Influencers love Ozempic—but they aren’t telling you about the risks

(Illustration: WSJ, IStock)
(Illustration: WSJ, IStock)

Summary

TikTok, Facebook and Instagram are supplanting physicians as the authorities on weight-loss drugs, but many posts don’t provide a complete picture of the hazards.

The friends and influencers on Facebook, Instagram and YouTube talking up drugs for weight loss aren’t always giving the full story.

Social media is displacing physicians as the trusted authorities on whether patients should take one of the medicines. People are not only deciding to take a weight-loss drug—called GLP-1s— based on posts by friends and influencers but sometimes also skipping their doctor to go with one mentioned online.

The virtual word-of-mouth can come across as authentic and accessible. People say they appreciate the tips and support they get from other online users. But many influencers and friends on social media play up all the pounds a person lost while playing down side effects that can be nasty, such as painful headaches and bouts of vomiting. Some omit the risks altogether.

Unlike company drug advertisements, social-media posts don’t have to describe a drug’s side effects, suggest other resources or tell people to speak with their doctors.

Karen Evans posted a video on YouTube that gave tips for taking Ozempic, including for managing the nausea. Since the video went online in May 2022, it has 454,000 views and more than 1,700 comments. Evans hasn’t followed up with a new video disclosing that the vomiting became so bad that she stopped using the drug.

“I was throwing up randomly. It was destroying my life," Evans said in an interview.

Brittany Buckner, a travel influencer who usually posts about plus-size clothing and travel under the handle @Plussizedandoutside, told her more than 58,000 Instagram followers about her use of a weight-loss drug after telehealth service Ro paid her to promote its weight-loss prescription program.

Buckner got the Ro partnership after searching through a site that connects influencers with brands. Under the arrangement, Buckner—who was taking a GLP-1 at the time—told followers that she didn’t get the medication from Ro, but “I wish I had gone through them."

Ro then paid Buckner to film two videos, which it posted months later on social media. In one Facebook video, she told viewers that Ro’s program “makes it super convenient" to access medication, including helping to find a pharmacy that can fill prescriptions. The posts sponsored by Ro are marked as paid promotions.

In reality, Buckner hadn’t been able to fill her prescription for Wegovy because of supply constraints. She hadn’t taken the drug for months, and didn’t attempt to do so through Ro.

Ro declined to comment on Buckner’s experience. A spokeswoman said the company only works with influencers who are on or have been on GLP-1 medication and can share their honest experiences. Their stories are then reviewed by clinical and legal teams to ensure the posts are medically accurate, the spokeswoman said.

Buckner, who wouldn’t say how much she was paid, said she declined to accept subsequent offers to promote weight-loss businesses because of her limited experience.

“I’m not a good person to say for sure that this is great," Buckner said. Some of the paid promotions remain online.

Listening to influencers, not doctors

The drugs used for weight loss, Ozempic and Wegovy from Novo Nordisk, along with Mounjaro and Zepbound from Eli Lilly, are the first medicines to become social-media sensations. (Ozempic and Mounjaro are approved for treatment of diabetes, while Wegovy and Zepbound are approved for weight loss.)

On TikTok alone, posts mentioning just the hashtag #Ozempic had drawn more than one billion views by the end of last year. There have been more than 2.2 million public posts about the drugs during the past year on YouTube, X and other social-media sites, according to an analysis by consulting firm ZS of data provided by social-media tracker Brandwatch.

The mentions have helped fuel prescriptions that J.P. Morgan says now average more than one million a week.

Jacqueline Castaneda got an Ozempic prescription from a clinic she heard about on Instagram, rather than from her physician.

Castaneda, a mother of three and tarot-card reader in California’s Central Valley who is in her early 40s, had first heard about Ozempic through TikTok. The testimonials of an Instagram plastic-surgery influencer whom Castaneda had long followed persuaded her to get the drug.

One of the influencer’s followers recommended the clinic that Castaneda went to for her prescription.

The prescription cost a lot: $1,300 a month, because her insurance wouldn’t cover the drug. In addition, Castaneda spent many mornings throwing up, one of the drugs’ common side effects.

After seven months, she asked her regular doctor for a prescription, hoping her insurance would then pay for it. But he didn’t feel comfortable, she said. He declined to comment.

Castaneda, who is 4 feet 11 inches tall and weighed as much as 140 pounds, said she felt the drug was worth it despite the vomiting because she has lost more than 40 pounds. She has persuaded others to take the drug. “I influenced, like, four of my friends," she said.

More than a third of people taking one of the drugs for weight loss said an influencer, celebrity recommendation or personal research was the top factor, according to a November survey of more than 388 users by venture firm Coefficient Capital and trends publication the New Consumer. Some 42% of those using the drug for weight loss said the main reason was the advice of a doctor.

The outsize role played by social media is a new and major change. For decades, drugmakers marketed their medicines to physicians and hospitals, not the public. The companies ran drug advertisements, not to bypass physicians, but to spur people to talk with them.

Patients demand Ozempic

Dr. Devika Umashanker, medical director for obesity medicine at Hartford Healthcare in Hartford, Conn., said patients come to her office vowing to go elsewhere if she won’t prescribe one of the newer weight-loss drugs.

Umashanker prefers to start people on an older drug such as phentermine because they are pills, rather than injections like the latest medicines. The older drugs are also less expensive if a patient’s health plan doesn’t cover weight-loss treatments.

But “patients hearing about these medicines on TikTok or Instagram only want to be on these meds, and are not interested in the whole comprehensive approach," Umashanker said.

When she does prescribe one of the new drugs, Umashanker starts with the lowest dose and monitors for difficult side effects. Nausea, diarrhea, vomiting and constipation are the most common.

Some patients have experienced more serious conditions, such as gallstones and a painful inflammation of the pancreas known as pancreatitis.

Given the risks, doctors said people need accurate information about the side effects, and people who aren’t obese shouldn’t take one of the drugs.

Both Novo Nordisk, manufacturer of Ozempic and Wegovy, and Eli Lilly, maker of Mounjaro and Zepbound, have criticized social media for portraying weight loss as cosmetic and minimizing obesity as a serious disease. Lilly ran an advertisement discouraging cosmetic use.

“Some people have been using medicine never meant for them," the ad said. The Food and Drug Administration approved Zepbound and Wegovy for people with obesity, or who are overweight and have at least one weight-related complication such as hypertension.

Influencers get paid for promotional posts

Influencers with fewer than 100,00 followers might command upward of $10,000 for health, wellness and pharmaceutical promotions, while influencers with more than one million followers might get between $50,000 and $125,000, according to Krishna Subramanian, chief executive of influencer marketing platform Captiv8.

Influencers can also make money through advertisements accompanying their YouTube videos or through affiliate links.

Evans, who has the popular YouTube video about Ozempic, is a 37-year-old teacher in Michigan who usually makes videos about books under the handle Roving Reader.

She started taking Ozempic in late 2021 to treat Type 2 diabetes. The drug lowered her blood sugar and helped her lose weight. Evans posted the video in May 2022, while she was still able to manage the side effects.

In the video, she described how she got “pretty sick" for a few days. One of her tips was to take the drug on a Friday to avoid dealing with nausea at work, which obesity-treatment specialists said was reasonable advice.

The video doesn’t capture Evans’s subsequent experience. Three months after the video went up, Evans quit Ozempic because the vomiting became unpredictable and was stopping her from living her life, she said. The final straw took place when she was vomiting during a vacation, which almost prevented her from meeting up with a friend.

She is now focused, she said, on diet and lifestyle changes to keep weight off.

Evans has mentioned in replies to comments that she stopped taking Ozempic. This month, after The Wall Street Journal asked whether she had done a follow-up video making clear she had stopped taking the drug, Evans posted an update in the text below her video saying she had.

Influencers who have posted about the downsides of weight-loss drugs say followers aren’t as interested in the negatives and the posts don’t get as many views as ones talking up the drugs.

The traffic for Evans’s Ozempic video has made her $2,371 from YouTube’s monetization program sharing ad revenue with content providers, she said.

Evans said earning money isn’t her main motive. “If I wanted to make money on YouTube, I would make a lot more Ozempic videos," she said. A YouTube spokesperson said the site tries to connect people with high-quality information and context about weight-loss drugs.

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