Hope, hype, and high costs: Navigating glucagon-like Peptide-1 based therapy initiation among young adults

BACKGROUND: Glucagon-like peptide-1 (GLP-1)-based therapies have emerged as a major option for weight management, with prescribing among young adults increasing nearly sixfold between 2020 and 2023 in the United States. Despite this growth, little is known about how young adults decide to initiate GLP-1 therapy, navigate access, and manage treatment costs. This study examined individual, social, financial, and structural influences shaping GLP-1 initiation for weight management among young adults. METHODS: This was a qualitative interview study that employed a semi-structured interview design utilizing a hybrid inductive-deductive thematic analysis framework guided by Andersen's Behavioral Model of Health Services Use. We recruited 25 young adults aged 18-30 years from the South Florida community who were currently using or had used GLP-1-based therapy for weight management within the preceding 12 months. Transcripts were coded deductively based on constructs from Andersen's model and inductively from themes identified directly from participant narratives. RESULTS: Participants had a mean age of 22 years; 20 (80%) were female and 19 (76%) identified as Hispanic or Latino. Four themes were identified: (1) motivations and expectations for initiation, including health needs, appearance-related goals, and social media-shaped expectations; (2) social and clinical pathways to GLP-1 introduction, particularly family networks and social media; (3) navigation of access pathways ranging from conventional clinical care to medical spas, telehealth, and unregulated self-procurement; and (4) financial barriers characterized by out-of-pocket costs and insurance exclusions that contributed to informal procurement. CONCLUSIONS: Within this sample, GLP-1 initiation among young adults was shaped by intersecting health needs, social influences, access structures, and financial constraints rather than by clinical considerations alone. Findings highlight that healthcare systems, policymakers, and public health practitioners must prioritize clinically appropriate access, reliable medication sourcing, and consistent clinical oversight to promote equity and safety among young adults.