The Skinny on Weight-Loss Drugs
How weight-loss drugs such as Ozempic are taking America by storm
—By Lily Kappa
Date nights have changed in the Bloom household since Jackie and Marc both started taking weight-loss drug Semaglutide. “We used to be the people who would order drinks, appetizers, and two meals. Now we go to a restaurant and skip the drinks, nix the appetizers, and split a meal,” says Jackie Bloom. Weight-loss drugs like Ozempic (generic name Semaglutide) have taken the medical industry by storm. Celebrities have been rapidly shrinking, with tabloid articles reporting on the latest updates in pop culture Ozempic use. Despite the drug’s reputation with celebrities, it has made its way into working-class households like the Blooms’.
With such a large media presence has come many concerns, as the drug has gained huge popularity in a short amount of time. The FDA approved the use of Semaglutide for weight management in 2021, and it is often prescribed with the intention of being taken for the duration of a patient’s life. The high demand for weight-loss injections caused a national drug shortage. Conversations about damaging beauty standards often surround these drugs as they can perpetuate unrealistic body images. Put together, these concerns tell the story of America’s relationship with weight management, and in the process expose the broader intricacies of our troubled mental health system, socioeconomic inequality, and complicated relationship with drug companies.
How weight-loss drugs work
In order to understand the “why” behind weight-loss drugs, it’s important to first understand the “how.” There are two dominant weight-loss drugs on the market: Semaglutide and Tirzepatide. You may have heard of Semaglutide before without even knowing it, as its brand names are Wegovy or Ozempic. The second drug, Tirzepatide, is commonly known by its brand name Mounjaro. Both drugs fall under a category called GLP-1 RAs (Glucagon-Like Peptide-1 Receptor Agonists).
These drugs mimic the structure of the GLP-1 hormone, interacting with our brain to signal the feeling of fullness, and even causing the stomach to empty less often. By having a similar structure to the GLP-1 hormone, they are able to bind to its receptor and cause the same signaling cascade as if our body was producing it naturally. Though they are not identical to our body’s natural hormone, these drugs are often referred to simply as GLP-1s. This class of drugs was first developed to treat Type II diabetes, as they regulate insulin. According to interventional cardiologist Dr. Marcel Zughaib, “The weight-loss ‘side effect’ was a very happy one—side effects are usually very unpleasant. Researchers stumbled over a gold mine.”
Side effects
While taking GLP-1 medications, patients may experience a loss of appetite, disgust for drinking alcohol, and most commonly nausea. “Everyone has that one time where you overeat and it spanks you,” says Bloom. “You end up getting sick, throwing up, miserable…and you never do it again.” Patients take these drugs via weekly self-injections, often in the lower belly. Injection dosage increases as a patient is on the drug for longer, and side effects are most common in the 3 days after injections and at the higher doses.
Harvard Health Publishing lists nausea and vomiting, diarrhea and constipation as the most common side effects, though in rare cases, patients may experience pancreatitis and bowel obstructions. The only major populations that cannot take the drugs are patients who have a family history of a very specific type of thyroid cancer and certain pancreatic cancers, according to Dr. Zughaib. This relatively small exclusion is partly responsible for the drugs’ popularity, as previous weight-loss drugs failed to gain popularity due to having too many side effects or excluding too many patients.
Not all side effects of the drug are unpleasant. According to Dr. Zughaib, “From the cardiovascular standpoint, we’re finding out that the drug has protective effects on the brain and reduces heart attacks and strokes, which is a completely unexpected beneficial effect.” A study at Case Western University even found that long term usage of GLP-1s could decrease a patient’s risk for Alzheimer’s disease. Dr. Zughaib explained that many of his patients plan to take the drug for the rest of their life—whether it’s for diabetes treatment or weight loss. Once patients stop taking the drugs, the effects completely wear off and a patient may gain the weight back. Many choose to remain on the drug at a small dosage in favor of the beneficial side effects—including Bloom, who has a family history of Alzhiemer’s disease.
Many skeptics are concerned that the buzz around GLP-1 medications is too good to be true. They argue that because these drugs are so new, scientists have not had enough time to see what long-term usage of them looks like. The first clinical trial for Ozempic started in 2015, with its FDA approval for diabetes treatment following in 2017. So what happens when patients have been on GLP-1s for 20 years? The truth is, we don’t really know, as we’ve been studying the drug for just under 10 years. Studies have pointed to positive effects, but we will not know the long term effects until patients have actually been taking the drug for the remainder of their lives—and we’re just not there yet.
Jennifer Zughaib—owner of a med spa offering weight-loss care and wife of Dr. Zughaib—argues, “We do know the long-term effects of obesity: risk of cardiovascular disease and cancers, joint and bone problems, liver problems. I agree with the studies that the benefits of the drugs far outweigh the risks.”
The Ozempic shortage increased its access
An NPR article suggested that prior to GLP-1s’ FDA approval for weight-loss treatments, pharmaceutical companies encouraged its off-label usage for weight-loss by including the number of pounds patients lost in their commercials. Despite promoting the drugs for weight-loss, they failed to accurately anticipate the influx of demand. Word of the drugs’ miraculous side effects spread, and in 2022, the companies that produce Ozempic, Wegovy, and Mounjaro declared a national shortage.
Large pharmaceutical companies take out patents on their drugs to hold a temporary monopoly and rack up the prices. While the patent is active, the company who registered it is the only company able to produce and sell the drug. When a drug is at a shortage, however, the FDA requires it to become commercially available. This essentially puts a temporary lift on the patent until the drug is no longer at a shortage. When the shortage is in effect, compounding pharmacies can produce the drug in order to increase its availability for those who need it. The moment the drug companies producing GLP-1s declared a national drug shortage was the moment weight-loss drug usage skyrocketed.
Because GLP-1s are used for both weight-loss and Type I Diabetes treatment, many raised concerns that their shortage caused by weight-loss interest restricted access to the drugs from those who needed it. While this may have been true prior to the allowance of compounding production, it no longer is, as weight-loss and diabetic patients are receiving their medications from completely separate production pools.
Jennifer Zughaib explained that sourcing Semaglutide in the brand name form (Ozempic) costs about $1,400 per month, whereas from compounding pharmacies can cost as low as $200 per month for chemically identical products. For this reason, boutique medical providers, such as online wellness site Hims/Hers and most med spas choose to source GLP-1s from compounding pharmacies. The price disparity also meant that after the shortage was declared, a wider range of clients could access the drug as it became more affordable.
Although Ozempic currently remains on a shortage (with whispers of the parent company lifting the shortage soon), Mounjaro was taken off of the shortage listing in October of 2024. This makes Eli Lilly the sole supplier of Mounjaro once more, restricting the access to the drug and increasing the price dramatically. According to Hers, Mounjaro costs about $1,300 per month through Eli Lilly, while the compounded version previously cost $200 to $400 per month through Hers. Pharmacies distributing Mounjaro can now only source the more pricey option, increasing the cost for consumers.
Cautions with compounding pharmacies
While compounding pharmacies allowed GLP-1s to be more accessible, they should be handled with discretion. The FDA reports that it “does not verify the safety, effectiveness or quality of compounded drugs before they are marketed.” Though the drugs themselves are not directly regulated by the FDA, the facilities that produce compounded drugs are regularly surveyed and required to operate under a licensed pharmacist and physician. Because of this, compounded drugs are overwhelmingly trustworthy, though in some instances a lack of regulation can lead to cracks in the system.
Mounjaro’s parent company, Eli Lilly, investigated numerous compounding pharmacies operating outside of pharmaceutical standards. The report details: “Some have contained bacteria, high impurity levels, different colors (pink, instead of colorless), or a completely different chemical structure than Lilly’s FDA-approved medicines.” In at least one instance, the supposed drug was nothing more than sugar alcohol. There were no investigations conducted by other companies or independent organizations regarding compounding pharmacies producing GLP-1s.
Though there is no direct governmental control of compounding pharmacies, legal action can be taken to prevent these operations from persisting. Eli Lilly filed cease and desist orders against facilities such as med spas selling these subpar quality drugs. It is important to note that they did not file these orders against the direct sources of the impure drugs.They were only able to take legal action against companies for selling drugs under the name brand when they are not sourced from the parent company. Legal action was not taken explicitly based on unsafe product distribution, and regulation in that department remains untapped.
It is in the direct interest of Eli Lilly to decrease the use of compounding pharmacies, as more consumers would buy the drugs through their own company. Quality control is not a widespread issue in compounding pharmacies, and there are very few cases of issues with patients’ compounded GLP-1s. It remains unclear if more compounded vials would be found below pharmaceutical standards had another, more thorough investigation occurred. Though these compounding issues are in the far minority, there is little infrastructure in place to find and shut down troubled operations. It is largely left up to competing companies to investigate and take legal action.
Counterfeit productions
With GLP-1s in such high demand, it is not surprising that counterfeit operations have emerged to cut corners for profits’ sake. Inspections, proper equipment, and brand names can be pricey. The World Health Organization issued a report of finding falsified Ozempic in the Americas and Europe. The report included photos of packaging of the counterfeit drugs, which alarmingly looked completely indiscernible from real products other than their lot number. Consumers could purchase these counterfeit products online, believing that they are buying the real brand-name products from their parent companies—when in reality, they were buying uninspected injectables of unknown ingredients.
The National Association of Boards of Pharmacy (NABP) identified thousands of websites illegally offering the purchase of GLP-1s. “These sellers likely offer, at best, research-grade versions of these drugs, which do not eliminate impurities at the same level as pharmaceutical-grade versions” said the NABP report. The sellers identified by the NABP are often complex networks of website managers, payment processors, and pharmaceutical sources. Many of these sites are “non-delivery schemes” where a buyer orders and pays for a product but never receives it. Some do, however, actually deliver the drugs without requiring a prescription. The illicitly sold products are sourced from various places, with some sites having their own production operations, and others falsifying medical records to source the drugs from pharmacies.
Legally—even through a compounding pharmacy—weight-loss drugs must be prescribed and monitored by a licensed physician. Dr. Zughaib says that “the physician that prescribes it is ultimately responsible for any ill effects or side effects.” Without a physician to monitor the prescriptions, there is no one to be held responsible for potential injection site complications, adverse side effects from the drug, or improper dosing. Even in cases where the sites source the drugs from a trustworthy pharmacy, it is difficult to control proper dosage from an online site when the medication is a self-injection. Overdoses of Ozempic have serious side effects, including seizures and even death. Without the care of a physician, even a safe drug can have dangerous repercussions.
The bigger picture
The vast majority of patients on GLP-1s are sourcing them through licensed physicians who prescribe the drugs from reputable pharmacies. Despite their controversial nature and a small minority of impure and counterfeit operations, GLP-1s have emerged as a very effective and beneficial class of medications. Their small number of unpleasant side-effects and potential to heal several major health concerns has led physicians to believe that they are here to stay. With promising studies on their potential to lower risk of heart and cognitive diseases, GLP-1s’ uses for weight-loss and diabetes treatment seem to be just the tip of the iceberg. In the meantime, drugs like Ozempic will continue to have a simple purpose, like that of Bloom. “I didn’t want to get skinny, I just didn’t want to buy new clothes.”
Feature photo: Common weight-loss injection, Ozempic/Semaglutide; Photo by https://www.chemist-4-u.com/ on Flickr