A rapid growth in demand for GLP-1 receptor agonists (RAs) medications has increased scrutiny around the relationship between patient-led recommendations – shared via ‘success stories’ on social media – and public health (both physical and mental).
Concerns about misuse of the drugs, which are prescribed for the treatment of diabetes and obesity, have led to calls for greater moderation of medical and weight-loss content, as well as stricter advertising standards online.
Already, worries around the recommendation of potentially harmful weight loss content to vulnerable young people have prompted some change. Most recently, this has included a policy shift by YouTube, which will adapt its algorithm to prevent the recommendation of content idealising specific fitness levels, physical features and body weights to children aged between 13 and 17.
However, critics feel that GLP-1 RA drugs are becoming ‘glamorised’ by celebrities and influencers, including famous faces such as Elon Musk and Oprah Winfrey. Detractors argue that these figures neglect to explain the risks inherent to improper drug use, resulting in a culture that normalises unnecessary medication. This presents a twofold risk: firstly to the physical and mental health of those who do not need the drugs, and secondly (in the form of supply shortages) for those who do.
Fasting + Ozempic/Wegovy + no tasty food near me
— Elon Musk (@elonmusk) November 16, 2022
The rise of GLP-1 RAs
GLP-1 RAs mimic the action of the GLP-1 hormone, assisting in insulin production and suppressing appetite. Currently, they are produced by two major companies: Novo Nordisk and Eli Lilly. The former produces semaglutide, sold as Ozempic for type 2 diabetes patients, and Wegovy for treating obesity. Eli Lilly’s drug tirzepatide, is sold to type 2 diabetics as Mounjaro, and marketed as Zepbound for treating obesity.
“GLP-1 RAs are a drug class targeting the glucagon-like peptide-1 receptor (GLP-1 receptor) in the body,” explains GlobalData pharmaceutical analyst Costanza Alciati. “This receptor is present in multiple tissues, hence the many effects of these drugs.”
“GLP-1 RAs are currently approved and on the market for type 2 diabetes and obesity patients, as the main effects of the drugs are improving metabolic markers (e.g. reducing HbA1c levels, and improving insulin sensitivity) and causing weight loss (through targeting insulin resistance, but also the brain receptors, exerting an anorectic effect).”
However, the rise has also prompted a wave of social media content recommending (directly or through personal 'transformations') GLP-1 RAs for cosmetic weight loss. Famously, members of the Osbourne family have used the drugs, despite having no known diabetes or obesity diagnoses.
Just when you thought it couldn't get any juicier! Today's Osbournes podcast episode drops with Kelly addressing the Ozempic controversy head-on.
— Sharon Osbourne (@MrsSOsbourne) March 26, 2024
Tune in for the latest dose of drama! New Ep. OUT NOW Youtube, Rumble or wherever you get your podcasts. pic.twitter.com/DZdne1w6ZD
In June, the European Medicines Agency (EMA) warned against this, as supplies of GLP-1 RAs ran low, leaving those in need of medication at risk. In a statement, it said: “The use of GLP-1 receptor agonists for cosmetic weight loss in people without obesity or people with overweight who do not have weight-related health problems has been mentioned frequently in news outlets and social media and is worsening existing shortages.
“The continued high demand for these medicines has also attracted criminal activity, increasing the risk of falsified products entering the market with serious consequences for public health.”
Online: Pandora’s box
Concerns about who is accessing this medication – and why – have become entangled in the debate around appropriate content moderation, and the material pushed by engagement-seeking algorithms.
YouTube recently announced that its algorithm would no longer recommend content relating to body image to children between 13 and 17. While this material will still be available to younger viewers, it won’t be suggested based on other recently viewed material.
In January, Meta (which owns Instagram and Facebook) updated its apps to hide search results relating eating disorders, as well as to suicide and self-harm. Instead, the apps now present a ‘help is available’ page, including a list of helplines and ‘suggestions from professionals outside of Meta’.
However, there are still calls for tighter moderation, and there is disparity among platforms. Meta and YouTube’s moves stand in stark contrast to recent complaints around other platforms, including X – previously known as Twitter – which has come under criticism for its lack of moderation. In December 2023, the European Commission opened formal proceedings against X to establish whether it had breached the Digital Services Act (DSA) in regard to risk management, content moderation, dark patterns, advertising transparency and data access for researchers.
Considering the impact of the online world on the mental health of young people, Olly Parker, head of external affairs at charity YoungMinds, says: “Record numbers of young people are being referred for help with their mental health and the online world is one of the big drivers. This is compounded by inequality, poverty, discrimination, insecure housing and an uncertain future. Add on intense academic pressure and it’s no wonder so many are struggling.”
He continues: “Algorithms make it harder to take breaks from social media and serve content many find harmful. Many young people have told us they are routinely shown distressing content online that they didn’t ask for. They feel trapped and unable to leave social media sites and some say they spend more time than they would like to online.”
The relationship between social media and users’ relationship with body image, has been well documented, but is complex and varied. According to some scholarship, social media content has the potential to improve body perception (posts connected to the recent body positivity movement being an example of this), although it can also enforce the status quo.
Some studies have suggested little correlation between the rise of social media and body image issues, demonstrating instead that these concerns have long existed outside of digital spaces. A twelve-year study started in 2002, which took place across 33 countries in Europe and North America, found that 10 out of 33 countries saw a small increase in boys perceiving their body as “too fat” while no change was found over time for girls. This study coincided with the rise of social media platforms, but according to Catharina Wold Robson, honorary visiting fellow at department of sociology at the University of York, it demonstrates that “although the literature tells us that ‘certain social media use seems to be bad for body perception’ trend studies (over time) do not find that body image was worse in the years that social media became mainstream.”
However, there is evidence that social media has powerful potential to exacerbate body image issues, even if it is not the sole cause. Expanding her point, Robson tells Pharmaceutical Technology that: “Certain behaviours, such as using visual platforms have been found to be more detrimental to body perception than text-based platforms, and that upward comparison (i.e. comparing oneself with someone you perceive as ‘better off’ rather than ‘worse off’ or ‘similar’) on social media can be detrimental to body perception.”
While she notes holes in the final argument, she points to research by Pedalino and Camerini, which identifies that the passive use social media can have negative impact on body perception. For those already struggling, algorithm programming can quickly create an echo chamber and leave vulnerable users exposed to content that reinforces negative messages. This includes being recommended semaglutide and tirzepatide to lose weight.
The risk of patient-led recommendations
The increasing uptake of GLP-1 RAs (including by celebrities and influencers) has been reflected in content posted on social media platforms, and ‘success stories’ or ‘journeys’ have garnered interest and followers.
As a result, conversations about the drugs have exploded on all major platforms. In most cases, content creators are looking to share their own legitimate experiences using semaglutide or tirzepatide in managing type 2 diabetes, or in achieving necessary weight loss. However, a rise in demand has fed fears that misinformation and the popularisation of these medications by famous faces is increasing the cosmetic use of the drugs.
For vulnerable social media users, there is a risk that this content (sometimes posted by paid advertisers) might be recommending unnecessary and dangerous medication for which they mistakenly feel the need.
Advertising any medication raises questions, particularly on platforms usually used to advertise consumer goods. Semaglutide and tirzepatide are being marketed alongside hair and beauty products, clothes, food and drink and other everyday items.
In Europe, there is a ban on direct-to-consumer advertising (DCTA) of drugs to avoid this problem, but the US has no such law in place, and GLP-1 RAs are widely available through private healthcare providers who advertise on social media platforms.
Expanding on this concern, Alciati notes that a lack of proper regulation around content advertised and sold on social media means the wrong people could be accessing the medication.
“On social media, there are a lot of programmes that couple the weight loss drug with lifestyle changes and include shipping the drug at the patient’s home,” she says. “Such programmes could be useful to reach patients and increase awareness regarding the drug, but I think most of these don’t check whether the patient really has diabetes or is actually obese, which is a problem because it means we are still giving drugs to people who don’t really need them.”
There is also a second risk: shortages. GLP-1RAs are, in Alciati’s words, “extraordinary drugs” for those who need them. However, with supply unable to match demand, there have been instances of diabetics struggling to obtain necessary treatment, leaving them at risk of hyperglycaemia.
Doctors have raised concerns about the shortages, which were first identified in 2022. The EMA responded, saying: “Use outside its authorised use, such as for weight management in people who do not have diabetes, is considered off-label and affects the availability of the medicine to treat patients with type 2 diabetes.”
