Abstract
Obesity is an exacerbated public health challenge, increasing the risk of several diseases and mortality while deteriorating the quality of life. There is significant dedication to exploring obesity therapies using glucagon-like peptide-1 (GLP-1) agonists, which have shown efficacy in reducing the number of deaths and complications associated with type 2 diabetes. This research aimed to examine the recent search popularity of GLP-1 agonists using Google Trends at both national (in Iraq) and global levels. To quantify relative search volume (RSV), the total search query activity has been transformed to a percentage scale ranging from 0% to 100%. The word "Ozempic" was chosen because of its extensive coverage in social media and web/print publications pertaining to this subject matter. A comparative search was performed targeting the phrases "Wegovy," "Saxenda," and "Mounjaro" to identify a novel combination GLP-1 agonist from August 2023 to August 2024. The present study demonstrated a statistically significant difference in the RSV among the four drugs (P < 0.0001) nationally and globally. In Iraq, the highest RSV for Ozempic was documented in Duhok, followed by Sulaymaniyah and Erbil. A comparable RSV profile has been noted for Saxenda, while substantial interest in Wegovy is seen in Ninawa. Meanwhile, globally, the highest RSV for Ozempic was recorded in Canada, the United States of America, and Australia. A distinct RSV profile has been observed for Saxenda, with heightened search interest recorded in Latin America, Poland, Sweden, and Australia. By contrast, Mounjaro received search interest primarily in Greenland and the United States, while Mounjaro search interest was noted in Canada, the United States, and Australia. This study demonstrates a significant and growing public interest in GLP-1 agonists, namely, Ozempic, Saxenda, Wegovy, and Mounjaro. As the use of GLP-1 agonists for weight loss becomes more common, more knowledge, understanding, and continuous scientific research will make it more convenient to obtain the best patient outcomes.
Keywords: glp-1 agonists, google trends healthcare, infodemiology, mounjaro, obesity, ozempic, saxenda, social media, wegovy, weight loss
Introduction
Approximately 650 million individuals worldwide are affected by obesity, a chronic condition characterized by excessive adiposity that deteriorates health; various metabolic issues, including type 2 diabetes, metabolic-dysfunction associated steatotic liver disease, heart disease, arthritis, and obstructive sleeping apnea, are more likely to develop as a result of obesity [1-3]. Lifestyle modifications, such as eating habits, physical activity, and alterations in behavior, are crucial for managing obesity and provide many advantages; however, even the most rigorous lifestyle interventions only lead to an average reduction in weight of up to 10%, maintaining this weight remains difficult, as 80% of the reduction in weight is anticipated to be regained within the following five years [4].
Innovative hormone-based medications with exceptional efficacy for obesity are emerging; this is partly motivated by the recognition of obesity as a disease characterized by energy dysregulation and intricate underlying pathology, in which the energy homeostasis system sustains an increased fat mass [5]. Investigation of the function of hormones in regulating metabolism and appetitive behavior, as well as their physiological impact on cerebral energy control, has redirected the focus of obesity treatment toward targeting fundamental processes via the invention of hormone-based drugs. Glucagon-like peptide-1 (GLP-1) makes up one of the nutrient-stimulated pancreatic and intestinal hormones that provide appetitive signals, initially designed as medications for managing type 2 diabetes (T2D) via the action of its incretin. GLP-1 receptor agonists (GLP-1 RAs) are now becoming recognized as very successful treatments for obesity [6]. Studies have shown that GLP-1 agonists result in placebo-adjusted weight reduction ranging from 12% to 18%, surpassing any previous pharmacological treatment and attracting significant interest and application [7]. However, there is still uncertainty among clinicians and the general public over the actual expenses, acceptability, and availability. Fifty percent of people in the United States express interest in using a prescription weight-loss medication, and among this group, 93 million individuals satisfy the eligibility requirements for GLP-1 [7]. Despite standard methods continuing to be valuable for tracking trends, the accessibility of Internet data provides researchers with a more efficient method to monitor emerging trends, an area now known as infodemiology [8]. While social networking tracking shows potential for infodemiology, it can be challenging by social media platforms restricting or altering data access, the constant flux of the social media landscape, with fluctuating user numbers and novel apps (e.g., TikTok) emerging and attracting substantial user bases, and the evolving nature of content on social networks, shifting from mainly text to graphic content and finally video-posing new computing challenges; search engine data, such as Google Trends (GT), is an alternative and potentially valuable data source for infodemiology [9]. While the data from Internet searches may not be as extensive as that from social media, they still provide interesting insights into the motives of search users, when handled adequately [10]. The purpose of this study is to offer an in-depth analysis of national and global interest data associated with GLP-1 receptor agonists over a one-year period.
Materials and methods
Study design
The current study presents an analysis of individuals' online search activity using the Google search engine for queries related to GLP-1 receptor agonists for weight loss during a period of one year, concentrated on the time frame starting from August 27, 2023, through August 25, 2024.
Data sources
Google Trends
The Google Trends platform offers unrestricted utilization of time-series data associated with the search volumes of certain phrases on the Google search engine [11]. To quantify the relative search volume (RSV), the total search query activity has been transformed to a percentage scale ranging from 0% to 100%. A value of 100% represents the highest point in search volume for a particular subject during a certain time period. In this situation, an RSV value of 50 would suggest that the search phrase had a popularity level that is 50% of the popularity seen in the most popular week. A score of 0 indicates a lack of searches to display for this topic throughout the week. Through a concurrent search of several phrases, we successfully compared the RSV for various terms. This paper specifically examined GLP-1 receptor agonists for weight loss searches both locally in Iraq and worldwide.
Search strategy
The word "Ozempic" was chosen because of its extensive coverage in social media and web/print publications pertaining to this subject matter. A comparative search was performed targeting the phrases "Wegovy," "Saxenda," and "Mounjaro" to identify a novel combination GLP-1 agonist, tirzepatide. All search criteria were restricted to include just inquiries conducted inside Iraq and to be opposed within the global dataset. The information used for statistical purposes was examined for an interval of one year.
Statistical analysis
The statistical analysis was carried out using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY). GraphPad Prism version 8 for Windows (GraphPad Software, Inc., California, USA) was used to create the graphical representation of the data. The Kolmogorov-Smirnov test was employed to examine the normality of the distribution of RSV scores based on geographical regions. By employing independent T-tests to evaluate the differences between the RSV descriptive statistics for RSVs include the mean together with the mean of differences, 95% confidence interval, and correlation coefficient (r). A relation was concluded to be statistically significant when the p-value was less than 0.05. The graphical representation of the RSV scores exhibits a temporal pattern. Temporal structures were shown in Google Trends visualizations to illustrate the concentration of interest in each individual location for a certain topic.
Results
Google search interests for Ozempic, Saxenda, Wegovy, and Mounjaro from August 2023 to August 2024 in various areas of Iraq are displayed in Figure 1. Overall, Ozempic interest searches have spiked over time. Saxenda search was at its peak in the last months of 2023, whereas the search interest was almost flat for Wegovy and fluctuating for Mounjaro.
Figure 1. Ozempic, Saxenda, Wegovy, and Mounjaro 12-month relative search volume (RSV) report in Iraq.
Analysis findings indicated a statistically significant difference in the RSV across all compared pairs in Iraq search interest, as illustrated in Table 1 and Figure 2.
Table 1. Ozempic, Saxenda, Wegovy, and Mounjaro pair analysis for their search interest in Iraq.
| Pairs | Mean of differences | 95% confidence interval | Correlation coefficient (r) | P-value |
| Ozempic versus Saxenda | -34.26 | -43.47 to -25.06 | -0.2450 | <0.0001 |
| Ozempic versus Wegovy | -54.57 | -59.94 to -49.19 | 0.1392 | <0.0001 |
| Ozempic versus Mounjaro | -49.58 | -56.58 to -42.59 | -0.1336 | <0.0001 |
| Saxenda versus Mounjaro | -15.32 | -22.53 to -8.110 | 0.0214 | <0.0001 |
| Saxenda versus Wegovy | -20.30 | -26.51 to -14.09 | 0.09344 | <0.0001 |
| Wegovy versus Mounjaro | 4.981 | 1.353 to 8.609 | 0.4150 | 0.0081 |
Figure 2. Ozempic, Saxenda, Wegovy, and Mounjaro relative search volume (RSV) mean difference in Iraq.
The highest RSV for Ozempic was documented in Duhok with 69, followed by Sulaymaniyah with 66 and Erbil with 53. A comparable RSV profile is noted for Saxenda, while substantial interest in Wegovy is seen in Ninawa. The comprehensive details are shown in Figures 3-4.
Figure 3. Ozempic, Saxenda, Wegovy, and Mounjaro relative search volume (RSV) in the Iraq subregion .
Darker shades indicate where the term has a higher probability of being searched.
Figure 4. Ozempic, Saxenda, Wegovy, and Mounjaro relative search volume (RSV) numerical value in the Iraq subregion .
The search phrases for the four products were not confined to their exact names; several inquiries have been documented, with some terms pertaining to pricing, side effects, and potency, while others were in Arabic, the native language of Iraq, as presented in Table 2.
Table 2. Documented search terms related to Ozempic, Saxenda, Wegovy, and Mounjaro in Iraq .
| Related search terms | RSV |
| How to use Mounjaro | 5 |
| Manjaro | 3 |
| Mounjaro injection | 100 |
| Mounjaro injection for weight loss | 11 |
| Mounjaro injection price | 10 |
| Mounjaro mechanism of action | <1 |
| Mounjaro price | 27 |
| Mounjaro side effects | 18 |
| Mounjaro vs. Ozempic | 11 |
| Mounjaro weight loss | 35 |
| Mounjaro دواء | 23 |
| Ozempic weight loss | 100 |
| دواء Ozempic | 20 |
| Ozempic 0.25 | 37 |
| Ozempic 0.25 mg | 21 |
| Ozempic 0.5 | 26 |
| Ozempic 1 mg | 73 |
| Ozempic 18 | 18 |
| Ozempic 1 mg | 16 |
| Ozempic dose | 40 |
| Ozempic dose for weight loss | 18 |
| Ozempic face | 20 |
| Ozempic for weight loss | 52 |
| Ozempic injection | 56 |
| Ozempic mechanism of action | 13 |
| Ozempic pen | 90 |
| Ozempic price | 32 |
| Ozempic side effects | 55 |
| Ozempic ابرة | 45 |
| Saxenda | 49 |
| Saxenda dose | 21 |
| Saxenda injection | 32 |
| Saxenda mechanism of action | 4 |
| Saxenda pen | 45 |
| Saxenda price | 12 |
| Saxenda side effects | 27 |
| Saxenda vs. Ozempic | 19 |
| Saxenda vs Ozempic | 13 |
| Saxenda علاج | 100 |
| Saxenda منحف | 14 |
| Semaglutide | 25 |
| Tirzepatide | 8 |
| Wegovy injection | 62 |
| Wegovy price | 43 |
| Wegovy vs. Ozempic | 27 |
| Wegovy سعر ابره | 100 |
| What is Ozempic | 21 |
| الاثار الجانبية Saxenda | 39 |
Figure 5 illustrates the global Google search interest for Ozempic, Saxenda, Wegovy, and Mounjaro from August 2023 to August 2024. Interest in Ozempic searches has increased over time. The search interest for Saxenda was the lowest among the four medications, whereas the interest for Wegovy and Mounjaro, although relatively low, demonstrated a gradual upward trend.
Figure 5. Ozempic, Saxenda, Wegovy, and Mounjaro global 12-month relative search volume (RSV) report .
Analysis findings indicated a statistically significant difference in the RSV across all compared pairs in global search interest, as illustrated in Table 3 and Figure 6.
Table 3. Ozempic, Saxenda, Wegovy, and Mounjaro pair analysis for their search interest worldwide .
| Pairs | Mean of differences | 95% confidence interval | Correlation coefficient (r) | P-value |
| Ozempic vs. Saxenda | -62.19 ± 2.062 | -66.28 to -58.10 | 0.8974 | <0.0001 |
| Ozempic vs. Wegovy | -51.45 ± 2.135 | -55.69 to -47.22 | 0.8482 | <0.0001 |
| Ozempic vs. Mounjaro | -53.79 ± 2.160 | -58.08 to -49.51 | 0.8564 | <0.0001 |
| Saxenda vs. Mounjaro | 8.396 ± 0.6686 | 7.070 to 9.722 | 0.6026 | <0.0001 |
| Saxenda vs. Wegovy | 10.74 ± 0.5820 | - 9.582 to 11.89 | 0.7659 | <0.0001 |
| Wegovy vs. Mounjaro | -2.340 ± 0.8662 | -4.057 to -0.6219 | 0.06555 | 0.0081 |
Figure 6. Ozempic, Saxenda, Wegovy, and Mounjaro relative search volume (RSV) mean difference in worldwide .
The worldwide geographic distribution of interest is shown in Figure 7, which indicates a significant increase in searches for Ozempic over the last 12 months (August 2023-August 2024).
Figure 7. Ozempic, Saxenda, Wegovy, and Mounjaro RSV geographic distribution worldwide.
Darker shades indicate where the term has a higher probability of being searched.
The worldwide search queries for the four drugs were not limited to their precise names; several questions were recorded, including keywords related to the scientific name, comparisons, costs, adverse reactions, and strength, as seen in Table 4.
Table 4. Ozempic, Saxenda, Wegovy, and Mounjaro related search terms documented worldwide .
| Related search terms | RSV |
| BMI | 11 |
| How to get ozempic | 17 |
| Liraglutide | 11 |
| Liraglutide saxenda | 11 |
| Mounjaro cost | 21 |
| Mounjaro coupon | 36 |
| Mounjaro diabetes | 16 |
| Mounjaro dose | 18 |
| Mounjaro for weight loss | 48 |
| Mounjaro injection | 28 |
| Mounjaro UK | 18 |
| Mounjaro vs. Ozempic | 27 |
| Mounjaro weight loss | 100 |
| Ozempic 1 mg | 16 |
| Ozempic buy | 13 |
| Ozempic cost | 21 |
| Ozempic diabetes | 18 |
| Ozempic dose | 16 |
| Ozempic face | 36 |
| Ozempic for weight loss | 48 |
| Ozempic injection | 14 |
| Ozempic Mounjaro | 95 |
| Ozempic online | 16 |
| Ozempic pen | 18 |
| Ozempic preã§o | 15 |
| Ozempic price | 13 |
| Ozempic Reddit | 16 |
| Ozempic side effects | 76 |
| Ozempic UK | 13 |
| Ozempic vs. Saxenda | 17 |
| Ozempic Wegovy | 100 |
| Ozempic weight loss | 100 |
| Preã§o Mounjaro | 18 |
| Preã§o Saxenda | 21 |
| Precio Saxenda | 37 |
| Reddit Mounjaro | 16 |
| Reddit Wegovy | 12 |
| Saxenda Australia | 9 |
| Saxenda cena | 12 |
| Saxenda dose | 12 |
| Saxenda for weight loss | 15 |
| Saxenda injection | 18 |
| Saxenda online | 14 |
| Saxenda Ozempic | 100 |
| Saxenda pen | 19 |
| Saxenda price | 10 |
| Saxenda side effects | 20 |
| Saxenda UK | 14 |
| Saxenda vs. Wegovy | 13 |
| Saxenda weight loss | 43 |
| Semaglutide Ozempic | 24 |
| Semaglutide Wegovy | 21 |
| Side effects Mounjaro | 70 |
| Side effects of Ozempic | 15 |
| Tirzepatide | 20 |
| Tirzepatide Mounjaro | 21 |
| Valor Saxenda | 13 |
| Victoza | 19 |
| Wegovy cost | 22 |
| Wegovy coupon | 16 |
| Wegovy dose | 11 |
| Wegovy for weight loss | 21 |
| Wegovy injection | 11 |
| Wegovy near me | 11 |
| Wegovy online | 15 |
| Wegovy price | 10 |
| Wegovy shortage | 10 |
| Wegovy side effects | 37 |
| Wegovy stock | 13 |
| Wegovy UK | 15 |
| Wegovy vs. Ozempic | 22 |
| Weight loss | 98 |
| Weight loss Wegovy | 58 |
| What is Mounjaro | 30 |
| What is Ozempic | 45 |
| What is Saxenda | 13 |
| What is Wegovy | 22 |
| Zepbound | 18 |
| Mounjaro drug | 13 |
| Mounjaro online | 13 |
The highest RSV for Ozempic was recorded in Canada, the United States of America, and Australia. A distinct RSV profile has been observed for Saxenda, with heightened search interest recorded in Latin America, Poland, Sweden, and Australia. By contrast, Wegovy received search interest primarily in Greenland and the United States, while Mounjaro's search interest was noted in Canada, the United States, and Australia. Figure 8 presents the entire information dissemination.
Figure 8. Ozempic, Saxenda, Wegovy, and Mounjaro RSV compared breakdown by region.
Darker shades indicate where the term has a higher probability of being searched.
Discussion
The research findings indicate a substantial rise in public interest in the search phrase “Ozempic, Saxenda, Wegovy, and Mounjaro related search terms” during the past 12 months in Iraq and the globe. GLP-1 agonists are recent additions to the healthcare sector, The US Food and Drug Administration first approved exenatide for type 2 diabetes mellitus in April 2005, subsequently bringing about the authorization of many more GLP-1 agonists [12]. In 2014, liraglutide became the initially approved GLP-1 agonist to get FDA clearance for weight loss in nondiabetic obese individuals [13]. In December 2017, Ozempic received approval for the management of type 2 diabetes mellitus. In June 2021, Wegovy received approval for the purpose of weight reduction in individuals with obesity or those who are overweight accompanied by at least one weight-related comorbidities. Mounjaro, a dual GLP-1 agonist and GIP (glucose-dependent insulinotropic polypeptide), received approval for use in the management of type 2 diabetes mellitus in May 2022 [14].
Wide-ranging social networking site recourse is frequently related to adverse self-perception regarding self-image and the onset of conditions such as depressive symptoms and eating habits. It has been argued that social media influencers and technologies like filters are responsible for an increase in certain complimentary cosmetic surgeries. A research study indicated that over 50% of participants undergoing nasal reconstruction were influenced by social networking sites "before and after" marketing campaigns [15]. Nonetheless, social media presents a significant opportunity for disseminating accessible health-informed advice aimed at mitigating obesity. Social media websites serve as an avenue of social assistance, which is essential for enhancing wellness across multiple illnesses. This could result in substantial weight loss due to social media-based programs for losing weight when compared to conventional strategies like leaflets or surveys [16]. Off-label prescriptions, particularly customized to the patient's specific demand, may be advantageous. Certain unapproved prescriptions have garnered an increasing amount of reliable information. Ozempic® at lesser dosages of 0.25, 0.5, and 1.0 mg is similar to Wegovy®, differing only in labeling and delivery method. Due to persistent supply chain challenges with Wegovy®, particularly affecting lower dosages, it may be beneficial to use Ozempic® off-label to mitigate these supply shortages. There is increasing evidence supporting the use of off-label antiobesity drugs, including metformin and topiramate [17].
Reviewers have raised reservations over off-label prescription usage of GLP-1 agonists. There is a significant worry over the dramatic increase in off-label prescriptions. Challenges arise from the few studies completed on the efficacy and safe administration of these drugs among adolescents. This may be ascribed to the latest authorization of many drugs for adults and the continuing studies [18]. A further problem is that the Food and Drug Administration prohibits direct-to-consumer marketing of off-label usage in patient awareness tools and commercials; nonetheless, off-label promotion by drug companies often triggers Medicaid false claim inspections [19]. There are concerns about the off-label use of these medications for those who do not meet the criteria of a BMI over 30 or a BMI over 27 with an accompanying weight-related disease. Numerous studies have shown effectiveness in individuals with diabetes and obesity; nevertheless, a concerning trend is the growing interest in Ozempic for aesthetic weight reduction, fueled by social media and celebrity endorsements. Moreover, off-label pharmaceuticals may interact with other drugs and exacerbate existing health disorders, and they may lack robust evidence to validate their safety and efficacy in both short and long-term scenarios across diverse patient groups [20].
Numerous limitations must be acknowledged when analyzing the findings of the current investigation. Initially, it is crucial to recognize that these results stem from an examination of consumer search habits and will probably impact by certain medication licenses and dissemination strategies. Second, these findings pertain only to search queries executed using the Google search engine. Despite Google's preeminence as a search engine, more research is required to ascertain how the search activity outlined above compares or contrasts with that of alternative search engines or networks. Social networking sites are now recognized as an important driver of spreading misconceptions about weight reduction. It is essential to acknowledge that the findings provided are derived from the total search volume assessed at the population level. Consequently, we cannot ascertain the extent to which alterations in Internet searching attitudes are attributable to variations in the number of individuals conducting a particular search, a spike in the frequency of searches by particular people, or an intersection of these elements.
Conclusions
This study demonstrates a significant and growing public interest in GLP-1 agonists, namely, Ozempic, Saxenda, Wegovy, and Mounjaro. The search queries for the four drugs were not limited to their precise names; several queries have been recorded. In Iraq, the highest RSV for Ozempic was documented in Duhok, followed by Sulaymaniyah. A comparable RSV profile has been noted for Saxenda, while substantial interest in Wegovy is seen in Ninawa. Globally, the highest RSV for Ozempic was found in Canada, the United States of America, and Australia. Saxenda has a unique RSV profile, with increased search interest reported in Latin America, Poland, Sweden, and Australia. Wegovy, on the other hand, got the majority of searches in Greenland and the United States, while Mounjaro garnered searches in Canada, the United States, and Australia. As the use of GLP-1 agonists for weight loss becomes more common, more knowledge, understanding, and continuous scientific research will make it more convenient to obtain the best patient outcomes.
Disclosures
Human subjects: All authors have confirmed that this study did not involve human participants or tissue.
Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following:
Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work.
Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work.
Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
Author Contributions
Concept and design: Laith G. Shareef, Shahad Sabah Khalid, Mohanad Faris Raheem, Ali Fawzi Al-Hussainy, Noor Sameer Al-Khayyat, Ahmed Zakaria Al Arajy, Mustafa M. Noori, Mohammad Alameen Qasim, Hanan Hussein Jasim
Acquisition, analysis, or interpretation of data: Laith G. Shareef, Shahad Sabah Khalid, Mohanad Faris Raheem, Ali Fawzi Al-Hussainy, Noor Sameer Al-Khayyat, Ahmed Zakaria Al Arajy, Mustafa M. Noori, Mohammad Alameen Qasim, Hanan Hussein Jasim
Critical review of the manuscript for important intellectual content: Laith G. Shareef, Shahad Sabah Khalid, Ali Fawzi Al-Hussainy, Noor Sameer Al-Khayyat, Ahmed Zakaria Al Arajy, Mustafa M. Noori, Mohammad Alameen Qasim, Hanan Hussein Jasim
Supervision: Laith G. Shareef
Drafting of the manuscript: Shahad Sabah Khalid, Mohanad Faris Raheem, Ali Fawzi Al-Hussainy, Noor Sameer Al-Khayyat, Ahmed Zakaria Al Arajy, Mustafa M. Noori, Mohammad Alameen Qasim, Hanan Hussein Jasim
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