How TikTok turned the diabetes drug Ozempic into a diet pill

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It’s the sign of any must-have product on TikTok: the item sails through the air, caught by eager hands. The latest is Ozempic, a diet drug that has been hashtagged on the app some 350 million times. Young women smile to the camera as they catch their dose. They pull injection pens from their packets. Push the needle into their stomachs. And then share how many more pounds they hope to shed over the coming week. In recent times, the diabetes treatment began to be prescribed “off-label” for weight loss. Its feverish popularity on social media has driven demand so great that there have been global shortages; it is the slimming method du jour in Hollywood too, where A-listers now pay $1,500 per month for the promise of shedding a few pounds.

Ozempic – for which the generic name is semaglutide – works by mimicking a hormone that regulates appetite, by creating the feeling of fullness. The dose is administered via a weekly injection, shown to produce an average reduction of 6 to 15 per cent of their body weight over the course of a year (depending on strength). The drug made manufacturers Novo Nordisk $3.4bn in 2020 alone, with analysts predicting sales to more than double to $7.8bn – particularly when Wegovy, a 2.4mg version of Ozempic approved for NHS use reaches the UK in early 2023.

In the reams of online posts, users share how their appetites have dwindled, with the falling number on the scales flashing up in multicoloured fonts. Quick waistline “fixes” have been around forever. But the TikTok effect is expanding their reach further and faster than ever before: an investigation by The Pharmaceutical Journal earlier this year found that the site was the “worst culprit” for bombarding young people with medical misinformation online.

For obese patients, Ozempic “works well,” says GP Simon Gordon, who has seen many of his own “lose lots of weight and [be] able to stop medicines for blood pressure… At the moment it’s helping.” Although it has been effective thus far, there’s reason for caution when it comes to declaring the drug a weight loss panacea – particularly given others’ tumultuous past. At least 25 have been approved by medical authorities in the last six decades, only to be banned once their side effects – from heart valve damage to strokes and primary pulmonary hypertension, a potentially fatal lung condition – became clear. It is partly this chequered history that has left pharmaceutical companies side-stepping an easy goldmine. With 3.5 billion obese adults globally – rates that have trebled since 1975 – that only one drug could be prescribed in the UK between 2010 until last year speaks to those lingering fears.

Between the 1930s and 1960s, it was a different story. Vast sums were being pumped into developing amphetamine-based weight-loss drugs, with Tenuate Dospan – one such pill known to cause side effects such as “confusions and hallucinations” – prescribed to a certain Donald Trump in the early Eighties. Psychosis was believed to be among its longer-term issues; shorter-term ones included “anxiety, insomnia and delusions of grandeur”.

But the race for medically induced shedding reached a nadir the following decade with Fen-Phen, a pill combining fenfluramine, an appetite suppressant, and phentermine (an amphetamine akin to speed). A single study of 121 patients reported a 14.2kg average weight loss over 34 weeks, compared to 4.9kg in the placebo control group; its popularity soared to such a degree that weight loss clinics were set up just to capitalise on demand.

Two years, six million patients and 18 million prescriptions later, it had become “a morality tale for our times,” according to medical experts, with 30 per cent of its users experiencing heart valve issues (as well as others reporting primary pulmonary hypertension, or PPH), leading to its licence being revoked. That didn’t come soon enough to save the likes of Mary Linnen, a 30-year-old from Massachusetts who, trying to slim for her wedding, spent three months in hospital before dying of PPH in 1997. Tens of thousands of legal claims were filed against Wyeth, the drug’s manufacturer, with $21bn set aside for payouts – a fallout so great that the US Food and Drug Administration approved no new diet pills for the following decade.

Fen-Phen, nor Phentermine – another amphetamine-based weight-loss drug still used in the US – were approved in the UK. But the legalities of weight loss pills aren’t always a barrier to entry for those seeking quick results. Since 2013, the UK Government’s Medicines and Healthcare products Regulatory Agency (MHRA) has seized more than £4m of illegal diet pills in Britain, including Dinitrophenol or DNP – used to treat obesity in 1933 but later classed as a “toxic chemical”. Available for purchase online, the compound has in recent years been linked to a string of deaths including father-of-one Liam Willis, 24, and 21-year-old student Eloise Parry. A 2019 study for Scotland’s Food Standards Agency found that, though they knew it could kill them, 5 per cent of respondents would still take DNP in order to slim; a government survey of dieters in 2017 found that more than 40 per cent of people used diet pills knowing that there were health risks associated. Sixty per cent reported their motivation as being “desperate to lose weight”, with the same number experiencing bleeding, heart problems and blurred vision due to taking weight-loss drugs.

Ozempic has thus far proved itself as both safe and effective – so much so that when Dr Gordon recently suggested that one of his patients, who is currently awaiting bariatric surgery, begin taking it, the surgeon refused; the drug will likely “hurt the careers of surgeons who specialise in obesity,” he thinks. Dr Alex Miras, a consultant endocrinologist and clinical professor of medicine at Ulster University, is equally supportive of its use among patients who are dealing with health issues as a result of excess weight. But he is “not surprised it is popular” in both Hollywood and across social media, noting that “in the UK, the biggest prescribers of Saxenda [the other legal weight loss drug, approved last year] are cosmetic salons”.

Once a slimming aid gets green-lit, demand among the body-conscious can often outweigh that of those in genuine need – which, without the input of a medical professional, can significantly up the potential risks. The medication is intended for use alongside a healthy eating plan and exercise regime, but when taken solo – and then stopped – any benefits are reversed; medically suppressing appetite alone cannot fix the global obesity crisis. And there is the matter of what happens after taking the drug, too. An April paper published in Diabetes, Obesity and Metabolism found that those on a 2.4mg dose of semaglutide regained two-thirds of the weight they had lost in the first year after stopping the medication, with those who had lost the most weight putting the most back on. Research has repeatedly shown the perils of yo-yo dieting, with gaining more weight than was originally lost and metabolic damage common outcomes.

One recent addition to TikTok’s Ozempic hashtaggers tells me that she began weekly injections five weeks ago, after her private doctor ran a series of tests to analyse her recent weight gain, and found no obvious reason. She has no particular goal on the scales, she says – “it’s a case of whatever I lose in six months. To be honest, I just want to give my weight loss a boost.” As the millions of identical hashtags attest, she’s not the only one.

This article was amended on 14 October 2022. It previously stated that Ozempic was available for purchase without prescription, but that is not the case in the United Kingdom.