Ozempic, Wegovy, Mounjaro and Zepbound are approved for two things: type 2 diabetes, and weight management at a BMI of 30 or more, or 27 or more with a weight-related condition. A study published on 22 September 2026 measured how often they are now prescribed to people with neither, and who those people are.
What happened
Researchers at NYU, led by Babak Orandi, MD, PhD, used Cosmos, a database of electronic health records drawn from health systems that use Epic, covering January 2021 to December 2025. The paper is in Obesity, the journal of The Obesity Society (PubMed 42768905).
They looked for adults with no record of type 2 diabetes and no record of obesity at the level the labels require, then counted who was prescribed liraglutide, semaglutide or tirzepatide. Anyone without a recorded weight at least six months before their first prescription was left out, so that a lower weight reached on an earlier course of the drug would not be mistaken for a starting weight.
| Adults with no approved indication | 92,415,648 |
| Prescribed a GLP-1 anyway | 1,133,953 (1.2%) |
| Share prescribed in 2021 | 0.1% |
| Share prescribed in 2025 | 1.5%, a 15-fold rise |
| Recipients with a normal BMI | 35.1% |
| Median BMI, recipients against non-recipients | 25.9 against 24.5 |
| Women | 85.5% |
| White | 60.0% |
| Recorded eating disorder, recipients against non-recipients | 1.8% against 0.3% |
Some reports round the overall figure to 1.1%; the paper says 1.2%.
Recipients had more high blood pressure and high cholesterol than non-recipients, and less coronary artery disease and heart failure. They were more likely to live in areas with lower social vulnerability and to have private insurance. The authors conclude that prescribing without an apparent approved indication "has increased rapidly", that it disproportionately reaches socioeconomically advantaged people, including people without obesity, and that the balance of benefit and risk in these groups "remains uncertain".
Read the numbers carefully
The headline that went around on X in October called these patients "healthy adults". The study does not.
- No indication on the record is not the same as healthy. Recipients had more high blood pressure and high cholesterol than everyone else. Some will have had reasons doctors prescribe for off-label, such as polycystic ovary syndrome. A diagnosis that never made it into the record is invisible to a study like this.
- It is 1.2% of a very large group. Most of the 92 million were not prescribed anything. The story is the speed of the rise, from 0.1% to 1.5% in four years.
- A median BMI of 25.9 sits just over the line into overweight. About a third were under it, in the normal range, and most of the rest were in the overweight range without the related condition the label asks for.
- It only sees Epic records. A prescription from a service that does not use Epic, including many online prescribers and compounding pharmacies, does not appear. The true count is likely higher, not lower.
Why it matters if you are in this group
This is not a story about who deserves a prescription. Many people reading it will have been prescribed a GLP-1 at a BMI under 30, and the decision was between them and their doctor. What the study does make plain is that the evidence was built on other bodies.
The trials did not include you. The doses, the side-effect rates and the weight-loss figures all come from people who started with obesity, or with overweight and a related condition. How the same doses behave at a starting BMI of 23 has not been studied in the same way.
There is less fat to lose before muscle goes. In a real-world study of 396 people, those who started leaner lost a larger share of muscle. Muscle carries your strength and a good share of your metabolism, and it is the thing worth protecting on any GLP-1. At a lower starting weight it matters more.
Bone and hair follow the same logic. Fast loss and too little protein are the common thread in hair shedding and in bone loss on a GLP-1. Both are easier to run into when there is little weight to lose.
The eating disorder figure deserves its own sentence. 1.8% against 0.3% is six times as common. A medicine that removes hunger can quiet a hard relationship with food, or hide one. If that is your history, read this first, and tell your prescriber.
What to do with this
Nothing here is a reason to stop a medicine you and your doctor chose. It is a reason to eat as if your muscle is the thing you are protecting, because at a lower starting weight it is.
- Set your protein from your body, not your appetite. How much protein you need on a GLP-1 has the numbers.
- Lift something twice a week. Protecting muscle on a GLP-1 explains why protein without load is half the signal.
- Keep the pace of loss sensible. Faster is not better when there is little to lose.
The calculator sets a protein floor from your weight and your dose, and caps the pace of loss.