Hollywood celebrities popularized taking diabetes medications off-label to lose weight, and now the trend is hitting mainstream markets. Google searches for “ozempic” and other diabetes medications spiked after last year’s Met Gala, and then hit an all-time peak around this year's Paris Fashion Week. Many fear this is the latest '90s resurgence, bringing with it the “heroin chic” body style and forgetting the dangerous weight-loss drug known as fen-phen that helped many women achieve it. But with most American women being overweight or obese, online pharmacies are jumping at the opportunity to cash in on closing the weight gap. Is America going to hit its weight loss goals with pills and shots? Or is this just the pharmaceutical child of the fad diets we grew up with?
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The Doctor (Won’t) See You Now
Digital pharmacies are becoming big business. The global e-pharmacy market is projected to be worth over $200 billion in the next five years, driven in no small part by direct-to-consumer pharmaceutical advertising. Drug companies use e-pharmacies to skip the middleman and encourage patients to use digital doctors, who do little more than sign the prescriptions. Many don’t even require a Zoom call; your appointment is with a chatbot. In recent years, many women have turned to e-pharmacies for things like birth control and skincare products. Companies like Nurx and Cerebral offer everything from antidepressants to morning-after pills shipped straight to your door. While the model is a plus for convenience, the lack of doctor-patient interaction means that you’re far less likely to have a doctor who considers your holistic health. You’re not paying for medical care, you’re paying for a signature.
Weight loss medications are taking advantage of the e-pharmacy model for obvious reasons. Not only does it offer women more privacy, but they’re also more likely to actually prescribe weight loss medications than an average family provider. Providers aren’t likely to prescribe the medications both because they’re concerned about the negative side effects and because success on the drugs requires that patients still eat healthy and exercise. In other words, the things doctors already wish you were doing to lose weight. Many doctors, including Obesity Medicine Association President Ethan Lazarus, also realize that weight loss meds aren’t the quick fix that celebrities make them out to be: “These shots and pills aren’t the miracle insta-svelte elixirs of our dreams.” Unlike your family practitioner, though, e-pharmacies don’t need to worry about trashing your hopes or your health by prescribing prescriptions that aren’t right for you. At least, not after they’ve already charged your credit card.
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Putting a Label on It
Ads for weight loss drugs like Ozempic will typically say “FDA Cleared,” not “FDA Approved.” While the terms sound similar, they’re not interchangeable. Using diabetes drugs for weight loss is considered “off-label use,” meaning the drug itself is cleared, but the FDA hasn’t said that it’s safe or effective in the way it’s being prescribed. Off-label uses aren’t always a sign of reckless medicine, and can sometimes allow providers much-needed flexibility with things like dosages or experimental usages. But in the case of weight loss medications, it does mean that the drug wasn’t developed with weight loss in mind, which has implications for the risk assessment associated with using it in place of non-pharmacological solutions. The side effect list for these drugs is quite extensive, including cardiac symptoms, slurred speech, and even seizures and breathing problems, so much so that it’s not even an obvious solution even for people who need it to survive. Even more shockingly, some Ozempic patients say their doctors didn’t even tell them they were on it.
The increased off-label use of diabetes medications is also affecting, well, actual diabetic people. The Ozempic craze has fueled a dangerous shortage of the drug for those who really need it, and doctors aren’t given much guidance over whether to prioritize those patients above the ones just using it to lose weight. “It really makes me mad; it infuriates me,” one diabetic patient said of the shortage. “We need it to stay alive and keep functioning on an everyday basis.” Patients like her are at risk of heart disease, kidney disease, hearing loss, and stroke due to blood sugar fluctuations and face side effects like nausea and vomiting even with short-term gaps in treatment.
Cutting Your Waist To Spite Your Face
Even if these medications faced no supply chain issues, they still wouldn’t necessarily be the right choice for women wanting to slim down. Doctors are now warning about both medical and cosmetic side effects of using these medications, including “Ozempic face,” a complication where users of the drug encounter extremely rapid facial aging. Some patients are shocked by this tradeoff, with one saying, “I remember looking in the mirror, and it was almost like I didn’t even recognize myself. My body looked great, but my face looked exhausted and old,” and dermatologists can spot “Ozempic face” from a mile away. Paul Jarrod Frank, FAAD, the dermatologist who coined the term, told The New York Times, “A 50-year-old patient will come in, and suddenly, she’s super-skinny and needs filler, which she never needed before. I look at her and say: ‘How long have you been on Ozempic?’ And I’m right 100% of the time.”
The negative effects of drugs like Ozempic aren’t just cosmetic, either. The FDA issued a warning about using Wegovy, an injectable intended for weight loss, saying the drug could lead to eye damage, kidney injury, pancreatitis, and even suicide. Other drugs’ side effect lists look similar, including Ozempic and Mounjaro, with the addition of thyroid tumors and thyroid cancer. While drug manufacturers admit that these drugs are shown to cause thyroid cancers in rats, they say it’s not proven to also cause cancer in humans. Still, one more recent study found that these drugs increased a patient’s likelihood of developing thyroid cancer by a staggering 60%.
A Cash Cow Crisis
Drug manufacturers want prescriptions to replace diet and exercise as the first line of defense against obesity, and they’re pretty much getting their wish. This weight loss trend is just one of several recent developments in an increasingly pharmaceutical approach to the obesity epidemic. Recently, the FDA even began recommending weight loss medications and surgeries as a first, rather than a last resort, for children. These recommendations bypass common sense solutions like diet and exercise for children as young as 6, recommending invasive surgery for children as young as 12.
Using medications and surgery as a first line of defense is total overkill. While medical intervention may be necessary in extreme, life-threatening cases of obesity, it’s simply not the case that most Americans should be using drugs with dangerous side effects to do what sneakers and a calorie-counting app can accomplish. The FDA’s tacit approval of these drugs is a symptom of a broken public health system. Drug companies may not have an incentive to do what’s in patients’ best interests, but our doctors and public servants should.
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America’s obesity crisis is no joke. Most Americans are now overweight or obese, and the numbers aren’t improving over time. Still, can it really be the case that our only options are “healthy at any size” ideologies or funding an out-of-control medical industrial complex? If you’re struggling with severe obesity and feel as though you’ve exhausted all your options, working with a trusted provider to evaluate medical options is a reasonable step. But there’s no excuse for the blind support these drugs are receiving from the medical establishment writ large, and drugs shouldn’t be used as a fast track for trendy bodies. Plenty of countries around the world boast healthy-size populations, and none of them got there with scalpels and needles in every home.
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