Despite the rise in prescriptions, young Americans remain skeptical about semaglutide, preferring natural health habits and voicing strong concerns about media-fueled hype and safety risks.

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In a recent study published in the Journal of Adolescent Health, researchers in the United States investigated the knowledge and opinions of youth regarding the use of medications such as Semaglutide for weight loss. The study comprised five open-ended questions shared among America’s youth (n = 753, aged 14-24) via a nationwide text messaging poll (MyVoice) conducted in March 2024.

Background

Overweight and obesity prevalence is at an all-time high, with the World Health Organization (WHO) estimates reporting more than 1 billion individuals living with the latter as of 2022. The incidence of maladaptive weight gain is alarming, having more than doubled since 1990, and is expected to increase further in the coming years. Research exploring unwanted weight gain management trends highlights children, adolescents, and young adults as target populations for interventions.

These conditions represent significant public health concerns. Medically validated, they are associated with several chronic, potentially fatal non-communicable diseases, including type 2 diabetes (T2D), cardiovascular diseases (CVDs), kidney conditions, and certain cancers. Conventional weight loss treatments combine pharmacological drugs with lifestyle improvements (diet and physical activity). Unfortunately, these interventions strongly depend on patient persistence, with even temporary gaps in treatment observed to rapidly reverse any weight improvements.

Semaglutide and similar glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shifted the paradigm in modern weight loss interventions. Initially developed for treating type 2 diabetes and metabolic conditions, these drugs have demonstrated significant potential for weight loss. Clinical trials report that the one-weekly consumption of Semaglutide can result in a body mass index (BMI) reduction of up to 17% in adolescents with higher weight, details of which have been widely publicised in online forums, health websites, and social media. Unfortunately, the long-term effects of these drugs and their notable side effects in youth remain understudied, and media coverage may not always present balanced information.

Young people are highly susceptible to social media influences, which, combined with their perceptions about weight and its associated stigmas, may encourage them to abuse these apparent miracle weight loss cures. Unfortunately, these concerns (youth weight loss medication perceptions) remain scientifically untested.

“…between January 2020 and December 2023, the number of adolescents and young adults who were dispensed GLP-1RA increased by nearly 600% (to over 60,000 individuals in 2023), underscoring the rapidly rising use of this class of weight loss pharmacotherapy.”

About the study

The present study aims to address these knowledge gaps and inform public health policy by determining the familiarity of youth with GLP-1RA-derived weight loss medications and their opinions on their use. Qualitative and quantitative study data were collected using the MyVoice project, a real-time nationwide text-message survey shared among America’s youth (ages 14-24).

The study data included demographic information (age, gender, education, geographical location, race/ethnicity, and socioeconomic status), as well as five open-ended questions tailored to assess respondents’ knowledge and opinions about Wegovy or Ozempic (Semaglutide brand names) for weight management.

“(1) There has been much in the media lately about medications like Ozempic, Wegovy, etc. Have you heard of these medications? What have you heard?; (2) Medications like Ozempic and Wegovy are sometimes used for weight loss. Do you know anyone who has taken these medications? Tell us about it; (3) Do you think people your age should take these medications to lose weight? Why or why not?; (4) What do you think is the impact of media content (news, social media, podcasts, etc) about these medications?; and, (5) What information do you wish was available to people your age about these medications?”

Survey responses were coded to highlight the frequency of answers, ideas, and opinions, and summary statistics were generated to facilitate quantitative analyses using Stata, version 18. Answers were analyzed as a whole and reanalyzed using demographic data as subcategories. Differences between subcategories were elucidated using chi-square tests.

Study findings

Of the 753 participants recruited into the study, 547 (73%, comprising 50.3% females) provided complete demographic and survey data and were included in subsequent analyses. Respondents were, on average, 20.4 years old, and the majority were White (60%). Study findings revealed that most respondents were aware of Ozempic and Wegovy (73.6%). When asked about their knowledge of these medications, almost half of the study cohort (48.8%) reported awareness of their use for weight loss and potential side effects, while fewer (18.2%) mentioned having heard about their use for diabetes management.

“Awareness was most common among respondents identifying as multiracial (84.6%) and White (76.9%) and least common among respondents identifying as Asian (64.1%) and Black (64.2%). Awareness also differed by level of education completed, with the highest awareness among individuals pursuing graduate degrees (96.9%) and lowest among participants who were high school graduates without further degrees (57.8%).”

Subgroup analyses failed to reveal differences in awareness levels across gender, ethnicity, geographical region, or age. Notably, 26.1% of respondents reported personally knowing a semaglutide user, with a higher likelihood of female reporters than male (31.6% vs. 20.8%).

Regarding whether youth should use these medications, more than half of the responders (57.5%) expressed negative opinions or hesitation about weight loss medication use amongst youth. The most cited reasons included safety concerns, inappropriate use, and a belief in personal responsibilities towards healthier/more natural weight loss options. Specific safety worries included potential side effects, promotion of disordered eating or unhealthy body image, and unknown long-term or developmental effects. Concerns about inappropriate use included the media glamorizing the drugs, leading to unnecessary use, and contributing to shortages for people with diabetes.

Even among the 37.2% who felt youth use could be acceptable, many added caveats, stating it should only be if medically necessary (48.2% of this group) or in extreme circumstances/as a last resort (23.4% of this group).

Many respondents (n = 101, primarily those who said ‘no’ to youth use) highlighted lifestyle changes, such as diet and exercise, as priorities over pharmacological interventions for weight management, with Semaglutide considered a ‘last resort.’ These perceptions were stronger in male respondents than those from other genders and were unaffected by other demographic variables. Respondents also noted that media, including news and social media, played a role in spreading awareness but also potentially spread misinformation, glamorized weight loss, and created pressure to fit unrealistic beauty standards, a pressure felt more acutely by suburban youth. Some also felt media coverage could stigmatize the use of these medications.

Conclusions

The present study highlights the surprisingly high awareness among America’s youth regarding the use of GLP-1RA medications for weight loss, but reveals that their overall perceptions about youth using them are largely negative or hesitant. Most respondents expressed concerns about safety or felt that Semaglutide was not appropriate for youth-aged individuals, believing that healthier ‘natural’ behavioral alterations were preferable to pharmacological weight management, or should at least be prioritized. The findings suggest that youth with higher weight who might medically benefit from these medications could face stigma, potentially worsened by media portrayals that both glamorize thinness and criticize medication use as a ‘quick fix’ or taking resources from others.