The Danger of Weight-Loss Drugs Going Mainstream

W alk into Cuba Libre in downtown Washington, D.C., and you’ll see a new menu: the “GLP-Wonderful” menu, which features smaller portions that cater to trendy customers on weight-loss medication. It’s the same in pockets of New York City, where restauranters have created “Teeny-Weeny Mini Meal” options, snack boards, and mini cocktails like the snaquiri (weight-loss drugs can also decrease alcohol cravings). At the stylish Tucci in downtown Manhattan, GLP-1 diners can feast on caviar-topped arancini for $12 each, or one meatball for $10. The fine-dining restaurant Fat Duck in Berkshire, England, also recently introduced a “mindful” dining experience with smaller portions.

Supermodel Kate Moss preached gospel when she said in 2008 that “nothing tastes as good as skinny feels.” That mantra, popularized by bone-thin celebrities and touted by teenagers with eating disorders, colored the way an entire generation thought about weight, food, and exercise. My generation’s mothers and mentors were obsessed with diet culture. My generation became obsessed with skinny.

When models in the 2010s ate calorie-free cotton balls dipped in juice or gelatin to make their stomachs feel full, young girls did, too. When celebrities embarked on the Master Cleanse in the early 2000s, a “detox” diet that consists of only a combination of lemon juice, maple syrup, water, and cayenne pepper for ten days, it became one of the most popular weight-loss methods. When the Biggest Loser aired in 2004, America cheered as overweight people embarked on a 30-week rapid weight-loss program, even though contestants were nearly starved.

For as outlandish as each of these crazes were, they all shared a common standard: None of them provided enough essential nutrients to make, or keep, a person healthy. Girls who ate cotton balls lost their hair and developed gastrointestinal problems. Master Cleansers passed out in the middle of the day. Biggest Loser contestants gained back the weight. Millennials coming of age in that era have been working ever since to develop healthy relationships with food and exercise. Gen Z inherited a weight-obsessed culture — one that social media has exacerbated. Photos and videos of idyllic bodies are streamed into our minds so often that bodies free of fat or imperfections seem like the norm. And to girls willing to starve themselves, those bodies are, at least for a time, an achievable norm.

Eating disorders more than doubled, from 3.5 percent during the 2000–2006 period to 7.8 percent during the 2013–2018 period, according to a 2019 study from the American Journal of Clinical Nutrition. The pandemic exacerbated the symptoms of those with self-reported eating disorders, according to a 2020 survey from the International Journal of Eating Disorders, as has access to social media, the internet, and television.

Enter weight-loss drugs. GLP-1s — originally intended to treat type 2 diabetes and now used for weight loss — seem to some like a boon, a game changer for obese people who need medical intervention. To others, GLP-1s seem like the next overhyped “miracle” drug, which, if marketed to the wrong subset of people, could perpetuate the myth that “skinny” is better than healthy. The problem is that GLP-1s have already been marketed to the latter clientele.

Willow, a telehealth clinic that doles out the weight-loss drugs semaglutide and tirzepatide, advertises its product on social media with a photo of a cake, frosted with the writing: “PSA for the girls: you don’t need to be obese to start a GLP-1.” Midi Health, a virtual company that specializes in care for middle-aged women, advertises a GLP-1 microdose program by lauding its ability to “reduce inflammation, balance metabolism and blood sugar.” GLP-1s “actually support my whole-body health — not just weight,” claims one Midi Health ad. Arrae, a supplement company that targets women, posted a clip of two healthy, thin women captioned, “When your bestie starts taking MB-1 because she saw you lose 12 pounds in 3 months.”

Weight-loss drugs could indeed be miraculous for obese individuals who need them. But who is getting prescriptions for weight-loss medication? A Yale School of Medicine study found that only 2.3 percent of almost 40 million eligible adults have received prescriptions for semaglutide or tirzepatide to treat obesity.

“Turns out, very few people who could benefit from these drugs are actually getting them,” Yuan Lu, an assistant professor of medicine at Yale and a senior author of the study, said. “We have a powerful new treatment here, but it is not reaching everyone who needs it.”

The best way to ensure that people who need the drugs get them is “a global access ecosystem” to enable “generic production, pooled procurement, tiered pricing, voluntary licensing, and local manufacturing,” the World Health Organization recommended in its guidelines on GLP-1 usage, released last week. In other words, the WHO advocates universal access to weight-loss drugs, provided to people deemed eligible by the WHO’s forthcoming qualifications.

President Trump has already expanded access to weight-loss drugs. He struck a couple of deals with drug companies to reduce the cost of the drugs, in exchange for Medicare coverage of medications for weight loss. Even when demand and government intervention make the drugs cheaper, patients will still have to pay hundreds per month for the drugs. And there’s the question of how doctors and companies will ensure that the people who need the drugs actually get the drugs.

In the meantime, there’s been little talk about who doesn’t need the drugs — say, a woman in her early 20s who wants to lose ten pounds before her wedding. Or a stay-at-home mom of one in Manhattan who wants to keep her 100-pound frame. Or a postpartum woman who wants to shed baby weight, fast. Women interested in the aesthetics that weight-loss drugs provide don’t even have to pretend to use the drugs for health reasons. It’s easy to order a weight-loss drug online.

These scenarios may not seem like a big deal. But for those of us who have been here before — an era in which potential long-term negative health effects are ignored in search of the next “miracle” weight-loss solution — history is repeating. Society is eager to discuss obesity but not unhealthy habits on the other end of the scale. Prominent women are wasting away in the public eye (see Ariana Grande and Cynthia Erivo); nearly every celebrity, it seems, is on a weight-loss medication, and many look worse after losing the weight, due to the hollow, gaunt effects of “Ozempic face.”

It should be easy enough to say that GLP-1 drugs have a place in curbing obesity, and not in mainstream diet culture. Because the proliferation of weight-loss drugs will do exactly what the skinny craze of the early 2000s did: teach young women that it’s unnatural to see changes to your body and weight with puberty, pregnancy, age, and illness.