‘It’s like magic!’
I gasp, hoping I sound naïve enough.
‘No, no – it is!’ the pharmacist replies with a chuckle. Let’s call her Susan. ‘You’re going to love what it does, and you’ll love being on the pen,’ Susan continues, startling me with her use of the future tense. No ifs? No buts? After all, that ‘pen’ she’s describing is a weekly, prescription-only weight-loss injection – a risky one at that. Plus, she’s a registered pharmacist, at a legitimate, UK, brick-and-mortar pharmacy… and we only met 10 minutes ago.
I won’t need to wait long, she explains. I can even have the first dose posted out to me tomorrow. The only ifs or buts – apart from paying the £195 invoice she’ll send over by email – are that I can’t get pregnant on the injections. Susan also warns me I’ll need to exercise more and eat less from now on, otherwise ‘the pounds will start piling on again’ when I reach my ‘target weight’ and come off the medication.
A familiar shame snakes up my spine. My mind drifts to the half-jar of chocolate spread in my cupboard and licked spoons in the sink. There’s so much I wish I’d said. No, for a start. I don’t need weight-loss injections in my life, for so many reasons – too many to get into now.
But I don’t. Because I want to test just how unrigorous – and at times unsafe – the prescribing of these medications has become. So instead, I say, ‘Can I pay extra to make sure it’s posted ASAP?’ As my consultation continues, Susan’s unconcerned about side effects, mentioning ‘a bit of nausea, heartburn, a bit of diarrhoea…’ She does mention a risk of pancreatitis: ‘completely reversible’ (a doctor will later explain that this was misleading).
‘Thankfully,’ Susan tells me, out of the 100-plus patients her pharmacy has seen, ‘no one’s experienced a side effect.’ And the needle? ‘Oh, it’s tiny,’ she reassures me. A scratch. In a never-say-never tone, she says that she’s not currently considering weight-loss injections for herself because she’s breastfeeding. ‘I do not wanna tell you the pregnancy weight I currently have!’ she splutters, and I really want to hug the misplaced shame out of her voice.
But I couldn’t hug her even if I wanted to, because this conversation happened over the phone. This pharmacist has never seen me in real life, nor a photo of me – she never asked, nor contacted my doctor. If she had, she’d have known I lied significantly about my weight on the pharmacy’s questionnaire, adding enough kilograms to bump myself out of the ‘healthy weight’ range and up two categories higher.
After we hang up, I assume someone, somewhere, will whistle-blow, perhaps a concerned colleague of hers who overheard a near-anonymous patient ordering life-altering medications like a Deliveroo curry. So, when the invoice lands in my inbox shortly after, I gasp. These medications can come with serious side effects, especially if they fall into the wrong hands. So why is it that I’ve had a harder time getting hold of some skincare serums?
Skinny-jab safaris
Here’s the thing: Ozempic, also known as a ‘GLP-1 receptor agonist’, is not even allowed to be prescribed in the UK or the USA for weight loss – it is, and was only ever, a medication for diabetes management. But that didn’t stop the world from getting obsessed with it, and other GLP-1 injections that actually are licensed for weight loss on both sides of the Atlantic.
And it’s hard to pinpoint when that obsession began. Most of us had never even heard of them a year ago – let alone considered taking them. Now? GLP-1s are so prevalent that there’s even reports of ‘skinny jab’-friendly menus, offering smaller portions, all said to be accommodating customers’ shrinking appetites. Red carpets have turned into ‘gotcha!’-style skinny-jab safaris. After this year’s Oscars, one tabloid headline even screamed: ‘And the award goes to… Ozempic!’ before listing all the rumoured celebrities said to be using Ozempic off-label for weight loss, or other GLP-1s like Mounjaro and WeGovy.
Before long, the public was copycatting. So many people rushed to use these medications that global shortages of Ozempic meant supply was strangled for diabetes patients. Some went without for several months – like Kate, 36, who’s used GLP-1s to manage her type 2 diabetes since 2020. ‘In 2022, I was told that stock wouldn’t be replenished until summer 2024,’ she recalls. The charity Diabetes UK says those shortages are now, thankfully, mostly resolved.
All that publicity meant that when the UK approved alternative GLP-1 injections specifically for weight loss, the public was invested. And for many, those injections have changed lives. Marcela Fiuza, a registered dietitian and spokesperson for the British Dietetic Association goes so far as to call them ‘game-changers’. But she adds that this is only the case when they’re used safely, with adequate support.
The only problem: generally speaking, that doesn’t seem to be what’s happening in the UK. Though these medications are available on the NHS, waiting lists can be discouragingly long. So, many turn to buying them privately – a speedier process, if you can afford the £150 to over £200 per month. Pharmacies are supposed to check your BMI – a calculation of your weight and height – is at least 30, or 27 with associated health issues, such as cardiovascular disease, high blood pressure or high cholesterol. So why are people whose BMIs are far lower than those requirements able to access them, like I did?
‘It’s everywhere,’ says one anonymous private healthcare worker. She tells me she knows of ‘many mid-size and straight-size’ people taking weight-loss injections, including a Harley Street surgeon. ‘Working in private healthcare has opened my eyes to a lot.’
‘INJECT WITH ME’
With lavender nails that match her syringe, the lifestyle influencer prepares the injection. ‘So, iiiiiiit’s jab day!’ she singsongs in the video. ‘If I can do it, you most definitely can!’ she says, and I wonder: could I? ‘Two clicks… prime it…’ and then she lifts her top and pushes it into her tummy. ‘Ta-da!’ Perhaps she’s cheering us on out of the goodness of her heart. Or maybe it’s because she’s got a discount code for a major GLP-1 provider up for grabs in her bio. I scroll. Another influencer, in a pink cardigan, talks me through taking a ‘golden dose’ by collecting the remaining ‘bonus’ fluid in a pen to recycle for another dose in order to save some money on prescriptions.
When Sami’s* first dose of GLP-1s arrived, he tore open his box excitedly. He felt like he was joining this inner circle of his favourite influencers. ‘Now I’m thinking about those words, “Inject with me” – that’s absolutely insane,’ he winces. But videos like this, alongside very targeted advertising campaigning, had reached him at a vulnerable period of his life. Originally, he was sceptical – his mother had passed away and he was worried about navigating side effects while grieving. But the slow, drip, drip, drip of marketing eventually persuaded him. Months after tearing open that initial box, he began to feel frail, often leaving work early, ‘exhausted, breathless and with a sense of overwhelming doom’ – a side effect he’d batted away after seeing it normalised in online support groups.
He was deficient in vitamin D, calcium and folic acid, but Sami didn’t pass this on to his provider, fearing that he’d lose access to the drug he thought could overhaul his life. ‘Coming from a place where you’re so desperate to lose weight, you’re not going to disclose that,’ he explains. Sami’s pharmacist even upped his dose, but he fell more ill, taking multiple trips to A&E in the middle of the night. ‘I was shaking, screaming and crying, saying, “This is killing me… I’m going to die in here, like my mum did.”’ He was kept on a drip and given morphine, before being discharged with medication to control his heart rate. Slowly, Sami came off the injections and was prescribed weight-gain shakes alongside therapy and antidepressants.
Like Glossier became the go-to for lip balms, private companies are wrestling to become the go-to for GLP-1s. That results in targeting would-be patients, like Sami, with adverts and influencer recommendations. That’s how Chelsea*, a 31-year-old content creator, first heard of GLP-1 injections. Almost pre-diabetic, she’d been suffering from health issues related to her weight. But the wait time for her NHS weight-loss clinic was eight months. ‘I kept getting ads for every single weight-loss injection,’ she tells me. ‘My feed was full of it.’ After four or five months of constant advertising, she decided to buy injections privately. By the time she’d reached a higher dose of the medication, several months in, Chelsea was forgetting to eat – sometimes for days at a time. ‘When you think about it, your body’s running on empty,’ she explains. GLP-1s work by increasing the levels of hormones, called incretins, that help the body produce more insulin, to lower blood sugars. This means that they slow down how quickly your food is digested, which leads to you eating less, according to Diabetes UK.
Chelsea ended up in A&E after waking up with migraines, hot and cold sweats and continuous vomiting. ‘The vomiting started to rip and cut the lining of my throat,’ she continues. ‘Something that looked like coffee granules came up – it was blood.’ At the hospital, nurses put her on a drip with concerns of meningitis. Tests revealed that her blood sugar was dangerously low. ‘[I was in] starvation mode,’ she says.
But are Sami and Chelsea’s nasty experiences a result of the drugs themselves, or a lack of support and monitoring? NHS doctor Jatinder Hayre says it’s the latter. ‘Even though GLP-1 agonists are safe with a generally tolerable side-effect profile, we mustn’t forget those side effects do exist,’ he explains. Anecdotally, he’s witnessed a rise in complications in patients who have accessed these drugs privately. ‘These people are not under observation, or being monitored, or having routine bloods taken by their doctors because they simply exist outside of the healthcare infrastructure.’
With most prescription-only medications, there are safety mechanisms in place, with doctors prescribing them and then checking in on patients regularly. But so many people can now skip that vital step, procuring the drugs privately online – or even illegally, with reports that some drug dealers now offer GLP-1s. Patients can end up facing debilitating side effects but feel unable to seek help because of shame and a lack of knowledge. How exactly did we get here?
THE PENDULUM SWING TO THINNESS
They were impossible to ignore: imposing, with a canary yellow bikini popping against monochrome, muscular flesh – demanding to know, ‘Are you beach body ready?’ The billboards were pasted from the skyscrapers of NYC’s Times Square to the depths of the London Underground. Inescapable. This was 10 years ago, and the Protein World adverts sparked such a huge debate that they were banned in the UK over body-image concerns. That ban signalled the birth of something different. In 2015, body positivity (and its successor, body neutrality) were just taking root, asking us to consider ourselves more holistically.
Of course, the posters were trashy low blows – but the backlash against them felt exhilarating and marked us sharpening our teeth against the fatphobic body-image standards so many of us had been raised under.
But now it feels like we’re back to square one. As compared with today’s standards, those printed billboards feel depressingly tame. In 2025, as we scroll through curated screenscapes of emaciated tradwifery, skinny-jeaned indie sleaze and disappearing buccal fat, is it any wonder that many are lunging for something that’s supposedly a sure-fire ticket to slim acceptability?
Many private corporations are, it seems, happy to oblige. ‘[They] are dealing these drugs out like smarties,’ says Dr Lara Zibarras, a psychologist and eating disorder recovery coach. She tells me she’s seen a rise in desire for thinness, adding she’s ‘seriously worried’ that these medications could worsen patients with anorexic tendencies to undereat. Similar concerns are echoed by Tom Quinn, a spokesperson at eating disorder charity Beat, which has also heard reports of people accessing weight-loss drugs online ‘fairly easily’. ‘We are very concerned,’ he says. ‘Medications that cause weight loss are incredibly attractive to people with eating disorders because they appear to provide quick results.’
A GLP-1 GOLD RUSH?
My name is on the weight-loss radar now. The places I’ve followed, and emailed, congratulate me ecstatically on ‘taking control’. They dangle discount codes, asking sweetly whether I need more information. Praise then turns to pestering. They aren’t allowed to promote the drugs upfront because of Advertising Standards Authority rules, but their workarounds signposting me to ‘weight-loss packages’ are thinly veiled. One upmarket service contacts me 16 times in 12 days. As menacing email subject lines warn me that time’s running out, I feel a synthetic anxiety gurgling. My WhatsApp pings. I’d forgotten I’d reached out to some black- market providers on social media: now they’re asking me what injection I want. Notifications pile up, massaging shame into me. Shame leads to sadness, and the sadness leads me to the cupboard, the chocolate spread and multiplying spoons, licked, in the sink.
Then the phone rings: Susan wants to know if I got her invoice. ‘I can’t push you to make a decision,’ she says, but something in her tone tells me she wants to. Surely a new wave of weight-loss customers paying £195 per month is useful to the struggling high-street pharmacy business, when 800 have closed permanently in England since 2020? After all, the weight-loss industry is a lucrative one. Some pharmacies and online services have even come under fire for setting ‘targets’ for the people approving prescriptions. Another ‘rapid-fire prescriber’ wasstruck off by the General Pharmaceutical Council (GPhC) after prescribing ‘in a dangerously transactional manner’ while working for three online pharmacies. At one point, she was receiving £2.50 for each prescription approval or rejection and is thought to have made over £89,000 while doing so.
Even Chelsea, who ended up in hospital, tells me that not only does she not regret going on the medication (which she is now working with her doctor to gradually come off), but that she’s become an influencer for a private provider. To me, that raises the question of just how lucrative and seductive this industry really is, if even its wounded critics are handing out referral codes.
Dr Hayre tells me that while sometimes targets are useful in medicine, the idea of anyone using targets to prescribe weight-loss injections is very ‘worrying’, adding that doing so ‘is profit-seeking and a rogue, cowboy way of prescribing’. When I asked a spokesperson at the GPhC whether these targets were appropriate, they told me that where concerns about targets have been raised with them, they have followed up and taken appropriate action and will continue to do so. They went on to add, ‘Our updated guidance states that incentives or targets must not put the health, safety and wellbeing of patients and the public at risk or affect the professional judgement of staff. Staff should be able to use their professional judgement so they can act in the best interests of the person receiving the services.’ They add that, according to GPhC guidance, pharmacy owners and superintendent pharmacists should ‘be able to show that arrangements with prescribers are transparent and do not cause conflicts of interest, for example by giving incentives to prescribers to issue prescriptions’.
I tell Susan to cancel my order. I unsubscribe from all the clinics’ emails. As I throw the empty jar in the bin and rinse the chocolate spread off my finger, I wonder if this is how this industry makes me feel, as a straight-size person signing up to these services for investigative research, how might a more vulnerable person be feeling.
THE CRACKDOWN
It’s obvious that the solution isn’t to just remove access to these medications, which can be a lifeline for many people struggling to manage diabetes or their weight in general. Like Kate, who tells me her experience of being prescribed Ozempic to manage her diabetes was mostly positive, with ‘great results’, despite vomiting and diarrhoea for the first couple of months. It lowered her blood glucose levels dramatically and gave her the feeling of being full – ‘which I had rarely experienced previously’. Kate’s experience could be considered a gold standard: she was introduced to the medication by her trusted healthcare providers, with support throughout.
Almost every expert I spoke to wanted to see wraparound care for patients on weight-loss drugs: blood tests, rigorous dietary advice and support, and stricter checks to stop the misprescribing of these injections. And the GPhC’s new guidance has begun to crack down on unsafe prescribing – but the fact I was able to get two illegitimate prescriptions in a single morning should raise alarm. The GPhC said that verifying information through a phone call would not be appropriate when supplying medication for weight loss and asked for details of the services and pharmacies I’d spoken to. It added, ‘The guidance explains that the prescriber should independently verify the person’s weight, height and/or body mass index through a video consultation, in-person, from the person’s clinical records or by contacting another healthcare provider such as the person’s GP.’
What’s more, it doesn’t think that it’s appropriate only to use a ‘photograph or pre-recorded video supplied by the person to verify their weight, height and/or body mass index’, because ‘it can be difficult to verify someone’s weight from a photo or pre-recorded video alone, especially when their BMI is between 25 and 30, and where there is the potential risk that the person could edit the images’.
Tom Quinn at Beat also tells me that although he feels the new guidance from the GPhC is a ‘good starting point’, he’d like to see further steps being taken, ‘including a mandatory mental health screening to go alongside physical health checks’. He adds that ‘eating disorders are serious mental health conditions, which cannot be properly assessed by looking at BMI alone’. The GPhC said: ‘Our guidance makes clear that before a medicine is supplied, there needs to be appropriate checks: this includes physical and mental health, and the person’s capacity to make informed decisions,’ before adding that the GPhC is in the process of reaching out to Beat for its input.
I’d like to say deleting the rogue prescriptions was a relief. But that’s a lie. Because the traumatised teen inside me – the one who lived through 2000s fat shaming, who’s scared to buy chocolate spread, who hasn’t confidently worn a bikini since she was 12 – momentarily flirted with the idea of GLP-1s. I’ve never felt more immersed in pressure. Beauty standards in 2025 are gnarlier, and ever-present in the palm of my hand. I’m exhausted. Who can blame someone looking for new ways to fight back? Demonising drugs, or the people who choose to use them (safely or otherwise), gets us nowhere. The issue is a society that manufactures insecurities in us all by praising thinness over all else. Our answer doesn’t lie in a new, rebranded body-image ideal, either. Instead, we should stop the pendulum from swinging – one body ideal to another – altogether. We should divorce our silhouettes from our self-worth – a sham marriage that’s made so many people so much money, at the cost of our wellbeing. Only then can we be sure that someone using a weight-loss injection is doing so because they decided it’s right for them – and not because a billboard, a rogue pharmacist, or the self-critic in their head told them to do so.