Tinkering with weight loss medication in clinical encounters: An ethnographic study

Abstract

The introduction of semaglutide, a glucagon-like-1 receptor agonist (GLP-1ra) as a weight-loss medication, has attracted considerable public and medical attention, reporting weight reductions of up to 15 %. However, its rapid adoption highlights the growing entanglement of the pharmaceutical industry, public health agendas, and cultural body ideals. This development calls for a closer examination of how such medications impact medical practices, patient experiences, and broader social norms. Based on three months of ethnographic fieldwork conducted in three general practices in Denmark in spring 2023, this study explores how patients and health care professionals navigate the use of weight-loss medication within clinical encounters. By theorising clinical encounters as iterative tinkering care practices, we analyse how timing, site and dosage of GLP-1ra are continuously adjusted in response to e.g., side effects and economic constraints. Our findings reveal that patients exhibit a strong commitment to obtaining and maintaining weight-loss medication despite significant disruptions to their daily lives. Health care professionals play a key role in aligning patients' high expectations for immediate weight loss; yet these encounters also expose moral reasoning over “right” motives and methods for weight loss, as well as acceptable levels of side effects. We discuss whether patients' strong willingness and effort to obtain and maintain access to GLP-1ra represent competing understandings of obesity and the pervasive stigma, fear and anxiety around body weight.