Constipation is associated with an increased risk of depression: A systematic review and meta-analysis of observational studies.

Obesity is a global epidemic [] with significant personal, economic, and societal impacts [, ]. Given its association with numerous comorbidities and an increased risk of all-cause mortality [–], the prevention and treatment of obesity is recognised as a global public health priority []. In particular, an estimated 64% of adults in the UK are living with overweight or obesity [], making obesity management a specific focus of Fit for the Future: 10-Year Health Plan for England []. Recent advancements in pharmacotherapy, particularly the development of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and associated dual acting therapies, have emerged as effective therapeutic options for supporting weight management and are becoming internationally established in clinical use in synergy with expanding commercial availability. These medications now have regulatory approval for inclusion in the UK’s weight management pathway. Despite their growing prominence, there remains limited understanding of public perceptions, expectations, and real-world experiences of GLP-1RA use in the UK, despite substantial and increasing public interest []. GLP-1RAs and dual agonists targeting the GLP‑1 and glucose‑dependent insulinotropic polypeptide (GIP) receptors (here collectively referred to as GLP-1RAs) represent a class of novel pharmacological agents that have demonstrated clinical efficacy in improving glycaemic control, supporting weight management, and enhancing lipid profiles in individuals with type 2 diabetes mellitus []. Mechanistically, GLP-1 RAs activate the GLP-1 receptor leading to enhanced glucose-dependent insulin secretion, suppressed glucagon release, slower gastric emptying, and increased satiety [], where additional GIP receptor agonism augments insulinotropic signalling and energy regulation []. Based on robust evidence from clinical trials confirming safety and effectiveness for weight management [] and the increased efficacy of dual GLP-1/GIP therapy [], GLP-1RAs monotherapies and dual-agonist therapies in the form of Semaglutide, Tirzepatide and specific brands of Liraglutide have approval in the UK for use as a pharmacological treatment for obesity. GLP-1RAs exert their effects by modulating brain regions involved in appetite regulation, influencing neurotransmitter and peptide release to control hunger and energy expenditure []. Multiple randomised controlled trials (RCTs) have shown that GLP-1RAs can lead to significant weight loss [–], with evidence suggesting that weight loss may be more pronounced in individuals without diabetes []. Their approval has resulted in widespread interest and increasing use, with recent data estimating that more than 1.6 million adults in the UK reporting using incretin mimetics in the last year []. Interestingly, outside the controlled environment of RCTs, real-world data indicate high discontinuation rates (32% to 50% after one year) when GLP-1RAs are used specifically for obesity treatment. Additionally, the magnitude of weight loss observed in real-world settings may be lower than that reported in clinical trials []. Reasons for discontinuation are not fully understood but are likely multifactorial, including cost, procurement practices, self-management challenges, and the impact of commonly reported adverse effects. Understanding the lived experiences of GLP-1RA medication users is therefore essential. Such insights may help not only explain discontinuation but also promote the understanding of real-world efficacy and aid in the development of guidelines for safe practice. Moreover, it has been demonstrated that the media’s agenda-setting, priming and framing of medication can influence attitudes, uptake and adherence []. Public knowledge, practices, and attitudes toward GLP-1RA medications have been significantly influenced by increased mainstream and social media coverage, making it essential to understand this impact to inform public health messaging, support safe self-management, and improve treatment adherence. This is particularly important considering evidence demonstrating inaccuracies and poor quality of health-related social media information []. Given this context, understanding perceptions among non-users is also important, as anticipated benefits, perceived risks, and expectations which are often shaped by media narratives may influence future uptake, adherence, and broader public discourse surrounding GLP-1RA use.