Content warning: This article mentions weight loss and diet culture.

The 2023 summer months in Toronto have come with their usual sweltering heat, lively festivals, doe-eyed tourists, and cheerful laughter from crowds in the parks. But this year, we had an unexpected and uninvited guest permeate the city: aggressive ads for Ozempic. 

Ozempic, a rising star in the weight-loss world, is a novel second-line treatment in type 2 diabetes mellitus that — through mechanisms not entirely known — has been shown to also assist in weight loss, leading to its current off-label usage and popularity in facilitating weight loss. While I think we should destigmatize medical interventions, including medication, overselling these products can be dangerous. Likewise, we can’t normalize flippant disregard about the risks these medications carry.

The normalization has in part come from a new-age type of direct-to-consumer-advertising that appears on typical billboard ads like those on the TTC, which showcases influencers rather than celebrities. In a different way from celebrity endorsements, which bring notoriety and recognition to a product, influencers have a unique role in the marketing space as they can leverage their parasocial relationship with a curated audience to promote a product they are being paid for while maintaining their relatability. 

This parasocial relationship between influencers and their audience is an insidious phenomenon, particularly in the marketing space. Consumers come across what many perceive as a hopeful and relatively easy fix promoted by someone they feel some sort of connection to based on the content they curate, but the nature of the relationship leaves them blinded to the issues that lay in the shadows. 

The effect of a virtual parasocial relationship mixed with heavy advertising and a sprinkle of hope has put us in an era of ‘fad-ceuticals’ —  an era fraught with misleading and dangerous ads, little accountability, hidden side effects, and the looming threat of a supply shortage to a medication which is lifesaving to many.  

Popularity and the emergence of common discourse of a medicine or medical intervention is the first step towards destigmatizing it — including when it comes to the often taboo topic of weight loss. For many people, lifestyle changes alone do not always allow them to lose weight, and medications can act as a necessary tool to allow lifestyle changes and holistic intervention to actually be successful. 

Before the introduction of a medication like Ozempic, many people’s repeated trial and error of weight loss tactics felt like pressing the gas pedal on a car that isn’t even on. The introduction of medication is the key-in-the-ignition many need. While there is much discourse about weight loss and its place in body positivity, there is unequivocal evidence that weight loss is the difference between a better quality of life and serious health risks for some. 

Obesity and related metabolic disorders are growing concerns in the public health landscape. According to the 2020-2021 community health survey from Statistics Canada, over 30 per cent of adults self-reported as overweight, with a body mass index (BMI) recording over 25. Similarly, around 30 per cent reported themselves as obese, with a BMI over 30. 

Not an instant game-changer but a kickstarter

Ozempic, Wegovy, and similar trending counterparts belong to a class of medications called ‘incretin mimetics’ that are traditionally used to manage Type 2 diabetes as a second-line therapeutic treatment. Semaglutide, the drug that makes up Ozempic, promotes the secretion of insulin — a hormone needed for most cells to take glucose in the body to convert into usable energy. Type 2 diabetes typically has a drug called metformin as its first line of defense in managing the condition. When this alone fails, the second-line therapeutic is often prescribed. 

Not only are incretin mimetics an effective second-line therapy, but they also carry significantly less risks and more protective effects compared to older, traditional second line therapeutics like sulfonylureas. 

This type of treatment is a unique approach to the management of diabetes and obesity, in that lifestyle change is an integral part of dealing with these unique conditions, and unlike its treatment counterparts, the medication can give a ‘kickstart’ to allow the user to better implement those changes and see results. Increasingly, we are seeing an increase in off-label prescriptions for Ozempic and its bedfellows to cause weight loss. 

However, in my view, the issue with the obsession with Ozempic is that we miss the mark on health. For one, many doctors are basing their decision to prescribe Ozempic on patient-reported BMI alone. As a population statistic, BMI can be helpful to give an insight into the health and trends of a given population to inform policy and programming changes. Yet, at an individual level, it gives nothing more than a framework to make clinical decisions — and certainly not the entire picture. 

BMI is taken by calculating a person’s body mass in kilograms and dividing it by their height squared in centimeters. A BMI of 30 is considered obese, but individuals who, for example, are athletic can easily reach a BMI of 30 without being medically considered overweight, let alone obese. Concerningly, Ozempic and similar drugs are being prescribed through telehealth providers who do not have pre-established relationships with patients and are not able to fully evaluate their physical status as one would be able to in person or with a pre-existing relationship. 

Aside from the medical and health concerns, the rise in Ozempic ads and availability begs the question of how ‘far’ we should go with weight loss treatments. Body trends are culture-specific and fluctuate through time. In Western culture in particular, unlike the archaic supermodel’s cigarette-a-day narrative, the trends we see today are not found through voluntarily watching the year’s fashion week or flipping through Vogue magazine, but by involuntarily being bombarded at every turn by the “body shape” of the time. 

In that sense, I believe we must separate our socially created desire to fit a certain mold that can entirely change tomorrow from our medical perceptions of something that is a necessity or beneficial. The solution is not to do away with medications, it is not to do away with the choice to change one’s body, nor is it to do away with consumer advertising using influencers — which is unlikely to go away anytime soon.

Meaningful change is going to come from stricter regulation and oversight. We should be creating better clinical oversight about the guidelines of prescribing these medications, particularly given they are done as off-label prescriptions. We need better oversight by federal regulators pertaining to advertising and the use of influencers in campaigns; we need increased transparency around risk/benefit analysis; and we need to have more conversations on the intertwining of social desires and medical practice. 

Huda El-Zein is a graduating University College student specializing in global health and minoring in German and physiology. She is the U of T student representative for the Consortium of Universities for Global Health and a youth consultant with the Canadian delegation to the World Health Assembly and Pan American Health Organization.