Anti-obesity drugs: Public skepticism surrounds long-term safety, tolerability

By Claire Bugos* 
When Ozempic and Mounjaro were approved to treat diabetes, they also ushered in a wave of opportunity for obesity medicine. This new class of drugs, called glucagon-like peptide (GLP-1) receptor agonists, has proven remarkably effective at promoting weight loss and other health outcomes. These drugs have become so hyped that some even claim it could bring about the end of the “obesity epidemic.”
For people living with obesity, however, the GLP-1 drugs hold promise for just one aspect of a larger treatment landscape riddled with challenges.
To understand patient perspectives, Verywell Health surveyed 2,016 adults who identify as obese, overweight, or larger-bodied. The survey explored their weight management experiences and interactions with healthcare providers.
While a majority of respondents seek regular health care and report positive relationships with their providers, many also encounter barriers to care. These obstacles can range from an ill-fitting gown to experiences of subtle or overt judgment from providers. Sometimes, a single negative experience in a medical setting can deter someone from seeking necessary health care.
Obesity drugs like Zepbound and Wegovy are the most effective obesity medications available today, and they’re changing the public conversation about weight management. However, most respondents are either unaware of these drugs or don’t use them. Improving obesity care will require more than introducing novel treatments, the Verywell survey shows.
“[GLP-1 drugs are] not going to make heavier people feel more respected,” said Sean Phelan, PhD, a professor of health services research at the Mayo Clinic who specializes in the impact of stereotyping, prejudice, and discrimination on the health care of people with obesity.
“It's almost easy to default to, ‘If they just take these drugs, then their [health] problems will go away.’ That’s a short-sighted view,” Phelan added. “It’s a very stigmatized group that is really poorly treated in society—that includes in the healthcare system and publicly. The impact of these drugs shouldn’t overshadow the very basic, fundamental truth that people—regardless of what kind of care they seek—deserve the highest quality care.”

If GLP-1s work, why don't more people want them?

For people who have struggled to lose weight through diet and exercise, having access to GLP-1s can be really helpful, Phelan said. These drugs acknowledge that, in some ways, their large body may be the result of biological factors. Deploying a treatment can help alleviate the personal shame and responsibility that some people may feel about their weight, he said.
In clinical trials, the most potent GLP-1s can help people lose more than 20% of their body weight. Newer research indicates they can even protect against heart disease and liver disease, as well as relieve symptoms of conditions like sleep apnea and addiction.
No medication works for everyone, however. For instance, about 15% of people won’t lose any meaningful weight on Eli Lilly’s Zepbound even at the highest dose.
“For those who are responders, [GLP-1s] can be highly effective,” said Fatima Cody Stanford, MD, MPH, MPA, an obesity medicine physician-scientist and associate professor of medicine at Massachusetts General Hospital and Harvard Medical School. “But can you imagine if you come in thinking these are going to change your life, and you’re not in that group?”

Public skepticism also surrounds the long-term safety and tolerability of the GLP-1 drugs. The Verywell survey respondents echoed that wariness: Less than a third of them perceive the drugs to be safe.
GLP-1s must be taken perpetually to maintain weight loss. But among the survey respondents who have taken them, more than a quarter plan to stop using them within a year, and more than half have already discontinued use.
Some patients may stop taking the drugs because of uncomfortable side effects or poor results. Stanford said it’s important to work with an experienced obesity medicine provider who prioritizes long-term health outcomes rather than rapid weight loss.
“I don’t see [GLP-1s] as this panacea,” Stanford said. “I see them as a very useful tool among other tools to treat patients with obesity. You need a skilled clinician to choose to use these, and I think we have a lot of unskilled clinicians using these medications.”

What weight bias looks like at the doctor's office

Even with the right treatment plan, social factors can influence a patient’s experience with weight management.
From the moment a patient walks into a doctor’s office, they receive a message about how welcome they are—or not. It can be demoralizing to arrive in a waiting room with chairs that are too small for their body, or to sit in a doctor’s office while the provider hastens to get a blood pressure cuff that will fit, said Erin Harrop, LICSW, PhD, an assistant professor at the University of Denver and a licensed medical social worker whose research specializes in weight stigma and patient-provider communication.
Nearly a third of the Verywell survey respondents said they've had difficulty accessing size-appropriate medical gowns, medical devices, or examination tables. A quarter of respondents said they've stepped backward on a scale or asked not to be weighed in a medical visit.

Phelan’s research shows that people in larger bodies are likely to be told to lose weight as a first step in most medical interventions, regardless of their specific health concerns. The biggest barrier to care for most people, he said, is finding a provider who aligns with their goals.
Weight loss isn’t always the answer to a health problem. Nearly a third of respondents said losing weight wouldn’t necessarily make them healthier, and a quarter said their size wasn’t preventing them from being healthy.
While GLP-1s can be helpful for some patients who seek to lose weight, an often-overlooked conversation is whether they reinforce the notion that smaller is better.
“There are people who feel good about living in a larger body, and for them, it’s part of their identity. It’s not something that they want to change,” Phelan said. “For those people, the existence of a drug whose target is to eliminate that identity, eliminate that part of their life, can be really threatening.”
Harrop added that people can generally gauge their own health pretty well.
“I’m in a ‘class three obese’ body right now. My blood pressure is well managed. My blood sugar is well managed. I’m an athlete—I play competitive volleyball at the university down the street,” Harrop said. “If you were to look at my chart, it would say, ‘Erin has obesity—this disease.’ I’m actually quite a healthy person in a larger body size.”
They said when health providers “get distracted” by a person’s weight, they may fail to address their true medical needs, whether it’s a knee replacement, gender-affirming care, migraine management, or another problem that may be unrelated to weight.
“Sometimes we hold the medical treatment hostage in hopes that it will motivate someone to pursue weight loss,” Harrop said.

Weight stigma takes a health toll

Three-quarters of young respondents in the Verywell survey said they’ve been told to lose weight by a friend or family member. More than a third of respondents said people who comment on their weight act with good intentions, but a similar portion also said those comments are unhelpful.
Stanford said even when someone believes they’re well adjusted to negative comments about their body and can just shake it off, the body tells a different story.
Her research shows that those who receive negative comments about their size have an increase in blood sugar, C-reactive protein, and cortisol and other stress hormones. Stress is related to binge eating, increased caloric consumption, maladaptive weight control, and a lower motivation for exercise. Those physiological changes can make it even harder for someone to control their health and weight.

“If stigma is coming from a healthcare provider, you can imagine that’s going to affect healthcare services, and they’re going to have poor treatment adherence,” Stanford said. “Would you want to come and see me if I caused some type of negative reaction? Would you trust me as the healthcare provider? Would you want to come and see me as a follow-up? Probably not.”
Fear of facing repeat stigma and discrimination can stop someone from seeking medical support. More than half of those in our survey who experienced size-based discrimination started going to the doctor less often, delayed a decision, or stopped treatment.
Phelan said those behaviors can be so entrenched in society and medicine that bigger people may not realize that they’re experiencing overt discrimination.
“I don’t know how good we are at identifying all the different ways that discrimination or poor treatment can work their way in. I think we’re really used to it. People get used to a tough love message,” Phelan said.

Small changes make obesity care more inclusive

A good starting point to make healthcare spaces more inclusive is to offer tools that accommodate the needs of the more than 40% of American adults with obesity, according to Stanford. That includes stocking large blood pressure cuffs and patient gowns in each exam room and increasing the number of larger exam tables in each hospital.
Beyond increasing accessibility, Stanford said long-term efforts to root out weight bias and stigma must focus on improving medical provider education.
“If you as a healthcare provider are not treating the person that’s sitting across from you exactly how you want to be treated, you are failing the patient,” she said.
Harrop suggested that another way to make health spaces more comfortable is to only measure a patient’s weight when it’s truly helpful and necessary.
This shift in approach aligns with the changing attitudes toward weight, especially among younger generations. Nearly half of Gen Z survey respondents refused to be weighed, stepped on a scale backward, or asked not to know their weight during a health visit. Only 8% of Boomers said the same.

“Starting from young ages, teach children things like how to take care of their bodies and how to tell if they're hungry or full. These are skills that fat children are trained out of, because they’re taught to distrust their body. They’re taught to rely on calculators and meal plans instead of tuning into their body’s wisdom,” Harrop said.
When attempting to dismantle anti-fat bias, Harrop said it’s not enough to just acknowledge that obesity is multifactorial. They made an analogy to disabilities: Someone who developed a disability because of sports injuries should not receive less accommodation than someone who was in a tragic car accident. An inclusive health system would tend to them both.
“If we only accommodate the people that we consider deserving in their illness, that’s a really dangerous line,” Harrop said. “It’s not enough to just say, ‘People don’t choose to be fat’ or ‘There are biological forces at play.’ The real message needs to be that everybody, no matter what size, deserves good, ethical, efficacious care.”

Methodology

Verywell Health surveyed 2,016 adults living in the U.S. from January 29 to February 7, 2024. The survey was fielded online via a self-administered questionnaire to an opt-in panel of respondents from a market research vendor. In order to qualify, respondents must have identified themselves as any of the following: overweight, obese, fat, person of size, or larger-bodied. Quotas were implemented in sampling using benchmarks from American Community Survey (ACS) from the U.S. Census Bureau for region, age, race/ethnicity, and household income.
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*Senior News Reporter; expertise: health and science, education, Northwestern University Medill School of Journalism. Factcheck by Nick Blackmer. Illustrations by Julie Bang. Consultation in survey development and design by Daphna Harel, PhD. Research analysis by Amanda Morelli. Story edited by Daphne Lee and Anisa Arsenault. Additional edits by Mackenzie Price, PhD and Shamard Charles, MD, MPH. Source: Verywell Health