Stewart RAH, Benatar JR. Intensity and duration of lifestyle interventions for long-\nterm weight loss and association with mortality: a meta-analysis of randomised trials. BMJ \nOpen 2019; 9: e029966. \n47  Madigan CD, Graham HE, Sturgiss E, Kettle VE, Gokal K, Biddle G et al. Effectiveness of \nweight management interventions for adults delivered in primary care: systematic review \nand meta-analysis of randomised controlled trials. BMJ 2022; 377: e069719. \n48  Avila C, Holloway AC, Hahn MK, Morrison KM, Restivo M, Anglin R et al. An Overview of \nLinks Between Obesity and Mental Health. Curr Obes Rep 2015; 4: 303–310. \n49  Milaneschi Y, Simmons WK, van Rossum EFC, Penninx BW. Depression and obesity: \nevidence of shared biological mechanisms. Mol Psychiatry 2019; 24: 18–33. \n50  Piccinelli M, Wilkinson G. Gender differences in depression. Critical review. Br J Psychiatry \nJ Ment Sci 2000; 177: 486–492. \n51  Pudney EV, Himmelstein MS, Puhl RM, Foster GD. Distressed or not distressed? A mixed \nmethods examination of reactions to weight stigma and implications for emotional wellbeing \nand internalized weight bias. Soc Sci Med 2020; 249: 112854. \n52  Markey CH, August KJ, Malik D, Richeson A. Body image and interest in GLP-1 weight loss \nmedications. Body Image 2025; 53: 101890. \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n25 \n \n53  McIntyre RS. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and suicidality: what \ndo we know and future vistas. Expert Opin Drug Saf 2024; 23: 539–542. \n54  Salvo F, Faillie J-L. GLP-1 Receptor Agonists and Suicidality—Caution Is Needed. JAMA \nNetw Open 2024; 7: e2423335. \n55  Aronson JK, Ferner RE. Unlicensed and off-label uses of medicines: definitions and \nclarification of terminology. Br J Clin Pharmacol 2017; 83: 2615–2625. \n56  Basch CH, Yousaf H, Hillyer GC. Online purchasing options for GLP-1 agonists: \nAccessibility, marketing practices, and consumer safety concerns. J Med Surg Public Health \n2025; 5: 100183. \n57  Pearson SD, Whaley CM, Emond SK. Affordable Access to GLP-1 Obesity Medications: \nStrategies to Guide Market Action  and Policy Solutions. Institute for Clinical and Economic \nReview, 2025https://icer.org/wp-content/uploads/2025/04/Affordable-Access-to-GLP-1-\nObesity-Medications-_-ICER-White-Paper-_-04.09.2025.pdf (accessed 28 Apr2025). \n58  National Institute for Health and Care Excellence. Diabetes - type 2: GLP-1 receptor \nagonists. 2025.https://cks.nice.org.uk/topics/diabetes-type-2/prescribing-information/glp-1-\nreceptor-agonists/ (accessed 27 May2025). \n59  Eguale T, Buckeridge DL, Winslade NE, Benedetti A, Hanley JA, Tamblyn R. Drug, Patient, \nand Physician Characteristics Associated With Off-label Prescribing in Primary Care. Arch \nIntern Med 2012; 172: 781–788. \n60  Van Norman GA. Off-Label Use vs Off-Label Marketing of Drugs. JACC Basic Transl Sci \n2023; 8: 224–233. \n61  Rubino F, Cummings DE, Eckel RH, Cohen RV, Wilding JPH, Brown WA et al. Definition \nand diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol 2025; 13: 221–262. \n62  Mytton OT, Campbell-Scherer D, Reckless I, Llewellyn C. Diagnosing and defining obesity. \nBMJ 2025; 388: r460. \n63  Department of Health and Social Care. Tackling obesity: empowering adults and children to \nlive healthier lives. 2020https://www.gov.uk/government/publications/tackling-obesity-\ngovernment-strategy/tackling-obesity-empowering-adults-and-children-to-live-healthier-lives \n(accessed 23 Jun2021). \n64  Evans M, Evans W, Godbeer F, Edgar L, Spaepen E, Davies AL. Analysis of Tirzepatide \nAcquisition Costs and Weight Reduction Outcomes in the United Kingdom: Insights from the \nSURMOUNT-1 Study. Adv Ther 2025. doi:10.1007/s12325-025-03194-8. \n65  Kim N, Wang J, Burudpakdee C, Song Y, Ramasamy A, Xie Y et al. Cost-effectiveness \nanalysis of semaglutide 2.4 mg for the treatment of adult patients with overweight and \nobesity in the United States. J Manag Care Spec Pharm 2022; 28: 740–752. \n66  Hu Y, Zheng S-L, Ye X-L, Shi J-N, Zheng X-W, Pan H-S et al. Cost-effectiveness analysis of \n4 GLP-1RAs in the treatment of obesity in a US setting. Ann Transl Med 2022; 10: 152. \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n26 \n \n  \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint \n\n27 \n \nDeclarations  \nEthics approval \nEthical approval for the STS was granted originally by the UCL Ethics Committee (ID 0498/001). \nParticipants provide informed consent to take part in the study, and all methods are carried out in \naccordance with relevant regulations. The data are not collected by UCL and are anonymised when \nreceived by UCL. \nCompeting interests \nLS has acted as paid reviewer for grant awarding bodies and as a paid consultant for health care \ncompanies.  \nFunding \nThis work was supported by Cancer Research UK (PRCRPG-Nov21\\100002). JB is a member of \nthe Behavioural Research UK Leadership Hub which is supported by the Economic and Social \nResearch Council (ES/Y001044/1). For the purpose of Open Access, the author has applied a CC \nBY public copyright licence to any Author Accepted Manuscript version arising from this \nsubmission. \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted June 6, 2025. ; https://doi.org/10.1101/2025.06.06.25329114doi: medRxiv preprint","source_license":"CC-BY-4.0","license_restricted":false}