Ozempic Influencers’ Time Might Be Up

Most afternoons around five, Susan Graham goes live on TikTok. She’s there to field questions from viewers who are considering — or have recently begun — prescription weight-loss medications like Ozempic and Mounjaro.

During a recent session, she featured a pair of her before-and-after weight-loss photos, captioned “down 88 in 8 months,” and “no medical advice given.” Over a soundtrack of Jack Harlow and Charli XCX, Graham told her viewers she wanted to take them down “memory lane,” revisiting photos from a couple years ago when she was heavier. “I was huge. I was not in a good place,” she said, holding up a tablet and swiping through photos for the few dozen viewers who had tuned in. “I want you to see that it’s possible, you guys. If you’re on the fence about starting this journey, do it.”

Unlike the celebrities who might be cast in a traditional weight-loss infomercial, Graham is a regular person — and so if she did it, you actually might, too. Graham, who is 61 and lives in Tennessee, has built a modest TikTok following of about 26,000 over a couple accounts by sharing her experiences with tirzepatide and answering questions from commenters. People ask her when they might expect their medication deliveries or how to know if they’ve injected properly, or they might just share how much they’ve lost in the past month. Viewers who scroll past Graham might come across a similar chat hosted by Jess Winfrey, a woman in Texas with 12,000 followers who lost 100 pounds through a combination of diet, exercise, and medications. Or another hosted by Jay Hutchins in Texas, who has around 4,600 followers and regularly posts about losing 115 pounds on Mounjaro.

But the livestreams go beyond the purely informational. Each of these people, like so many others who gained followings talking about weight-loss drugs, are part of a robust network of paid ambassadors for telehealth companies that supply compounded versions of the medications to consumers. Their vibe feels fundamentally different from Lady Gaga in a migraine-medication commercial or Cyndi Lauper pitching a psoriasis drug. Telehealth ambassadors tend to be microinfluencers for whom this is a side hustle on top of a traditional job. Many of their transformations are recent or still ongoing, and viewers can watch them unfold in real time.

Though some telehealth start-ups offer name-brand drugs, most cater primarily to patients whose insurance won’t cover them. For these people, telehealth companies can act as middlemen, connecting them with compounding pharmacies that make medications like semaglutide or tirzepatide to order when the FDA says there are shortages and that are subject to relatively lax oversight. In 2022, both semaglutide and tirzepatide joined the FDA’s shortage list, which allowed compounding pharmacies to start making them. A cottage industry was born: New weight-loss-focused telehealth companies like Amble Health, Fridays, Emerge, and Ivím sprung up to sell the compounded drugs at reduced rates. Hims and Ro, telehealth companies both founded in 2017 in large part to sell erectile-dysfunction drugs to younger men, also recently began offering off-brand semaglutide. An estimated 2 million Americans now rely on compounded versions of these drugs.

The savviest of these telehealth brands have made their way into online spaces where influencers talk about weight loss, recruiting TikTokers like Graham — who works with Amble — as promoters. Those I spoke with were tight-lipped about the details of their contracts, citing nondisclosure agreements, but several confirmed that they’re compensated based on new customer sign-ups as well as for posting related videos or going live. (Monthly compensation for top promoters can reach $30,000, according to the Washington Post.) Some also said they received discounted or free medication.

But this whole ecosystem could soon collapse. Earlier this month, the FDA announced that the tirzepatide shortage had been “resolved,” meaning that patients — and companies — who rely on the compounded version of the medication might not be able to get it anymore. As the news broke, current and prospective patients turned to creators like Graham for answers. Amble was working quickly to fill pending tirzepatide orders before the compounded drug was discontinued, she said. “Listen, we’re all in this together,” she told her livestream audience. “We’re all on this medication, even some of the owners.” The situation raised an even scarier question: could compounding pharmacies eventually have to stop making semaglutide, too?

Jess Winfrey, who is 37, started trying to lose weight back in 2018 with diet and exercise alone. For a while, it worked — she lost 80 pounds — but then her progress stalled, and during the pandemic, she regained some weight. After receiving a PCOS diagnosis and watching friends lose weight on GLP-1 medications, Winfrey decided to try compounded semaglutide through a telehealth company. “It was slow for me. I wanted to feel better and lose weight in a way that was sustainable,” Winfrey told me. “When I started having little results here and there, it was great. And I wanted to share that.”

Winfrey had a TikTok account where she had been documenting her weight-loss efforts since around 2021. In early 2024, she decided to switch telehealth providers to Ellie MD and began sharing her affiliate link through her profile. Winfrey, who is bubbly and upbeat, started going live a couple times a week to discuss her experiences on the medication, imparting info and advice. She tends to get questions about how to get a GLP-1 prescription or is asked to explain how to prepare for self-injection.

Patient after patient told me that starting these drugs can be isolating. They’re often prescribed by primary-care physicians who don’t specialize in weight loss or by no-frills telehealth services. And then there’s the pervasive stigma around obesity. As a result, there’s little information about what to expect early on, such as side effects like nausea, or tips for self-injection. Communities on platforms like TikTok provide a nonjudgmental space for newer patients to gather and get answers.

It can also be where prospective patients finally decide to get a prescription. Viewers can easily click through Winfrey’s personal link to sign up with Ellie MD, which has offered compounded semaglutide starting at $300 a month and tirzepatide starting at $450 a month.

But there can be real risks to taking a DIY approach to weight-loss drugs. Telehealth start-ups typically funnel patients through an initial consultation with a physician, which could entail just a video call or the simple filling out of a form for the physician to review. Depending on a given prescriber’s level of expertise, patients might not be getting sufficient counseling before starting on a medication, Jason Baker, an endocrinologist and diabetes specialist at Weill Cornell Medicine in New York, told me. For example, he said, doctors should make clear to patients the risks including those for serious conditions like thyroid cancer or gallbladder disease. Patients should also have baseline blood work before beginning the medications, he said, and then blood tests around every three to six months. Fridays says its providers might order initial blood tests, and it has an arrangement with Quest Diagnostics that provides a discount to patients who need to get blood work. But on the whole, patients getting weight-loss drugs through telehealth companies told me they receive minimal monitoring. “They prescribe it, and you’re on your own,” Graham said.

There are also safety concerns with compounded medications, specifically. According to the FDA, they can be “made and distributed with fewer restrictions” than what the agency usually requires. With compounded medications, “there’s potential for contamination or incorrect amounts of effective ingredients, or the addition of other ingredients that could change how the medication has its effect,” said Brianna Johnson-Rabbett, an endocrinologist specializing in obesity medicine at the University of Nebraska Medical Center. The FDA recently issued safety recommendations for compounded GLP-1 drugs, which it said might make patients particularly susceptible to “dosing errors” that have caused health issues.

And then are issues that can arise while these drugs are being stored and distributed, like temperature control. During a recorded Q&A session in June, Sina Arham, co-founder of the telehealth platform Fridays, said that the company recently discontinued shipping from a pharmacy that failed to keep medication cool with appropriate packaging in the summer heat. “We had many discussions like, ‘Hey, here’s five more cases of medications arriving, sweating and hot,’” he said. “We had to basically reassign all of their locations to our pharmacies that we know can handle the job.”

Rumblings of concern about the safety and ethics of a system where patients are incentivized to market compounded drugs online — and where neither supply chains nor patients may receive enough oversight — have grown louder in recent months. In April, TikTok announced tighter rules for weight-loss influencers that relegate videos promoting “potentially harmful weight-management behaviors,” including using medication or supplements for weight loss, to viewers 18 and older, and make them ineligible for the “For You” page. The changes meant some creators like Graham found themselves on the wrong side of the platform’s community guidelines; one of her accounts was banned from live broadcasting, she said, and she removed pricing details from her background images. Even with these disclosures, people searching for weight-loss advice online might be particularly vulnerable to the sway of promoters, said Corey H. Basch, professor of public health at William Paterson University, who studies health issues on social media.

Undercover law-enforcement agents have been watching, too, in an attempt to keep counterfeit medication from making its way to unwitting consumers. In May, Isis Navarro Reyes, a content creator, was arrested on Long Island for selling improperly labeled Ozempic on TikTok and was released on bail.

Still, more and more telehealth companies have emerged as founders seize a potential business opportunity. Amble was formed last November by Joseph Stiver, an entrepreneur who was indicted in 2014 for a money-laundering scheme that involved stealing personal information and selling steroids illegally. He later pleaded guilty to one count of conspiracy to launder money. (Stiver wrote in an email that his “convictions emanate from conduct in 2014, when I was 23 years old.” Since then, he wrote, “I have recognized my mistakes” and “worked tirelessly to rehabilitate myself.”) In May, Hanieh Sigari, a San Francisco entrepreneur, founded Ellie MD. As part of its multilevel-marketing structure, you get a discount if you sign on to join the company’s 1,500 existing “brand partners” in selling its products as well as if you recruit new sellers.

For months, some online sellers have even been claiming to offer retatrutide, a promising Eli Lilly drug that is currently in clinical trials and has not been approved for market. In the June Q&A session, someone asked Arham, the Fridays co-founder, about other sellers promoting bootleg versions of the forthcoming medication. “This is a gold rush,” he said. “People start to make really questionable decisions based on money.”

With tirzepatide’s status still in question (a lawsuit from compounding pharmacies has stopped the change from taking immediate effect as the FDA reviews the situation), telehealth companies have more to worry about — especially if semaglutide, too, comes off the FDA’s shortage list. It’s not clear whether the companies that formed to capitalize on distributing compounded weight-loss medications could survive a scenario where those drugs are no longer available.

“In this instance, we won the battle. But we have not won the war,” Jess Winfrey, the Texas influencer, said in a recent post. “We’re going to see Eli Lilly challenge this until the patent either expires or is reversed by Congress.”

In the meantime, as the path to obtaining these drugs becomes increasingly chaotic and confusing, surely more patients will want to compare notes online. In a Facebook group for Amble customers, a new patient recently sought support. “I’m so scared to start,” she wrote. “I’m scared of how heavily promoted it’s been on TikTok. Usually stuff like that is ‘scammy.’”

“I don’t fault the TikTokers for promoting it because they have lost weight on it,” another woman replied, adding that she’d followed many of their transformations. “When they get people to sign up, they get it for free as brand reps,” she explained. “Shoot, I thought about doing it too,” she went on. “I would love to not pay for it.”