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Future Prospects of GLP-1–Based Biopharmaceuticals in Obesity and Diabetes Management: A Food and Biotechnology Perspective

Sraboni Akter Student Faculty of Engineering & Technology Department of Computer Science and Engineering (CSE) Shanto-Mariam University of Creative Technology Bangladesh Email: asraboni787@gmail.com ORCID: https://orcid.org/0009-0001-2277-9217

Dr Khandaker Mursheda Farhana Associate Professor Faculty of Humanities & Social Sciences Department of Sociology & Anthropology Shanto-Mariam University of Creative Technology Bangladesh Email: drfarhanamannan@gmail.com ORCID: https://orcid.org/0009-0009-1526-6147

Prof. Dr Kazi Abdul Mannan Department of Business Administration Faculty of Business Shanto-Mariam University of Creative Technology Dhaka, Bangladesh Email: drkaziabdulmannan@gmail.com ORCID: https://orcid.org/0000-0002-7123-132X

Corresponding author: Sraboni Akter: asraboni787@gmail.com

J. biotechnol. food eng.  2026, 4(1); https://doi.org/10.64907/xkmf.v4.i1.jbfe.1

Submission received: 11 October 2025 / Revised: 19 November 2025 / Accepted: 21 December 2025 / Published: 12 January 2026

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Abstract

The global rise in obesity and type 2 diabetes has intensified interest in glucagon-like peptide-1 (GLP-1)–based biopharmaceuticals as transformative metabolic therapies. While these agents demonstrate substantial efficacy in glycemic control, weight reduction, and cardiovascular risk mitigation, their long-term population-level impact depends on broader behavioural, food system, and policy contexts. This study explores the prospects of GLP-1–based therapies from an integrated food and biotechnology perspective using a qualitative research design. Semi-structured interviews were conducted with experts in endocrinology, nutrition science, biotechnology, and public health policy, followed by thematic analysis. Findings indicate that technological innovation—such as oral formulations and multi-agonist molecules—may improve scalability and patient acceptance, but sustainable outcomes require concurrent dietary quality improvement, supportive food environments, and healthcare system integration. Participants emphasised that pharmacotherapy facilitates but does not replace behavioural change and that inequitable access and regulatory fragmentation remain major barriers. The study concludes that GLP-1–based biopharmaceuticals should be embedded within interdisciplinary metabolic health strategies that align pharmaceutical innovation with nutrition policy and food system reform. Such alignment is essential for achieving durable and equitable reductions in metabolic disease burden worldwide.

Keywords: GLP-1 receptor agonists; obesity management; type 2 diabetes; biopharmaceutical innovation; food systems; qualitative research; metabolic health policy

1. Introduction and Rationale

The global prevalence of obesity and T2DM continues to escalate, contributing to rising morbidity, mortality, and health system burdens worldwide (Tu & Yu, 2025). Traditional lifestyle interventions, while foundational, often produce limited and unsustained benefits for many patients, prompting demand for efficacious pharmacological options. GLP-1 receptor agonists (GLP-1 RAs), originally developed for glycemic control in T2DM, have rapidly evolved to address obesity by modulating appetite and metabolic pathways (Alzahrani et al., 2025; Wang et al., 2025). This dual effect positions them uniquely at the intersection of metabolic disease management, food behaviour modification, and biotechnology innovation.

From a biotechnological standpoint, GLP-1 is a peptide hormone secreted by intestinal L-cells post-prandially, enhancing insulin secretion, suppressing glucagon, slowing gastric emptying, and inducing satiety (He et al., 2025). Synthetic GLP-1 RAs, such as semaglutide and tirzepatide, harness these mechanisms to deliver unprecedented clinical outcomes, including substantial weight loss and cardiometabolic risk reductions (Emerging Frontiers in GLP-1 Therapeutics, 2025). The rapid innovation pipeline incorporating oral formulations and multi-receptor agonists signals a new era for these biopharmaceuticals.

While the clinical efficacy of GLP-1 therapeutics is well documented, there remains an imperative to explore their integration within broader food science, biotechnology, and public health domains, particularly in shaping nutritional behaviours, production systems, and equitable healthcare delivery.

Despite the demonstrated medical effectiveness of GLP-1–based therapies in T2DM and obesity, several critical gaps endure:

• Sustainability of Weight Loss and Metabolic Benefit: Evidence indicates weight regain is common when GLP-1 therapy is discontinued, highlighting challenges with long-term behavioural change and maintenance (BMJ study; People.com, 2026).
• Integration with Food and Dietary Practices: Although GLP-1 agonists modulate appetite, their role within dietary strategies and food environment interventions remains underexplored in biotechnology and food systems research.
• Accessibility and Equity: High cost, limited access, and healthcare infrastructure challenges constrain global reach, particularly in low-income settings (WHO guidelines; Reuters, 2025).
• Biotechnological Innovation Adoption: Emerging modalities such as oral preparations and multi-agonist molecules require assessment of prospective impacts on therapeutic use, patient compliance, and food-derived peptide production technologies.

2. Theoretical Framework

This study is grounded in an interdisciplinary theoretical framework that integrates Diffusion of Innovation Theory, Technology Acceptance and Biotechnological Adoption Models, and Health Behaviour Change Theories, complemented by a socio-ecological perspective on food systems and health. This combined framework is appropriate for examining the prospects of GLP-1–based biopharmaceuticals because their effectiveness and sustainability depend not only on pharmacological efficacy but also on behavioural, technological, regulatory, and food-environment interactions.

2.1 Diffusion of Innovation Theory

Diffusion of Innovation (DOI) Theory, proposed by Rogers (2003), explains how new technologies spread through populations over time via communication channels within social systems. The theory identifies five key attributes influencing adoption: relative advantage, compatibility, complexity, trialability, and observability. These constructs are particularly relevant to GLP-1–based therapies, which represent disruptive biomedical innovations in both obesity and diabetes management.

GLP-1 receptor agonists demonstrate a strong relative advantage compared to conventional antidiabetic agents due to superior weight loss, glycemic control, and cardiovascular protection. However, issues of complexity (injectable delivery, dose titration, gastrointestinal side effects) and limited trialability in low-resource settings may slow adoption. New oral GLP-1 formulations and multi-agonist compounds reduce complexity and enhance compatibility with routine dietary and lifestyle practices, potentially accelerating diffusion into broader healthcare and consumer markets.

DOI theory also highlights the role of institutional and professional networks in accelerating uptake. Endocrinology guidelines, pharmaceutical marketing, and digital health platforms act as diffusion agents, influencing clinicians and patients. From a food systems perspective, DOI suggests that acceptance of GLP-1 therapies may reshape dietary norms, portion sizes, and food demand patterns, indirectly influencing food industry reformulation strategies.

2.2 Technology Acceptance and Biotechnological Adoption Models

While DOI explains macro-level diffusion, individual-level adoption is better explained by the Technology Acceptance Model (TAM) and broader biotechnological acceptance frameworks. TAM proposes that perceived usefulness and perceived ease of use predict user acceptance (Davis, 1989). In healthcare, these constructs translate into patient beliefs regarding therapeutic benefit, safety, convenience, and lifestyle compatibility.

GLP-1 therapies are perceived as highly useful due to clinically observable weight loss and improved metabolic markers. However, barriers such as injection anxiety, gastrointestinal adverse effects, and cost reduce perceived ease of use. Biotechnological adoption models extend TAM by incorporating regulatory trust, ethical acceptability, cultural beliefs, and economic accessibility (Siegrist & Hartmann, 2020). These factors are especially relevant when biopharmaceuticals influence eating behaviour and body image, areas deeply embedded in cultural norms.

Moreover, biotechnology diffusion is shaped by supply-chain scalability and manufacturing platforms, including peptide synthesis technologies, cold-chain logistics, and emerging small-molecule GLP-1 agonist production. These technological infrastructures determine affordability and accessibility, thereby influencing long-term public health impact. Thus, prospects of GLP-1 therapies depend not only on molecular innovation but also on industrial biotechnology capacity and regulatory harmonisation.

2.3 Health Behaviour Change Theories

Pharmacological appetite suppression does not automatically translate into sustainable lifestyle change. Therefore, this study integrates Health Behaviour Change Theories, particularly the Health Belief Model (HBM) and Social Cognitive Theory (SCT).

HBM posits that health behaviours are influenced by perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy (Rosenstock et al., 1988). GLP-1 therapy may increase perceived benefits by producing visible weight loss, but barriers such as nausea, dependency concerns, and long-term cost may reduce adherence. Importantly, without improvements in dietary literacy and food environment, patients may not sustain healthy behaviours once medication is discontinued.

SCT emphasises reciprocal determinism between individual behaviour, environmental influences, and cognitive factors such as self-efficacy (Bandura, 1986). From this perspective, GLP-1 medications act as biological facilitators that reduce physiological hunger signals, enabling behavioural change, but sustained outcomes require supportive food environments, social support, and positive reinforcement. Thus, medication is viewed as an enabling tool rather than a replacement for nutritional behaviour modification.

These theories collectively highlight that pharmacological efficacy alone cannot ensure long-term obesity prevention; rather, therapeutic success depends on interactions between medication, food availability, psychosocial support, and health education.

2.4 Socio-Ecological and Food Systems Perspective

To bridge biomedical and food science domains, the framework incorporates the Socio-Ecological Model (SEM), which recognises that health outcomes are shaped by interactions across individual, interpersonal, community, institutional, and policy levels (Bronfenbrenner, 1994). GLP-1 therapies operate primarily at the biological and individual behaviour levels, but their ultimate effectiveness is mediated by broader food systems, urban food access, marketing practices, and nutrition policies.

From a food biotechnology standpoint, SEM underscores the need to align pharmacotherapy with dietary quality improvements, functional food innovation, and public health nutrition strategies. For example, appetite suppression without nutrient-dense food availability may lead to malnutrition risks, while reformulated foods with lower energy density may synergise with GLP-1 therapy to enhance long-term metabolic stability.

Policy-level interventions, such as insurance coverage, essential medicine listing, and price regulation, further shape access and sustained use. Therefore, the socio-ecological framework allows analysis of GLP-1 therapies not merely as medical products but as components of integrated metabolic health ecosystems.

2.5 Integrative Conceptual Model

Together, these theories form an integrative conceptual model in which:

• Biotechnological innovation drives therapeutic capability (TAM, biotechnology adoption),
• Healthcare systems and professional networks determine diffusion (DOI),
• Patient behaviour and food practices shape long-term outcomes (HBM, SCT),
• Policy and food environments moderate equity and sustainability (SEM).

This multi-level framework is particularly suited to qualitative inquiry, as it allows exploration of stakeholder perceptions, institutional barriers, and food-health interactions that are not captured by clinical trials alone.

3. Literature Review

3.1 Global Burden of Obesity and Type 2 Diabetes

Obesity and type 2 diabetes mellitus (T2DM) are among the most pressing public health challenges worldwide. According to the World Health Organisation (WHO, 2023), global obesity has nearly tripled since 1975, while the International Diabetes Federation (IDF, 2023) estimates that over 537 million adults currently live with diabetes, with projections reaching 783 million by 2045. These conditions are strongly interlinked, as excess adiposity contributes to insulin resistance, dyslipidemia, chronic inflammation, and progressive β-cell dysfunction (Kahn et al., 2014).

Traditional management strategies have focused on lifestyle modification, including calorie restriction and increased physical activity, alongside pharmacological glycemic control. However, long-term adherence to lifestyle interventions remains limited, and many glucose-lowering medications fail to address the underlying obesity that exacerbates disease progression (Lean et al., 2018). This therapeutic gap has intensified interest in agents that simultaneously address both metabolic dysregulation and appetite control, positioning GLP-1–based therapies as a breakthrough in metabolic medicine.

3.2 Physiology of GLP-1 and Mechanisms of Action

Glucagon-like peptide-1 (GLP-1) is an incretin hormone secreted by intestinal L-cells in response to nutrient intake. It enhances glucose-dependent insulin secretion, suppresses glucagon release, delays gastric emptying, and activates satiety centres in the hypothalamus (Holst, 2007). These integrated actions regulate postprandial glucose metabolism and reduce energy intake.

In individuals with T2DM, endogenous GLP-1 secretion and activity are often impaired, contributing to postprandial hyperglycemia (Nauck & Meier, 2019). GLP-1 receptor agonists (GLP-1 RAs) mimic the physiological effects of endogenous GLP-1 while resisting enzymatic degradation by dipeptidyl peptidase-4 (DPP-4), thereby extending biological activity (Meier, 2012). Beyond pancreatic effects, GLP-1 receptors are expressed in the cardiovascular system, kidneys, and central nervous system, explaining the pleiotropic benefits observed in clinical trials, including cardioprotection and neuroendocrine regulation of appetite (Drucker, 2018).

From a food and nutrition science perspective, GLP-1 plays a central role in meal termination and post-meal satiety, linking gastrointestinal nutrient sensing with central appetite regulation. This highlights the biological interface between dietary intake patterns and pharmacological appetite modulation, supporting the relevance of GLP-1 therapies within broader food system discussions.

3.3 Clinical Effectiveness of GLP-1–Based Therapies

Multiple randomised controlled trials have demonstrated that GLP-1 RAs significantly improve glycemic control and induce clinically meaningful weight loss. Semaglutide and liraglutide reduce HbA1c by approximately 1.0–1.8% and promote average weight loss of 10–15% in obese patients (Wilding et al., 2021; Davies et al., 2015). More recently, dual incretin agonists such as tirzepatide, targeting both GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptors, have achieved weight loss exceeding 20% in some populations (Jastreboff et al., 2022).

Importantly, GLP-1 RAs also demonstrate cardiovascular risk reduction, including lower incidence of major adverse cardiovascular events, independent of weight loss (Marso et al., 2016). This has elevated GLP-1 therapies from glucose-lowering agents to disease-modifying metabolic treatments.

However, concerns remain regarding sustainability. Long-term follow-up studies indicate that discontinuation often results in weight regain and deterioration of metabolic markers, emphasising the chronic nature of obesity and the need for sustained intervention strategies (Rubino et al., 2021). This raises questions about dependence on pharmacotherapy versus integration with lifestyle and dietary systems.

3.4 Advances in Biopharmaceutical and Food Biotechnology Applications

The biotechnology pipeline is rapidly expanding beyond injectable peptide therapies. Oral GLP-1 receptor agonists and small-molecule agonists are under development to overcome barriers associated with injections and cold-chain storage (Tu & Yu, 2024). These advances are expected to significantly expand patient access and adherence, particularly in primary care and resource-limited settings.

Additionally, research into multi-agonist molecules combining GLP-1, GIP, and glucagon receptor activity aims to enhance energy expenditure alongside appetite suppression (Müller et al., 2019). Such compounds represent a shift toward metabolic reprogramming rather than simple appetite control.

From a food biotechnology perspective, interest is growing in bioactive peptides, functional foods, and nutraceuticals that stimulate endogenous GLP-1 secretion through dietary pathways, such as protein hydrolysates, fermentable fibres, and microbiome-mediated metabolites (Zhao et al., 2020). These strategies suggest future convergence between pharmacological therapy and functional nutrition, enabling dietary modulation to complement pharmaceutical GLP-1 action.

3.5 Behavioural and Dietary Implications of GLP-1 Therapy

GLP-1 therapies influence food preferences, portion sizes, and reward pathways associated with eating behaviour (van Bloemendaal et al., 2014). Patients frequently report reduced cravings for high-fat and high-sugar foods, which may facilitate dietary adherence. However, qualitative studies indicate that medication-induced appetite suppression does not automatically translate into improved dietary quality or nutritional adequacy (Astbury et al., 2023).

Moreover, concerns have emerged regarding inadequate protein intake, micronutrient deficiencies, and muscle loss among patients experiencing rapid weight reduction (Cava et al., 2023). This highlights the need for integrated dietary counselling and food-based interventions to ensure metabolic health preservation.

Behavioural science literature emphasises that sustained weight management requires environmental restructuring, habit formation, and social support, not solely pharmacological appetite suppression (Hall & Kahan, 2018). Therefore, GLP-1 therapies should be embedded within multidisciplinary obesity management frameworks that include nutrition education and food environment modification.

3.6 Socio-Economic and Access Considerations

Despite clinical success, GLP-1 therapies remain expensive and unevenly distributed globally. High manufacturing costs, patent protections, and insurance restrictions limit access in low- and middle-income countries (WHO, 2024). Even within high-income countries, off-label use and supply shortages have intensified inequities between diabetes patients and individuals seeking obesity treatment.

Health economics studies suggest that long-term cost savings from reduced cardiovascular and diabetes complications may justify public investment in GLP-1 therapies, but upfront costs pose policy challenges (Ikramuddin et al., 2022). Ethical concerns also arise regarding the medicalisation of obesity in societies where food systems promote unhealthy dietary patterns, raising questions about shifting responsibility from structural prevention to pharmaceutical treatment.

3.7 Policy and Regulatory Perspectives

Recent global health policy statements recognise obesity as a chronic disease requiring long-term medical management (WHO, 2024). This has expanded regulatory support for GLP-1 therapies, but also increased scrutiny regarding long-term safety, off-label prescribing, and marketing practices.

Regulatory agencies increasingly require real-world evidence on long-term outcomes, quality of life, and discontinuation effects. Additionally, integration into national essential medicine lists remains limited, restricting availability in public health systems. Policy scholars argue that pharmaceutical innovation must be accompanied by nutrition policy reforms, food labelling regulations, and urban planning strategies to create synergistic metabolic health environments (Swinburn et al., 2019).

3.8 Research Gaps and Emerging Directions

While biomedical efficacy is well established, several gaps persist in the literature:

• Limited qualitative research on patient experiences, food behaviours, and social impacts of GLP-1 therapy.
• Insufficient integration of food system interventions with pharmacotherapy in obesity management models.
• Lack of long-term studies assessing the combined effects of GLP-1 therapy and dietary restructuring.
• Minimal exploration of biotechnological food products designed to stimulate endogenous incretin pathways.

These gaps justify qualitative inquiry into expert perspectives, patient experiences, and policy environments, aligning with the present study’s methodological approach.

4. Conceptual Framework

4.1 Overview of the Conceptual Framework

The conceptual framework of this study integrates biomedical innovation, behavioural responses, food system influences, and policy environments to explain how GLP-1–based biopharmaceuticals impact obesity and diabetes management outcomes. Unlike traditional clinical models that focus primarily on pharmacodynamics, this framework adopts a multi-level systems approach, recognising that therapeutic effectiveness emerges from interactions between biological mechanisms, patient behaviour, technological accessibility, and socio-economic structures (Bronfenbrenner, 1994; Swinburn et al., 2019).

The framework is informed by Diffusion of Innovation Theory, Health Behaviour Change Models, and socio-ecological perspectives. It conceptualises GLP-1 therapies not only as metabolic regulators but also as agents influencing dietary practices, food demand, and healthcare delivery systems.

4.2 Conceptual Framework Figure (Narrative Description)

Biotechnological Innovation as the Enabling Mechanism: At the foundational level, advances in peptide engineering, receptor selectivity, and pharmacokinetics determine the physiological effectiveness of GLP-1 therapies (Drucker, 2018). Emerging oral formulations and small-molecule agonists enhance convenience and expand patient eligibility, which influences adoption rates and continuity of care (Tu & Yu, 2024). However, technological efficacy alone does not guarantee population-level impact without systemic integration.

Figure 1 illustrates four interrelated domains influencing metabolic health outcomes:

Healthcare Systems and Policy as Structural Gatekeepers: Healthcare delivery systems regulate access through clinical protocols, reimbursement policies, and essential medicine listing. Diffusion of Innovation theory suggests that institutional endorsement accelerates technology adoption, while fragmented systems inhibit equitable dissemination (Rogers, 2003). Pricing strategies and patent frameworks further shape availability in low- and middle-income countries, creating stratified access landscapes (WHO, 2024).

Food Environment and Dietary Behaviour as Sustainability Drivers: GLP-1 therapies alter appetite and meal patterns, but food choices remain contingent on environmental factors such as affordability of healthy foods, urban food deserts, and cultural dietary norms (Swinburn et al., 2019). Without parallel improvements in dietary quality, pharmacologically induced caloric reduction may not yield optimal metabolic health. Thus, food systems function as moderators of therapeutic sustainability.

Individual and Psychosocial Factors as Behavioural Mediators: Health behaviour models emphasise perceived benefits, treatment confidence, and social reinforcement as determinants of adherence (Rosenstock et al., 1988; Bandura, 1986). Weight stigma, fear of dependency, and concerns about long-term medication use influence willingness to initiate and continue GLP-1 therapy. These psychosocial dynamics mediate real-world effectiveness beyond clinical trial settings.

At the centre of the framework lies Metabolic Health Outcomes, including glycemic control, weight reduction, cardiovascular risk modification, and quality of life. Arrows between domains indicate bidirectional interactions, signifying that changes in food environments or policy incentives can amplify or diminish the therapeutic effectiveness of GLP-1 interventions.

4.4 Integrative Pathways and Outcome Expectations

The framework proposes that optimal metabolic outcomes occur when biotechnological innovation aligns with supportive healthcare policies and health-promoting food environments, reinforced by patient empowerment and social support. Conversely, disconnections among these domains result in fragmented care, weight regain, and inequitable health benefits. This conceptualisation justifies qualitative exploration of stakeholder perceptions across clinical, biotechnological, and food systems sectors.

5. Expanded Methodology

5.1 Research Design

This study employed a qualitative, exploratory research design grounded in phenomenological and interpretivist paradigms to understand how stakeholders perceive the evolving role of GLP-1–based biopharmaceuticals within obesity and diabetes management. Qualitative inquiry is particularly suitable for examining complex health technologies embedded in social, institutional, and behavioural contexts (Creswell & Poth, 2018).

The research aimed to capture lived experiences, professional judgments, and systemic insights that are not accessible through quantitative clinical outcome measures.

5.2 Sampling Strategy and Participants

A purposive sampling strategy was employed to recruit participants with direct professional engagement in metabolic disease management, biotechnology development, or food and nutrition policy. Snowball sampling was used to identify additional experts with specialised knowledge of GLP-1 therapies.

Participants (n = 25) were drawn from four professional groups:

• Endocrinologists and metabolic disease specialists
• Pharmaceutical scientists and biotechnologists
• Food scientists and nutrition researchers
• Health policy analysts and public health practitioners

This interdisciplinary sampling ensured representation of biomedical, food system, and policy perspectives, supporting triangulation across domains.

Participants were required to have at least five years of professional experience in relevant fields and active involvement in research, clinical practice, or policy development related to metabolic health or pharmaceutical innovation.

5.3 Data Collection Procedures

Primary data were collected through semi-structured interviews conducted via video conferencing platforms. An interview guide was developed based on the theoretical and conceptual frameworks, covering themes such as:

• Perceived future directions of GLP-1 biotechnology
• Integration with dietary and food system interventions
• Barriers to access and patient adherence
• Policy and regulatory implications

Interviews lasted between 45 and 75 minutes and were audio-recorded with participant consent.

To enhance contextual understanding, policy reports, regulatory guidelines, and recent scientific reviews on GLP-1 therapies were systematically analysed. Document analysis served to corroborate interview data and identify institutional narratives surrounding pharmacological obesity treatment.

5.4 Data Analysis and Coding Procedures

Data were analysed using reflexive thematic analysis as outlined by Braun and Clarke (2006). Analysis followed six iterative phases:

• Familiarisation with data
• Initial code generation
• Theme development
• Theme review
• Theme definition and naming
• Integration with theoretical framework

NVivo software facilitated the organisation and retrieval of coded data segments.

Both deductive and inductive coding approaches were applied. Deductive codes were derived from the conceptual framework domains (e.g., biotechnology, food environment, policy), while inductive coding captured emergent themes such as patient stigma, pharmaceutical marketing influence, and digital health monitoring integration.

To enhance credibility, multiple strategies were employed:

• Triangulation across interview and document data
• Member checking with selected participants
• Peer debriefing among research team members

Dependability was supported through detailed audit trails documenting analytic decisions, while reflexivity journals were maintained to minimise researcher bias.

5.5 Ethical Considerations

Participants provided informed consent and were assured of confidentiality and voluntary participation. Data were anonymised and securely stored in encrypted digital systems, consistent with international ethical research standards (Creswell & Poth, 2018).

6. Results and Thematic Findings

This section presents the major findings derived from semi-structured interviews and document analysis, organised into five overarching themes: biotechnological innovation and therapeutic evolution, patient experience and behavioural adaptation, food environment and dietary implications, healthcare system and access challenges, and policy, ethics, and long-term sustainability. These themes reflect the multi-level conceptual framework and illustrate how GLP-1–based biopharmaceuticals operate within biological, social, and institutional ecosystems.

6.1 Biotechnological Innovation and Therapeutic Evolution

Participants consistently emphasised that GLP-1 therapies are undergoing rapid technological transformation, shifting from peptide injections to oral formulations and multi-receptor agonists. Biotechnologists highlighted that pharmaceutical innovation is now targeting not only glycemic control but also energy expenditure and metabolic flexibility.

Several respondents described multi-agonist molecules (GLP-1/GIP/glucagon) as representing a paradigm shift toward “metabolic reprogramming,” rather than appetite suppression alone. This aligns with emerging evidence that polyagonist therapies may enhance lipid metabolism and thermogenesis (Müller et al., 2019). Experts noted that such agents may reduce reliance on strict caloric restriction by altering substrate utilisation at the cellular level.

Oral GLP-1 receptor agonists and small-molecule compounds were widely perceived as crucial for future scalability. Injectable therapies were considered effective but socially and logistically burdensome, particularly in primary care and low-resource settings. Participants stressed that oral delivery could improve adherence, reduce stigma, and enable integration into routine medication regimens, thereby accelerating diffusion across healthcare systems, consistent with diffusion of innovation theory (Rogers, 2003).

However, concerns were raised about long-term safety data for novel agents, particularly regarding cardiovascular and gastrointestinal effects. Experts called for post-marketing surveillance and real-world evidence generation to complement clinical trials, echoing regulatory recommendations (WHO, 2024).

6.2 Patient Experience and Behavioural Adaptation

A dominant theme across clinical respondents was that GLP-1 therapies profoundly alter patients’ subjective experience of hunger and food motivation. Patients reportedly describe feeling “neutral” toward food, reduced cravings for energy-dense foods, and diminished emotional eating. These effects were viewed as enabling initial behavioural change, particularly in individuals with longstanding obesity who previously struggled with dietary control.

However, clinicians noted that pharmacologically induced satiety does not necessarily translate into healthy food choices. Some patients reduce overall intake but continue to consume nutritionally poor diets, raising concerns about micronutrient deficiencies and lean mass loss during rapid weight reduction. This finding corresponds with emerging clinical evidence indicating risk of sarcopenia and inadequate protein intake during pharmacological weight loss (Cava et al., 2023).

Behavioural scientists emphasised that sustainable weight management requires habit formation and environmental restructuring, not only biological appetite suppression. Several experts reported that patients who did not receive dietary counselling were more likely to regain weight after discontinuation of therapy, supporting findings that GLP-1 withdrawal frequently leads to metabolic relapse (Rubino et al., 2021).

Psychosocial dynamics also emerged strongly. While some patients experience empowerment and improved self-efficacy, others fear dependency on lifelong medication or experience social stigma related to pharmaceutical weight loss. These attitudes influence adherence and long-term engagement with treatment, consistent with Health Belief Model constructs of perceived barriers and benefits (Rosenstock et al., 1988).

6.3 Food Environment and Dietary Implications

Food scientists and nutrition policy experts emphasised that GLP-1 therapies operate within highly obesogenic food environments. While medications reduce appetite, they do not modify food availability, marketing practices, or socio-economic constraints that shape dietary behaviour. Participants argued that without food system reforms, pharmacotherapy risks becoming a compensatory strategy for structural nutritional failures.

Several experts noted opportunities for synergy between GLP-1 therapies and functional foods that stimulate endogenous incretin secretion, including fermentable fibres, protein hydrolysates, and microbiome-targeted dietary interventions. These strategies were seen as complementary rather than competitive with pharmacological approaches (Zhao et al., 2020).

However, some respondents warned that appetite suppression could inadvertently reduce the consumption of nutrient-dense foods if patients prioritise convenience foods due to reduced motivation to prepare meals. This highlights the importance of integrating nutrition education and food accessibility into obesity pharmacotherapy programs.

Food industry implications were also discussed. Reduced caloric demand among GLP-1 users may influence product reformulation and portion sizing trends. Experts predicted increased demand for high-protein, nutrient-dense foods to prevent muscle loss during weight reduction, suggesting future shifts in food product development.

These findings reinforce socio-ecological models asserting that health interventions must align with environmental and policy contexts to achieve sustainable population-level impact (Swinburn et al., 2019).

6.4 Healthcare System and Access Challenges

All stakeholder groups identified access and affordability as major constraints on the public health potential of GLP-1 therapies. Clinicians reported that insurance restrictions often limit prescriptions to advanced diabetes cases, excluding individuals with obesity alone despite clinical eligibility. This results in delayed intervention and missed prevention opportunities.

Health policy participants highlighted that global access disparities are substantial, with most low- and middle-income countries lacking coverage for obesity pharmacotherapy. High manufacturing costs, patent protections, and limited local production capacity exacerbate inequities (WHO, 2024).

Supply shortages and off-label demand for cosmetic weight loss were also identified as threats to the continuity of care for diabetes patients. Several respondents criticised the lack of coordinated regulatory oversight of marketing practices, which may distort therapeutic priorities.

From a systems perspective, participants emphasised that primary care providers often lack training in obesity pharmacotherapy and integrated lifestyle counselling. This leads to fragmented care, with pharmacological treatment delivered without sufficient behavioural support.

Economic analyses discussed by experts suggest that long-term reductions in cardiovascular events may offset drug costs, but budget constraints discourage public investment. This disconnect between long-term societal benefits and short-term healthcare financing remains a critical barrier to policy adoption (Ikramuddin et al., 2022).

6.5 Policy, Ethics, and Long-Term Sustainability

Ethical considerations featured prominently in participant narratives. While many viewed GLP-1 therapies as legitimate medical treatments for chronic disease, concerns were raised about the over-medicalisation of conditions rooted in social and environmental determinants.

Several public health experts argued that pharmaceutical dominance may divert attention from food policy reforms, urban design, and socioeconomic inequalities that drive obesity prevalence. They cautioned that reliance on medication could normalise unhealthy food systems rather than incentivise structural change.

Nonetheless, most participants supported a hybrid approach in which pharmacotherapy complements, rather than replaces, prevention strategies. They advocated for policies that integrate GLP-1 therapies into comprehensive metabolic health programs, including nutrition education, physical activity promotion, and food security interventions.

Regulatory experts stressed the need for long-term outcome data on morbidity, mortality, and quality of life, not merely weight loss metrics. They emphasised that future approvals should incorporate patient-reported outcomes and functional health indicators.

Sustainability was also framed in economic terms. Long-term treatment dependency raises questions about healthcare affordability, particularly as obesity prevalence continues to rise. Participants called for differential pricing models, public–private manufacturing partnerships, and global licensing mechanisms to expand access while maintaining innovation incentives.

6.6 Integration of Findings with Conceptual Framework

The thematic findings validate the multi-level conceptual framework guiding this study. Biotechnological innovation was confirmed as a necessary but insufficient condition for population-level metabolic health improvement. Healthcare systems and policy structures emerged as decisive gatekeepers of access and continuity of care. Food environments and dietary behaviours moderated long-term outcomes, while psychosocial factors mediated individual adherence and perception of treatment legitimacy.

These interacting domains illustrate that GLP-1 therapies function within complex socio-biological systems, where therapeutic success depends on coordinated interventions across technology, policy, nutrition, and behavioural health sectors. This reinforces calls for interdisciplinary models of obesity and diabetes management that extend beyond pharmacology alone (Hall & Kahan, 2018).

6.7 Implications for Future Research and Practice

The results suggest several implications:

• Clinical practice should integrate GLP-1 therapy with structured nutritional and behavioural counselling to preserve lean mass and promote sustainable dietary habits.
• Biotechnology development should prioritise oral and long-acting formulations to enhance accessibility and adherence.
• Food system interventions should be aligned with pharmacotherapy to ensure nutrient adequacy during appetite suppression.
• Policy frameworks must address pricing, insurance inclusion, and ethical marketing to prevent widening health disparities.

These findings justify continued qualitative and mixed-methods research to evaluate patient experiences, social consequences, and food system interactions associated with long-term GLP-1 use.

7. Discussion

This study explored the prospects of GLP-1–based biopharmaceuticals in obesity and diabetes management from an integrated food and biotechnology perspective. The qualitative findings demonstrate that while pharmacological innovation has substantially improved metabolic outcomes, long-term effectiveness and population-level impact depend on behavioural, food system, healthcare, and policy contexts. This section discusses the findings in relation to the theoretical framework—Diffusion of Innovation Theory, Technology Acceptance and Biotechnological Adoption Models, Health Behaviour Change Theories, and the Socio-Ecological Model—and situates them within existing empirical literature.

7.1 Biotechnological Innovation and Diffusion of GLP-1 Therapies

Findings indicate strong optimism regarding oral formulations and multi-agonist molecules, which participants perceived as critical for scaling adoption. This aligns closely with Diffusion of Innovation Theory, which posits that technologies with lower complexity and higher compatibility diffuse more rapidly (Rogers, 2003). Injectable GLP-1 receptor agonists, while clinically effective, introduce psychological barriers (needle aversion), logistical complexity (storage requirements), and social stigma, limiting trialability and long-term adherence.

Recent pharmaceutical developments toward small-molecule oral GLP-1 agonists and dual or triple receptor agonists may reduce perceived barriers and enhance adoption across broader patient populations (Tu & Yu, 2024; Müller et al., 2019). Participants’ emphasis on manufacturing scalability further supports biotechnology adoption models that consider industrial capacity and supply-chain stability as determinants of technology diffusion (Siegrist & Hartmann, 2020).

However, participants also stressed the importance of post-marketing surveillance and long-term safety data, reflecting concerns echoed in regulatory literature. While clinical trials demonstrate cardiovascular benefits and weight loss, less is known about lifelong metabolic modulation and potential endocrine adaptations (Drucker, 2018). These concerns may slow institutional endorsement and guideline expansion, illustrating how diffusion is mediated not only by technological superiority but also by regulatory confidence.

7.2 Technology Acceptance, Patient Perception, and Adherence

The study revealed that the perceived usefulness of GLP-1 therapies is high due to rapid and visible weight loss and glycemic improvement, consistent with Technology Acceptance Model predictions (Davis, 1989). However, perceived ease of use remains variable due to side effects, injection requirements, and concerns about medication dependency.

Biotechnological acceptance frameworks extend TAM by incorporating ethical trust and cultural compatibility (Siegrist & Hartmann, 2020). Several participants noted patient apprehension about relying on medication for weight control, reflecting moral narratives around self-discipline and stigma associated with obesity. These sociocultural beliefs may influence willingness to initiate or continue therapy despite clinical benefits.

These findings support previous qualitative studies showing that patients often view obesity pharmacotherapy as a last resort rather than a legitimate chronic disease treatment (Astbury et al., 2023). Such attitudes can undermine sustained engagement, particularly when side effects occur or when weight loss plateaus. Therefore, improving public understanding of obesity as a biological and environmental disease is essential for increasing acceptance of pharmacological interventions.

7.3 Health Behaviour Change and Sustainability of Outcomes

Health Behaviour Change theories emphasise that physiological appetite suppression alone cannot sustain long-term behaviour modification (Rosenstock et al., 1988; Bandura, 1986). The present findings strongly support this premise. Participants reported that while GLP-1 therapies facilitate initial reductions in energy intake, dietary quality does not necessarily improve without structured nutritional counselling.

This supports literature indicating that behavioural capability, self-efficacy, and environmental reinforcement remain critical determinants of sustained weight management (Hall & Kahan, 2018). Moreover, rapid pharmacological weight loss may lead to lean mass reduction and micronutrient deficiencies, highlighting the need for concurrent dietary strategies that prioritise protein intake and nutrient density (Cava et al., 2023).

Social Cognitive Theory emphasises reciprocal determinism between personal factors, environment, and behaviour (Bandura, 1986). Participants’ observations that supportive food environments and social reinforcement enhance treatment outcomes underscore this interaction. Without accessible, healthy foods or supportive family structures, medication benefits may be transient.

These insights align with long-term clinical evidence showing that discontinuation of GLP-1 therapy frequently results in weight regain and metabolic deterioration (Rubino et al., 2021). Therefore, pharmacotherapy should be viewed as a facilitator of behavioural change rather than a substitute for lifestyle interventions.

7.4 Food Systems as Moderators of Therapeutic Effectiveness

A major contribution of this study is highlighting the role of food systems in moderating pharmacological effectiveness. While GLP-1 therapies operate at the biological level, food environments determine dietary choices and nutrient adequacy. This aligns with socio-ecological models that locate health behaviours within multilayered environmental contexts (Bronfenbrenner, 1994; Swinburn et al., 2019).

Participants emphasised that appetite suppression may reduce overall caloric intake but does not guarantee consumption of nutrient-dense foods. In food deserts or low-income settings, reduced hunger may simply reduce meal frequency without improving diet quality, potentially exacerbating micronutrient deficiencies.

The literature increasingly recognises the potential synergy between pharmacotherapy and functional foods that stimulate endogenous incretin secretion, including dietary fibres and microbiome-modulating interventions (Zhao et al., 2020). Such approaches could reduce pharmaceutical dosage requirements and improve metabolic resilience, particularly in preventive contexts.

However, commercialisation of such functional foods remains limited, and regulatory frameworks often treat them separately from pharmaceutical therapies. This regulatory fragmentation limits opportunities for integrated metabolic health strategies.

7.5 Healthcare Systems and Structural Barriers to Access

Consistent with global policy analyses, participants identified cost and insurance limitations as dominant barriers to equitable access. Despite strong clinical evidence, GLP-1 therapies remain financially inaccessible to large segments of the global population (WHO, 2024).

From a diffusion perspective, this represents a failure of institutional compatibility rather than technological inadequacy (Rogers, 2003). When reimbursement policies and essential medicine lists lag behind clinical guidelines, diffusion stalls at early-adopter stages.

Participants also highlighted workforce limitations, noting that many primary care providers lack training in obesity pharmacotherapy and behavioural counselling. This supports existing concerns that obesity treatment remains marginalised within medical education and practice (Ikramuddin et al., 2022).

Moreover, off-label cosmetic use has strained supply chains, diverting medications from patients with metabolic disease. This phenomenon illustrates how market forces can distort therapeutic priorities, reinforcing the need for stronger regulatory oversight and ethical marketing practices.

7.6 Ethical Tensions and Medicalisation of Obesity

Ethical debates surrounding GLP-1 therapies emerged prominently in the findings. While participants recognised obesity as a chronic disease requiring medical management, concerns persisted regarding pharmaceutical dominance over structural prevention strategies.

This tension reflects broader debates in public health about medicalisation versus environmental reform (Swinburn et al., 2019). Pharmaceutical solutions may inadvertently legitimise unhealthy food environments by shifting responsibility from industry and policymakers to individuals and clinicians.

However, participants largely supported a complementary approach, where pharmacotherapy functions alongside nutrition policy, urban planning, and food system reform. This aligns with systems-based approaches to chronic disease prevention, which emphasise multi-sectoral interventions (WHO, 2024).

Ethical concerns also included long-term dependence and unknown metabolic consequences of lifelong incretin modulation. Although current evidence suggests cardiovascular benefit, participants emphasised the importance of monitoring musculoskeletal health, neuroendocrine adaptation, and quality of life outcomes beyond weight loss metrics.

7.7 Integration with Theoretical Framework

The findings strongly validate the study’s multi-theoretical framework:

• Diffusion of Innovation Theory explains how oral formulations and simplified delivery systems may accelerate adoption, while institutional barriers slow diffusion.
• Technology Acceptance Models illuminate patient perceptions of usefulness and ease of use, moderated by cultural beliefs and stigma.
• Health Behaviour Change Theories explain why pharmacological appetite suppression must be supported by environmental and cognitive reinforcement.
• Socio-Ecological Models contextualise pharmacotherapy within food systems, healthcare infrastructure, and policy environments.

Together, these theories illustrate that GLP-1 therapies function as socio-biological interventions rather than isolated medical technologies. Their ultimate impact depends on coordinated change across technological, behavioural, and structural domains.

7.8 Implications for Interdisciplinary Research and Practice

The study underscores the necessity of interdisciplinary collaboration between endocrinology, nutrition science, food technology, behavioural psychology, and health policy. Pharmaceutical innovation alone cannot resolve metabolic disease if food systems and social determinants remain unchanged.

For practice, clinicians should integrate GLP-1 therapy with nutrition counselling and physical activity support. For biotechnology development, emphasis should be placed on affordable manufacturing and alternative delivery systems. For food science, opportunities exist to develop complementary functional foods that enhance metabolic regulation.

Policy implications include expanding insurance coverage, regulating off-label marketing, and integrating obesity pharmacotherapy into national non-communicable disease strategies.

7.9 Limitations and Transferability

As a qualitative study, findings are not statistically generalizable but offer analytical generalisation to similar healthcare and food system contexts. Participant perspectives may reflect professional biases toward biomedical or policy priorities. However, triangulation across disciplines strengthens the credibility of conclusions.

Future studies employing mixed methods and longitudinal designs could quantify behavioural changes, dietary quality, and healthcare utilisation patterns associated with long-term GLP-1 therapy.

Overall, this discussion highlights that GLP-1–based biopharmaceuticals represent a transformative but incomplete solution to global metabolic disease. Their success will depend not only on molecular innovation but also on reshaping food environments, healthcare delivery systems, and societal attitudes toward obesity and chronic disease management.

8. Conclusion and Future Research Directions

This study examined the prospects of GLP-1–based biopharmaceuticals in obesity and diabetes management through an integrated food and biotechnology lens. The findings suggest that while GLP-1 receptor agonists and multi-agonist therapies represent major pharmacological advances, their long-term effectiveness and population-level impact are contingent upon broader systemic factors, including food environments, healthcare infrastructure, regulatory frameworks, and sociocultural attitudes toward obesity. Pharmacological innovation alone cannot sustainably reverse the global burden of metabolic disease without coordinated behavioural, nutritional, and policy interventions.

From a biotechnology perspective, future development should prioritise oral and long-acting formulations, scalable manufacturing platforms, and combination therapies that target multiple metabolic pathways. Advances in peptide engineering, small-molecule agonists, and synthetic biology may reduce production costs and enhance global accessibility. Additionally, research into nutraceuticals and functional foods that stimulate endogenous incretin secretion offers promising complementary strategies, potentially enabling lower pharmaceutical dosages and earlier preventive interventions. Integration of microbiome-targeted approaches may further personalise metabolic therapies and enhance treatment durability.

Policy implications are equally critical. Governments and health systems must recognise obesity and type 2 diabetes as chronic, relapsing diseases requiring long-term management rather than short-term lifestyle correction. Inclusion of GLP-1–based therapies in essential medicine lists, expansion of insurance coverage, and regulation of off-label cosmetic use are necessary to ensure equitable access for patients with clinical need. Moreover, workforce training in obesity medicine and nutrition counselling should be strengthened to support integrated treatment models that combine pharmacotherapy with behavioural and dietary interventions.

Future research should adopt mixed-methods and longitudinal designs to assess not only metabolic outcomes but also dietary quality, physical function, mental health, and socioeconomic impacts of long-term GLP-1 therapy. Comparative effectiveness studies between pharmacological, dietary, and combined interventions would clarify optimal treatment sequencing. Furthermore, real-world implementation research is needed to evaluate how food environments, cultural norms, and healthcare delivery models influence treatment adherence and sustainability across diverse populations.

In conclusion, GLP-1–based biopharmaceuticals hold transformative potential for addressing obesity and diabetes, but their success depends on integration within broader food systems, behavioural frameworks, and health policies. A coordinated, interdisciplinary approach that aligns biotechnology innovation with public health strategies is essential to achieving sustainable and equitable metabolic health outcomes in the coming decades.

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