Baltimore-based influencer Stella Kittrell says two “suspicious” emails landed in her inbox last summer. The first was from a huge online-based medical brand “casting” people interested in promoting GLP-1 medication (like Ozempic) on their social platforms. The second was an unknown medical brand offering Kittrell $15,000 outright for posting one 15-second Instagram story ad. “There was no information about the company and no email on the site,” she says. “It just felt really sketchy.”

Naturally, Kittrell says she was briefly tempted by the fast cash, but, out of a sense of care and duty to her followers, she declined both offers. Since then, however, she’s had an increasing number of emails from “very well-known” at-home medication delivery companies across the US. “The most insane offer I’ve received was $20,000 for a three-frame Instagram story this year,” she says. “There’s something very personal about someone you trust saying ‘Hey, here’s this medication’, you should try it too.” 

After being approved for weight loss by the FDA in 2021, we’ve seen an explosion in demand for semaglutide over the past couple of years, usually sold under the brand names Ozempic or Wegovy, both of which are manufactured by Danish pharmaceutical company Novo Nordisk. Initially, only celebrities and fashion industry A-listers (and people with diabetes) seemed to be able to get their hands on Ozempic, but the shortages only led to a rise in readily available FDA-approved alternatives. Currently, Weight Watchers offers a GLP-1 program, and large telehealth platforms like Hims & Hers and Ro sell compounded semaglutide kits with two-day express shipping. No one, not even the FDA, is tracking these online-only sales, but pharmacist Mark Mikhael guessed they may account for up to 30 per cent of the semaglutide sold in the US. Online weight loss clinics like Zappy Health also use influencer marketing across TikTok and Instagram to grow their customer base. 

“Now that I’m down 25 pounds, I’m feeling amazing! Less bloating, I sleep better, no food noise, and my cardio is actually getting better in the gym,” one lifestyle influencer wrote in a paid post with Zappy Health, offering followers $50 off their first month. Another content creator offered “a free month of semaglutide” through a new online telehealth service, MinuteMD. But, according to Ashley Dunham, a content creator in Florida, many of these companies aren’t providing influencers with enough time to actually try the product before promoting it. Dunham says she gets daily offers from telehealth companies reaching out to use her likeness without being a patient of theirs, offering $50 to $100 per referral. “One company reached out to help me hard launch their GLP-1 service but only offered me a week to use their platform,” she says. “When I started seeing posts from creators who I knew only had days with it, I had to ask, do you guys really lack this much integrity by telling people that you lost X amount of weight using this service that you only got an email for a week ago?” 

Steven Woloshin, professor of medicine at Dartmouth Medical School, says it’s increasingly difficult to quantify how big of a problem influencer marketing has become for prescription advertising regulation, especially considering that many of the posts come from micro and macro influencers. “Marketing drugs through influencers is not really different than marketing drugs through traditional advertising,” he says. “The difference is that there is so much more of it, and they’re so much more creative and engaging, so they may be more effective.”

When I started seeing posts from creators who I knew only had days with it, I had to ask, do you guys really lack this much integrity? – Ashley Dunham

Unlike the side effect disclaimers required for pharmaceutical television ads across the US, many influencers are also currently not making their audiences aware of any potential adverse effects. “If the benefit is exaggerated or really ambiguous so that people fill in the blanks, then that leads to trouble,” says Woloshin. And, as pharmaceutical influencer marketing largely flies under the radar, sponsored GLP-1 posts can prey on people’s desire to lose weight as quickly as possible (despite the risks). Dunham says she’s even received a DM from a follower who is taking three Ozempic pen injections a week (well above the prescribed dosage). 

There’s currently a new bill under consideration with US Congress proposing penalties for telehealth companies, social media influencers, and healthcare providers who benefit financially from sharing misleading information about prescription drugs on social media. However, according to Woloshin, the true challenge comes with enforcing the legislation. Woloshin says the FDA’s “very small staff” simply can’t keep up with the sheer number of posts, and Sneha Dave, the executive director of Generation Patient, says that much of the social media marketing around prescription medication disappears within 24 hours. “Something that claims to be a quick fix can be really harmful not only to physical health but also because you’re then emotionally being targeted by the algorithm and bound to see more of those types of ads,” she says. “I think it’s really important for people online to not over-medicalise symptoms that may not often even require prescription medicines.” In the world of weight loss online, this includes terms like “bloating”. 

Dunham considers herself an influencer with a code of ethics. While she does post about her health journey using an “Ozempic dupe” for PCOS, she declines offers for sponsored semaglutide collaborations. “Because my stepdad is a nurse practitioner, I have access to medical journals and advice that most creators don’t,” she says. “I give people questions to ask their medical provider and refer people to a dietitian when people ask me for nutrition advice because I feel like there’s a right and wrong way to take it [semaglutide].” Dunham believes many of the influencers promoting weight loss drugs similarly started with good intentions, but then “everybody started seeing the dollar signs”. “Most of these companies don’t even require bloodwork anymore,” she says. “They don’t care about you; they care about the dollar you represent. It gives MLM vibes.”

Unfortunately, without regulation from social media executives or an effective implementation strategy from the FDA, more sponsored GLP-1 testimonies are bound to populate online (especially with $20,000 up for grabs). As a result, there’s an urgent need for people to become more critical of medical information online. Here’s where transparent influencers like Kittrell come in: after noticing that many of the people on a TikTok live stream that had “an overlay of Ozempic” didn’t seem to realise the post was sponsored, Kittrell told her almost 500,000 followers on the platform that she’d been offered (and declined) to push semaglutide. Scrolling through the comments on the now-viral post is a disappointing sight, filled with people scrambling to ask how they can get sponsored instead. “I feel like it exposes the general mass thinking – not caring about what you’re offered because you just want to get skinny,” she says. “At the end of the day, the whole point is just weight loss culture”.