What would you do if someone offered you a drug that would make dieting a breeze? A drug that not only helped you lose weight, but would also reduce your appetite so that you didn’t even notice you were dieting? This may sound like something from a fairytale, but the pharmaceutical industry has introduced several drugs that promise to do exactly that, and several more are on the way.

Weight-Loss Drugs

The past few years have seen an explosion of drugs for weight loss, such as Wegovy, Mounjaro, and Ozempic. Delivered via a weekly, self-administered injection, these drugs—called GLP-1 receptor agonists—work by mimicking the hormone responsible for making you feel full after you’ve eaten. Similar drugs have been used since 2005 to treat type 2 diabetes, however, it was quickly realized that one of their side effects was weight loss.

In the U.S., the most commonly used weight-loss injections are Ozempic and Wegovy, both sold by Novo Nordisk. Ozempic was approved by the FDA for treating type 2 diabetes in 2017 but has never been approved for weight loss. Wegovy was developed specifically for treating obesity and was approved for that use in 2021. Despite the different names and usages, they are just different doses of the hormone semaglutide. Eli Lilly sells its own diabetes treatment called Mounjaro, which is being used off label as a weight-loss drug, though Lilly is seeking FDA approval for treating obesity.[1]

These drugs really do seem effective in causing weight loss, so much so that people have referred to Ozempic as “the skinny pen.”[2] In a study in the New England Journal of Medicine, those who took semaglutide for a little over a year lost an average of 15 percent of their body weight.[3] This is not to say the injections are without risks, however. For Wegovy, Novo Nordisk lists “nausea, diarrhea, vomiting, constipation, stomach (abdomen) pain, headache, tiredness (fatigue), upset stomach, dizziness, feeling bloated, belching, gas, stomach flu, heartburn, and runny nose or sore throat” as common side effects.[4] More serious possible side effects include pancreatitis, gallbladder problems, hypoglycemia (low blood sugar), kidney problems, and increased heart rate.

Viral Spread

Those who have shed pounds because of their injections often become evangelists for the drugs, sharing the “good news” of their weight loss through social media. Celebrity and influencer endorsements have further spread the drugs’ reach. On TikTok, videos about #Ozempic alone have received 1.1 billion views.[5] Influencers commonly take their followers along on their “weight-loss journey” and tout the almost miraculous results. All of this has contributed to prescriptions for weight loss injections increasing by 2,000 percent over the past 4 years.[6]

Another reason for this precipitous increase is that getting a prescription has become quite easy. Several telehealth websites offer easy access to medication with vanishingly little oversight. Journalists have reported getting a prescription for Ozempic without ever seeing a doctor—they simply filled out a survey, had a brief phone conversation or message exchange, and paid a fee. The doctors involved never actually saw the “patient,” and no diagnosis of type 2 diabetes or obesity was required.[7]

These factors have turned medicalized weight loss into a hugely profitable field. Ozempic and Wegovy generated $10 billion in 2022 alone. If tirzepatide, (the active ingredient in Mounjaro, which causes even greater weight loss) is approved to treat obesity, some estimate it could bring in $50 billion per year.[8]

Ethical Issues

A number of things about the increasing popularity of weight-loss injections should give pause. Since Ozempic and Mounjaro have so far only been approved for treating type 2 diabetes, prescribing them for weight loss involves an off-label use. While doctors commonly prescribe drugs off label if they believe it will benefit their patients, these uses have not been thoroughly tested. In fact, Novo Nordisk has specifically stated that the company “does not support or promote the use of our medicines outside of the FDA approved indication, whether by telehealth providers or otherwise.”[9] This is easily lost on someone who hears the drug’s benefits peddled on social media and then receives a telehealth prescription.

Relatedly, there has not been time for long-term studies on those who use them for weight loss. Numerous other weight-loss drugs have been taken off the market due to serious side effects that were not recognized until they had been in use for several years. Even if the drugs prove safe, studies seem to indicate that they will need to be taken long term to keep the weight off—those who stop taking the medications tend to see their appetites (and weight) increase.[10] The newness of these treatments, and the fact that they are being prescribed off label, also mean that most insurance plans do not cover them, which leads to steep costs—a year of injections costs upwards of $15,000.

The direct-to-consumer advertising, a somewhat uniquely American phenomenon that leads to people asking for medications that may not be indicated for them, is another concern. This dynamic is exacerbated by the popularity of these drugs among influencers on social media. Laws around influencer marketing in the U.S. are outdated and unclear. And, even if Novo Nordisk and Eli Lilly do not pay influencers, select distributors of their products do. Some pay influencers directly; others don’t pay them but provide free medication.[11] The testimonials people see on social media have proven to be very persuasive, especially to those who have struggled to shed extra weight put on during Covid lockdowns.

Even more concerning is that the drugs are being promoted on social media platforms frequented by children and adolescents. Teens are impressionable and tend to be very concerned about their body and self-image. If adults are easily sucked in by the promise of easy weight loss, we should expect that teens will be too. Wegovy has already been FDA-approved for treating obesity in children as young as 12. Combined with lax telehealth standards, it is not unthinkable that impressionable teens might start trying to get their hands on weight-loss injections, even if they are not truly obese.

A final concern is that the drugs’ newfound popularity has led to supply shortages affecting those who need them to manage their diabetes. Patients usually start on low doses and work their way up to higher ones as their body acclimates; in response to the shortages, Novo Nordisk has limited starter doses until they can work out the supply issues to be sure that those already on the medication can receive what they need. The company even halted advertisements for Wegovy. Though the supply is ticking up, the FDA still lists Ozempic, Wegovy, and tirzepatide injections as being in shortage.[12]

Reflections

Despite the many causes for concern, safe drugs to help people control their obesity have their place. Obesity-related illnesses lead to thousands of deaths every year. A disciplined diet and exercise regimen is effective for weight loss, but there are a variety of factors why someone could struggle with these, some personal and some physiological. The human body can be quite averse to losing weight and actively fight against it, meaning that sometimes people need additional help.[13] Shedding excess weight can improve mobility, energy level, and self-perception. Thus, the questions around injectable weight-loss medications are not about whether their effects are beneficial, but about whether these medications are the best way to achieve them—especially for children or those who are mostly healthy but want to shed a few pounds.

That said, weight-loss injections, or any other medication, should not be put forth as a substitute for self-discipline. The abundance enjoyed by many in the U.S. can lead to overindulgence and a lack of care for our bodies. While Ozempic or other medications can help regain control of weight and appetite, the fact that people tend to regain weight once they stop taking it could be evidence that at least some of them failed to address the underlying issues that led to weight gain in the first place. Novo Nordisk itself has recognized this, and those who are prescribed Wegovy also receive access to supports like a personalized health coach to help them develop better health habits in tandem with taking the medication.[14]

Humans, and Americans in particular, are prone to searching for technological solutions to their problems. Weight-loss injections may seem like a much easier path to weight loss than a diet and exercise routine that requires consistency and discipline. For some, their use may be indicated and will have many benefits. For others, however, the promise of easy weight loss may deter them from developing self-control or addressing underlying personal and emotional factors that led to overeating in the first place. Thus, we should approach the use of weight-loss medications carefully, being sure that we are not substituting technology for a disciplined, healthy lifestyle.

Notes

[1] Amelia Tait, “Weight-Loss Injections Have Taken Over the Internet. But What Does This Mean for People IRL?” MIT Technology Review (Mar. 20, 2023): https://www.technologyreview.com/2023/03/20/1070037/weight-loss-injections-societal-impact-ozempic/.

[2] Jamie Nguyen, Joe Enoch, and A. Pawlowski, “To Get Off-Label Ozempic Prescriptions, Some People Turn to Telehealth Websites,” Today (Feb. 2, 2023): https://www.today.com/health/diet-fitness/ozempic-online-prescriptions-weight-loss-rcna68445.

[3] John P. H. Wilding et al., “Once-Weekly Semaglutide in Adults with Overweight or Obesity,” New England Journal of Medicine 384, no. 11 (2021): https://doi.org/10.1056/NEJMoa2032183.

[4] “Weight Loss with Wegovy®,” Novo Nordisk (accessed June 14, 2023): https://www.wegovy.com/about-wegovy/weight-loss-with-wegovy.html.

[5] “#ozempic,” TikTok (accessed June 14, 2023): https://www.tiktok.com/tag/ozempic?lang=en.

[6] Tina Reed, “Hyped Weight Loss Drugs Raise Supply, Equity Concerns,” Axios (Feb. 13, 2023): https://www.axios.com/2023/02/13/weight-loss-drugs-supply-equity-concerns.

[7] Nguyen, Enoch, and Pawlowski, “To Get Off-Label Ozempic Prescriptions.”

[8] Jonel Aleccia, “Powerful New Obesity Drug Poised to Upend Weight Loss Care,” Associated Press (Apr. 27, 2023): https://apnews.com/article/mounjaro-wegovy-ozempic-obesity-weight-loss-bd0e037cc5981513487260d40636752a.

[9] Nguyen, Enoch, and Pawlowski, “To Get Off-Label Ozempic Prescriptions.”

[10] Allison Aubrey, “Wegovy Works. But Here’s What Happens if You Can’t Afford to Keep Taking the Drug,” NPR (Jan. 30, 2023): https://www.npr.org/sections/health-shots/2023/01/30/1152039799/ozempic-wegovy-weight-loss-drugs.

[11] Tait, “Weight-Loss Injections Have Taken Over the Internet.”

[12] “FDA Drug Shortages,” US FDA (accessed June 14, 2023): https://www.accessdata.fda.gov/scripts/drugshortages/default.cfm.

[13] Jonel Aleccia, “What to Know about Prescription Drugs Promising Weight Loss,” Associated Press (Mar. 8, 2023): https://apnews.com/article/weight-watchers-wegovy-ozempic-obesity-92fa95115429c163eb7fa527ca6d94ce.

[14] “Get WeGoTogether® Support,” Novo Nordisk (accessed June 16, 2023): https://www.wegovy.com/coverage-and-savings/get-wegotogether-support.html.