Thin…But at What Cost? The craze for weight-loss drugs and the LGBQT+ community

Thin…But at What Cost?

The craze for weight-loss drugs and the LGBQT+ community

By Kimberly Adamski

It’s rare to see prescription medication cause the level of cultural controversy that Ozempic has. Endless online discussions about whether it’s a miracle drug or “cheating” at weight loss proliferate in every corner of the internet. Internet users share their experiences with the medication, varying from extremely positive to nightmarishly negative…and everything in between. 

Ozempic is categorized as a glucagon-like peptide-1 receptor agonist, which are commonly referred to as GLP-1 drugs. These drugs mimic the naturally occurring GLP-1 hormone, which signals to the brain that the stomach is full and triggers the release of insulin. Most GLP-1 medications are administered via injection once per week.

Although Ozempic is being touted as a weight loss drug, the drug’s FDA approval is for management of type 2 diabetes. Given that the CDC reports almost 10 percent of Americans have type 2 diabetes, Ozempic is an incredible advance in diabetes care. By helping the body moderate blood sugar, it reduces dangerous blood sugar spikes. It’s highly effective for this purpose. “I was prediabetic,” says Naipaul, age 62, “[and Ozempic] controlled my blood sugar within weeks.” Type 2 diabetes is also strongly associated with obesity, and diabetics who take Ozempic tend to lose a significant amount of weight. In this case, weight loss is not the intended purpose, but rather an often-beneficial side effect. “I lost 30 pounds,” observes Naipaul. “My Ozempic experience has been very positive overall.”

For people who need help with weight loss but do not have Type 2 diabetes, accessing GLP-1 medications can be more complicated. Off-label use is rarely covered by insurance, and paying out-of-pocket can cost $499 to $1,200 per month, according to several retail sites. Insurers are tightening requirements for GLP-1 agonists, particularly Ozempic. CVS Health, for example, terminated coverage of Ozempic or Zepbound for weight loss. Their plans still cover the GLP-1 agonist Wegovy if the patient meets certain criteria. For weight management, most insurers require that a patient has a BMI of over 30 and has already tried healthy lifestyle changes before they will pay for GLP-1’s. 

GLP-1 drugs like Ozempic can have an immensely positive effect on the health of people who need them. At the same time, when a drug appears on the market that is purported to make losing weight effortless, it captures the public imagination. In the mid-20th century, for example, new medical uses for amphetamines were discovered. They were originally approved by the AMA— the FDA was not yet the governing body for drug approval—for psychiatric conditions in the 1920s, but they were widely used off-label for weight loss. By 1949, the manufacture of amphetamines was a multi-million-dollar industry. Today, medical authorities recognize the clinical value of amphetamines like Adderall for the management of ADHD and other mental health conditions, but they are not regularly prescribed for weight loss. Despite this, amphetamines are still abused today for “easy” weight loss.

Ozempic and LGBTQ+ Individuals

Gay, bisexual, and trans people, in particular, are at higher risk of trying dangerous weight loss methods than the general population. LGBTQ+ men are increasingly pressured to conform to ideals that are impossible for most people to achieve. A 2022 German study found that gay and bisexual men had worse body image than heterosexual men. They also valued thinness over muscularity more often, striving for a different body ideal more suited to the results promised or delivered by weight loss drugs.

Thus, it’s easy to see why Ozempic would be sought after in the gay community. Body image is an important part of self-esteem and mental well-being. When cultural views of the ideal body are skewed or unattainable, body satisfaction is negatively impacted. For some, this leads to disordered eating and exercise habits. For a smaller subset with greater economic means, it gives rise to an overuse of drugs like Ozempic

Socioeconomic status is an important consideration with respect to off-label use. “The monthly cost of Ozempic without insurance starts at around $800,” says Anthony Crisci, CEO of Circle Care Center. “The vast majority of our patients could not afford that.” In addition, healthcare providers like those at Circle do not prescribe Ozempic and other GLP-1 agonists to people for whom there would be no medical benefit. In wealthy areas, it’s not unheard of to pay out-of-pocket for weight loss drugs without medical need. According to Crisci, the primary way that inappropriate use of Ozempic and similar drugs comes about is via telehealth providers associated with manufacturers of unapproved generic versions of the drug.

The most common method for producing these generics is through compounding. This is where a manufacturer uses FDA-approved ingredients and creates a customized drug for an individual consumer. Compounding has valid medical uses, such as removing an allergen or creating a specific dose that isn’t available with the standard version of the drug. Compounded drugs that mimic the original can also be manufactured legally during drug shortages. Ozempic was considered in shortage between 2022 and early 2025, so manufacturers were permitted to produce these unapproved generics. 

Unfortunately, compounded GLP-1 agonists can be misused and mis-prescribed, posing risks to the public. Due to a lack of regulation, some products have been found to contain contaminants, while others are produced in unsanitary conditions. A recent study published in JAMA estimated that nearly half of the online pharmacies selling compounded GLP-1 drugs were operating illegally. Incorrect dosing also happens with alarming regularity with mis-prescribed compounded GLP-1’s. According to Brown University Health, 2023 saw a 1,500 percent spike in Poison Control Center calls associated with accidental injectable weight loss drug overdoses. Aside from these acute dangers, some less-scrupulous providers prescribe compounded imitations to people for whom there is little medical benefit. 

Despite these risks, the misuse of GLP-1 agonists persists. While the research on how the LGBTQ+ community uses Ozempic is lacking, anecdotally, it’s clear that this weight loss drug is culturally significant among gay men. Popular gay influencers joke on TikTok about being “Ozempic daddies.” Drag queens joke about how “gay” Ozempic is. And while Ozempic is taken by people from all demographics, many prescribers who work with the gay community have found that demand is very, very high among people who wouldn’t be considered appropriate candidates for the drug. Mark Bessler, MD and Chief of Bariatric Surgery at Columbia University, says that while GLP-1 agonists can be an incredible tool and effective alternative to bariatric surgery, he “know[s] a lot of people who are taking it for just 10 or 15 pounds,” even though it is not indicated for such small increments of weight loss.

Nathan*, age 42, shared with me his experience obtaining a compounded version of the GLP-1 tirzepatide. He used an online pharmacy that used AI to initially screen for eligibility. He was required to send his BMI information and a photo, as well as to describe his eating and exercise habits. Then, he spoke briefly to a prescribing doctor. The medication cost $500 for a 6-month supply. Nathan has experience in the medical field, so he figured he had the knowledge to safely administer a compounded GLP-1 but did acknowledge that it came with some level of risk. First, he said, it’s difficult to gauge the telehealth prescriber’s integrity; you’re also rolling the dice in terms of drug safety, since there’s no way of knowing what the manufacturing conditions are, nor that you are receiving the same formulation every time. 

The other big concern Nathan pointed out was dosing. Even when it’s prescribed by a reputable provider, dosing can be a trial-and-error process because everyone reacts to GLP-1 drugs differently. He is taking half of the standard dose, which is working for him, but if he had followed the instructions on the box, he said he’d “probably die of gastroparesis.” While he was likely exaggerating a bit, he illustrates a danger presented by inadequate medical supervision.

When taking any drug, a patient works with their provider to determine whether the benefits outweigh the potential side effects. Compared to weight loss drugs of the past, Ozempic is generally well-tolerated by people who medically benefit from it. However, when taken inappropriately the side effects can far outweigh the marginal benefits of taking it. Adverse effects of Ozempic can include gastrointestinal issues like cramping, irregular or difficult bowel movements, and nausea.

The Stigma of Ozempic

Yes, some people who take GLP-1 agonists are heavily stigmatized, too. According to Dr. Judith Korner of Columbia University, the popular narrative about GLP-1 drugs is that they are “the easy way out,” while weight loss via exercise and diet are in some way morally superior. The blame society assigns to overweight people, while also denouncing medical interventions as “cheating,” creates a no-win situation that may prevent people from accessing a drug that could benefit them.

Conversely, some people encounter pressure directly from medical providers to take GLP-1 drugs. One individual I spoke to, Jennifer*, age 43, said that she visited a nutritionist to discuss lifestyle changes that would help her lose weight. “The nutritionist only wanted to talk about Ozempic,” she said. She tried it, and when she lost 15 pounds, the nutritionist hugged her. While this action was certainly well-intentioned, it made Jennifer feel uncomfortable. It seemed like a value judgment on her weight.

It’s clear that the concern around Ozempic is a very complex issue. Unrealistic body standards, assumptions about weight, the desire for a “quick fix,” and economic status all play heavily into pressures around weight loss. Obviously, most people want to feel attractive, and there’s nothing wrong with that. It’s when we create a very specific, rigid idea of what counts as attractive that people start going to dangerous lengths to attain it.

On a structural level, some changes have been made to discourage the overprescribing of GLP-1 agonists like Ozempic. “Ozempic [is] becoming harder to get due to its popularity and insurance providers tightening criteria for coverage,” says Crisci. Insurer restrictions such as prior authorization requirements have left millions of people who might benefit from GLP-1 agonists without access. While these restrictions are meant to prevent clinically inappropriate use of medications, applying them across the board may drive people to seek higher risk options, like poorly regulated compounding pharmacies or even counterfeit products.

What is the solution? Martin Binks, chair of the Department of Nutrition and Food Studies at George Mason University, believes that improving access to FDA-approved GLP-1 agonists is key, along with increased patient education from licensed clinicians. A 2025 review from the University of Utah recommends regulatory steps by the government, including aggressively prosecuting illegal compounding operations and tightening advertising standards for compounding pharmacies’ marketing.

You can protect yourself by remembering that if it seems too good to be true, it probably is. “Don’t rely on online sources that promise cheap or no prescription access,” says Binks. “Talk to a licensed healthcare provider about safe, approved options.” 

Any time a new and effective weight loss intervention hits the market, the potential for misuse exists. Weight stigma, unrealistic beauty standards, and cultural pressure set the stage for weight loss drug abuse; popular media normalizes the practice. Through a combination of educating patients, removing stigma, and improving access to GLP-1’s to those with medical need, we can prevent Ozempic misuse while getting prescriptions into the hands of people for whom it may be lifesaving.

*Names have been changed to protect identities.