Prescriptions for GLP-1 receptor agonists written to US adults with no documented reason for taking them rose roughly 15-fold between 2021 and 2025, according to an analysis of electronic health records published on 22 September in Obesity. Among 92.4 million adults whose records showed neither type 2 diabetes nor obesity with a qualifying comorbidity, about 1.13 million were prescribed liraglutide, semaglutide or tirzepatide. More than a third of them had a body mass index in the normal range.
What the records show
The study, led by researchers at New York University, drew on Cosmos, a dataset built from Epic electronic health records covering a large share of US health systems. The authors examined prescriptions written between January 2021 and December 2025, and counted an adult as lacking an apparent FDA-approved indication when the record showed no type 2 diabetes and no obesity accompanied by a qualifying weight-related condition. Adults with no weight recorded in the six months before their first prescription were excluded.
Of 92,415,648 adults meeting that description, 1,133,953 — 1.2% — received one of the three drugs. The share climbed from 0.1% in 2021 to 1.5% in 2025. Recipients had a slightly higher median BMI than non-recipients, 25.9 against 24.5 kg/m², a difference that places the typical recipient in the overweight band rather than the obese one. They were overwhelmingly female (85.5%) and most often White (60.0%). Hypertension and dyslipidaemia were more common among recipients; coronary artery disease and heart failure were less common.
Two figures stand out. 35.1% of recipients had a BMI in the normal range. And a recorded eating disorder was six times more common among recipients than in the comparison group, 1.8% against 0.3%. Use was also concentrated among people with private insurance and lower social vulnerability scores.
Why the pattern matters
That concentration — privately insured people in less socially vulnerable areas — is close to the mirror image of where weight-related disease sits in the United States. Access to this class of drug has been shaped less by who carries the most weight-related illness than by who can pay for it, a gap that also runs through what these drugs cost without insurance.
The normal-BMI finding is the one likely to draw attention. The approved indications for these medicines are type 2 diabetes, and obesity or overweight alongside a weight-related condition; none covers a person at a normal weight who simply wants to be lighter. The trials that established how much weight these drugs take off, and what they do to muscle, bone and the gut, enrolled people well above that threshold. What the same drug does to someone starting at a BMI of 22 has not been tested, which is the authors’ stated reason for calling the risk–benefit balance in this group uncertain.
The eating-disorder signal is harder to read in either direction. It may reflect people with a history of disordered eating seeking out a drug that blunts appetite; it may reflect clinicians recording such a diagnosis more often in patients they are already watching closely. This study was not designed to separate the two.
Several limits matter. “Without an apparent FDA-approved indication” means the indication was not in the record, not that it did not exist: a diagnosis made elsewhere, a prescription written outside the health system, or an unrecorded comorbidity would all place a patient in this group. The analysis is retrospective and descriptive — groups were compared with t-tests and chi-square tests, with no adjustment for confounding — so none of the differences between recipients and non-recipients should be read as an effect of the drugs. Cosmos is large but is not a probability sample of the country. And a record shows what was prescribed, not what was dispensed, paid for or taken.
Sources: Orandi BJ, Yan L, Levan ML, Lofton HF, Chhabra KR, Ren-Fielding CJ, Husain SA, McAdams-DeMarco MA, Segev DL, Mankowski MA, Massie AB. Trends in GLP-1 Receptor Agonist Prescribing Without an Apparent FDA-Approved Indication. Obesity (Silver Spring), published online 22 September 2026. doi:10.1002/oby.70301.
