GLP-1 Without Diabetes or Obesity: Use Is Rising

Use of a GLP-1 without diabetes or obesity is increasing, but a new study doesn't establish whether the benefits outweigh the risks. It found more than 1.1 million recipients without documented eligibility in their medical records. That finding makes a careful medical review more important. It doesn't settle whether any one person's prescription was appropriate.

GLP-1 medicines copy a gut-hormone signal involved in appetite and blood sugar. The question here is who is receiving them, and what we know about those people's health.

GLP-1 without diabetes or obesity: the September study

As of September 30, 2026, the day this article was written, a study published September 22 in Obesity offers a large new look at this prescribing pattern. Babak Orandi and colleagues at New York University examined Epic Cosmos, a database of electronic health records, the charts health systems keep.

The researchers looked back at January 2021 through December 2025. They identified prescriptions for liraglutide, semaglutide or tirzepatide among adults without a documented qualifying use.

Here are the figures reported in the study's abstract:

BMI means body mass index, a measure of weight relative to height. The study’s normal range was 18.5 to below 25. The table describes prescribing, not treatment success or harm.

What an “apparent indication” means

An indication is a use listed on a medicine's official label. “Apparent” means the researchers could find evidence of it in the records available to them.

They looked for type 2 diabetes, or a BMI of at least 30. A BMI from 27 to below 30 also qualified when paired with a relevant health condition. Someone below those weight thresholds could still have a medical reason for treatment that wasn't documented in Cosmos.

Weight history mattered. The study excluded people without a recorded weight at least six months before their first prescription. That helped avoid counting someone whose weight had already fallen after treatment elsewhere.

For someone considering semaglutide, the useful question is what treatment is meant to address and what evidence supports that goal. A current weight alone doesn't answer it.

What this means for semaglutide and tirzepatide

Not having diabetes does not, by itself, make weight treatment unusual. The STEP 1 semaglutide paper in the New England Journal of Medicine, 2021 studied 1,961 adults without diabetes. They had obesity, or overweight with a weight-related condition. Our STEP 1 results guide explains that trial.

That trial didn't enroll adults with normal BMI. Its results cannot establish the same balance of benefit and risk for someone seeking weight loss at a normal weight.

As of September 30, 2026, the day this article was written, the current Wegovy label reads “Revised: 6/2026.” Its weight-management use covers obesity, or overweight with a related condition. The injection also has a use for MASH, liver inflammation associated with fat buildup, with moderate to advanced liver scarring. So “no diabetes or obesity” isn't a complete account of every possible labeled use.

Off-label use means prescribing a branded medicine outside its listed uses. FDA's patient explanation, dated February 5, 2018, says providers generally may do this when medically appropriate. It also says the agency hasn't established safety and effectiveness for that particular use.

Tirzepatide was included in the September study too. Switching the name of the medicine doesn't fill an evidence gap about the person receiving it. Both choices need a clear treatment goal, an explanation of the evidence and a plan for follow-up.

The eating-disorder finding needs careful reading

The abstract reports an eating-disorder history in 1.8% of recipients, compared with 0.3% of nonrecipients in the comparison group. That's about six times as common. It does not mean the medicines caused six times as many eating disorders.

An eating disorder is an illness involving harmful eating patterns, often with distress about weight or body shape. The Cosmos study couldn't reliably distinguish the different types. Severe food restriction and binge eating—episodes of unusually large meals with a sense of losing control—present different clinical questions.

As of September 30, 2026, the day this article was written, a separate World Psychiatry consensus study, published online September 15, supports screening for current and past eating disorders before treatment. Its 45-member panel included clinicians, researchers and people with lived experience. This was expert agreement, not a trial measuring drug effects.

The panel recommended generally avoiding these medicines in active eating disorders, particularly anorexia, including its atypical form. It also singled out bulimia with marked food restriction or weight substantially below a person’s previous level.

Anorexia involves restrictive eating; its atypical form can occur without low body weight. Bulimia involves binge eating with behaviors intended to compensate, such as vomiting.

The recommendations call for individual assessment and ongoing monitoring. Eating-disorder history deserves a real conversation, without assuming a person's diagnosis from their appearance.

What the medical records cannot settle

Missing documentation can change who gets counted. The authors note that weight and health conditions may be incompletely recorded. Cosmos couldn't identify compounded prescriptions, medicines prepared by a pharmacy for an individual prescription. It also missed prescriptions written outside its systems.

That means the study is neither a complete count of all use nor an assessment of every prescriber's reasoning. It couldn't determine patient motivation.

The practical distinction is between evidence about prescribing patterns and evidence about outcomes. This study answers the first question. Someone considering treatment needs the second question discussed too.

What a semaglutide review is for

At Promise, a licensed provider reviews every request, including BMI, weight history, medical history and eating-disorder risk; not everyone qualifies. The questions to ask before semaglutide explain the broader safety conversation.

A useful review identifies the reason for treatment, checks current medicines and relevant history, and explains what follow-up would involve. More information or specialist input may be needed before a decision.

Through Promise, semaglutide is dispensed as a compounded medication, which is different from an FDA-approved product: the formulation offered here is not FDA-approved. FDA's compounding explanation describes the product distinction. A licensed provider may still prescribe a compounded formulation; that decision is between you and your doctor.

What to watch next

Studies tracking benefits, nutrition and eating-disorder symptoms over time would help clarify the balance for people outside the usual weight-treatment populations. Better records of previous weight, diagnoses and the reason for prescribing would help separate missing documentation from treatment outside established uses.

For a first visit, the question this news raises is concrete: what evidence supports this medicine for the health problem being treated? A careful answer includes the limits of that evidence and how the clinician would know whether the plan still fits.