Association between socioeconomic factors and semaglutide use for weight loss: a population-based cross-sectional study in Denmark

Background: Glucagon-like peptide-1 agonists like semaglutide are effective treatments for obesity. High costs may create economic barriers. This study examines the association between income and prescriptions for semaglutide for weight loss. Methods: This nationwide register-based cross-sectional study of all adults in Denmark without diabetes, analyzed the association between household income adjusted for family size divided into quartiles and semaglutide prescription redemption for weight loss. We obtained weight and height on a representative sample of the population from The Copenhagen General Population Study which randomly selected individuals in 2014–2019. Obesity was defined as a body mass index >30 kg/m ². Findings: A total of 4,531,146 adult individuals were included after excluding individuals with diabetes (186,823, 3·8%), and individuals without income data (146,639, 3·0%). The proportion of individuals with a redeemed semaglutide prescription increased with income, from 1·3% (n = 13,925) in the lowest income quartile to 3·6% (n = 41,298) in the highest. Conversely, in a representative sample of 36,391 individuals, the proportion living with obesity was 26% (n = 1310) in the lowest income quartile compared to 13% (n = 1872) in the highest. During the year 2023 we found a general increase in Semaglutide use from 40,605 (0·9%) in the first quarter of 2023 to 85,250 (1·9%) in the fourth quarter, which was most pronounced in women in the highest income group with an increase from 10,818 (1·9%) to 23,069 (4·1%). Interpretation: Semaglutide use increased with income while obesity declined. This suggests that economic concerns lead to a systematic undertreatment for obesity for low-income individuals, potentially exacerbating existing health inequalities. Funding: None.