Off-Label Ozempic Usage Is Fueling Our Culture of Disordered Eating
"We just add another tool to the stockpile of ways to self-destruct with an eating disorder," one doctor told Jezebel.In Depth
Illustration: Vicky Leta
There’s a new name on the lips of everyone looking to shed their last five, 10, or even 25 pounds. That name is semaglutide.
Better known by its commercial name Ozempic, semaglutide is an injectable antidiabetic medication that curbs hunger and makes food seem unappetizing. A side effect of that diminished appetite is pound shedding, which has led to explosive off-label use for weight loss. (Wegovy, also a semaglutide, is approved by the Food and Drug Administration for weight loss for “overweight” people with a BMI of 27 or 30.) In early 2023, TikTok users posted recipes to help each other mix Ozempic on their own at home. Rumors flew about which Hollywood elites use it for weight loss; professional troll Meghan McCain said she was pressured to take the injectable to lose weight after birthing her second child. A software developer told NBC News that using Ozempic was like a “diet” that helped her drop more than 50 pounds.
Then, on Monday, New York published a feature about how trendy Ozempic and semaglutides generally have become with the headline “Life After Food?” Interviewees reported a severe lack of appetite; one source said they even had to remind themselves to drink water. Another said, “It’s really fun for [already-thin women] to have their jeans hang off of them like they’re a Hadid. There is an addictive quality to it.” An actor described herself as less anxious because she was less hungry, and said Ozempic allowed her “to be casual about food”: “I can just have one bite, or two bites, or three.”
That this feature about no longer wanting to eat came out on the first day of Eating Disorders Awareness Week put the limits of irony to the test.
“One of the things that we know from the research and eating disorders is that one of the biggest risk factors to developing an eating disorder when you haven’t had one is dieting,” Dr. Kim Dennis, co-founder and CEO of SunCloud Health and a clinic advisory council member for the National Eating Disorders Association, told Jezebel. The off-label use of semaglutide is “like medically sanctioned dieting,” she continued. “We just add another tool to the stockpile of ways to self-destruct with an eating disorder.”
Some people interviewed about their Ozempic experiences described the hallmarks of disordered eating—routine, rigidity, anxiety around food or non-consumption of food—if not eating disorders. Research shows that eating disorder diagnoses are rising. And yet, because the medical community too often views the physical markers of fatness as awful and upsetting, prescriptions for off-label use are still being written. One drug discount company with 5 million members saw prescriptions for Ozempic triple from 2021 to 2022, NBC News reported. The demand is causing a shortage for people who need the medications for medical purposes—diabetic and prediabetic diagnoses—and for people who just have to have it. Its out-of-pocket price is ungodly high, and that’s what you’re usually paying for off-label usage.
In the diabetic community, Ozempic and its ilk are sometimes referred to as “eating disorder drugs,” according to Zoë Witt, an organizer at Mutual Aid Diabetes who previously wrote about diabetes for Jezebel. “If your side effects are so bad you can’t (or don’t) eat you should not be taking them,” she tweeted. Abby Rose Morris, host of the podcast More Than Tracy Turnblad, which is about fat representation in culture, tweeted about Ozempic: “We have this idea in our culture that wanting to eat and enjoying eating is abnormal, wrong, or even some sort of mental illness. We have pathologized the desire for food, something we need to survive. It’s absurd.”
It would be one thing if people who got semaglutide prescriptions for weight loss were given informed consent, like, “By the way, taking this medication puts you at greater risk of developing a potentially deadly eating disorder,” Dennis said. “But nobody’s getting that in their informed consent. Nobody at the primary care office or the endocrinologist’s office or the family practice office is being told, ‘Yes, you can try this medication, but please be aware that one of the potential side effects is the development of an eating disorder.’”
The use of semaglutide for vanity, not FDA-approved medical treatment, could also reinforce existing eating disorders, potentially prolonging the time it takes people to seek treatment. Dennis compared it to getting bariatric surgery when you have an untreated eating disorder. The band will help reverse potentially organ-threatening diabetes, hypertension, and joint diseases. “But if the person also has an eating disorder and that’s untreated, they’re still going to have their eating disorder after the surgery,” she said. “So all of these people are still going to have their eating disorders and obsession with weight loss and obsession with calories in/calories out well after they’re off of their one-year, two-year, three-year course of Ozempic.”
“When we treat people with eating disorders, so much of our work is focused around… getting them connected to and in-tune enough to hear hunger and food cues.”
As soon as I read about people saying they weren’t hungry or that they were skipping meals, I was transported back to being 19, when I insisted I simply wasn’t hungry anymore—that yes, the venti black coffee was more than enough. For decades we’ve told people that fatness is an affliction that can be cured if you’re vigilant. Too thin is never too thin until it’s a real problem and you’re losing hair and you’re not menstruating anymore—and that’s just if you’re identifying as a woman. If you’re a man or anyone on the genderqueer spectrum, good fucking luck finding adequate treatment. We’re messing with how people are connected to their bodies and how they react to hunger.
“When we treat people with eating disorders, so much of our work is focused around getting them back connected to their bodies, getting them connected to and in-tune enough to hear hunger and food cues, and supporting them in eating in flexible ways at regular intervals so that their body gets used to having like a steady rhythm of food,” Dennis said.
Even if society is a lot better at recognizing eating disorders than it was during the peak years of heroin chic, pro-ana discourse, body negativity, and Y2K fashion, society still codes disordered eating as the ideal. We see women making themselves smaller and cheer. We see men having problems eating food and jeer. I will spend the rest of my life repairing my eating disorder brain—and I’m one of the lucky ones.
Using Ozempic and other semaglutide medications for off-label weight loss is simply recycling the worst parts of diet culture and packaging them in a syringe with a doctor’s approval. “It’s like the same old thing, just the new 2023 iteration of it,” Dennis said. “Which is also really sad.”
If you or someone you know needs help, contact the National Eating Disorders Association (NEDA) online or at (800) 931-2237. If you have an emergency, text NEDA at 741741.