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10.1146/annurev-animal-111523-102249 Annu Rev Anim Biosci

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To get a therapeutic effect, patients have to macro-dose, leading to severe GI distress

Clinical evidence suggests that whilst these medicines do not directly damage the eyes, they may be associated with worsening diabetic retinopathy in certain patients, particularly those with pre-existing eye disease who experience rapid improvements in blood glucose control

In rats, portal vein levels of total GLP-1 peak around 15 min after intragastric infusion of a liquid meal and return to baseline levels after 90120 min [231]

They probably have other psychological issues perhaps, or they stayed away from fitness and sports because they were never good at them or they were embarrassed to do it, so they don't have the skill set and the liking of being physically active