A deep dive into public Facebook posts uncovers the real-world side effect patterns of GLP-1 medications, revealing what users actually experience outside of clinical trials.
Study: Harnessing Facebook to Investigate Real-World Mentions of Adverse Events of Glucagon-Like Peptide-1 Receptor Agonist (GLP-1 RA) Medications: Observational Study of Facebook Posts From 2022 to 2024. Image Credit: zimmytws / Shutterstock
In a recent article published in the journal JMIR Infodemiology, researchers analyzed public Facebook posts to examine public discussion of adverse effects associated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs).
They identified gastrointestinal (GI) issues, particularly vomiting and nausea, as the most common side effects for most GLP-1 RAs, while headache and joint pain were most frequently discussed in posts about tirzepatide. Mental health concerns, such as anxiety and depression, were present but less frequently mentioned (<1% of posts) compared to GI symptoms, with depression noted in up to 1.57% of Wegovy posts.
Background
GLP-1 RAs, such as tirzepatide and semaglutide, have become widely used to treat obesity and type 2 diabetes. With nearly 38 million adults in the U.S. living with diabetes and over 100 million affected by obesity, the rising demand for these drugs has caused global shortages.
Due to inadequate insurance coverage, limited availability, and high costs, many people are turning to compounded GLP-1 RAs, which are often cheaper and easier to access but lack standardized efficacy, safety, and dosage information, and their safety profile is largely unknown.
GLP-1 RAs work by enhancing insulin release, suppressing glucagon, and slowing gastric emptying, which leads to lower blood glucose levels and weight loss. However, these mechanisms may also cause significant muscle loss, gastrointestinal issues, and there is potential for malnutrition and loss of lean body mass in some individuals.
Adverse events such as mental health concerns like depression and anxiety, nausea, and vomiting have been reported. Traditional clinical trials often miss rare or long-term side effects due to limited follow-up and participant diversity.
About the Study
In this study, researchers collected public Facebook posts from U.S.-based users between 2022 and 2024 that mentioned GLP-1 RA medications, limiting their search to posts in English and pages administered in the U.S., and excluding posts from Facebook groups.
They focused on posts discussing adverse events, specifically negative psychological and physical symptoms, linked to these medications. Adverse event categories were drawn from prior literature, clinical knowledge, and a drug side-effect database, covering a wide range of symptoms from gastrointestinal to mental health issues. Duplicate posts were removed to ensure accuracy.
For analysis, researchers calculated the frequency with which specific side effects were mentioned about each medication and over time. They also tracked how adverse event mentions fluctuated during key events, including the FDA approval of Wegovy for pediatric use in December 2022, Oprah Winfrey’s public endorsement in December 2023, and the expansion of Medicare coverage for weight loss medications in March 2024.
The co-occurrence of symptoms was examined through a cluster analysis, which mapped connections between side effects frequently mentioned together, helping to identify common symptom groupings.
Key Findings
Researchers analyzed 59,293 unique public Facebook posts discussing GLP-1 RA medications. About 14% of posts referenced adverse events. General GI symptoms were the most frequently mentioned side effects. Nausea and vomiting were also common, appearing in 2–3% of posts for many drugs. For tirzepatide, headache and joint pain were more commonly mentioned than GI symptoms.
Mental health concerns like anxiety and depression were present across all medications, though at lower frequencies (mainly under 1%), with depression mentioned in 1.57% of Wegovy posts. Other notable side effects included fatigue, joint pain, hair loss, and headaches, particularly with drugs such as tirzepatide.
Temporal trends revealed that discussions of adverse events increased significantly after notable events, including government approvals, viral media coverage, celebrity endorsements, and the expansion of Medicare coverage for weight loss medications. The write-up also captures that, although the number of adverse event mentions rose over time, the proportion of posts focusing on side effects declined, reflecting a shift in online conversations toward other aspects of these drugs.
A co-occurrence network analysis revealed three clusters of frequently co-mentioned symptoms. Cluster 1 included allergies, anxiety, depression, chronic obstructive pulmonary disease, fatigue, fever, hypertension, indigestion, insomnia, gastroesophageal reflux disease, hives, swelling, restlessness, and seizures; Cluster 2 comprised constipation, dehydration, headache, diarrhea, dizziness, hypoglycemia, sweating, and jaundice; Cluster 3 included GI symptoms such as nausea, pancreatitis, rash, and vomiting.
Strong connections were observed between vomiting and nausea, pancreatitis and GI distress, and depression and anxiety, highlighting patterns of symptom overlap among users.
Conclusions
This study analyzed public Facebook posts to examine public discussion of adverse events associated with GLP-1 RAs from 2022 to 2024. GI issues, particularly vomiting and nausea, were the most frequently mentioned side effects. Mental health concerns, including anxiety and depression, especially with semaglutide, were also notable but occurred less often than GI symptoms, with Wegovy showing the highest depression mention rate. Social media activity spiked following celebrity endorsements, regulatory approvals, the FDA pediatric approval, and media attention, revealing how external events influence public discourse. Co-occurring symptom clusters emerged, with Cluster 1 encompassing a mix of somatic and psychological symptoms (such as allergies, anxiety, and hypertension), Cluster 2 encompassing neuromuscular and metabolic symptoms (such as dehydration, headache, and hypoglycemia), and Cluster 3 focusing on gastrointestinal distress.
Strengths of this study include its broad, real-world sample and its ability to capture underrepresented voices that are not often seen in clinical trials. However, limitations involve unknown user demographics, reliance on self-reported data, and the inability to confirm medication duration or dosage. Findings reflect self-reported symptoms from social media users, not confirmed clinical diagnoses.
Social media insights complement traditional research by surfacing potential concerns early. As the use of GLP-1 RA expands, ongoing monitoring of side effects, especially those that are underrecognized in clinical settings, is essential for a better understanding of patient experiences and guiding future studies.
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