A qualitative study exploring experiences about using semaglutide for weight loss in a rural setting in Denmark – ‘she is probably on the meds’

Abstract

Introduction

Semaglutide has gained attention for its efficacy in weight loss. However, little is known about patients’ experiences. This study explores patient experiences with using Semaglutide for weight loss (SEMA-WL) in a rural Danish context.

Methods

We conducted semi-structured interviews with nine participants from a rural Danish municipality, recruited from a local clinic. The sample included six women and three men, aged 33–65, who had been prescribed SEMA-WL for at least two months. Data was analysed using systematic text condensation.

Findings

We identified four themes. First, we highlight different experiences of negative perceptions from the local community for using SEMA-WL, often perceived as ‘cheating’ or as ‘an easy way out’. Furthermore, we describe how SEMA-WL is experienced to provide more energy in the participants everyday lives but also viewed as a short-term intervention rather than a permanent solution, assisted by concerns of weight regain. Finally, we show how the participants continuously outweigh the risks of using new medication fearing potential long-term side effects versus living with obesity.

Conclusion

The study highlights the complex social dynamics and personal experiences of using SEMA-WL. While medication offers benefits, it also presents challenges such as social stigma, concerns about long-term effectiveness and side effects, and financial costs. Future research should focus on investigating the experiences of using SEMA-WL in other and more diverse settings as well as the contact and information exchange between patients and healthcare providers.

Introduction

In a biomedical context a BMI (kg/m²) above 25 and 30, defined as overweight and obesity, has been recognised as an increasing global health problem [1] and is sometimes even termed an epidemic [2]. In response to the understanding of obesity as a growing epidemic, a variety of weight loss interventions have been developed. These range from behavioural interventions such as facilitating changes in diet and exercise to pharmacological treatments and surgical options [3]. Among these interventions, pharmacological approaches have been attempted in several ways [4], however the recent discovery of glucagon-like peptide-1 (GLP-1) receptor agonists has gained significant attention for its efficacy and safety. These weight loss medications (WLM) are often prescribed and monitored in general practice.

Semaglutide for weight loss (SEMA-WL) has been examined in a series of clinical studies showing that, when combined with a lifestyle intervention involving a reduced calorie intake and regular exercise, significant weight loss can be obtained [5–7]. However, clinical studies also showed that individuals who discontinued SEMA-WL treatment but continued with the lifestyle intervention alone gradually regained weight [5].

Since the launch of SEMA-WL in Denmark in December 2022, demand for SEMA-WL has steadily increased. In the period from December 2022 to October 2025, approximately 268,000 individuals were prescribed SEMA-WL, corresponding to about 4.5% of the Danish population [8]. According to the current criteria, body mass index ≥ 30 kg/m² (obesity) or ≥ 27 kg/m² to < 30 kg/m² (overweight) with at least one weight-related comorbidity, treatment is potentially indicated for at least one million Danes [8,9]. The majority of prescriptions are issued in general practice, where general practitioners (GPs) are most often responsible for monitoring patients using weight loss medications (WLM) [8]. The increasing attention to SEMA-WL underscores the need to ensure that GPs and other healthcare professionals are well-equipped for consultations in which SEMA-WL is a central topic. Healthcare professionals in general practice should strive to practice evidence-based medicine [10]. Evidence-based medicine is built upon three core principles: available evidence, the patient’s perspective, and clinical context [11]. While the clinical effects of SEMA-WL have been extensively studied, there is a notable gap in the literature concerning experiences with this medication from both provider and user perspectives [12–14].

A few studies across different countries have focused on general practitioners’ perspectives on its integration into healthcare practices [15,16]. GPs viewed SEMA-WL as promising but raised concerns about resource constraints, challenging patient expectations, and the risk of oversimplifying obesity and the authors point to a need for well-resourced, holistic integration of SEMA-WL into primary care [16]. Regarding patient or user perspectives, studies have found that semaglutide is described as life-changing, and that patients prefer to manage their dosing themselves, often taking a lower dose than recommended. The authors highlight the key role of healthcare professionals and a need for support in dosage, side effects, and personalized guidance [16]. In addition to these findings, the studies also reveal moral considerations regarding the ‘right motives and methods for weight loss’ [15,16].

The normative idea of a ‘right’ way to weight loss is well known in qualitative literature on bariatric surgery, where studies have found that patients who use other weight loss options than a change of diet and physical activity, often experience stigmatisation from their surroundings, leading to efforts of non-disclosure or selective disclosure about having had surgery [17,18]. These accounts include being perceived as lazy or choosing the easy way out and experiences of social avoidance or lack of social support [19]. Such experiences might also differ according to the cultural or geographic setting [20]. For this study, we had access to experiences of using SEMA-WL among individuals living in a small rural community. Small communities are unique in the sense that the social visibility of individuals in such communities differs from that in large urban cities due to the interconnected nature of local social networks. Social dynamics are consequently distinct, and one study indicates that people in small communities are particularly concerned with how they are perceived by others [21].

Thus, the aim of this study was to examine the experiences from the everyday life of individuals receiving Semaglutide treatment for weight loss.

Methods

This is a qualitative study employing semi-structured interviews with participants recruited from general practice, focusing on their experiences with using SEMA-WL in a small rural community. The study did not apply a predefined theoretical framework or methodological orientation, as both the interviews and subsequent analysis were conducted inductively.

Sampling strategy and recruitment

The participants in this study were recruited from a general practice in a small rural community in Denmark with approximately 3,000 inhabitants. The first author grew up in a similar area and is therefore familiar with the dynamics of such close-knit communities. This insider status – which allowed him to quickly establish rapport during interviews – coupled with the small size and specificity of the community, meant that fewer participants were needed to achieve information power [22], as greater relevance and richness of information within a sample reduced the need for a larger sample.

We aimed to interview approximately 10 patients aged 18 years or older who had been undergoing SEMA-WL treatment for a minimum of two months and had their medication prescribed by their general practitioner at the specific clinic from which we conducted the recruitment. We chose to not contact individuals at the beginning of their treatment (two months), to avoid issues related to the treatment initiation and to ensure that participants had sufficient experience with the treatment to provide meaningful insights. Using the clinic’s IT system, we extracted data on patients who had been prescribed SEMA-WL. The search yielded a total of 75 patients: 19 men (aged 28–79) and 56 women (aged 22–68). We aimed for an equal gender distribution and the broadest possible age range. Initially, the first author contacted the first person who appeared in the search results in each age decade by phone. We contacted six women that all agreed to be interviewed. In addition, we reached out to 19 men, of whom five accepted to take part in an interview; however, two of the male participants withdrew without further explanation.

Data collection and ethical considerations

The study’s empirical basis consisted of nine semi-structured interviews. These interviews were conducted using an interview guide (see appendix 1) developed through repeated discussions between KT, TD and AG. The interviews took place between February and March 2024.

All interviews were conducted by the first author, AG, who introduced himself as a medical student. Acknowledging the inherent power asymmetry between healthcare professionals and patients, potential participants were assured that declining participation would not affect their treatment. It was further clarified that their identities would remain anonymous and that they could withdraw consent at any time. During the interviews, participants were encouraged to share both positive and negative experiences and were informed that their statements would not be disclosed to their GP or other clinic staff. While the interview guide sought to create space for participants to reflect on their experiences within general practice, these accounts emerged only marginally during the conversations. This may reflect underlying relational asymmetries, but it may equally reflect that other experiences were more central to participants’ everyday lives.

All participants gave their oral and written consent to participate. To protect their identities, the name of the community, the clinic, and individual participant characteristics have been anonymized and described in general terms. These measures were necessary given the small size of the community, where social proximity could render individuals more easily identifiable. Data materials were anonymized and stored according to standards of the University of Copenhagen. According to Danish legislation an approval from the Danish Data Protection Agency is not necessary for qualitative studies.

The findings from the interviews were discussed during data collection to further refine the interview guide and offer advice to the first author. Five interviews were conducted face-to-face in the participants’ homes, and four in a room provided by the clinic. The author group preferred having interviews conducted privately in the participants’ homes, but several participants preferred the interviews to be held at the clinic for practical or personal reasons. The interviews lasted between 27 and 45 min, were audio-recorded, and subsequently transcribed ad verbatim.

Data analysis

The collected data were processed using cross-sectional thematic analysis in the form of systematic text condensation [23]. In the literature, systematic text condensation is described and divided into four subsequent stages, but in practice, these stages in the analysis process are often performed in an iterative, flexible, and inductive manner [23]. Thus, in the first stage of our analysis process the interviews were initially read through to gain an overall impression and to identify preliminary themes. In the second stage, the interviews were re-read to identify meaning units, which were then linked to a code. The coding process was iterative and primarily performed by the first author, with code groups being added, removed, split, and merged following discussions within the author group. In the third stage, the final codes were divided into subgroups, and a condensate was written for each subgroup. In the final stage, the decontextualised elements were recontextualised, forming the basis for the study’s findings. Analytical decisions were discussed within the author group. The analytical findings were ultimately divided into four themes presented in the results section.

Results

In total, nine participants – six women and three men – took part in the study. They were between 33 and 65 years old. The group was relatively homogeneous in that all participants were married, had children, and were affiliated with the same clinic, living nearby. Their experiences with WLM varied; some had tried different types of pharmacological treatment while others had only used SEMA-WL. At the time of the interview, everyone was using SEMA-WL.

Below we present the four themes we identified in the analysis on participants’ experiences with using the medication in a small rural community: 1) SEMA-WL as ‘cheating’ – experiences of negative community perceptions, 2) The trade-off between gaining energy and losing the pleasure of eating, 3) SEMA-WL as a booster treatment to taper of eventually, and 4) Weighing the pros and cons of using new medication. In some respects, the close-knit community played a central role in shaping participants’ experiences with weight-loss medication, while other experiences reflected more general patterns.

SEMA-WL as ‘cheating’ – experiences of negative community perceptions

The close-knit rural community meant that residents knew most people from the area, fostering a greater interest in each other’s lives. Participants explained how information is shared and spreads quickly in the community as people frequently meet in town for various activities, exchanging stories and news. Overall, this was highlighted as a positive aspect of smaller communities.

Participants generally experienced support from their closest family and friends about their decision to use weight loss medication, however, many also experienced negative comments from people in their community, distant family, friends, or network.

The primary negative perception the participants encountered was that using weight loss medication was an easy way out. In the interviews, the word ‘cheating’ was repeatedly mentioned when discussing weight loss with SEMA-WL. For instance, one participant, Kirsten, experienced that her weight loss was compared to that of her spouse. While she had been undergoing treatment with SEMA-WL, her husband had lost weight without using WLM. She stated:

And when I started losing weight and some of them, like family and friends, knew it was because of the medication, I would often hear comments like, ‘Yes, but it’s also impressive how much he is losing.’ And I had actually lost the same amount [of weight], but it didn’t seem as impressive because it was due to the medication. It was cheating.

Kirsten explained that the lack of recognition had made her consider stopping the treatment because she wanted to prove, mostly to others, that she could achieve a weight loss without SEMA-WL. Furthermore, the negative attitudes and comments towards using SEMA-WL to obtain a weight loss might be ascribed to the setting in which we conducted the interviews. Especially one participant Hanne, who, because of her profession interacted with a wide range of people from the local community on a daily basis explained how she often experienced people commenting on her weight loss mostly in a disapproving way. She, and other participants, stressed that being a part of a small rural community influenced the urge to gossip about others in the community because everyone know each other – at least in a peripheral way; ‘So you really have to put up with a lot. And it’s just because our community is so small down here. When you lose weight in this town, it’s, “Oh, she must be on the meds (in Danish “på sprøjten”).”’ (Hanne). According to Hanne, this was a comment often expressed towards people in the community having obtained weight loss quickly.

Peter had a similar experience during a conversation in the Men’s Club he is a member of. Here SEMA-WL came up as a discussion point in general terms but also related to his use of the medication. Although the club members did not articulate it explicitly, he remarked that the discussion implied that ‘he had no backbone’ (Peter). These stories are manyfold in our data material and highlights the distinction between two methods of weight loss – pharmacological and non-pharmacological – where the perception of obtaining a weight loss with medication is not acknowledged in the same way as weight loss through diet and exercise, which is believed to require hard work and willpower, whereas medication is perceived as a means of avoiding personal effort:

It is the perception that you have to work hard to lose weight because otherwise, it is not real. Or people who can’t get off the couch can’t lose weight. You must do some hardcore working out, because otherwise you almost do not deserve to lose weight! (Lise).

As a response to these negative comments and attitudes, many participants frequently felt the need to defend themselves. This could lead to a form of discouragement, contributing to a lack of desire to engage in social situations, especially with those outside their immediate social circle.

I’ve always been a bit of a party animal. But not since I started this [SEMA-WL]. I don’t know if it’s because everyone has an opinion on things. And we constantly must defend ourselves. I can feel it makes me so tired. I’m mentally exhausted from having to defend why I’m on this medication to other people. And I really don’t want to. So sometimes I try not to mention it, but it doesn’t take much if you’ve lost a little weight. ‘Oh, you’re on that medication.’ That’s what people say. (Hanne).

The quote suggests that a judgmental approach from others and the feeling of needing to defend one’s choice to use SEMA-WL can affect emotional well-being and social life, and from the viewpoint of this particular participant, may be more pronounced in smaller rural communities.

The trade-off between gaining energy and losing the pleasure of eating

A shared experience among the participants was that the medication provided increased energy. This was not only experienced because of the weight loss itself, but also due to the excess time and energy available from not having to be concerned about food consumption, calories, or experiencing guilt related to food consumption. As an example, Jens described how he was able to spend more time on activities with his family:

My energy level has increased dramatically. And it has received very positive feedback at home because my wife also notices that I get more things done at home. And when I’m done, there’s also enough energy to take my son out on his scooter because the energy is there. Instead of being exhausted and collapsing on the couch. (Jens).

The energy increase was not only associated with weight loss but also attributed to reduced appetite, which was experienced as a liberation from the constant worry about food. ‘That craving is completely gone. And I really think that’s wonderful. I must say it’s really wonderful. It has really been a huge burden to constantly think about what tasty thing I could have next.’ (Hanne).

Despite these positive accounts related to changes in appetite regulation and weight loss, several participants experienced negative side effects of using SEMA-WL, such as bodily discomfort and a loss of enjoyment as they were prevented from consuming certain foods and could not eat larger portions. One participant mentioned that he had a great love for food and therefore found it frustrating that he could now only eat limited amounts:

I’m still fond of food, and sometimes I’ll admit that it bothers me a bit that I can’t eat more because I really enjoy food. So that’s… it takes some mental effort on my part, you could say… to think about it, because I know I can force it down, but then there’s a bill to pay afterwards, where I feel unwell. (Ole).

This ‘bill’ was also mentioned by other participants. If they consumed larger portions or certain foods, they would experience nausea, vomiting, and/or diarrhoea. For some, the reduced appetite also affected their social relations. One participant mentioned that her spouse got annoyed because she could not eat much and might say, ‘Why on earth do we go out to eat when you don’t eat anything anyway?’ (Marie). However, experiencing limitations in food consumption, as well as bodily discomfort, was for most participants outweighed by the benefits: ‘There are some side effects. There are some things that are unpleasant. But I still think that the benefits outweigh them for me.’ (Kirsten).

SEMA-WL as a booster treatment to taper of eventually

Although the benefits of SEMA-WL outweighed its downsides, several participants did not perceive SEMA-WL as a permanent treatment, but rather as a ‘booster’ to kickstart the weight loss, after which they would taper off. Related to tapering, participants often expressed concerns about regaining weight following the forthcoming treatment termination:

My biggest worry is when I must stop it again. Because you hear about this fluctuating effect, where the weight comes back. But I believe that if you can maintain the lifestyle changes that have occurred in the meantime, that will help to maintain the weight loss. Because I don’t wish to be on this continuously. I wish to either taper down to the lowest dose or completely off. (Jens).

Moreover, the medication costs also affected the decision to discontinue treatment. With a monthly expense of up to 2400 DKK (270 GBP), the cost led several participants to involve their spouses in deciding whether treatment with SEMA-WL was something they should prioritise. One participant, Jens, mentioned that he was willing to prioritise the treatment because it had brought many other benefits, but it meant that the family would not go on summer vacation that year. Another participant furthermore explained, how they in their family had tried to prioritise her medication for a while, but that it became too difficult to manage financially for her to continue the treatment. ‘For me, it worked well. I have no side effects. And I’ve lost weight, and I want to lose 15 more kg, so that. Yes, I’d like to continue, but I just think it’s too expensive.’ (Anna).

Weighing the pros and cons of using new medication

Another aspect which might contribute to the perception of SEMA-WL as a temporary treatment rather than a lifelong commitment, was the perceived future consequences of using SEMA-WL. Several participants expressed scepticism about whether the existing medical knowledge of SEMA-WL was sufficient, and the decision to use this new weight-loss medication was described by participants as being fraught with dilemmas. On the one hand, they wanted to contribute and benefit from the potentially positive effects of SEMA-WL. These were described as health benefits, as well as increased self-esteem and energy. On the other hand, some were concerned about the long-term prospects of using a medication that was not considered to be thoroughly tested. As an example, Ole stated ‘And it might very well be that they find out in 20 or 30 years that it was a terrible thing. But that would also have been the case if I had continued to weigh 150 kg’ (Ole). The quote reflects concerns about potential unforeseen long-term side effects. However, in this case, it is the alternative to not starting SEMA-WL and remaining in a larger body was perceived as an equally significant health risk.

Accounts of making one’s body available for research was present in several interviews. The term ‘guinea pig’ was directly used by two participants (Ole and Jens) about the treatment with SEMA-WL: ‘I kind of see myself as a bit of a guinea pig. But I feel like that’s okay. Because I tell myself that I’m getting something out of it. And I think someone must do it. And if I get something out of it along the way, then that’s fine.’ (Ole). The use of the term guinea pig to describe oneself in this context, which pertains to the introduction of new medication, suggests that participants perceive the use of the drug as associated with a certain level of risk. This reflects a lay perception that the medical field has not yet fully mapped out the potential long-term consequences. Thus, the decision to use the medication becomes a matter of risk assessment, where participants are willing to accept this uncertainty because they believe that the potential negative consequences are outweighed by the positive effects of weight loss. Furthermore, several participants highlight that their use of the medication also entails a sense of contributing to the generation of new knowledge in the field, which may benefit others.

Discussion

In this study we explored the experiences of using SEMA-WL among individuals in a small rural community. We presented our findings in four themes based on our analysis using systematic text condensation.

Below we discuss our findings in relation to existing literature, the strengths and limitations of the study, and use these considerations to point towards potential areas for further investigation.

In our first theme ‘SEMA-WL as “cheating” – experiences of negative community perceptions’ we highlighted a complex interplay between social support and negative perceptions from different social circles in our participants’ social networks, which was both experienced directly and indirectly. While close social relations in the immediate family (spouses or children) generally provided support, people within the more distant relations often expressed negative perceptions about SEMA-WL as an ‘easy way out’ or ‘cheating’. This perception led some participants to feel the need to defend their choice, which could potentially cause social isolation and terminating treatment to avoid the stigma associated with using SEMA-WL. A study has described the discrimination against people with obesity presented either as harmful stereotypes, negative attitudes, prejudice, or stigmatisation [24]. Examples of these negative stereotypes are that individuals with obesity are lazy, weak-willed, unsuccessful, lack self-discipline, and are not compliant with weight loss treatment [24]. Much like we found in our results, these negative perceptions also exist in relation to people choosing to undergo bariatric surgery, which is also perceived as an ‘easy way out’ [25]. Among individuals awaiting bariatric surgery the fear of stigma following the procedure was a contributing factor for dropping out of the waiting list [26]. Drawing on the experiences of individuals who have lost weight through bariatric surgery, using new WLM to lose weight may have similar consequences [27], as people who use such medication often encounter negative social attitudes [28–30]. Although our findings show similarities with judgements about bariatric surgery, more research is needed to further determine whether this is context-specific to small rural communities or prevalent in other parts of society. Even though weight loss medication and bariatric surgery face social stigma, surgery is often seen as a last resort after failed lifestyle interventions and pharmacological treatments, which may lead to even greater disapproval from others. This hierarchy of treatment options could be further investigated to highlight the differences and challenges encountered by patients [29,31].

Heitmann [32] conducted a narrative review on the potential implications of novel medications for weight loss (GLP-1 receptor agonists) on social attitudes and stigma towards weight loss achieved through pharmacological methods. She highlighted the need for further research on social attitudes and stigma surrounding these new medications, as only two studies have addressed this topic so far. Our study contributes to this area by investigating the experiences of taking weight loss medication in a close-knit community in Denmark [32]. Heitmann [32] suggests that ‘The introduction of effective weight loss medications like GLP-1 receptor agonists, in addition to providing a realistic method to manage weight, has the potential to reduce both internalized and externalized stigmatization of people living with obesity’. This hypothesis was likewise proposed by Goldkorn et al. (2025), who on the contrary found that increased awareness on weight loss medications did not change the general publics on opinion on the role of willpower and failure related to obesity [33]. Their findings are in line with stigma being a prominent theme in our empirical material, negatively affecting users as they experienced both direct negative attitudes from their surroundings and internalised them. Although we cannot draw definitive conclusions from our study, our findings indicate that it is questionable whether these new medications can minimize stigma, given the negative social attitudes and lack of access to medication as a long-term treatment due to financial constraints, which may lead to experiences of personal failure if weight loss is not sustained.

The concept of food noise refers to persistent, intrusive thoughts about food [34,35]. Weight-loss medications such as Liraglutide have been shown to reduce this mental preoccupation [36]. Our study adds that when food noise is quieted through SEMA‑WL, participants report having more energy for physical activity and social engagement. However, we also find a trade‑off: reduced enjoyment of food and challenges participating fully in social eating situations. These findings highlight the need for further research into the potential social side‑effects of WLM.

We furthermore found that several participants viewed the use of SEMA-WL as a temporary weight loss booster rather than a long-term treatment and expressed worries about regaining weight after discontinuing the treatment. A Danish survey has shown that only four out of ten patients discussed the duration of treatment with their GP before being prescribed the medication, and that only one in ten expected SEMA-WL to be a lifelong treatment [37]. Furthermore, studies have shown, that 50–75% of patients stop treatment with GLP-1 receptor agonists (GLP-1RA) within the first twelve months - a trend that may lead to weight cycling and loss of lean muscle mass that might not be fully recovered after discontinuation [38]. In line with this, a cohort study revealed a substantial gap between the premarket testing of Semaglutide in clinical trials and its real-world application among Danish adults. The study showed that 5.7% discontinued treatment after the first prescription, increasing to 25% after the fifth prescription, where several continued treatment at a lower dosage than prescribed [39]. These numbers align with the perception of weight loss medication as a temporary weight loss booster in our material, emerging from the participants’ concerns about weight regain after discontinuation. Moreover, we add to these results by pointing towards how social side effects of using SEMA-WL in terms of the medications costs as well as not experiencing the joy of social and sensory aspects of eating could lead to the decision of discontinuing treatment.

A qualitative study investigating experiences from 36 adult medication continuers and discontinuers with type 2 diabetes support these findings, showing that cost and the need for lifelong treatment were barriers among patients with type 2 diabetes undergoing treatment with GLP-1RA [40]. They moreover found, that improved glucose control and weight loss facilitated treatment continuation, whereas side effects and high cost served as barriers [40]. There is a need for more knowledge beyond the facilitators and barriers of using these new medications, looking more in-depth at perceptions and how they fit into the context of people’s daily lives.

In our fourth theme, we described how participants expressed concerns about the lack of scientific and professional knowledge regarding weight loss medication, particularly its long-term side effects. Some felt they were contributing to scientific understanding by using the medication, which helped them justify their choice. This relates to other findings in the literature regarding the use of weight loss medication [41]. In our study, we did not investigate patient experiences of their interaction with healthcare professionals regarding their use of SEMA-WL. A study that investigated how SEMA-WL was negotiated in general practice found that healthcare professionals expressed trust in the development process of SEMA-WL and had no significant concerns about its long-term side effects [15]. We need more knowledge to understand how information about the effect and long-term effects are negotiated and delivered regarding SEMA-WL between healthcare professionals and patients.

Strengths and limitations

One of the key strengths of this study is the broad research question, which allowed participants to introduce new topics and perspectives. This approach was particularly beneficial given the limited existing knowledge in this area. However, the broad scope may have resulted in less depth compared to a more narrowly defined question. The interdisciplinary approach, also adds to the strength of the study. The analysis was carried out collaboratively by the author group. The interdisciplinary composition—combining expertise in medicine, public health, and anthropology—strengthened both the interpretation of the data and its clinical relevance. Furthermore, the interdisciplinary collaboration enabled the identification of aspects of patient experiences that might otherwise have been overlooked within a single-disciplinary framework.

The unique context of a smaller local community might influence the transferability of the findings to other settings and underscores the need for studies conducted in urban or mixed settings. The interview setting and access to participants were key strengths, providing rich data. However, the limited sample size, suggest a need for further research including more participants.

Conclusion

This study highlights the complex social dynamics and experiences of individuals using SEMA-WL. While the medication offers significant benefits, such as increased energy and food control, it also presents challenges related to social stigma and financial cost, leading to the perception of the medication as a temporary weight loss treatment, as well as balancing the perceived risk of using newer medication. Future research should focus on exploring user experiences including individuals residing in non-rural areas to further explore these issues and improve treatment strategies.

Funding Statement

KT, SO, and the publication of this article were supported by The Novo Nordisk Foundation (grant NNF22SA0080921) as a side project to the LightCOM trials. All scientific activites, from study design to manuscript writing, were carried out independently of the funding source and the study was likewise conducted independently of the LightCOM trials.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical considerations

The first author recruited the participants and clarified that they would remain anonymous and could withdraw their consent at any time. All participants gave their oral and written consent to participate. Data materials were anonymized and stored according to university standards. According to Danish legislation, qualitative research does not require approval from the Danish Data Protection Agency.