Off-label Ozempic, a diabetes drug that also helps users lose weight, is being sold at med spas across the U.S. (Illustration: Dura Lee for The Free Press)

The Booming Market for Backdoor Ozempic

It’s not just celebrities. Women around the country are going to great lengths to procure ‘liquid gold’ in our bottomless appetite to be thin.

It’s noon on a Wednesday, when most people would be eating lunch. But not Kate Barone, an Atlanta-based salon owner who is 5 feet 1 with blonde hair down to her waist. She recently got down to 90 pounds from a high of around 120 on semaglutide, the active ingredient in the blockbuster diabetes drug Ozempic.

She said she’s off the injections for now while she undergoes fertility treatment to freeze her eggs. But she can’t wait to get back on the drug, which, she says, still has the lingering effect of suppressing her appetite.

“I feel like I’m a drug addict—I want to, like, relapse,” she told me, laughing. 

Barone, 37, represents a new kind of Ozempic user, who gets the drug off-label from a medical spa that also provides Botox, fillers, and hair loss treatments—taking the drug far away from its medical roots and deep into the cosmetic sphere.

Ozempic, taken once a week as a shot in the arm, stomach, or thigh, was first approved by the FDA in 2017 to lower blood sugar in people with type 2 diabetes. But the drug came with an incredible side effect: rapid weight loss. In 2021, the FDA greenlit a higher dose semaglutide product, Wegovy—made by the same Danish manufacturer, Novo Nordisk—as an obesity treatment.

Meanwhile, over the past year, the world has watched as some of our most famous celebrities started to shrink. Khloé Kardashian, who once called herself the “fat sister,” now has abs. Rebel Wilson and Mindy Kaling, who for years have admitted to struggles with their weight, are suddenly the smallest they’ve ever been. While all credited their new shape to exercise and foods like grilled salmon, unfounded rumors on social media alleged that the real cause was Ozempic. TikTokers even claimed, with no proof, that semaglutide helped Kim Kardashian shed 16 pounds to fit into Marilyn Monroe’s “Happy Birthday” dress for the Met Gala (although she told Vogue it was a “sauna suit” and “strict” eating regime).

Kim Kardashian at last year’s Met Gala. (Kristin Callahan via Alamy)

As the rumors kept growing, Ozempic quickly became headline news as the magic bullet for getting skinny. Hollywood elites were outed for using it. So were rich people in the Hamptons and the tech world, including Elon Musk. Its use became so prevalent that, last January, The New York Times heralded the rise of “Ozempic face,” experienced by those who’ve lost so much weight on the drug they’re now injecting filler to correct their “facial aging and sagging.”

Ozempic and Wegovy, which come in the form of preloaded injection pens, both require a prescription. They’re also not cheap. One Ozempic pen, which lasts about a month, costs around $1,000 before insurance. Wegovy is even more expensive, with prices starting at $1,300, and it isn’t covered by most insurance plans.

Neither is a problem for rich, connected people, who can cajole a prescription out of doctors willing to figure out how to put the tab on their insurance—or can just pay the price. So many in these circles are now on the drug that one New York socialite told me Ozempic is “old news.”

But that’s not the case for Barone, who feels as though she’s just discovered “liquid gold.” She and untold numbers of women, who work nine to five jobs but want to look like they spend all day at the gym, are going a different route for their fix. 

Healthcare lawyer Harry Nelson says there are “well over 100” businesses across the U.S. now peddling off-brand semaglutide. Most get the Novo Nordisk knockoff from compounding pharmacies—places that mix and combine active ingredients to create custom formulations. A quick online search pulls up promises for same-day prescriptions with no office visits needed. While none of this is illegal, medical experts question the ethics of the off-label boom.

Medical spas, which sell Botox and fillers but are overseen by a physician, typically prescribe off-label semaglutide after a weight-loss consultation. Clients pay about $300–$600 a month for an off-brand prescription, and within a week the drug arrives at patients’ homes, usually in the form of a vial and a syringe.

And because many of these visits are done online, it’s easy to get around the guidelines.

One Midwest designer, who asked me not to print her name, said she was technically overweight at 5 feet 7 and 190 pounds when she met with an obesity doctor over Zoom. The doctor mailed her a blood pressure cuff and a scale to check her weight on the call. But because she was never asked to show the reading on her scale, she lied and said she was 200 pounds—which pushed her into the obese range. 

The doctor prescribed her semaglutide, which has since helped her reach 140 pounds.

“This is what I used to weigh when I was in my twenties,” the designer said. “It’s a miracle drug—it just falls off.”

Heather McKerrow, an Atlanta-based licensed physician assistant who helps run a new chain of telehealth clinics called RegenMD, says she’s turned a small army of users on to the drug, including her mom, her stepmother, her nanny, her housekeeper, six of her best friends, her neighbor, her hairdresser, and “a guy that sells diamonds that is our jeweler.” 

“I’ve got 60-year-old women saying it saved their marriage—like literally they’re having sex with their husband again for the first time in years,” McKerrow told me.

Heather McKerrow and Elliot Campbell help run RegenMD, a new chain of clinics that sell off-label semaglutide among other services. (Nicole Craine for The Free Press)

Ayla Humphrey, a 27-year-old influencer in Atlanta, said the off-label semaglutide she obtained from RegenMD helped her fit back into her clothes after a breast augmentation, followed by a family tragedy, landed her on the couch for weeks. 

“The thought of food repulsed me,” Humphrey told me about the effects of the drug. “I’d have two or three bites of chips and salsa and be like, ‘I don’t want any more.’ ”

She is now back to her presurgery clothes (size small). 

Elliot Campbell, the sales director for RegenMD (and McKerrow’s boyfriend), says his clinics obtain off-brand semaglutide, which he also calls a “peptide therapy,” from four compounding pharmacies, including Pavilion Compounding Pharmacy in Atlanta. 

Compounding pharmacies serve an important function of converting medication for patients—say, from a pill to a topical cream for a patient who can’t swallow. The FDA allows compounders to sell their own formulations when there’s a shortage of brand-name drugs, including Wegovy, which has been on the agency’s short-supply list since March 2022. But an FDA press officer told me compounded drugs, since they’re not FDA-approved, “pose a higher risk” and “should only be used to fulfill the needs of patients whose medical needs cannot be met by an FDA-approved drug.” 

Ozempic was approved by the FDA in 2017 as a diabetes drug. (Jason Bergman via Sipa USA)

Medical experts I talked to say they have no idea where compounding pharmacies get their semaglutide from. After I asked five compounding pharmacies where they get semaglutide, only one got back to me—Pavilion, which gave me this statement: “All of the ingredients we use to compound are from FDA registered and inspected, cGMP compliant, state licensed distributors.” A spokesperson for Novo Nordisk, which holds the patent on the drug, firmly stated that they’re not the ones supplying semaglutide to compounders. 

Doctors caution that unless you’re injecting brand-name Ozempic or Wegovy, there’s no way to know what you’re putting in your body. 

Dr. Scott Isaacs, an Atlanta-based endocrinologist, wonders how off-label semaglutide is created. “It’s a very complex molecule,” Isaacs says. “It’s not something that someone could just make, or buy from India.” 

Isaacs, who has two decades of experience in his field, said he has seen patients come into his Atlanta practice with mysterious prefilled syringes. He said few have been trained on how to use the drug, or even inject it.

“It’s just sort of like, ‘Pay me the money and I’ll write you the prescription,’ ” Isaacs says. “And very few of them are told about the fact that this is a long-term medication. If the drug is stopped people gain the weight back, and people don’t know that.”

Dr. Domenica Rubino, an obesity doctor whose Virginia practice participated in a Wegovy study, says one representative from a compounding pharmacy even tried to get her to prescribe off-brand semaglutide to her patients.

“Ultimately it’s about greed,” says Rubino of the off-brand compounding boom. “It is absolute deception… and it’s sad because it’s ruining a lot of the progress we’ve made in this field to help people with serious disease.”

One off-brand semaglutide user displays the vial she received from a compounding pharmacy, along with syringes and alcohol wipes.

Sarah Hoover, a socialite once called “The Fabulous First Lady of New York’s Art Scene,” says she first started to wonder—what is everybody on?—when she showed up to the CFDA Fashion Awards last November and noticed everyone was rail-thin. 

“The thing that startled me most at that event was how people that I suspected were on it due to rapid weight loss—and a lot of industry chatter that they definitely were on it—seemed to expect us all to not notice or ask questions,” says Hoover.

Later that night, when Kim Kardashian won an innovation award for her loungewear line SKIMS (it’s unclear what the innovation was, but words like inclusive and body positivity were thrown around), Hoover posted an Instagram story calling out Kardashian for what she thought was unethical: to lose a bunch of weight—no matter how she lost it—and continue pushing body positivity to the masses. She wondered what dystopian reality this would create, convincing people to inject god knows what to achieve a size zero.

But to Elliot Campbell, RegenMD’s sales director, this is not a dystopia. As his girlfriend McKerrow, who helps run the clinics, puts it: “We’re not in the Ozempic business or the peptide business—we’re in the hope and happiness business.” 

It’s also a multimillion-dollar enterprise, Campbell says, and they’ve been open only since August. Campbell, who also runs Balanced Aesthetics Medspa in Atlanta, spoke to me from Fort Lauderdale, where RegenMD just opened its third clinic. (A fourth location, in California, is set to open soon.)

“If my locations burned to the ground, I wouldn’t care,” jokes Campbell, because 90 percent of his business is conducted online. 

Campbell, who says he himself has tried semaglutide, adds that most of his clients come from word of mouth, and all it takes is for one client to attend a dinner party—“and I’m not kidding you, 10 or 15 people that were at dinner with them will call me that week.” 

Ozempic and its active ingredient, semaglutide, are not without their drawbacks. For one, there’s the diarrhea, nausea, and vomiting, which one off-brand Ozempic user described to me as a “quick five-minute hangover.” Another put it more bluntly: “I would inject it Monday and feel like I was going to shit my pants until Wednesday.” Plus, a recent study found that most people who stopped taking semaglutide gained back a majority of their weight within one year. Then, the big one: Novo Nordisk warns that studies with rodents showed Ozempic can cause thyroid cancer. Maybe that’s not a problem if you’re hopping on it for a month or two like many of the users I spoke to, but perhaps it’s a different story if you’re on it for life, as drugmakers and regulators now recommend for patients with diabetes and obesity—including kids. 

One out of every five children in the U.S. is affected by obesity. The FDA just approved Wegovy for kids twelve and up diagnosed with the condition, while the American Academy of Pediatrics now recommends that doctors offer “weight loss pharmacotherapy” to youths who fall in that camp. But so far there has been just one major study of how Wegovy affects kids—a trial recently published in The New England Journal of Medicine, which had a pool of only about 200 participants (Novo Nordisk confirmed this via email). Calley Means, a healthcare entrepreneur, says even if kids manage to lose weight on Wegovy, they could still develop health issues like fatty liver disease unless they change their diet.

“It’s just like a massively expensive Band-Aid,” Means, who previously consulted for Coca-Cola and Big Pharma before switching sides, says about semaglutide. “If you’re mass-prescribing this and making parents and kids feel like they’re doing something but not changing their underlying nutrition, it’s not gonna solve the problem.”

Means says he’d rather see the government invest in things like revamping school lunches, which he says will target the source of all obesity: diet. 

But not everyone agrees obesity can be solved by proper nutrition. Recent reporting from The New York Times describes childhood obesity as “complicated,” and the Centers for Disease Control (CDC) defines obesity as a “complex disease” that can be impacted by “social determinants of health,” like racism and climate change. (The UK’s National Health Service is more clear-cut: “Obesity is generally caused by eating too much and moving too little.”)

Meanwhile, we’ve been inundated with messages of “body positivity” for years, even as (or possibly because) more than two-thirds of Americans are overweight or obese. Dana Omari, a plastic surgery consultant with med spa clients, says the first thing many of the loudest body positivity advocates did when Ozempic came out was lose weight.

“I don’t think it was all bullshit. I think we have more appreciation for lots of bodies than when I was growing up in the ’90s and 2000s,” said Omari, who is on semaglutide herself. “But it’s also revealing that we never stopped wanting and appreciating thinness. That’s still the ideal, no matter what we talked about—curvy, and all of that.” 

Back in Eastern Ohio, a stay-at-home mom called Emily (who asked me to withhold her last name) had no idea about all the Hollywood buzz over Ozempic. She says she was 5 feet 5 and 189 pounds the day her doctor handed her semaglutide to treat her prediabetes and rising cholesterol levels—health issues that have run in her family for generations. Three months later, she went to a party 40 pounds lighter, and a friend asked her if she was on “that thing” in the news.

Suddenly, Emily realized the medication she associates with health, everyone else associates with vanity. 

Mindy Kaling said grilled salmon and sautéed spinach helped her shed pounds. That hasn’t stopped the social media rumor mill from claiming the real cause is Ozempic. (Gilbert Flores via Getty Images)

“It almost got more embarrassing, like ‘Oh, God, I do not want to be on this,’ ” Emily, 42, told me. The fact she was doing it for insulin resistance “made me feel, like, okay. It shows I’m not doing this to cheat.”

She says she feels like she’s broken the “genetic track” that consigned her family members to a life of health problems. But taking the drug also made her “feel a little bit of guilt because I wasn’t losing the weight on my own.” 

Emily’s now trying to get off of semaglutide, injecting it every other week instead of weekly since her blood sugar and insulin levels have improved. 

“Now I just pray people don’t ask me,” she adds, referring to the drug. “I wish it could be for the people who really need it.”

Meanwhile, Atlanta salon owner Kate Barone is itching to get back on semaglutide. She says her weight has crept back up to 105–110 pounds since she’s come off it for fertility treatment.

“Everyone around me is getting skinnier,” she jokes. 

She says she has vials of semaglutide waiting for her in the fridge at home that she’s specifically instructed her boyfriend, who’s also on the drug, not to touch. It’s probably expired, she says, but “it’s just for comfort.”

“As soon as these eggs are done,” she told me, “I’m doing another round of semaglutide.” 

What do you think about obesity in America? Is Ozempic a salvation—or a new addiction? This week on Honestly, we hosted a conversation on the subject and it got heated. In a good way. Give it a listen here:

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