GLP-1 medications: Use and Intention in a Representative Survey of Finns

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Chang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8016813/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Background and objectives: Semaglutide was approved for obesity treatment in 2021 in the US and 2022 in Europe, sparking global interest. Despite widespread attention, survey-based data on who uses or considers these medications—especially across socioeconomic groups, BMI categories, and experiences with weight management—remain limited. Subjects/methods: A nationally representative online survey of Finnish adults (n = 1 729) was conducted in June 2025 via a market research company using quota sampling. Use and awareness of GLP-1 medications for obesity were measured with a single item that listed widely known brands— Ozempic, Wegovy, Zepbound, and Mounjaro —to aid recognition. In regression analyses, current, past, and potential users (n = 322) are grouped together. Results 3.5% reported current and 2.0% past use of GLP-1 medications. 13.5% expressed interest in future use. Notably, ~ 40% of individuals with obesity were not interested. Bivariate analysis showed that current use was more common among women, those aged 50–69, those with household income exceeding €70,000, individuals with higher BMI, frequent weight loss attempts, experiences of weight-based discrimination, and self-blame. Regression analysis confirmed these patterns, with strongest associations for BMI ≥ 30.0, repeated or persistent weight loss attempts, experiences of discriminatory treatment due to weight, self-blaming thoughts and hopeful perceptions of GLP-1 medications. Concern about serious health risks was associated with lower likelihood of use or intention. Conclusions In clinical practice, GLP-1 users and potential users should not be viewed solely through a lens of obesity. Their long histories of weight management and experiences of obesity stigma highlight the need for sensitive, and informed communication and care. Health sciences/Health care/Weight management Health sciences/Health care/Disease prevention/Preventive medicine GLP-1 receptor agonists BMI weight loss weight stigma public perceptions socio-demographic factors Introduction Semaglutide (2.4 mg) received regulatory approval for the treatment of obesity in the United States in 2021 ( 1 ), and Europe in 2022 ( 2 ), following randomized controlled trials demonstrating substantial weight reduction in individuals with overweight or obesity, regardless of type 2 diabetes status ( 3 , 4 ). Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that enhances satiety, suppresses appetite, reduces energy intake, and improves glycemic control by stimulating glucose-dependent insulin secretion, suppressing glucagon release, and delaying gastric emptying ( 5 ). Following its approval and clinical success, interest in incretin-based therapies for obesity has grown rapidly. Tirzepatide, a dual agonist targeting GLP-1 as well as GIP (gastric inhibitory peptide) receptors, has since demonstrated even greater efficacy in promoting weight loss relative to GLP-1 monotherapy ( 6 , 7 ). Since 2021, Ozempic – a brand name for semaglutide – has become a symbolic shorthand for the entire class of GLP-1 medications and their broader cultural significance. Formally, Ozempic (semaglutide 1 mg) is approved for type 2 diabetes, while Wegovy (semaglutide 2.4 mg) is indicated for obesity. However, widespread off-label use of Ozempic as a substitute for Wegovy has blurred these distinctions in public discourse. Tirzepatide is approved in Europe under the brand name Mounjaro for the treatment of both type 2 diabetes and obesity, while in the United States, Mounjaro is indicated for diabetes, and Zepbound for obesity. Liraglutide, an earlier GLP-1 receptor agonist, is also approved for both indications (Victoza for diabetes and Saxenda for obesity), but its clinical use has declined with the emergence of longer-acting and more efficacious agents. The rapid uptake of GLP-1 based medications has coincided with notable cultural and societal shifts. In popular and media discourse, these therapies are often portrayed as transformative "miracle drugs" for weight loss and personal reinvention ( 8 , 9 ). Accordingly, demand has surged in several countries ( 10 – 13 ), while traditional behavioral programs, such Weight Watchers, have seen declining engagement and revenue ( 14 ). Despite the enthusiasm, concerns have been raised. The most common side effects include nausea, vomiting, diarrhea, constipation, and abdominal discomfort, with rarer reports of pancreatitis, gallbladder disease, and dehydration ( 3 , 7 , 15 , 16 ). Additional risks include muscle loss, malnutrition in certain populations, and potential misuse, especially among persons with eating disorders ( 17 , 18 ). Broader concerns relate to the longer-term economic impact of these drugs for individuals as well as public healthcare systems and concerns around health equity. Despite this growing clinical and cultural relevance, little is known about the actual users and interest in using these medications in real-world settings. While data from clinical trials provide insight into efficacy and safety, they do not capture broader population-level patterns of use, or interest. Survey-based data on who uses or seeks these medications—particularly across different BMI categories, socioeconomic backgrounds, and prior weight management experiences—remain scarce. To date, only a few population surveys on perceptions of GLP-1 medications have been published, such as one in Saudi Arabia ( 19 ), two in the United States ( 20 , 21 ), and one in the United Kingdom ( 22 ). Of these, only the US study uses data that is weighed to be representative of adult population. Another US study targeted a university student population ( 23 ). These earlier studies have shown that interest in using GLP-1 medications was associated with higher BMI, greater weight concerns, more body shame, greater maladaptive weight loss behaviours (such as skipping meals), and lower body appreciation ( 23 ). Awareness of GLP-1 medications was higher among women than men, among those who had tried to lose weight compared to those who had not ( 22 ) and among higher income groups ( 21 ). Finally, current medication users trusted the effectiveness and safety of these medications more than non-users ( 22 ). There is a notable lack of research based on representative population samples that examines individuals’ experiences with GLP-1 medications and their associations with sociodemographic and weight-related factors. This study addressed this gap by utilizing a representative, population-based data. First, we conduct bivariate analysis to explore the associations between GLP-1 medication use (categorized as current use, past use, potential use, lack of interest, and lack of awareness) and key variables including gender, age, education, income, BMI, and weight-related experiences. These analyses are performed in two directions: ( 1 ) assessing the distribution of GLP-1 use and awareness across sociodemographic and weight-related factors, and ( 2 ) examining the sociodemographic and weight-related profiles withing each GLP-1 user category. In the final phase, multivariate regression is employed to identify the association between sociodemographic and weight-related factors and a combined outcome variable representing current, past, or potential use of GLP-1 medications. This study contributes novel data to inform clinical practice, public health guidance, and responsible messaging around weight loss pharmacotherapy. The study setting Finland, the setting of the study, offers a Northern European and Nordic welfare state perspective on the use of GLP-1 medications. The Finnish health care system is based on universal access, with publicly funded services available to all residents ( 24 ). While private and employer-based healthcare options exist, the system emphasizes equity, affordability, and preventive care, ensuring that access is not dependent on income or employment status. In terms of weight status, over 60% of Finnish adults have overweight or obesity (BMI ≥ 25) and over 26% have obesity (BMI ≥ 30) in 2023 ( 25 ), placing Finland at the higher end of the European spectrum ( 26 ). Since 2021, the use of GLP-1 medications has steadily increased ( 10 ), with prescriptions issued through obesity care units, public healthcare centres, and private clinics. Monthly costs range from 100€ to 550€ depending on dosage and whether the medication is reimbursed or not. For low-income Finns, cost might be a barrier for use if they do not get the medications reimbursed due to type 2 diabetes or some other condition. Regarding reimbursement policy, liraglutide 3mg (Saxenda) and naltrexone-bupropion (Mysimba) are currently eligible for restricted basic reimbursement for obesity, and liraglutide 1.8 mg (Victoza) and semaglutide (Ozempic, Rybelsus) for type 2 diabetes. There is potential in Finland for both acceptance and scepticism regarding GLP-1 medications. As a high-trust society, Finland is characterized by strong confidence in physicians ( 27 ) and scientific expertise ( 28 , 29 ). Trust in pharmaceuticals compared to ‘natural remedies’ increased until 2019, but has somewhat decreased since then ( 29 ). Recent challenges – including an aging population, healthcare workforce shortages, and prolonged waiting times – have begun to erode public trust in healthcare system’s performance ( 30 ). In summary, certain population characteristics—such as high prevalence of obesity and relatively strong trust in medical solutions—may support the uptake of GLP-1 medications. At the same time, a portion of the population may remain hesitant, unwilling, or unable to access these treatments due to financial or other barriers. Methods Data A survey was conducted as part of [Anonymised name of the project]. The survey was commissioned from Taloustutkimus Oy, which conducted the data collection between June 16 and June 25, 2025, among members of its consumer panel living in mainland Finland. Taloustutkimus, a leading market research company in Finland, uses quota sampling to ensure representativeness in terms of age, gender, and region. Younger age groups are slightly oversampled to account for typically lower response rates. During data collection, quotas are actively monitored, and reminders are sent as needed to maintain balanced participation. The questionnaire covered topics such as respondents’ weight management history, current weight and height, use of GLP-1 medications, beliefs about the causes and responsibilities for obesity, perceptions of various experts involved in obesity care, and views on various obesity management approaches, including GLP-1 medications. Measures For this study, an item was included that assessed both use and awareness of newly available medications used for weight loss. The question was intentionally framed using the term ‘obesity medications’ to prompt respondents to consider their use and interest specifically in the context of obesity, rather than type 2 diabetes. This terminology also aligns with language commonly used in the popular press, whereas medical terms like semaglutide and GLP-1 receptor agonists may have been less familiar to respondents. To aid recognition, the questionnaire listed brand names - Ozempic, Wegovy, Zepbound, and Mounjaro - as examples. Although only Wegovy and Monjaro currently hold official indications for obesity treatment in Europe, in practice Ozempic is frequently prescribed in Finland for individuals with obesity alone, without other comorbid conditions. The respondents were asked "Have you heard about the new obesity medications, such as Ozempic, Wegovy, Zepbound, and Mounjaro?" with answering options: “Yes, and I currently use myself”, “Yes, and I have earlier used (don’t use anymore)”, “Yes, and I am interested in using”, “Yes, but I have not used myself, nor am I interested in using” and “I have not heard of these medications”. We refer to this five-category outcome as the “GLP-1 use” variable. Unless otherwise indicated, all variables in the study are operationalized as categorical variables. We included the following sociodemographic variables: gender, age, household yearly gross income, and education. Table 2 displays the categories used in our analyses. BMI was calculated from self-reported weight and height using the formula: weight (in kg) dived by height squared (m 2 ). Participants were categorized into the following BMI groups: <18.50 (Underweight), 18.50-24.99 (Normal weight), 25.00-29.99 (Overweight), 30.00-34.99 (Obesity I), 35.00-39.99 (Obesity II), and ≥ 40.00 (Obesity III). Past weight loss attempts were assessed with the following question: “Have you ever tried to lose weight during your life?” (“Never”, “No, but I try to keep my weight steady”, “Yes, 1–2 times during my life”, “Yes, 3 times or more during my life”, “Yes, I am constantly trying to lose weight”). Weight-related experiences and thoughts were ascertained with the following questions: “Have you been treated unfairly or discriminated against because of your weight during the past year” (“Never”, “Seldom”, “Sometimes”, “Often”, “I don’t know”), and “I blame myself for my weight” (“Fully disagree”, “Somewhat disagree”, “Neither agree, not disagree”, “Somewhat agree”, “Fully agree”, “I don’t know”). GLP-1 medication-related perceptions were assessed with items preceded by the header “In recent years, pharmaceutical companies have developed new medications, such as Ozempic, Wegovy, Mounjaro and the like. In the following, we ask for your views on them”. The following statements were included in the analysis: “I am hopeful that the obesity medications will help people effectively lose weight” and “I am concerned that serious health risks may emerge from new medications” (“Fully disagree”, “Somewhat disagree”, “Neither agree, not disagree”, “Somewhat agree”; “Fully agree”, “I don’t know”). The study was conducted in accordance with the guidelines by the Finnish National Board on Research Integrity (TENK). The study does not fall under the scope of Finnish Medical Research Act and Decree, and it does not include particularly sensitive questions. Therefore, [Anonymized] University does not mandate an ethics board review for this type of research. To ensure compliance, the legal advisor of [Anonymized] Region Research Ethics board was consulted, who confirmed that an ethical review was not required and was unnecessary for confirming the study’s ethical soundness. Given the complete anonymity of the data, there is no risk of identifying or harming of participant. Furthermore, all participants were recruited voluntarily through Taloustutkimus Oy, a reputable research company, ensuring informed participation. Statistical analysis Respondents who identified as other than female or male were excluded from the analysis due to their small number (n = 11, 0.6%). Additionally, 24 respondents were dropped due to missing data on weight or height and one respondent due to unreliable height and weight responses, resulting in a final analytic sample of 1 693 participants. First, sociodemographic characteristics of the survey sample are presented alongside population data from Statistics Finland for comparison. Second, we conduct bivariate analyses for associations of the GLP-1 use variable with sociodemographic variables, BMI category, and the various other weight- and medication-related variables. Statistical significance was assessed using chi-square tests. These results are presented in two tables, one displaying row percentages, and another presenting column percentages, as we felt that each was informative. The table showing column percentages additionally reports mean age and BMI values across the five GLP-1 use categories, with ANOVA used for statistical testing. Third, we examine the association of GLP-1 use with the various covariates in a multivariate context. Due to relatively small numbers for current and former use, the response categories “I am currently using,” “I have used in the past,” and “I am interested in using” were combined into a single category and modeled as a dichotomous variable representing current, past, or potential use (n = 322, 19.0%). Logistic regression was then used to model the association of this composite variable with covariates. Categories were also merged for other variables due to low frequencies. For the item on experiences of discrimination and unfair treatment, the categories of “never” and “don’t know” were combined, as were “sometimes” and “often”. Similarly, in the items measuring self-blame, and perceptions of GLP-1 medications, the responses “fully agree” and “somewhat agree” were combined, while the remaining categories were grouped together. SPSS version 29.0 was used for all analyses. Results Table 1 presents characteristics of the survey respondents. A comparison with Statistics Finland’s reports ( 31 ) indicates that the sample is representative in terms of gender, age and geographical distribution. Individuals with only elementary level education were underrepresented. Furthermore, when compared with the nationally representative Healthy Finland Study 2024, the present sample shows a slight overrepresentation of individuals with obesity (29.7% vs. 24.5%) ( 32 , 33 ). Table 2 shows bivariate associations of the GLP-1 use variable with sociodemographic variables, BMI category, and the various other weight- and medication-related variables. A majority of respondents (74.3%) had at least heard of GLP-1 medications. Current use was reported by 3.5% of participants, while 2.0% indicated past use. Additionally, 13.5% expressed interest in using these medications. There are gender differences in GLP-1 medication use and awareness. Women were more likely than men to report current use (4.2% vs. 2.9%) and interest in future use (16.7% vs. 10.1%), whereas men more frequently indicated that they had not heard of these medications (32.2% vs. 19.5%). Individuals aged 50–69 were the most likely to be current users, while those aged 70 and older were most often unaware of GLP-1 medications. Respondents with Master’s degree were least likely to report current or past use or express interest in future use. In terms of income, current use was most common among those with household incomes exceeding €70 000, while lack of interest was most pronounced among individuals in the lowest income group. Current use and interest in GLP-1 medications increased with BMI. While a small share of individuals with normal BMI expressed interest (3.8%), a notable proportion of those in the groups with BMI ≥ 30.0 – ranging from 37.8% to 42.9% – reported no interest in using these medications. Awareness also varied by BMI, with the proportion of respondents who had not heard of GLP-1 medications decreasing as BMI increased. Current and past use as well as interest in using GLP-1 medications increased gradually with the frequency of past weight loss attempts. Respondents who had sometimes or often experienced unfair treatment due to their weight in the past year were more likely to be current or past users than others. Respondents with self-blaming thoughts more often than others were current or past users, as well as interested in using GLP-1 medications. Those who were hopeful about the potential of GLP-1 medications in weight loss were more frequently users than others. In contrast, those who hold concerns about the serious health risks related to the medications, were more often not interested in using these medications. Table 3 presents the cross tabulations of Table 2 with column, rather than row, percentages. Individuals aged 50–69 were notably overrepresented among both current and past users. Mean age was highest among former users (57.29 yrs) and those who had not heard of GLP-1 medications (56.73) and lowest among those not interested in using (49.26) and those interested (50.37). Regarding income, current users were most commonly found in the highest income bracket (over €70 000), whereas former users were more frequently from households with annual income below €40 000. Mean BMI was highest among users (35.42) and former users (33.72) and lowest among those not interested in using (27.03) and those who had not heard of GLP-1 medications (26.52). Among users, 75.0% had a BMI ≥ 30.0, 53.3% reported constant weight loss efforts and 40.0% having attempted to lose weight at least three times during life, 46.7% reported having faced weight-related unfair treatment or discrimination in the past year and 81.7% blamed themselves for their weight. Respondents who were either not interested in or unaware of GLP-1 medications tended to have lower BMI classifications, most commonly falling within the normal or overweight range. They were also more likely to report no history of weight loss attempts, no experiences of weight-based discrimination or unfair treatment in the past year and expressed lower levels of self-blame related to their weight. Among current users and interested individuals, optimism about the effectiveness of GLP-1 medications was high (80.0% and 84.4% respectively), though about half also expressed concerns about potential serious health risks. In contrast, those not interested or unaware were more likely to express concern than hope. Finally, Table 4 displays the results of multivariate logistic regression with the composite GLP-1 use variable as the outcome. This is an indicator variable denoting current, past, or potential use. For brevity, we will refer to “current, post, or potential use” as “use” in this section. Model 1 includes sociodemographics and BMI as independent variables. Here, women, individuals with household income over €40 000, and individuals with a BMI ≥ 25.00 had significantly higher odds of use relative to the reference categories. For BMI, the odds ratios for each category above normal weight (18.50-24.99) increased in a monotonic fashion. Model 3 adds the various other weight- and medication-related variables. Women continue to have higher odds of use, but the coefficient is greatly attenuated and no longer statistically significant. Those who are 50–69 years old have 86% higher odds of use relative to those who 18–29 years old. For education, the highest category had 42% lower odds of use relative to the lowest category, but this difference was not significant. While all income categories were estimated to have higher odds of use relative to the lowest category, these differences were not significant. BMI category remains a strong and significant predicator of use. Relative to the normal weight category, persons with overweight had 68% higher odds of use, persons with obesity 1 had 3.9 times higher odds, and those with obesity 2 and obesity 3 categories had over 4 times higher odds. Past weight loss attempts, unfair treatment/discrimination, and self-blame were also strongly and significantly associated with use, despite adjusting for BMI. Being hopeful about GLP-1 medications was associated with 6 times higher odds of use. Conversely, being concerned about serious health risks from GLP-1 medications was associated with 70% lower odds of use. Discussion This study is among the first to examine the use of and interest in GLP-1 medications within a nationally representative adult sample. In the survey, GLP-1 medications were framed as ‘obesity medications’ to prompt respondents to consider their use in the context of obesity, rather than type 2 diabetes. GLP-1 medications have attracted considerable attention in both national and international media highlighting their growing clinical relevance, and cultural significance ( 8 , 9 ). This visibility has been amplified by widespread social media marketing, and influencer engagement ( 9 , 34 ). As a result, this study shows that by June 2025, 74.5% of Finnish adults were aware of GLP-1 medications. Among the respondents of this study, 3.5% reported current use, 2.0% past use, and 13.6% interest in future use. However, 55.2% were not interested, and 25.7% had not heard of them. Even among individuals with a BMI ≥ 30.0, approximately 40% reported no interest in using these medications. Notably, interest in these medications extended beyond BMI-based eligibility: 10.7% of respondents with overweight and 3.8% with normal BMI expressed interest in using them. In bivariate analyses, women were more likely than men to be current users of GLP-1 medications and to express interest in their use. Awareness was also higher among women (80.5%) compared to men (67.7%), reflecting similar gender disparities reported in a UK study (87.2% vs. 68.2%) ( 22 ). These patterns align with cultural narratives that position weight control and dietary restraint as more central to women’s lives ( 35 , 36 ). However, gender was not significant predictor in regression models for current, past, or potential use once weight loss and stigma-related factors were accounted for. Interestingly, in bivariate analysis, former users were more commonly found in the €20 001–40 000 income bracket. This is notable given the out-of-pocket cost of GLP-1 medications, which may present financial barriers to initiating or maintaining use, particularly for individuals in lower and lower-middle income groups. In multivariate analyses income was generally positively associated with current, past, or potential use, but did not retain statistical significance in the full model. In bivariate analyses, BMI, prior weight loss attempts, and other weight-related experiences were associated with use and awareness of the GLP-1 medications. Consistent with Markley et al. ( 23 ), use, as defined in the multivariate analysis of our study, was associated with higher BMI, repeated weight loss attempts, negative weight-related experiences, and self-blaming thoughts. The association with BMI is not surprising. Association with prior weight loss efforts is understandable, too, as these earlier efforts may have reinforced the perception that sustainable weight loss is difficult, increasing openness to pharmacological solutions. Notably, negative weight-related experiences and self-blaming thoughts were associated with current, former, or potential use independently of BMI. A noteworthy sub-group across all BMI categories is those who express no interest in using GLP-1 medications. Compared to current or potential users, this group was more concerned about potential health risks and less optimistic about the medications’ effectiveness. They also reported fewer experiences of weight-related discrimination, unfair treatment or self-blame. A UK study showed similar results ( 22 ). Although the sample size limits deeper analysis of subgroups within the non-interested population, this area warrants further investigation. From a healthcare perspective, GLP-1 users and potential users often have long histories of weight management shaped by stigma, societal judgement, and internalized shame. For many, these medications represent both hope and uncertainty as they navigate new therapeutic options, potential side effects, and evolving understandings of weight loss. These findings underscore the need for sensitive, informed communication that considers not only medical factors but also the financial, cultural and psychosocial realities of living with higher weight. Several limitations should be noted. First, the lack of statistical significance for some estimates in our multivariate model may reflect insufficient power given the magnitude of the estimates. Second, the questionnaire did not capture participants’ health conditions or eating disorders, which may influence engagement with GLP-1 medications. Third, future research should differentiate between specific medication brands, indications (e.g. obesity vs. other conditions), and reimbursement status. Fourth, the lack of data on the number of adults in each household limits the accuracy of household income estimates relative to household size. Fifth, individuals with only elementary level education were underrepresented. In conclusion, while these treatments may be moving toward mainstream recognition, this study suggests that full normalization is still in progress. A substantial share of individuals with obesity remains uninterested, and concerns about serious health risks persist. The findings are situated within the Finnish context —a Nordic welfare state characterized by relatively high income levels ( 37 ) and strong public trust in medical and healthcare institutions ( 27 ). A promising direction for future research would be a comparative study across countries with varying income structures, healthcare systems, and cultural attitudes toward medicine and pharmaceuticals. Such research could offer valuable insights into how social and systemic contexts shape public perceptions and adoption of GLP-1 medications. Declarations Competing Interests Statement Jallinoja and Chang declare no competing financial or other interests. Pietiläinen declares the following: Lectures/Honoraria: AstraZeneca, Boehringer Ingelheim, Eli Lilly & Company, Lundbeck, Johnson & Johnson, MSD, Novo Nordisk, Orion, UCB; Advisory Board: Boehringer Ingelheim, Eli Lilly & Company, IKEA, Novo Nordisk, Takeda, Vivus; Grants: Novo Nordisk Foundation, grant numbers NNF10OC1013354, NNF17OC0027232, NNF20OC0060547, NNF24OC0091683, NNF25SA0103783. Author Contributions. PTJ was responsible for the questionnaire design, the overall conception and design of the study, data interpretation, and drafting and revising the manuscript. VC and KP contributed to the conception and design of the study, participated in data interpretation, and co-authored sections of the manuscript. Both VC and KP also provided comments and revisions throughout all phases of the writing process. All authors approved the final version of the manuscript and are accountable for its content. Acknowledgement. The data collection was funded by the Ministry of Social Affairs and Health, Finland, as a part of National Health and Wellbeing Programme. The funding source was not involved in the interpretation of data, writing of the manuscript, and the decision to submit the article. Data Availability Statement. The data used in this article (i.e., variables included in the reported analyses) are available from the author upon reasonable request. References FDA. Wegovy - semaglutide. 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Body image and interest in GLP-1 weight loss medications. Body Image. 2025;53:101890. Tynkkynen, L-K, Keskimäki, I, Karanikolos, M, Litvinova, Y. Finland: health system summary 2023. European Observatory on Health Systems and Policies, 2023. Lehtoranta, L, Kaartinen, N, Jääskeläinen, T, Mäki, P, Pietiläinen, K, Sares-Jäske, L, et al. Lihavuus - ilmiöraportti. THL, Helsinki, 2023. Eurostat. Overweight and obesity - BMI statistics. Publications Office of the European Union, Luxembourg, 2025. Saarinen, AO, Räsänen, P, Kouvo, A. Two dimensions of trust in physicians in OECD-countries. Int H Health Care Qual Assur. 2016;29:48–61. Wellcome Global Monitor. How does the world feel about science and health. London: Wellcome Trust, https://wellcome.org/reports/wellcome-global-monitor/2018 ; 2018. Tieteen tiedotus. Tiedebarometri. Tieteen tiedotus, https://www.tieteentiedotus.fi/files/Tiedebarometri_2024.pdf , Helsinki, 2024. Parikka, S, Koskela, T, Sarttila, K, Ikonen, J. Luottamus terveys-ja sosiaalipalveluihin heikentynyt–asiakastyytyväisyys säilynyt korkealla tasolla. Tutkimuksesta Tiiviisti, THL. 2025. Statistics Finland. Population structure and educational structure of population. https://stat.fi/en/statistics , 2025. THL. Lihavien osuus - Terve Suomi 2024. THL, https://www.thl.fi/tervesuomi_verkkoraportit/kyselyosuus_2024/ath_obesity_bmi30. html accessed 1 Nov 2025, 2025. THL. The adult population’s well-being and health – Healthy Finland survey. Finnish Institute for Health and Welfare, https://thl.fi/en/statistics-and-data/data-and-services/quality-and-statistical-principles/quality-descriptions/the-adult-population-s-well-being-and-health-healthy-finland-survey#quality accessed 1 Nov 2025, 2025. Han, SH, Safeek, R, Ockerman, K, Trieu, N, Mars, P, Klenke, A, et al. Public interest in the off-label use of glucagon-like peptide 1 agonists (Ozempic) for cosmetic weight loss: a google trends analysis. Aesthet Sur J. 2024;44:60–7. Brumberg, JJ. Fasting girls: The emergence of anorexia nervosa as a modern disease. Vintage Books, New York, 1988. Harjunen, H. Gendered fat bodies as neoliberal bodies. The contemporary reader of gender and fat studies. London & New York, Routledge, 2023. p. 30–40. Eurostat. Key figures on Europe. 2025 edition. Publications Office of the European Union, Luxembourg, 2025. Tables Tables 1 to 4 are available in the Supplementary Files section. Additional Declarations Yes there is potential conflict of interest. Supplementary Files GLP1USEtables1.xlsx Table 1 GLP1USEtable2.xlsx Table 2 GLP1USEtable3.xlsx Table 3 GLP1USEtable4.xlsx Table 4 Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: revise 11 Mar, 2026 Review # 3 received at journal 03 Mar, 2026 Reviewer # 3 agreed at journal 19 Feb, 2026 Review # 2 received at journal 22 Dec, 2025 Reviewer # 2 agreed at journal 11 Dec, 2025 Reviewer # 1 agreed at journal 08 Nov, 2025 Reviewers invited by journal 04 Nov, 2025 Submission checks completed at journal 04 Nov, 2025 First submitted to journal 03 Nov, 2025 Editor assigned by journal 03 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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11:40:35","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":22644,"visible":true,"origin":"","legend":"\u003cp\u003eTable 4\u003c/p\u003e","description":"","filename":"GLP1USEtable4.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-8016813/v1/689870d9b7dcd57fbaf472c6.xlsx"}],"financialInterests":"\u003cb\u003eYes\u003c/b\u003e there is potential conflict of interest.","formattedTitle":"GLP-1 medications: Use and Intention in a Representative Survey of Finns","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSemaglutide (2.4 mg) received regulatory approval for the treatment of obesity in the United States in 2021 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), and Europe in 2022 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), following randomized controlled trials demonstrating substantial weight reduction in individuals with overweight or obesity, regardless of type 2 diabetes status (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that enhances satiety, suppresses appetite, reduces energy intake, and improves glycemic control by stimulating glucose-dependent insulin secretion, suppressing glucagon release, and delaying gastric emptying (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Following its approval and clinical success, interest in incretin-based therapies for obesity has grown rapidly. Tirzepatide, a dual agonist targeting GLP-1 as well as GIP (gastric inhibitory peptide) receptors, has since demonstrated even greater efficacy in promoting weight loss relative to GLP-1 monotherapy (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSince 2021, Ozempic \u0026ndash; a brand name for semaglutide \u0026ndash; has become a symbolic shorthand for the entire class of GLP-1 medications and their broader cultural significance. Formally, Ozempic (semaglutide 1 mg) is approved for type 2 diabetes, while Wegovy (semaglutide 2.4 mg) is indicated for obesity. However, widespread off-label use of Ozempic as a substitute for Wegovy has blurred these distinctions in public discourse. Tirzepatide is approved in Europe under the brand name Mounjaro for the treatment of both type 2 diabetes and obesity, while in the United States, Mounjaro is indicated for diabetes, and Zepbound for obesity. Liraglutide, an earlier GLP-1 receptor agonist, is also approved for both indications (Victoza for diabetes and Saxenda for obesity), but its clinical use has declined with the emergence of longer-acting and more efficacious agents.\u003c/p\u003e\u003cp\u003eThe rapid uptake of GLP-1 based medications has coincided with notable cultural and societal shifts. In popular and media discourse, these therapies are often portrayed as transformative \"miracle drugs\" for weight loss and personal reinvention (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Accordingly, demand has surged in several countries (\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), while traditional behavioral programs, such Weight Watchers, have seen declining engagement and revenue (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Despite the enthusiasm, concerns have been raised. The most common side effects include nausea, vomiting, diarrhea, constipation, and abdominal discomfort, with rarer reports of pancreatitis, gallbladder disease, and dehydration (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Additional risks include muscle loss, malnutrition in certain populations, and potential misuse, especially among persons with eating disorders (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Broader concerns relate to the longer-term economic impact of these drugs for individuals as well as public healthcare systems and concerns around health equity.\u003c/p\u003e\u003cp\u003eDespite this growing clinical and cultural relevance, little is known about the actual users and interest in using these medications in real-world settings. While data from clinical trials provide insight into efficacy and safety, they do not capture broader population-level patterns of use, or interest. Survey-based data on who uses or seeks these medications\u0026mdash;particularly across different BMI categories, socioeconomic backgrounds, and prior weight management experiences\u0026mdash;remain scarce. To date, only a few population surveys on perceptions of GLP-1 medications have been published, such as one in Saudi Arabia (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), two in the United States (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), and one in the United Kingdom (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Of these, only the US study uses data that is weighed to be representative of adult population. Another US study targeted a university student population (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese earlier studies have shown that interest in using GLP-1 medications was associated with higher BMI, greater weight concerns, more body shame, greater maladaptive weight loss behaviours (such as skipping meals), and lower body appreciation (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Awareness of GLP-1 medications was higher among women than men, among those who had tried to lose weight compared to those who had not (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and among higher income groups (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Finally, current medication users trusted the effectiveness and safety of these medications more than non-users (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThere is a notable lack of research based on representative population samples that examines individuals\u0026rsquo; experiences with GLP-1 medications and their associations with sociodemographic and weight-related factors. This study addressed this gap by utilizing a representative, population-based data. First, we conduct bivariate analysis to explore the associations between GLP-1 medication use (categorized as current use, past use, potential use, lack of interest, and lack of awareness) and key variables including gender, age, education, income, BMI, and weight-related experiences. These analyses are performed in two directions: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) assessing the distribution of GLP-1 use and awareness across sociodemographic and weight-related factors, and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) examining the sociodemographic and weight-related profiles withing each GLP-1 user category. In the final phase, multivariate regression is employed to identify the association between sociodemographic and weight-related factors and a combined outcome variable representing current, past, or potential use of GLP-1 medications.\u003c/p\u003e\u003cp\u003eThis study contributes novel data to inform clinical practice, public health guidance, and responsible messaging around weight loss pharmacotherapy.\u003c/p\u003e\n\u003ch3\u003eThe study setting\u003c/h3\u003e\n\u003cp\u003eFinland, the setting of the study, offers a Northern European and Nordic welfare state perspective on the use of GLP-1 medications. The Finnish health care system is based on universal access, with publicly funded services available to all residents (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). While private and employer-based healthcare options exist, the system emphasizes equity, affordability, and preventive care, ensuring that access is not dependent on income or employment status.\u003c/p\u003e\u003cp\u003eIn terms of weight status, over 60% of Finnish adults have overweight or obesity (BMI \u0026ge; 25) and over 26% have obesity (BMI \u0026ge; 30) in 2023 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), placing Finland at the higher end of the European spectrum (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Since 2021, the use of GLP-1 medications has steadily increased (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), with prescriptions issued through obesity care units, public healthcare centres, and private clinics. Monthly costs range from 100\u0026euro; to 550\u0026euro; depending on dosage and whether the medication is reimbursed or not. For low-income Finns, cost might be a barrier for use if they do not get the medications reimbursed due to type 2 diabetes or some other condition. Regarding reimbursement policy, liraglutide 3mg (Saxenda) and naltrexone-bupropion (Mysimba) are currently eligible for restricted basic reimbursement for obesity, and liraglutide 1.8 mg (Victoza) and semaglutide (Ozempic, Rybelsus) for type 2 diabetes.\u003c/p\u003e\u003cp\u003eThere is potential in Finland for both acceptance and scepticism regarding GLP-1 medications. As a high-trust society, Finland is characterized by strong confidence in physicians (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) and scientific expertise (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Trust in pharmaceuticals compared to \u0026lsquo;natural remedies\u0026rsquo; increased until 2019, but has somewhat decreased since then (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Recent challenges \u0026ndash; including an aging population, healthcare workforce shortages, and prolonged waiting times \u0026ndash; have begun to erode public trust in healthcare system\u0026rsquo;s performance (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn summary, certain population characteristics\u0026mdash;such as high prevalence of obesity and relatively strong trust in medical solutions\u0026mdash;may support the uptake of GLP-1 medications. At the same time, a portion of the population may remain hesitant, unwilling, or unable to access these treatments due to financial or other barriers.\u003c/p\u003e\u003c/div\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003ch2\u003eData\u003c/h2\u003e\u003cp\u003eA survey was conducted as part of [Anonymised name of the project]. The survey was commissioned from Taloustutkimus Oy, which conducted the data collection between June 16 and June 25, 2025, among members of its consumer panel living in mainland Finland. Taloustutkimus, a leading market research company in Finland, uses quota sampling to ensure representativeness in terms of age, gender, and region. Younger age groups are slightly oversampled to account for typically lower response rates. During data collection, quotas are actively monitored, and reminders are sent as needed to maintain balanced participation.\u003c/p\u003e\u003cp\u003eThe questionnaire covered topics such as respondents\u0026rsquo; weight management history, current weight and height, use of GLP-1 medications, beliefs about the causes and responsibilities for obesity, perceptions of various experts involved in obesity care, and views on various obesity management approaches, including GLP-1 medications.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eFor this study, an item was included that assessed both use and awareness of newly available medications used for weight loss. The question was intentionally framed using the term \u0026lsquo;obesity medications\u0026rsquo; to prompt respondents to consider their use and interest specifically in the context of obesity, rather than type 2 diabetes. This terminology also aligns with language commonly used in the popular press, whereas medical terms like semaglutide and GLP-1 receptor agonists may have been less familiar to respondents. To aid recognition, the questionnaire listed brand names - Ozempic, Wegovy, Zepbound, and Mounjaro - as examples. Although only Wegovy and Monjaro currently hold official indications for obesity treatment in Europe, in practice Ozempic is frequently prescribed in Finland for individuals with obesity alone, without other comorbid conditions. The respondents were asked \"Have you heard about the new obesity medications, such as Ozempic, Wegovy, Zepbound, and Mounjaro?\" with answering options: \u0026ldquo;Yes, and I currently use myself\u0026rdquo;, \u0026ldquo;Yes, and I have earlier used (don\u0026rsquo;t use anymore)\u0026rdquo;, \u0026ldquo;Yes, and I am interested in using\u0026rdquo;, \u0026ldquo;Yes, but I have not used myself, nor am I interested in using\u0026rdquo; and \u0026ldquo;I have not heard of these medications\u0026rdquo;. We refer to this five-category outcome as the \u0026ldquo;GLP-1 use\u0026rdquo; variable. Unless otherwise indicated, all variables in the study are operationalized as categorical variables.\u003c/p\u003e\u003cp\u003eWe included the following sociodemographic variables: gender, age, household yearly gross income, and education. Table\u0026nbsp;2 displays the categories used in our analyses. BMI was calculated from self-reported weight and height using the formula: weight (in kg) dived by height squared (m\u003csup\u003e2\u003c/sup\u003e). Participants were categorized into the following BMI groups: \u0026lt;18.50 (Underweight), 18.50-24.99 (Normal weight), 25.00-29.99 (Overweight), 30.00-34.99 (Obesity I), 35.00-39.99 (Obesity II), and \u0026ge; 40.00 (Obesity III).\u003c/p\u003e\u003cp\u003ePast weight loss attempts were assessed with the following question: \u0026ldquo;Have you ever tried to lose weight during your life?\u0026rdquo; (\u0026ldquo;Never\u0026rdquo;, \u0026ldquo;No, but I try to keep my weight steady\u0026rdquo;, \u0026ldquo;Yes, 1\u0026ndash;2 times during my life\u0026rdquo;, \u0026ldquo;Yes, 3 times or more during my life\u0026rdquo;, \u0026ldquo;Yes, I am constantly trying to lose weight\u0026rdquo;). Weight-related experiences and thoughts were ascertained with the following questions: \u0026ldquo;Have you been treated unfairly or discriminated against because of your weight during the past year\u0026rdquo; (\u0026ldquo;Never\u0026rdquo;, \u0026ldquo;Seldom\u0026rdquo;, \u0026ldquo;Sometimes\u0026rdquo;, \u0026ldquo;Often\u0026rdquo;, \u0026ldquo;I don\u0026rsquo;t know\u0026rdquo;), and \u0026ldquo;I blame myself for my weight\u0026rdquo; (\u0026ldquo;Fully disagree\u0026rdquo;, \u0026ldquo;Somewhat disagree\u0026rdquo;, \u0026ldquo;Neither agree, not disagree\u0026rdquo;, \u0026ldquo;Somewhat agree\u0026rdquo;, \u0026ldquo;Fully agree\u0026rdquo;, \u0026ldquo;I don\u0026rsquo;t know\u0026rdquo;).\u003c/p\u003e\u003cp\u003eGLP-1 medication-related perceptions were assessed with items preceded by the header \u0026ldquo;In recent years, pharmaceutical companies have developed new medications, such as Ozempic, Wegovy, Mounjaro and the like. In the following, we ask for your views on them\u0026rdquo;. The following statements were included in the analysis: \u0026ldquo;I am hopeful that the obesity medications will help people effectively lose weight\u0026rdquo; and \u0026ldquo;I am concerned that serious health risks may emerge from new medications\u0026rdquo; (\u0026ldquo;Fully disagree\u0026rdquo;, \u0026ldquo;Somewhat disagree\u0026rdquo;, \u0026ldquo;Neither agree, not disagree\u0026rdquo;, \u0026ldquo;Somewhat agree\u0026rdquo;; \u0026ldquo;Fully agree\u0026rdquo;, \u0026ldquo;I don\u0026rsquo;t know\u0026rdquo;).\u003c/p\u003e\u003cp\u003e The study was conducted in accordance with the guidelines by the Finnish National Board on Research Integrity (TENK). The study does not fall under the scope of Finnish Medical Research Act and Decree, and it does not include particularly sensitive questions. Therefore, [Anonymized] University does not mandate an ethics board review for this type of research. To ensure compliance, the legal advisor of [Anonymized] Region Research Ethics board was consulted, who confirmed that an ethical review was not required and was unnecessary for confirming the study\u0026rsquo;s ethical soundness. Given the complete anonymity of the data, there is no risk of identifying or harming of participant. Furthermore, all participants were recruited voluntarily through Taloustutkimus Oy, a reputable research company, ensuring informed participation.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eRespondents who identified as other than female or male were excluded from the analysis due to their small number (n\u0026thinsp;=\u0026thinsp;11, 0.6%). Additionally, 24 respondents were dropped due to missing data on weight or height and one respondent due to unreliable height and weight responses, resulting in a final analytic sample of 1 693 participants.\u003c/p\u003e\u003cp\u003eFirst, sociodemographic characteristics of the survey sample are presented alongside population data from Statistics Finland for comparison.\u003c/p\u003e\u003cp\u003eSecond, we conduct bivariate analyses for associations of the GLP-1 use variable with sociodemographic variables, BMI category, and the various other weight- and medication-related variables. Statistical significance was assessed using chi-square tests. These results are presented in two tables, one displaying row percentages, and another presenting column percentages, as we felt that each was informative.\u003c/p\u003e\u003cp\u003eThe table showing column percentages additionally reports mean age and BMI values across the five GLP-1 use categories, with ANOVA used for statistical testing.\u003c/p\u003e\u003cp\u003eThird, we examine the association of GLP-1 use with the various covariates in a multivariate context. Due to relatively small numbers for current and former use, the response categories \u0026ldquo;I am currently using,\u0026rdquo; \u0026ldquo;I have used in the past,\u0026rdquo; and \u0026ldquo;I am interested in using\u0026rdquo; were combined into a single category and modeled as a dichotomous variable representing current, past, or potential use (n\u0026thinsp;=\u0026thinsp;322, 19.0%). Logistic regression was then used to model the association of this composite variable with covariates.\u003c/p\u003e\u003cp\u003eCategories were also merged for other variables due to low frequencies. For the item on experiences of discrimination and unfair treatment, the categories of \u0026ldquo;never\u0026rdquo; and \u0026ldquo;don\u0026rsquo;t know\u0026rdquo; were combined, as were \u0026ldquo;sometimes\u0026rdquo; and \u0026ldquo;often\u0026rdquo;. Similarly, in the items measuring self-blame, and perceptions of GLP-1 medications, the responses \u0026ldquo;fully agree\u0026rdquo; and \u0026ldquo;somewhat agree\u0026rdquo; were combined, while the remaining categories were grouped together. SPSS version 29.0 was used for all analyses.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;1 presents characteristics of the survey respondents. A comparison with Statistics Finland\u0026rsquo;s reports (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) indicates that the sample is representative in terms of gender, age and geographical distribution. Individuals with only elementary level education were underrepresented. Furthermore, when compared with the nationally representative Healthy Finland Study 2024, the present sample shows a slight overrepresentation of individuals with obesity (29.7% vs. 24.5%) (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;2 shows bivariate associations of the GLP-1 use variable with sociodemographic variables, BMI category, and the various other weight- and medication-related variables. A majority of respondents (74.3%) had at least heard of GLP-1 medications. Current use was reported by 3.5% of participants, while 2.0% indicated past use. Additionally, 13.5% expressed interest in using these medications.\u003c/p\u003e\u003cp\u003eThere are gender differences in GLP-1 medication use and awareness. Women were more likely than men to report current use (4.2% vs. 2.9%) and interest in future use (16.7% vs. 10.1%), whereas men more frequently indicated that they had not heard of these medications (32.2% vs. 19.5%). Individuals aged 50\u0026ndash;69 were the most likely to be current users, while those aged 70 and older were most often unaware of GLP-1 medications. Respondents with Master\u0026rsquo;s degree were least likely to report current or past use or express interest in future use. In terms of income, current use was most common among those with household incomes exceeding \u0026euro;70 000, while lack of interest was most pronounced among individuals in the lowest income group.\u003c/p\u003e\u003cp\u003eCurrent use and interest in GLP-1 medications increased with BMI. While a small share of individuals with normal BMI expressed interest (3.8%), a notable proportion of those in the groups with BMI \u0026ge; 30.0 \u0026ndash; ranging from 37.8% to 42.9% \u0026ndash; reported no interest in using these medications. Awareness also varied by BMI, with the proportion of respondents who had not heard of GLP-1 medications decreasing as BMI increased.\u003c/p\u003e\u003cp\u003eCurrent and past use as well as interest in using GLP-1 medications increased gradually with the frequency of past weight loss attempts. Respondents who had sometimes or often experienced unfair treatment due to their weight in the past year were more likely to be current or past users than others. Respondents with self-blaming thoughts more often than others were current or past users, as well as interested in using GLP-1 medications. Those who were hopeful about the potential of GLP-1 medications in weight loss were more frequently users than others. In contrast, those who hold concerns about the serious health risks related to the medications, were more often not interested in using these medications.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;3 presents the cross tabulations of Table\u0026nbsp;2 with column, rather than row, percentages. Individuals aged 50\u0026ndash;69 were notably overrepresented among both current and past users. Mean age was highest among former users (57.29 yrs) and those who had not heard of GLP-1 medications (56.73) and lowest among those not interested in using (49.26) and those interested (50.37). Regarding income, current users were most commonly found in the highest income bracket (over \u0026euro;70 000), whereas former users were more frequently from households with annual income below \u0026euro;40 000.\u003c/p\u003e\u003cp\u003eMean BMI was highest among users (35.42) and former users (33.72) and lowest among those not interested in using (27.03) and those who had not heard of GLP-1 medications (26.52). Among users, 75.0% had a BMI \u0026ge; 30.0, 53.3% reported constant weight loss efforts and 40.0% having attempted to lose weight at least three times during life, 46.7% reported having faced weight-related unfair treatment or discrimination in the past year and 81.7% blamed themselves for their weight. Respondents who were either not interested in or unaware of GLP-1 medications tended to have lower BMI classifications, most commonly falling within the normal or overweight range. They were also more likely to report no history of weight loss attempts, no experiences of weight-based discrimination or unfair treatment in the past year and expressed lower levels of self-blame related to their weight.\u003c/p\u003e\u003cp\u003eAmong current users and interested individuals, optimism about the effectiveness of GLP-1 medications was high (80.0% and 84.4% respectively), though about half also expressed concerns about potential serious health risks. In contrast, those not interested or unaware were more likely to express concern than hope.\u003c/p\u003e\u003cp\u003eFinally, Table\u0026nbsp;4 displays the results of multivariate logistic regression with the composite GLP-1 use variable as the outcome. This is an indicator variable denoting current, past, or potential use. For brevity, we will refer to \u0026ldquo;current, post, or potential use\u0026rdquo; as \u0026ldquo;use\u0026rdquo; in this section. Model 1 includes sociodemographics and BMI as independent variables. Here, women, individuals with household income over \u0026euro;40 000, and individuals with a BMI \u0026ge; 25.00 had significantly higher odds of use relative to the reference categories. For BMI, the odds ratios for each category above normal weight (18.50-24.99) increased in a monotonic fashion.\u003c/p\u003e\u003cp\u003eModel 3 adds the various other weight- and medication-related variables. Women continue to have higher odds of use, but the coefficient is greatly attenuated and no longer statistically significant. Those who are 50\u0026ndash;69 years old have 86% higher odds of use relative to those who 18\u0026ndash;29 years old. For education, the highest category had 42% lower odds of use relative to the lowest category, but this difference was not significant. While all income categories were estimated to have higher odds of use relative to the lowest category, these differences were not significant. BMI category remains a strong and significant predicator of use. Relative to the normal weight category, persons with overweight had 68% higher odds of use, persons with obesity 1 had 3.9 times higher odds, and those with obesity 2 and obesity 3 categories had over 4 times higher odds. Past weight loss attempts, unfair treatment/discrimination, and self-blame were also strongly and significantly associated with use, despite adjusting for BMI. Being hopeful about GLP-1 medications was associated with 6 times higher odds of use. Conversely, being concerned about serious health risks from GLP-1 medications was associated with 70% lower odds of use.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study is among the first to examine the use of and interest in GLP-1 medications within a nationally representative adult sample. In the survey, GLP-1 medications were framed as \u0026lsquo;obesity medications\u0026rsquo; to prompt respondents to consider their use in the context of obesity, rather than type 2 diabetes.\u003c/p\u003e\u003cp\u003eGLP-1 medications have attracted considerable attention in both national and international media highlighting their growing clinical relevance, and cultural significance (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This visibility has been amplified by widespread social media marketing, and influencer engagement (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). As a result, this study shows that by June 2025, 74.5% of Finnish adults were aware of GLP-1 medications. Among the respondents of this study, 3.5% reported current use, 2.0% past use, and 13.6% interest in future use. However, 55.2% were not interested, and 25.7% had not heard of them. Even among individuals with a BMI \u0026ge; 30.0, approximately 40% reported no interest in using these medications. Notably, interest in these medications extended beyond BMI-based eligibility: 10.7% of respondents with overweight and 3.8% with normal BMI expressed interest in using them.\u003c/p\u003e\u003cp\u003eIn bivariate analyses, women were more likely than men to be current users of GLP-1 medications and to express interest in their use. Awareness was also higher among women (80.5%) compared to men (67.7%), reflecting similar gender disparities reported in a UK study (87.2% vs. 68.2%) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). These patterns align with cultural narratives that position weight control and dietary restraint as more central to women\u0026rsquo;s lives (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). However, gender was not significant predictor in regression models for current, past, or potential use once weight loss and stigma-related factors were accounted for.\u003c/p\u003e\u003cp\u003eInterestingly, in bivariate analysis, former users were more commonly found in the \u0026euro;20 001\u0026ndash;40 000 income bracket. This is notable given the out-of-pocket cost of GLP-1 medications, which may present financial barriers to initiating or maintaining use, particularly for individuals in lower and lower-middle income groups. In multivariate analyses income was generally positively associated with current, past, or potential use, but did not retain statistical significance in the full model.\u003c/p\u003e\u003cp\u003eIn bivariate analyses, BMI, prior weight loss attempts, and other weight-related experiences were associated with use and awareness of the GLP-1 medications. Consistent with Markley et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), use, as defined in the multivariate analysis of our study, was associated with higher BMI, repeated weight loss attempts, negative weight-related experiences, and self-blaming thoughts.\u003c/p\u003e\u003cp\u003eThe association with BMI is not surprising. Association with prior weight loss efforts is understandable, too, as these earlier efforts may have reinforced the perception that sustainable weight loss is difficult, increasing openness to pharmacological solutions. Notably, negative weight-related experiences and self-blaming thoughts were associated with current, former, or potential use independently of BMI.\u003c/p\u003e\u003cp\u003eA noteworthy sub-group across all BMI categories is those who express no interest in using GLP-1 medications. Compared to current or potential users, this group was more concerned about potential health risks and less optimistic about the medications\u0026rsquo; effectiveness. They also reported fewer experiences of weight-related discrimination, unfair treatment or self-blame. A UK study showed similar results (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Although the sample size limits deeper analysis of subgroups within the non-interested population, this area warrants further investigation.\u003c/p\u003e\u003cp\u003eFrom a healthcare perspective, GLP-1 users and potential users often have long histories of weight management shaped by stigma, societal judgement, and internalized shame. For many, these medications represent both hope and uncertainty as they navigate new therapeutic options, potential side effects, and evolving understandings of weight loss. These findings underscore the need for sensitive, informed communication that considers not only medical factors but also the financial, cultural and psychosocial realities of living with higher weight.\u003c/p\u003e\u003cp\u003eSeveral limitations should be noted. First, the lack of statistical significance for some estimates in our multivariate model may reflect insufficient power given the magnitude of the estimates. Second, the questionnaire did not capture participants\u0026rsquo; health conditions or eating disorders, which may influence engagement with GLP-1 medications. Third, future research should differentiate between specific medication brands, indications (e.g. obesity vs. other conditions), and reimbursement status. Fourth, the lack of data on the number of adults in each household limits the accuracy of household income estimates relative to household size. Fifth, individuals with only elementary level education were underrepresented.\u003c/p\u003e\u003cp\u003eIn conclusion, while these treatments may be moving toward mainstream recognition, this study suggests that full normalization is still in progress. A substantial share of individuals with obesity remains uninterested, and concerns about serious health risks persist. The findings are situated within the Finnish context \u0026mdash;a Nordic welfare state characterized by relatively high income levels (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) and strong public trust in medical and healthcare institutions (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). A promising direction for future research would be a comparative study across countries with varying income structures, healthcare systems, and cultural attitudes toward medicine and pharmaceuticals. Such research could offer valuable insights into how social and systemic contexts shape public perceptions and adoption of GLP-1 medications.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCompeting Interests Statement\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eJallinoja and Chang\u003c/em\u003e declare no competing financial or other interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePietil\u0026auml;inen\u003c/em\u003e declares the following: \u0026nbsp;Lectures/Honoraria: AstraZeneca, Boehringer Ingelheim, Eli Lilly \u0026amp; Company, Lundbeck, Johnson \u0026amp; Johnson, MSD, Novo Nordisk, Orion, UCB; Advisory Board: Boehringer Ingelheim, Eli Lilly \u0026amp; Company, IKEA, Novo Nordisk, Takeda, Vivus; Grants: Novo Nordisk Foundation, grant numbers NNF10OC1013354, NNF17OC0027232, NNF20OC0060547, NNF24OC0091683, NNF25SA0103783.\u003c/p\u003e\u003ch2\u003eAuthor Contributions.\u003c/h2\u003e\u003cp\u003ePTJ was responsible for the questionnaire design, the overall conception and design of the study, data interpretation, and drafting and revising the manuscript. VC and KP contributed to the conception and design of the study, participated in data interpretation, and co-authored sections of the manuscript. Both VC and KP also provided comments and revisions throughout all phases of the writing process. All authors approved the final version of the manuscript and are accountable for its content.\u003c/p\u003e\u003ch2\u003eAcknowledgement.\u003c/h2\u003e\u003cp\u003eThe data collection was funded by the Ministry of Social Affairs and Health, Finland, as a part of National Health and Wellbeing Programme. The funding source was not involved in the interpretation of data, writing of the manuscript, and the decision to submit the article.\u003c/p\u003e\u003ch2\u003eData Availability Statement.\u003c/h2\u003e\u003cp\u003eThe data used in this article (i.e., variables included in the reported analyses) are available from the author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFDA. Wegovy - semaglutide. U.S. Food and Drug Administration, 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEMA. Wegovy - semaglutide. European Medicines Agency, 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilding, JPH, Batterham, RL, Calanna, S, Davies, M, Van Gaal, LF, Lingvay, I, et al. Once-weekly semaglutide in adults with overweight or obesity. NEJM. 2021;384:989\u0026ndash;1002.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDavies, M, F\u0026aelig;rch, L, Jeppesen, OK, Pakseresht, A, Pedersen, SD, Perreault, L, et al. Semaglutide 2\u0026middot; 4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. The Lancet. 2021;397:971\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNauck, MA, Quast, DR, Wefers, J, Pfeiffer, AF. The evolving story of incretins (GIP and GLP-1) in metabolic and cardiovascular disease: a pathophysiological update. Diabetes Obes Metab. 2021;23:5\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAronne, LJ, Horn, DB, le Roux, CW, Ho, W, Falcon, BL, Gomez Valderas, E, et al. Tirzepatide as Compared with Semaglutide for the Treatment of Obesity. NEJM. 2025;393:26\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJastreboff, AM, le Roux, CW, Stefanski, A, Aronne, LJ, Halpern, B, Wharton, S, et al. Tirzepatide for obesity treatment and diabetes prevention. NEJM. 2025;392:958\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHari, J. Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs. Bloomsbury Publishing, London, 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarjunen, H, Puhakka, A. (Re) conceptualizing fatness as a medical and moral issue in the Finnish media discourse on fat and Ozempic in 2022\u0026ndash;2023. Fat Studies. 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePajunen, P, Nurminen, F, Koskinen, H, Kari, H. Lihavuusl\u0026auml;\u0026auml;kkeiden k\u0026auml;ytt\u0026auml;ji\u0026auml; Suomessa jo yli 75 000.: Kela, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://tietotarjotin.fi/en/research-blog/1213382/lihavuuslaakkeiden-kayttajia-suomessa-jo-yli-75-000\u003c/span\u003e\u003cspan address=\"https://tietotarjotin.fi/en/research-blog/1213382/lihavuuslaakkeiden-kayttajia-suomessa-jo-yli-75-000\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 1 Nov 2025; 2025 [\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMailhac, A, Pedersen, L, Potteg\u0026aring;rd, A, S\u0026oslash;ndergaard, J, Mogensen, T, S\u0026oslash;rensen, H, et al. Semaglutide (Ozempic\u0026reg;) use in Denmark 2018 through 2023. Clinical Epidemioly. 2024;16:307\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYeo, YH, Rezaie, A, Hsieh, TY-J, Hu, X, Gaddam, S, Ma, KS-K, et al. 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Aesthet Sur J. 2024;44:60\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrumberg, JJ. Fasting girls: The emergence of anorexia nervosa as a modern disease. Vintage Books, New York, 1988.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarjunen, H. Gendered fat bodies as neoliberal bodies. The contemporary reader of gender and fat studies. London \u0026amp; New York, Routledge, 2023. p. 30\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEurostat. Key figures on Europe. 2025 edition. Publications Office of the European Union, Luxembourg, 2025.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-obesity","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"ijo","sideBox":"Learn more about [International Journal of Obesity](http://www.nature.com/ijo/)","snPcode":"41366","submissionUrl":"https://mts-ijo.nature.com/cgi-bin/main.plex","title":"International Journal of Obesity","twitterHandle":"@intjobesity","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"GLP-1 receptor agonists, BMI, weight loss, weight stigma, public perceptions, socio-demographic factors","lastPublishedDoi":"10.21203/rs.3.rs-8016813/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8016813/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and objectives:\u003c/h2\u003e\u003cp\u003e Semaglutide was approved for obesity treatment in 2021 in the US and 2022 in Europe, sparking global interest. Despite widespread attention, survey-based data on who uses or considers these medications\u0026mdash;especially across socioeconomic groups, BMI categories, and experiences with weight management\u0026mdash;remain limited.\u003c/p\u003e\u003ch2\u003eSubjects/methods:\u003c/h2\u003e\u003cp\u003eA nationally representative online survey of Finnish adults (n\u0026thinsp;=\u0026thinsp;1 729) was conducted in June 2025 via a market research company using quota sampling. Use and awareness of GLP-1 medications for obesity were measured with a single item that listed widely known brands\u0026mdash; Ozempic, Wegovy, Zepbound, and Mounjaro \u0026mdash;to aid recognition. In regression analyses, current, past, and potential users (n\u0026thinsp;=\u0026thinsp;322) are grouped together.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003e3.5% reported current and 2.0% past use of GLP-1 medications. 13.5% expressed interest in future use. Notably, ~ 40% of individuals with obesity were not interested. Bivariate analysis showed that current use was more common among women, those aged 50\u0026ndash;69, those with household income exceeding \u0026euro;70,000, individuals with higher BMI, frequent weight loss attempts, experiences of weight-based discrimination, and self-blame. Regression analysis confirmed these patterns, with strongest associations for BMI \u0026ge; 30.0, repeated or persistent weight loss attempts, experiences of discriminatory treatment due to weight, self-blaming thoughts and hopeful perceptions of GLP-1 medications. Concern about serious health risks was associated with lower likelihood of use or intention.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eIn clinical practice, GLP-1 users and potential users should not be viewed solely through a lens of obesity. Their long histories of weight management and experiences of obesity stigma highlight the need for sensitive, and informed communication and care.\u003c/p\u003e","manuscriptTitle":"GLP-1 medications: Use and Intention in a Representative Survey of Finns","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-14 11:40:30","doi":"10.21203/rs.3.rs-8016813/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2026-03-11T13:12:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-03-03T18:03:00+00:00","index":3,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-02-19T09:59:06+00:00","index":3,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-12-22T15:35:03+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-12-11T14:30:11+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-11-08T08:31:49+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-11-04T18:01:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-04T11:26:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Obesity","date":"2025-11-03T08:36:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-03T08:36:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-obesity","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"ijo","sideBox":"Learn more about [International Journal of Obesity](http://www.nature.com/ijo/)","snPcode":"41366","submissionUrl":"https://mts-ijo.nature.com/cgi-bin/main.plex","title":"International Journal of Obesity","twitterHandle":"@intjobesity","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3f3e7d82-afd7-4f5e-8c2b-c0d7a676fd1e","owner":[],"postedDate":"November 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":57440212,"name":"Health sciences/Health care/Weight management"},{"id":57440213,"name":"Health sciences/Health care/Disease prevention/Preventive medicine"}],"tags":[],"updatedAt":"2026-05-12T10:54:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-14 11:40:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8016813","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8016813","identity":"rs-8016813","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}