Introduction
Obesity can currently be classified as a chronic, multifactorial, and relapsing disease, rather than just a product of personal decisions made. It is linked to various conditions, including type 2 diabetes mellitus, cardiovascular diseases, metabolic dysfunction-associated steatotic liver disease, sleep apnea, decreased quality of life, and higher costs [1,2]. In Saudi Arabia, systematic reviews have found that obesity represents a serious problem for a notable proportion of the population and is a prevalent noncommunicable disease [3]. Additionally, modern Saudi statistics suggest that obesity and being overweight are especially relevant issues in Makkah and among people studying in universities [4,5].
A new generation of pharmacotherapy for obesity emerged due to incretin-based treatments. The current leading incretin-based therapy is tirzepatide, which is the first dual GIP/GLP-1 receptor agonist that demonstrated notable weight reductions in phase 3 trials [6,7]. Besides weight loss, tirzepatide also showed improvements in glycemic outcomes and cardiometabolic indicators. For example, in the trial called SURMOUNT-1 [6], tirzepatide successfully induced clinically significant and sustained reductions in body weight in adults suffering from obesity or being overweight [7]. Later research confirmed the high efficiency of the medicine compared to other anti-obesity treatments, including the comparison between tirzepatide and semaglutide. Hence, tirzepatide can be regarded as one of the most promising obesity medicines [8,9].
Tirzepatide is accompanied by additional problems related to its promotion and use. Guidelines state that anti-obesity pharmacotherapy should always include a combination of such components as lifestyle intervention, proper assessment of eligibility for the treatment, counseling, dose adjustment, and adverse effect surveillance [10]. Common side effects of the medicine include gastrointestinal complaints, such as nausea and vomiting. Post-marketing pharmacovigilance is still needed to detect any other risks associated with the treatment. Besides, regulatory approval and prescription access differ across countries, which adds to possible public confusion about the medicine [11].
Public awareness of this kind of medicine depends not only on medical personnel and health system activities but also on modern digital tools. Social media represent the most widespread digital means of disseminating information about GLP-1 receptor agonists and dual incretin therapies, often highlighting spectacular results achieved by users and their body images [12,13]. Recent studies show the fast expansion of GLP-1 agonists' presence on social media, with their representation often focused on topics like aesthetics, fast transformation, issues specific to women, obstacles to accessing the medicine, and ways of acquiring the drug. Social media is especially important in Saudi Arabia; a recent survey found that this platform was the main source of patients' information on GLP-1 agonists [14,15].
Additionally, the stigma of obesity may persist regardless of the effectiveness of treatments available. Obese individuals using anti-obesity pharmacology are often seen as incapable of controlling themselves or taking an easy road to weight loss [16]. This attitude is incompatible with the current scientific understanding of obesity as a chronic disease and may prevent patients from seeking medical assistance and taking necessary actions. It is important to take into account that stigma of obesity can play a particularly critical role among young adults attending university [17,18].
This problem highlights the need to assess knowledge, attitudes, and practices (KAP) of university students regarding tirzepatide (Mounjaro®). As university students have distinctive characteristics, such as changing health behaviors, frequent use of social media, and greater exposure to weight loss messages, it is timely and essential to perform a KAP study among this population. Hence, the following attached study attempted to evaluate students' knowledge, attitudes, and practices toward using tirzepatide (Mounjaro®) for weight management in Jeddah, Saudi Arabia.
Methods
Study Design and Setting: A descriptive, cross-sectional design was conducted in various governmental and private colleges located in Jeddah, Makka Province, Saudi Arabia. Data were collected using a structured online questionnaire during the period September to November 2025.
Study Population and Sampling: The target population was undergraduate students currently enrolled in various governmental and private colleges located in Jeddah, Makka Province, Saudi Arabia. The required sample size was calculated using the Cochran formula [19] for estimating sample size in studies with an unknown population size: N= PQZ2/d2 was used, where N=sample size, P= estimated prevalence of the attribute in the population (0.5, assuming maximum variability), Q=1-p, Z= standard normal deviate corresponding to the desired confidence level (1.96 for 95% confidence interval), d= desired margin (0.05). N= ((1.96)2 (0.5) (0.5)) / (0.05)2 = 384. Thus, the minimum required sample size was 384 participants. To increase statistical power and account for potential non-response, a total of 422 participants were ultimately included in the study. The participants were recruited using a convenience sampling method, and the survey link was distributed to targeted groups across social media platforms (WhatsApp, Facebook, and Telegram).
Data Collection Tool and Procedure: A structured questionnaire was developed in both Arabic and English. The questionnaire was validated by 2 experts in pharmacy practice to ensure its suitability and relevance in the Saudi context, and adjustments were made based on their recommendations. A pilot study was conducted with 20 students to further examine the instrument's reliability. The questionnaire had a Cronbach’s alpha of 0.78. The questionnaire consisted of the following sections:
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Demographic characteristics (age, gender, education, occupation, etc.)
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Knowledge about tirzepatide (Mounjaro®), including its mechanism, benefits, and risks.
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Attitudes toward its use, focusing on safety, cost, and accessibility.
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Practices and experiences related to tirzepatide (Mounjaro®), including actual use, perceived side effects, and consultation with healthcare providers.
Statistical Analysis: Data were entered and analyzed using the Statistical Package for the Social Sciences (SPSS, version 25). Descriptive statistics (frequencies, means, and standard deviations) were used to summarize the data.
Ethical Considerations: The study was conducted in accordance with the ethical standards in the 1975 Declaration of Helsinki. Ethical approval (IRRB-02-18112025) was obtained from Ibn Sina National College (ISNC) Institutional Research Review Board (IRRB). Written informed consent was obtained from all participants before participation. Confidentiality and anonymity were maintained by ensuring that no personal identifiers were collected. Data were securely stored and accessible only to the research team.
Results
Sociodemographic characteristics of participants: A total of 422 participants responded to this study. The sociodemographic profile of the participants showed a predominance of males (75.4%) and individuals aged 22–25 years (63.5%). Medical students represented 70.9% of the cohort, compared with 29.1% from nonmedical fields (Table 1).
| Variable | Frequency | Percent | |
| Gender | Male | 318 | 75.4 |
| Female | 104 | 24.6 | |
| Age (years) | Less than 22 | 95 | 22.5 |
| 22 – 25 | 268 | 63.5 | |
| More than 25 | 59 | 14.0 | |
| Field of study | Medical | 299 | 70.9 |
| Non-Medical | 123 | 29.1 |
Knowledge of participants regarding Tirzepatide (Mounjaro®): Most of the respondents, 61.4%, had heard of Tirzepatide (Mounjaro®), while 21.1% had not. When asked about its main indication, 32.9% believed it is indicated for type 2 diabetes, 34.8% for weight management, and 21.8% correctly recognized both indications (Table 2). Regarding its availability in Saudi Arabia, 53.1% believed that it is sold with a prescription, whereas 23.5% believed it is sold without a prescription. About its mode of administration, 44.1% correctly identified that it is given as a once-weekly injection. Over half, 55.7%, agreed that taking weight loss medications requires supervision by a doctor (Table 2).
Concerning the sources of information, most of the participants learned about Tirzepatide (Mounjaro®) from healthcare professionals (30.5%) and social media platforms (29.8%), followed by advertisements and family/friends (both 19.8%). Regarding side effects, nausea and vomiting were the most recognized side effects at 34.2%, followed by fatigue at 25.9%, hair growth at 12.9%, and increased appetite at 11.2%. About 15.8% were unsure (Table 2).
| Knowledge question | Frequency | Percent | |
| Have you heard of the medication Tirzepatide (Mounjaro®) | No | 89 | 21.1 |
| Not sure | 74 | 17.5 | |
| Yes | 259 | 61.4 | |
| What is Tirzepatide (Mounjaro®) primarily used for? | Both Type 2 Diabetes and weight management | 92 | 21.8 |
| I don't know | 44 | 10.4 | |
| Managing Type 2 Diabetes | 139 | 32.9 | |
| Weight management | 147 | 34.8 | |
| Is Tirzepatide (Mounjaro®) available for sale in pharmacies in Saudi Arabia for weight management? | I don't know | 59 | 14.0 |
| No | 40 | 9.5 | |
| Yes, with a prescription | 224 | 53.1 | |
| Yes, without a prescription | 99 | 23.5 | |
| How is Tirzepatide (Mounjaro®) typically administered? | As a daily injection | 94 | 22.3 |
| As a nasal spray | 17 | 4.0 | |
| As a pill | 70 | 16.6 | |
| As a weekly injection | 186 | 44.1 | |
| I don't know | 55 | 13.0 | |
| Do you believe that using weight loss medications requires medical supervision? | I don't know | 49 | 11.6 |
| Maybe | 53 | 12.6 | |
| No, it's not necessary | 85 | 20.1 | |
| Yes, it is essential | 235 | 55.7 | |
| Where do you hear about the Tirzepatide (Mounjaro®)? | Advertisements | 85 | 19.8 |
| Doctor/Pharmacist | 131 | 30.5 | |
| Social Media | 128 | 29.8 | |
| Friends or family | 85 | 19.8 | |
| What is the common side effect of Tirzepatide (Mounjaro®)? | Nausea and vomiting | 207 | 34.2 |
| Fatigue | 157 | 25.9 | |
| Hair growth | 78 | 12.9 | |
| Increase appetite | 68 | 11.2 | |
| I don't know | 96 | 15.8 |
Attitudes of participants regarding Tirzepatide (Mounjaro®): Regarding safety and effectiveness, 38.4% strongly agreed, and 23.7% agreed that Tirzepatide (Mounjaro®) is an effective and safe way to lose weight (Table 3). A majority (61.8%) believed that users of weight-loss medications are “taking the easy way out”. In the question about the personal likelihood of using it, 38.9% would consider it, whereas 33.9% would consider it after consultation with a doctor. The leading concerns among participants were cost, 30.6%; side effects, 26.1%; and long-term health risk, 24.2% (Table 3).
| Attitude question | Frequency | Percent | |
| To what extent do you agree with the following statement: "Medications like Mounjaro® are an effective and safe way to lose weight." | Agree | 100 | 23.7 |
| Disagree | 54 | 12.8 | |
| Neutral | 78 | 18.5 | |
| Strongly agree | 162 | 38.4 | |
| Strongly disagree | 28 | 6.6 | |
| Do you think people who use Tirzepatide (Mounjaro®) for weight loss are taking the "easy way out"? | I'm not sure | 79 | 18.7 |
| No | 82 | 19.4 | |
| Yes | 261 | 61.8 | |
| If you were struggling with your weight, would you consider using a medication like Tirzepatide (Mounjaro®)? | I'm not sure | 38 | 9.0 |
| Maybe, after consulting a doctor | 143 | 33.9 | |
| No, I prefer other methods (e.g., diet, exercise) | 77 | 18.2 | |
| Yes, definitely | 164 | 38.9 | |
| Do you believe that weight loss medications, including Tirzepatide (Mounjaro®), should be readily available for anyone who wants to lose weight? | I'm not sure | 69 | 16.4 |
| No, they should be strictly regulated | 146 | 34.6 | |
| What is your main concern about using Tirzepatide (Mounjaro®) for weight management? | Cost | 129 | 30.6 |
| Lack of information | 19 | 4.5 | |
| Long-term health risks | 102 | 24.2 | |
| No concerns | 29 | 6.9 | |
| Side effects | 110 | 26.1 | |
| The need for injections | 33 | 7.8 |
Practices of participants regarding Tirzepatide (Mounjaro®): as shown in Table 4, 17.1% of respondents have had previous experience with using Mounjaro®, and this experience occurred in short periods, mostly less than three months. As for the sources of obtaining the drug, in most cases, they were prescriptions from physicians, but in a few cases, participants admitted to using the medicine without supervision. Patients' adherence to changes in their daily life was also found to be low since only a small proportion of participants managed to combine pharmacotherapy with other weight loss methods such as dieting and exercise. Furthermore, Perceptions of long-term use varied, as 45.5% of participants viewed weight loss medication as an effective solution that could work for them. Finally, social media's impact on respondents was moderate, with 21.2% of individuals being heavy users of these platforms. As for the selection criteria of weight loss strategies, respondents valued effectiveness (30.5%), safety (31.5%), price, and convenience equally (Table 4).
| Practice question | Frequency | Percent | |
| Have you ever used Tirzepatide (Mounjaro®) for weight management? | No | 350 | 82.9 |
| Yes | 72 | 17.1 | |
| (If yes) How long did you use it? | Not used | 350 | 82.9 |
| 3-6 months | 25 | 5.9 | |
| Less than 3 months | 30 | 7.1 | |
| More than 6 months | 17 | 4.0 | |
| If you have used Tirzepatide (Mounjaro®), did you receive a prescription from a doctor? | No | 19 | 4.5 |
| Not applicable (I have not used it) | 350 | 82.9 | |
| Yes | 63 | 14.9 | |
| If you have used Tirzepatide (Mounjaro®), did you combine its use with a healthy diet and exercise | No | 8 | 1.9 |
| Not applicable (I have not used it) | 350 | 82.9 | |
| Sometimes | 21 | 5.0 | |
| Yes, consistently | 43 | 10.2 | |
| Do you currently have a prescription for a weight loss medication? | I am considering getting one | 61 | 14.4 |
| No | 289 | 68.5 | |
| Yes | 72 | 17.1 | |
| Do you consider the use of weight loss medications to be a long-term solution? | I'm not sure | 79 | 18.7 |
| No, it's a temporary solution | 151 | 35.8 | |
| Yes | 192 | 45.5 | |
| To what extent do you rely on social media for information about weight loss medications | A little | 160 | 37.9 |
| A lot | 87 | 20.6 | |
| Not at all | 175 | 41.5 | |
| What is the most important factor for you when choosing a weight management method? | Cost | 58 | 13.7 |
| Doctor's recommendation | 46 | 10.9 | |
| Ease of use | 52 | 12.3 | |
| Effectiveness | 133 | 31.5 | |
| Safety | 133 | 31.5 |
Discussion
These results indicate that tirzepatide is known to many students in Jeddah; however, this recognition is not synonymous with pharmacotherapy literacy. More than 60% of respondents mentioned that they had heard of tirzepatide; this is understandable due to the increasing international focus on the drug after the release of the SURMOUNT and SURPASS series and the development of incretin-based pharmacotherapy for obesity [6,20]. The excellent outcomes of tirzepatide trials, its fast adoption in clinical practice, and media hype around the drug have contributed to this recognition among young people [7,9].
However, recognition is not equal to literacy in pharmacotherapy. Thus, less than 22% of respondents recognized the connection between tirzepatide and both type 2 diabetes mellitus and weight management. Also, only slightly more than half of the students knew that this drug is injected once a week. In addition, about 25% were convinced that the drug is available over the counter. All these data confirm a certain trend of "headline recognition": the student recognizes the name of the drug, associated it with weight loss, but knows little about the indications, prescribing principles, administration of tirzepatide, and monitoring of therapy. A similar trend was observed in the recent Saudi community survey regarding GLP-1 agonists, where the awareness was moderate to high, the most popular was Mounjaro®, and social media played the role of the main information source [14,15].
The analysis of sources of medication information is highly interesting. Thus, healthcare providers are listed as the leading source of information, but social media also occupies the second place. Consequently, students are influenced by two parallel information ecosystems [14]. The first is the professional ecosystem that focuses on the clinical approach to pharmacotherapy, and the second is the media-based information ecosystem that often promotes simple approaches to medication use. This dichotomy explains why students have relatively good knowledge about the possible adverse effects and still think that this drug can be used without a prescription or consultation. As it was recently shown, there is a high volume of online communication regarding GLP-1 drugs [13,18,21].
Another aspect to highlight is the co-existence of a positive perception of the drug and a persistent stigma regarding the person who uses it. Indeed, although about 60% of the students agreed that medications like tirzepatide can provide significant benefits, almost as many participants thought that the person using the drug "is taking the easy way out." This situation represents the typical example of weight stigma – when obesity treatments are perceived both medically and morally. Numerous public health studies have shown that stigmatization can be associated with a lower propensity to ask for medical assistance [16,17,22].
It is necessary to analyze the findings related to students' practices cautiously. Although 17.1% of respondents admitted to using tirzepatide for weight loss, this number is surprisingly high for university students. It can be explained by several overlapping reasons, such as the great popularity of GLP-1 drugs on social media, the dominance of medical students, self-selection of respondents with special interests, and the method of sampling [12]. Even though there is an overestimation in the estimation of the prevalence of the behavior, it is evident that tirzepatide has become the topic of conversation and interest among university students rather than remaining the exclusive domain of specialists working with obese patients. This assumption is confirmed by a great number of participants who currently received the prescription for anti-obesity drugs or considered purchasing it [14,15,23].
The most alarming observation concerns the unsupervised use of the drug reported by the participants. Almost one-third of them used tirzepatide without consulting physicians. The prescribed use of the drug requires patient selection, gradual dose escalation, adverse effect management, contraindication assessment, and close longitudinal monitoring [11]. Although side effects such as nausea and vomiting are expected and can be managed, numerous pharmacovigilance studies have revealed safety concerns that should be considered in clinical practice [11,24]. Furthermore, issues such as the cost, adverse effects, and long-term health consequences mentioned by the participants are quite common barriers to obesity pharmacotherapy described by researchers [24].
The limitations of this research should be highlighted. First, this is a convenience sampling study with voluntary participation, which may lead to overrepresentation of respondents who are interested in the issue. Second, the sample is predominantly male and consists mainly of medical students, which reduces generalizability. Third, all outcomes were obtained through self-reporting, which may lead to recall bias, reporting biases, and possible overestimation of the prevalence of medication use. Fourth, the cross-sectional design precludes any causal interpretations. Fifth, the uploaded manuscript presents the relationships between selected variables, but it does not include all statistical outputs in the text.
Conclusion
Tirzepatide has become the topic for discussion among university students in Jeddah; however, there is still a lack of knowledge regarding the drug. Many students are not aware of the indications, prescription requirements, administration route, and necessary monitoring procedures. However, it cannot be denied that young people recognize the advantages of this drug and are open-minded regarding the use of obesity drugs and are very dependent on social media for medication information. This combination requires integrated educational, regulatory, and professional measures to enhance pharmacotherapy literacy, ensure prescription-only, reduce obesity stigma, and improve the quality of obesity-related information in social media.
Declarations
Ethical Clearance
The study was conducted in accordance with the ethical standards in the 1975 Declaration of Helsinki. Ethical approval (IRRB-02-18112025) was obtained from Ibn Sina National College (ISNC) Institutional Research Review Board (IRRB). Written informed consent was obtained from all participants before participation. Confidentiality and anonymity were maintained by ensuring that no personal identifiers were collected. Data were securely stored and accessible only to the research team.
Conflict of interest
The authors declare that there is no conflict of interest
Funding/ financial support
This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sector
Author Contributors
HA, MAE, and ENA: Conceptualization, Methodology, Investigation, Data collection and curation, Writing original draft, YSK and EIA: Conceptualization, Methodology, Formal analysis, Data curation, Visualization, Software, Writing – review and editing. BAY: Supervision, Conceptualization, Formal analysis, Data collection and curation, Writing – review and editing. All authors approved the final manuscript
Acknowledgements
None