Weight-loss drugs are coming for a new kind of customer.
“You don’t need to be obese to start a GLP-1,” reads an ad from a telehealth startup, the words scrawled in icing on a cake. Another one features a slender woman excited to lose a little weight before her wedding. Yet another says patients can drop 17 pounds in two months by microdosing copycat Ozempic.
They’re part of a marketing blitz that’s ramped up in recent months, with ads plastered on billboards, in subway stations and online.
As the body positivity era gives way to a “thin is in” moment, telehealth platforms are seizing the opportunity to cash in. Increasingly, their marketing is positioning blockbuster weight-loss shots not as medicines to treat obesity or diabetes but as cosmetic elixirs for anyone who wants to lose a few pounds.
But GLP-1 medications aren’t approved for use in people whose body mass index, or BMI, falls below 27. Drug companies haven’t tested their drugs for people with those BMIs, either. Doctors warn that such patients could put themselves at risk for potentially serious side effects, such as gastrointestinal issues and pancreatic damage, with little to no health benefits. Experts also worry it leaves people vulnerable to developing an unhealthy relationship with food and their bodies.
Eli Lilly & Co., which makes Mounjaro and Zepbound, and Novo Nordisk A/S, which makes Ozempic and Wegovy, oppose the use of their products for cosmetic weight loss. Due to US Food and Drug Administration rules, they’re prohibited from marketing their drugs for those purposes and must promote them in a way that’s consistent with the labels.
A spokesperson for Lilly said the company is “deeply concerned” about telehealth companies “encouraging ‘cosmetic’ use and making false and misleading claims about the safety and effectiveness of untested and unproven” versions of its drugs. Novo declined to comment. Both companies have filed lawsuits against telehealth companies and compounding pharmacies for their practices.
Telehealth platforms and their marketing of GLP-1s, however, have proliferated largely unchecked. Until recently, the FDA long ignored their practices, which has led to a raft of ads capitalizing on the allure of thinness from companies like Willow Health Services, EllieMD, Midi Health and Fridays Health.
Although the FDA asserts the same oversight of them as pharmaceutical companies, telehealth firms circumvent the rules by omitting brand-name drugs like Ozempic, Wegovy or Zepbound from their ads. They feature images of vials sometimes labeled with the drugs’ generic names, or they’ll promote the class of medications rather than one specific treatment.
Roughly 93% of telehealth ads for GLP-1s analyzed last year emphasize a skinny or “ideal” body and prioritized benefits over risks, according to research conducted by Erin Willis, a health advertising professor at the University of Colorado.
Spokespeople for Willow and Midi said clinicians use their judgment to prescribe the drugs to people they think would benefit medically from the shots. The companies did not comment on their advertising practices. A spokesperson for Noom, another telehealth company, said marketing language for its microdose program is meant to highlight that patients can achieve weight-loss goals while minimizing the side effects that can sometimes lead to discontinuing the drugs.
EllieMD and Fridays did not respond to requests for comment.
The aggressive marketing is starting to draw the ire of regulators. The Trump administration is cracking down on telehealth companies’ ads, saying they need to disclose more side effects and play by the same rules as pharmaceutical companies. In September, the FDA sent about 100 cease-and-desist letters, some of which accused telehealth platforms of using deceptive tactics to sell GLP-1s. They didn’t specifically address marketing to unintended patient populations.
When asked for comment, an FDA spokesperson referred Bloomberg News to a press release on the enforcement letters. The release said 88% of advertisements for top-selling drugs are posted by individuals and organizations that fail to adhere to the FDA’s fair balance guidelines, and noted the agency “will no longer tolerate such deceptive practices.”
Despite misgivings of some physicians, people who aren’t obese or diabetic are getting weight-loss drugs from both telehealth companies and traditional doctor’s offices. A study released in August found that off-label Ozempic prescriptions for people who weren’t obese, overweight or diabetic grew from 3% in 2018 to 30% in 2023. For off-label Wegovy, it rose as high as 38%.
The FDA has approved the shots for people with a BMI of 27 or more, but patients say they’ve been able to get same-day prescriptions without weight verification. A spokesperson for telemedicine platform Midi, which has been advertising GLP-1 microdoses on Instagram, said health risks from being overweight, like cardiovascular disease, can begin at BMIs lower than 27 and the shots have a range of benefits like improving fatty liver disease and easing sleep apnea symptoms. Zepbound is approved for sleep apnea and Wegovy is approved for heart disease, but only in patients with obesity.
A spokesperson for Willow said the company connects patients with licensed physicians who “make independent clinical judgments to help those patients achieve their health goals.”
The CEOs of telehealth companies themselves say they take GLP-1s despite not having obesity. Noom’s Chief Executive Officer Geoff Cook says he has a healthy BMI and is using a GLP-1 to kick-start his fitness journey. Zachariah Reitano, CEO of telehealth company Ro, is also microdosing because of his family’s heart health history. Hims & Hers Health Inc. CEO Andrew Dudum is another microdoser.
“I’m very aggressive when it comes to metabolic health and cardiovascular health,” Reitano said.
Katarina Harris, 30, decided to take a GLP-1 after she kept seeing social media posts and videos promoting weight-loss drugs on TikTok. At 5 feet 6 inches and 135 pounds, putting her BMI at 21.8, the content creator from Charleston, South Carolina, wanted to lose a few pounds. She had little concerns about taking one, she said, particularly after seeing so many influencers on her feeds promoting them.
Harris signed up with digital health platform EllieMD in June. After a virtual consultation with a doctor, she was approved for a three-month supply of compounded semaglutide, the active ingredient in Ozempic, for $687. It arrived on her doorstep in two days. She microdosed for eight weeks, dropping 13 pounds.
“It’s definitely fast results,” she said. “If you have a wedding coming up in three to four months, just get on a GLP-1 really quick.”
Whereas a few years ago, Hollywood celebrities and other public figures were shamed for using GLP-1s, now more are being open about taking them for cosmetic purposes. Model Brooks Nader said her “career took off” once she started injecting a weight-loss drug.
“I typically microdose GLP-1,” Nader said in a September episode of her reality television show, Love Thy Nader. “Since I have Maxim coming up and I’m probably gonna be half-naked, I’m upping my dose a little because I want to be extra snatched.”
But she admitted that the symptoms of the weight-loss drug had “gotten a lot worse recently.” Soon after, she was found nearly unconscious in a bathtub, prompting her sisters to stage an intervention.
“The thing that I was so shocked about with the show was that I had so many people reach out to me, saying, ‘I’m also addicted to GLP-1,’” Nader told Bustle in an interview published this month. “I’m still on it. It’s a crutch for me, too. It’s not healthy. I should get off it.”
Many med spas and telehealth companies are also partnering with social media influencers, who receive commissions to hawk their services. Paid influencers are bound by the same rules regarding accurate and safe promotion of drugs, but the FDA has largely turned a blind eye to them, too.
Galina Antonova, 43, is one such brand ambassador for Ivy RX. The 5-foot-7 fashion startup founder first went on a GLP-1 when her weight was fluctuating from 130 to 150 pounds, which at her heaviest would put her BMI at 23.5 — considered in the “healthy weight” category. She reached her goal weight of 125 with the drugs, which she said also helped eliminate food noise and relieve inflammation and joint pain.
Now, Ivy RX covers the cost of her medication in exchange for social media posts about her experience, and she gets a small commission for every new customer who uses her affiliate link to sign up. Ivy RX did not respond to a request for comment.
Antonova, who lives in Los Angeles, is required to disclose that she’s posting on behalf of the company through hashtags or in the content of her videos.
“It seems like everyone is on it, whether it’s to maintain or to lose,” she said. “And a lot of people are just trying to lose a little bit.”
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