Survey of 518 US adults finds insurance and cost top barriers to starting tirzepatide
A survey of 518 US adults starting tirzepatide shows what drove them to begin treatment and what stood in the way, with insurance and cost concerns far ahead of other barriers.
A real-world survey of 518 US adults found that the top reasons people started tirzepatide were improving overall health and well-being (83.8%) and physical functioning (58.3%), while the most common barriers were concerns about health insurance coverage (90%) and treatment cost (57.7%) [1].
The findings come from the PERCEPTIONS survey, an observational study conducted in the US between June and November 2025 [1]. It enrolled adults with obesity (BMI of 30 or higher) or overweight (BMI of 27 or higher with at least one obesity-related complication) who did not have type 2 diabetes [1]. Participants completed the survey four to eight weeks after their first tirzepatide dose; the average gap between first dose and survey was about 26 days [1].
Participants had a mean age of 46.0 years, were 78.2% female and 69.5% White, and had a mean BMI of 38.4 [1]. Most — 89.2% — started tirzepatide at the 2.5 mg dose, and 12.7% had previously received semaglutide [1]. Nearly half reported they had previously been unable to lose weight or keep it off through exercise and dietary changes [1].
Beyond overall health and physical functioning, 51.4% named self-confidence and appearance outside of work as a motivator [1]. The same group reported substantial impairments in physical functioning and psychosocial well-being, along with high internalized weight bias, at the time they started treatment [1].
On practical questions, most users found the drug easy to handle: 98.0% of auto-injector users and 95.8% of vial users said tirzepatide was easy to use [1]. The article appears in the journal Obesity Pillars, volume 19, dated September 2026, and its copyright is held by Eli Lilly and Company [1].
Why it matters for patients
The survey describes a group that was, by its own account, struggling before treatment: impaired physical functioning, impaired psychosocial well-being, and high internalized weight bias at the start [1]. That context matters because the decision to begin a GLP-1 drug is often framed as a matter of willpower, while these participants reported health and daily functioning as their primary motivations [1].
Coverage and cost stand out as the barriers patients flagged most. Nine in ten cited concerns about health insurance coverage, and more than half cited treatment cost [1]. Those numbers describe what people worried about as they started, not whether they ultimately got or kept coverage [1]. The study did not measure whether cost or coverage stopped anyone from continuing treatment [1].
It is also worth being precise about what this survey is. It is descriptive and based on self-report at a single point after the first dose, with no comparison group [1]. It reports who these 518 people were and what they said, not whether tirzepatide caused any particular change in their lives. The abstract notes that tirzepatide showed sustained weight reduction and improvements in health-related quality of life in the SURMOUNT trials, which are separate studies [1].
The manuscript does not describe how participants were recruited, and it does not say whether this group represents all US adults using tirzepatide [1].
What happens next
This paper reports baseline data only — the information collected near the start of treatment [1]. Follow-up results from the same survey, and any timeline for reporting them, have not been disclosed [1].
Tirzepatide is the molecule in Mounjaro, which is approved for type 2 diabetes, and Zepbound, which is approved for chronic weight management. This survey enrolled people without type 2 diabetes [1].
Sources
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