GPs’ perspectives on GLP-1RAs for obesity management: a qualitative study in England

Sabrina Keating; Cervantée Wild; Jadine Scragg; Sharon Dixon; Julian Treadwell; Lisa Hinton; Susan Ann Jebb

doi:10.3399/BJGP.2025.0065

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Addressing clinical nihilism to improve GLP-1RAs implementation for obesity
Fei Zhang and Zhong Wang

Published on: 26 November 2025

Published on: (26 November 2025)
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Addressing clinical nihilism to improve GLP-1RAs implementation for obesity
Fei Zhang, GP, Department of General Practice, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
Other Contributors:
Zhong Wang, Professor of General Practice
We read with great interest the qualitative study by Keating et al.¹ exploring the perspectives of UK general practitioners (GPs) on glucagon-like peptide-1 receptor agonists (GLP-1RAs) for obesity management. While the study offers valuable insights, we have several points for further discussion.

Although the authors astutely pointed out that 'limited utility' (INT23) was a reason for avoiding discussion of weight, they failed to link this insight to the broader concept of 'clinical nihilism'. This nihilism, defined not in a philosophical sense but as a clinical mindset, refers to a physician's underlying belief that a condition (like obesity) is difficult to treat or that patients lack sufficient motivation for change, leading to the perception that intervention is futile.² This mindset is particularly common in managing other complex lifestyle-related chronic diseases.³

For instance, in the management of alcohol use disorder (AUD), although effective medications such as naltrexone have been incorporated into guidelines, prescription rates by GPs remain low. It’s not entirely due to a lack of medication availability within the healthcare system, but rather stems from physicians' inherent cognitions. For example, believing medications can only partially suppress cravings without addressing the underlying psychosocial roots of addiction, a sentiment that directly parallels GPs' concerns that...
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We read with great interest the qualitative study by Keating et al.¹ exploring the perspectives of UK general practitioners (GPs) on glucagon-like peptide-1 receptor agonists (GLP-1RAs) for obesity management. While the study offers valuable insights, we have several points for further discussion.

Although the authors astutely pointed out that 'limited utility' (INT23) was a reason for avoiding discussion of weight, they failed to link this insight to the broader concept of 'clinical nihilism'. This nihilism, defined not in a philosophical sense but as a clinical mindset, refers to a physician's underlying belief that a condition (like obesity) is difficult to treat or that patients lack sufficient motivation for change, leading to the perception that intervention is futile.² This mindset is particularly common in managing other complex lifestyle-related chronic diseases.³

For instance, in the management of alcohol use disorder (AUD), although effective medications such as naltrexone have been incorporated into guidelines, prescription rates by GPs remain low. It’s not entirely due to a lack of medication availability within the healthcare system, but rather stems from physicians' inherent cognitions. For example, believing medications can only partially suppress cravings without addressing the underlying psychosocial roots of addiction, a sentiment that directly parallels GPs' concerns that GLP-1RAs 'fail to address the social determinants of obesity'. Another important factor is the tendency to primarily attribute treatment failure to patients' 'lack of willpower' rather than conducting a holistic assessment based on the biopsychosocial medical model.

A GP might think: "Even if I prescribe a GLP-1RA, if he/she doesn't change their lifestyle habits, the weight will still rebound after discontinuation. So what is the point of intervening now?" This sense of "anticipated failure" erodes the willingness to act. Therefore, the solution requires a dual approach. Merely increasing resources (e.g., extending consultation time) may be insufficient to change GP behaviour if they fundamentally perceive weight-related discussions as inherently ineffective or unwelcome. In addition to the adequate resourcing recommended by the authors, future implementation strategies must also include targeted education, communication skills training, and the sharing of successful case studies.

References
1 Keating S, Wild C, Scragg J, et al. GPs’ perspectives on GLP-1RAs for obesity management: a qualitative study in England. Br J Gen Pract 2025; 75:e759–67.

2 Mamede S, Schmidt HG. The twin traps of overtreatment and therapeutic nihilism in clinical practice. Med Educ 2014;48(1):34-43. doi:10.1111/medu.12264.

3 Berry P. Addressing Therapeutic Nihilism in Alcohol-Related Liver Disease: A Hepatology Perspective to Terminal Illness and Palliative Care. Alcohol Treat Q 2023; 41:362–8.

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Competing Interests: None declared.

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