GLP-1 drugs have gained popularity, transforming the treatment of obesity and diabetes and showing promise for a growing range of other conditions. According to Gallup, about 11% of U.S. adults currently take GLP-1 for weight loss, nearly four times the rate since 2024.
But despite their clinical benefits, people taking GLP-1 may face dual stigma: criticism related to their size and judgment over the use of weight loss medications. These attitudes can influence patients’ decisions to disclose their GLP-1 use, how they discuss treatment with others, and even their health care decisions.
In a qualitative study published in Health CommunicationResearchers interviewed 34 adults taking GLP-1 medications to examine how they experienced and managed stigma through communication. Participants described facing judgment from friends, family members, and broader public discourse, sometimes withholding information about their treatment or emphasizing its medical necessity to defend their decisions.
Medscape Medical News spoke with Braidyn Lazenby, PhD, assistant professor in the School of Communication at Florida State University in Tallahassee, about their findings as well as how clinicians can foster more supportive conversations about GLP-1 medications.
The many forms of GLP-1 stigma
What led you to examine the stigma surrounding GLP-1 drugs through the lens of communication?
Body size is a common source of stigma in our society, particularly in the United States. The relatively new applications of GLP-1s for weight loss and other conditions and their contested nature have made stigma management a natural setting for studying how patients communicate about their weight and GLP-1s.
As communication scholars, my co-authors and I know that the way members of society communicate about a topic shapes our understanding of that concept. In the case of GLP-1, communication from family, friends, clinicians, and the media shapes individuals’ perceptions of the drug and its usefulness.
I got the idea to study this topic after a conversation with two people taking a GLP-1 drug. I noticed that they communicated strategically to alleviate the stigma they had experienced or perceived.
What were the most common forms of stigma encountered by participants and how did they overcome the double stigma of being judged for their weight and for using weight loss medications?
Common trends include feeling that GLP-1 users are “cheating” when it comes to weight loss or taking a shortcut instead of working hard to lose weight over time.
For women in particular, GLP-1s are often referred to as vanity drugs, so many participants believed their friends or family would judge them not only on how well they lost weight, but also, in some cases, on their willingness to lose weight in the first place.
Many participants felt like they were judged for their larger bodies and then for losing weight “the wrong way” or, in some cases, for not being able to lose weight even on GLP-1.
Participants reflected on being treated differently after losing weight, such as receiving more romantic attention and acts of kindness from strangers. These observations led them to assess whether a situation or person was “safe” to discuss their use of GLP-1 with.
At times, this led participants to withhold GLP-1 from close friends and family members because of the way these people talked about weight, other people’s bodies, and GLP-1.
What communication strategies did participants use to manage stigma?
Two key trends come to mind. First, participants often changed who they revealed their GLP-1 use to based on how they heard friends, family, coworkers, and dates talk about GLP-1 or other people’s weight.
Most participants did not openly disclose their use of GLP-1 or took on the role of educator to change outside perceptions.
The other tendency was to identify oneself as part of the “group” by using GLP-1 correctly. Participants often reiterated that GLP-1s are just a tool, but without the hard work of diet, exercise, and other long-term behavior changes, the medications would not have been effective.
Participants also provided evidence of health conditions or medical necessity to legitimize their need for a GLP-1, as opposed to others perceived to be in the “out-group” – those taking a GLP-1 medication for the “wrong reason.”
These categorizations essentially reinforce the same type of stigma. They put people into categories based on whether they have “suffered enough” and those who are trying “the most.”
Helping clinicians identify and address stigma
Why is it important for clinicians to understand the stigma their patients may experience?
Social media can and does significantly affect attitudes toward health care and influence medical decisions.
Stigma associated with GLP-1 medications and choices made to manage them influence perceptions of GLP-1 use, decisions about whether to take a medication, and self-perceptions. These perceptions in turn shape the way people communicate with others and can reinforce stigma. It really is a big cycle.
Unfortunately, most of the stigma our participants experienced came from people in their close social networks. Adopting a patient-centered approach to health care involves considering all the ways patients seek and receive support, particularly when discussing medications and stigmatizing experiences.
Could stigma affect how patients communicate openly with clinicians?
Yes, absolutely! Our data already suggests that some patients will refrain from asking about a GLP-1 if they believe members of their social network will not support it.
We particularly saw this in the way participants chose to acquire a GLP-1. If participants anticipated stigma from their clinician, they often intentionally sought out another clinician who they knew would prescribe a GLP-1, found a telehealth service that did not require an in-person appointment, or sought a GLP-1 at a medical spa or related facility.
Participants also described increasing or decreasing doses without medical supervision to achieve specific goals and manipulating dosage and frequency to intentionally restrict or binge or be perceived as eating “normally” in front of others.
I also worry that the stigma surrounding stereotypical side effects, such as the “Ozempic face” or gastrointestinal issues, will make patients less likely to ask about side effects at follow-up appointments.
What should clinicians watch for?
The first step is to recognize that discussing weight or potentially embarrassing side effects is sensitive and can bring up negative emotions. Although a clinician may focus on medical outcomes, a patient often considers many other factors.
It is important to notice when patients express hesitation about a new medication or bring up preconceived ideas. It is entirely appropriate to ask them why they are hesitant and where they heard their information.
A good place to start is: “When I mentioned the use of GLP-1, you seemed hesitant. What do you think of GLP-1?”
What concrete steps can clinicians take to reduce stigma and make conversations about GLP-1 treatment easier?
There are a few simple steps. The first is to build rapport with patients in every interaction, whether by asking simple questions about their lives or expressing understanding and empathy during difficult conversations. It doesn’t take a long date to build a foundation of trust.
Another strategy is to use open-ended questions. Ask “What are your concerns?” » instead of “Do you have any concerns?” ” will almost always get a better response.
It is important to talk about medical goals as objectively and clearly as possible. For example, if a GLP-1 medication is being considered for weight loss, it is important not to suggest that the patient has failed in some aspect of weight loss, such as implementing a specific diet or exercise program.
You can support the patient by saying, “I know we’ve already discussed losing weight to help with his sleep apnea. It seems like this has been quite difficult, which is very common for patients. A GLP-1 medication might be a good tool to help achieve this goal.”
Sometimes patients demonstrate the stigma they feel by making jokes or derogatory comments. A clinician can help redirect this situation by highlighting how a GLP-1 drug can concretely improve the patient’s health and quality of life.
Lazenby has not reported any relevant financial relationships.
John Watson is a freelance writer in Philadelphia.
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