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Everyone’s on GLP-1s. But at What Cost?

As compounded versions proliferate, reports of eating disorders and adolescent use are on the rise.

Inae Oh

When Layla Taylor, the 25-year-old Utah influencer and member of MomTok, went public with her use of the GLP-1 drug Tirzepatide in the latest season of The Secret Lives of Mormon Wives, her pain was palpable. “I’m so exhausted all the time because I don’t eat,” Taylor shares with two cast-mates during a spa day. “My body hurts every night when I go to bed. When I lie down, if my knees are touching, it hurts because I don’t have enough fat on my body.”

Here was a young woman on reality television, clearly struggling with her mental health as she admits, “I don’t know how to stop.”

Were the producers unimpressed? Because, aside from a quick follow-up of Taylor seeking treatment for her eating disorder, her story mostly fades, cast aside as a minor detail amid the show’s on-again, off-again torture of other cast members. Perhaps even more unsettling were the ads for Ro, the telehealth company, that played throughout the season, specifically highlighting its “weight loss expertise”—even as one of the show’s central figures opened up about her issues with GLP-1s.

The result, for viewers, could feel sensationally callous; Taylor herself has said that she was disappointed by how little airtime her admission received. But the show’s treatment of Taylor reflects a culture where GLP-1s are ubiquitous and normalized, even when their use sometimes leads to extreme and troubling results.

Hulu did not respond to my questions about how it handled Taylor’s GLP-1 story. But Sabrina Strings, a professor and author of Fearing the Black Body: The Racial Origins of Fat Phobia, who had not seen the show, imagined that for its executives, “You can see the importance of not spending too much time lingering on the issue.” By welcoming the advertisements, the overall message became: “Yes, [Layla] may have a mental health concern, but that’s separate from the excellent quality of these drugs—and you need to take them too.”

Backing up a little: How was a reality television star with open body image struggles able to get Tirzepatide in the first place? Taylor, who, since the season finale, says that she has stopped using the drug, revealed that it was a plastic surgeon in Utah who wrote the prescription. “They just handed it to me without ever having an appointment with me,” Taylor told Allure. “They got me a prescription, and it was at my house the next day.” 

Most Americans might not have plastic surgeons to hit up for weight-loss concerns. But they do enjoy unfettered access to telehealth companies and medspas that offer GLP-1s in abundance. These companies share a slickness in marketing, often employing the language of empowerment to drill into our minds that the body we want is within reach.

“I’m on Ro,” Serena Williams says in the ad that aired throughout Mormon Wives. As thumping music plays in the background, Williams rattles off the benefits she reaped: “34 pounds down on GLP-1s. Healthier on Ro. Supported on Ro. FDA-approved GLP-1 options.”

The ad never discloses that Williams’ husband, Reddit co-founder Alexis Ohanian, is a Ro investor and board member. More importantly, Williams doesn’t mention that telehealth providers like Ro are not under the jurisdiction of the Food and Drug Administration, and the online health assessments they use to determine eligibility can be shaky.

Consider the experience of my colleague, Schuyler Mitchell. Schuyler has a history of previous eating disorders and recently attempted to see if she could become eligible to microdose the medications through two telehealth companies, Noom and Hers. “I lied about past eating disorder history by checking a box,” she said, echoing similar reports of how easy it is to be untruthful in these assessments—whether about age, past eating disorders, or current BMI—to obtain a prescription, even when companies insist that licensed physicians evaluate each application.

Here’s what unfolded after Schuyler submitted their online quizzes:

Hers—a women’s telehealth company that launched in 2018 with a focus on sexual wellness and skincare and has since become better known for offering weight loss drugs—warned me that my prescription would not be “evaluated for safety, effectiveness, or quality by the FDA.” It asked me harrowing questions such as, “How disruptive would vomiting, constipation, and diarrhea be to your daily life?” And then, thank God, Hers told me I didn’t qualify.

Noom let me right in. After it thanked me for taking the “important (and hard) first step” of sharing my current weight, it prompted me to buy my “personalized plan” for shedding 10 pounds in seven weeks.

Schuyler had specifically been attempting to get a compounded GLP-1. These versions are generally cheaper and more easily accessible than brand-name medications like Ozempic and Zepbound, and have been critical to the rise in popularity of GLP-1s. To distinguish themselves and not get sued, these copycat drugs include additional enhancements, such as Vitamin B12, to accompany the broader promise of weight loss. And perhaps most critically, compounded GLP-1s are not approved by the FDA. Instead, they were originally developed as a temporary solution in response to a 2022 national shortage of their brand-name precursors.

Even though the shortage resolved in late 2024, Alka Menon, a sociologist at Yale, said that compounded GLP-1s continue to proliferate, with little oversight over the drugs themselves and the popular pathways for accessing them, like telehealth companies. And for wide swaths of the user population, conditions appear rosy; a recent New York Times poll that surveyed over 2,000 GLP-1 users found that most of them were “enthusiastic” about their experience on the medications, with 63 percent saying that the drugs had relieved the conditions they were treating for. Though hard numbers on how many people are using compounded versions of brand-name medications are notoriously hard to find, Menon told me that pharmaceutical companies believe the market for these copycat drugs is “fairly significant in size.”

“Some of the really big telehealth companies have partnered directly with pharmaceutical companies to get branded versions of the drugs,” Menon said. “But they started by offering compounded versions. Most of the telehealth companies we see are doing something compounded.”

The public appears to know little about compounded GLP-1s. Even talking to people in my own social circles about their use of the drugs, no one could tell me if the medications they were taking were compounded or brand-name. The very word itself, “compounded,” appeared alien to them; the cascade of issues attached to the drugs was also similarly unknown. What they did know, however, was exactly how much the GLP-1s were costing them.

They aren’t the only ones with blinders on. A recent puff piece in the New York Times featuring Medvi, an AI-powered telehealth start-up, failed to mention a litany of legal problems facing the company, including a February warning from the FDA against Medvi’s use of “false or misleading” claims about compounded GLP-1s. After reader uproar, an editor’s note quickly accompanied the article, acknowledging that the reporting should have included the FDA’s warning. The fact that a major paper missed this crucial context seemed to reflect society’s willingness to overlook the dangers of GLP-1s due to our insatiable appetite for the promise of thinness.

Meanwhile, telehealth companies that market these medications receive little scrutiny as they race toward a $100 billion industry evaluation by the end of the decade. As the drugs and their copycat versions become easier and easier to obtain, it’s hard not to wonder if an emerging public health crisis is coming into view, especially as the use of the drugs increases among young people, some as young as 12.

Dr. Rebecca Boswell, a clinical psychologist and director at the Princeton Center for Eating Disorders, said that she had seen a “substantial uptick” in patients abusing GLP-1s, as well as severe cases of malnutrition. Boswell has been struck by how aware kids seem to be of the medications.

While speaking at a recent elementary school event about body image, she was astounded by how many kids brought up Ozempic. “They sang the jingle to me and the chorus,” Boswell said. “It was terrifying.”

“This was a turn I had never seen before,” she added, “kids really understanding the drive for thinness at such a young age.”

The relationship between GLP-1s and eating disorders is complicated; there is some evidence that the medications can help people struggling with binge eating because they suppress appetite. But Boswell called that strategy a “Band-Aid over a bullet hole.” While the urge to binge may be “less strong,” she said that the strategy was not addressing the deeper underlying factors that were causing individuals to binge eat in the first place.

Physicians also reported seeing similar health risks crop up for people on GLP-1s as they do for people with eating disorders. “We know that individuals with eating disorders have a high risk of bone fragility due to malnutrition and bone loss, and we’re beginning to see individuals prescribed GLP-1s with bone loss,” Dr. Elizabeth Wassenaar of The Eating Recovery Center in Denver, Colorado, said.

Though Wassenaar did not specify which age, she confirmed that the center has seen “pre-pubescent children on GLP-1s seeking treatment for eating disorders.”

“I’d like for there to be better oversight for the prescription of these medications,” Wassenaar said, “and better support for the real possibility of disordered eating after taking these medications.” She emphasized that a focus on cosmetic changes from GLP-1s was especially dangerous for children and young adults.

Even for adults curious about the medications, Menon, the Yale sociologist, cautions consumers to tread carefully when using medications procured online. “Even if you’re getting the branded product through a telehealth service and your insurance is reimbursing you, are you being seen by a doctor who’s making sure that the side effects are okay?” Menon said. “Are you ramping up the dose appropriately? Do you meet the diagnostic criteria that you report in the form? Are you taking the right dosage? Is it mixed properly? These are all big safety concerns, no matter what the product itself is.”