AI analysis finds huge public interest in GLP-1 drugs for weight loss and mental health benefits

Using a large language models (LLMs) to analyse over 391,000 unique discussions related to glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RAs), on the social media platform Reddit, research led by Stanford University, Stanford, CA, reported there is high public interest in GLP-1 RA and identified potential priorities for the clinical and policy communities, including monitoring side effects, addressing access barriers and acknowledging both the physical and psychological benefits of GLP-1 RAs. Overall, the results showed a mainly neutral-to-positive view of these medications.

According the study’s authors although there are now several large-scale randomised clinical trials programmes (eg. STEP, SURMOUNT) investigating the safety and efficacy of GLP-1 RAs, public perceptions of GLP-1 RAs, which can affect intended treatment uptake, access and adherence, are not well studied in the literature.

Manual analysis of large volumes of social media content to identify relevant topics of discussion is resource and time-intensive but may be accelerated using techniques in natural language processing, especially large language models (LLMs). Therefore, the investigators utilised LLMs to augment this approach for characterising public perceptions about GLP-1 RAs on Reddit. They uncovered topics around weight loss, side effects of different GLP-1 RAs, and concerns about drug access and supply, with a mainly neutral-to-positive view of GLP-1 RAs, highlighting the role of an AI-enabled pipeline to help monitor for emerging side effects, uncover public sentiment and guide future directions for research and public health efforts.

They curated all GLP-1 RA-related discussions via an Application Programming Interface called PullPush that indexes and permits retrieval of all openly available Reddit content by searching for discussions containing the brand- and generic names of available GLP-1 RA drugs: ‘semaglutide’, ‘rybelsus’, ‘wegovy’, ‘ozempic’, ‘tirzepatide’, ‘mounjaro’, ‘liraglutide’, ‘saxenda’, ‘retatrutide’, ‘dulaglutide’, ‘trulicity’, ‘exenatide’, ‘bydureon’, ‘byetta’, ‘lixisenatide’, ‘adlyxin’. This AI-enabled topic modelling clusters discussions into topics and groups to identify emergent topics, largely similar to previous work.

They analyses identified a total of 391,461 unique discussions, including 71,982 posts and 319,479 comments from 116,216 unique authors (Figure 1). Most discussions (97.1%) focused on GLP-1 RA medications that are actively being prescribed for weight loss, including semaglutide, tirzepatide and liraglutide. Across these brand- and generic drugs, ‘Ozempic’ had the most discussions (41.4%), even though it was not FDA-approved for weight loss in the US. Only a minority of discussions (2.9%) focused on GLP-1 RAs that were only approved for use in diabetes mellitus. The number of discussions increased substantially over time, with greater than 95% of discussions taking place after 1 January 2022. Notably, this followed the 2021 Food and Drug Administration (FDA) approval for the brand formulation of semaglutide (Wegovy), which became the second GLP-1 RA to gain approval for weight loss.

Figure 1: Glucagon-like peptide-1 receptor agonist discussions over time: Heatmap showing the number of glucagon-like peptide-1 receptor agonist (GLP-1 RA) discussions by the Reddit search string (generic name and all brand formulations) over time. Boxes are colored in logarithmic scale and annotated based on the number of discussions for that search string and year. Black boxes with no number indicate no Reddit posts prior to an initial post on the topic (any year with zero posts after the occurrence of an initial post is a black box labeled with a zero). White vertical lines depict a year of initial FDA approval for any clinical indication.

The topic modelling pipeline identified a total of 168 discussion topics with most discussions focusing on individual experiences with GLP-1 RA for weight loss with respect to medication efficacy, comparison to other treatments, impact on appetite, and side effects. The most common side effect described was nausea, followed by vomiting, constipation, injection site issues, pancreatitis and gastroparesis.

Some notable topics also included discussing access issues, including market shortages, ethics of off-label use, insurance coverage, and strategies to obtain GLP-1 RAs from nonprescription pharmacies internationally. Other identified topics reflected the positive impact of these medications for weight loss on motivation levels and mental health associated with specific obesity-related comorbidities. One topic also identified the value of these therapies in avoiding bariatric surgery. Individuals described their experiences with different GLP-1 RA types and doses, celebrity endorsements and side effects from dose adjustments.

Most groups discussions reflected the following four themes: (1) comparisons of weight loss efficacy with other treatments, supplements, and different GLP-1 RAs; (2) side effects and injectable administration nuances of GLP-1 RA; (3) access concerns including market availability and insurance coverage; and (4) anecdotal experiences of the positive psychological impact of GLP-1 RA use.

They also performed a sentiment analysis on all discussions using a separate, pretrained language model was used to classify sentiment (i.e., “positive”, “neutral”, or “negative”). Of all discussions, 124,667 had negative (31.8%), 198,535 had neutral (50.1%) and 68,259 had positive (17.4%) sentiment.

The findings may help identify new side effects not previously seen in clinical trials and highlight future directions for research and public health efforts, the researchers concluded.

The findings were featured in the paper, ‘Using large language models to assess public perceptions around glucagon-like peptide-1 receptor agonists on social media’, published in Communications Medicine. To access this paper, please click here