Is the Off-Label Use of Diabetes & Weight Loss “Wonder Drugs” a Sign of Mental Illness?
You may have read or seen the news that a viral TikTok “health trend” has exploded into the mainstream of medicine and is now one of the hottest topics for physicians and patients looking to lose weight. For some time, social media influencers have been touting the benefits of diabetes and weight loss medications Ozempic and Wegovy. Both drugs have the same active ingredient, Semaglutide, but are marketed and indicated for two different conditions: Ozempic is an FDA-approved diabetes medication taken by injection that regulates insulin secretion from the pancreas but showed significant weight loss as a side effect. Wegovy, distributed by the same pharmaceutical company, is an FDA-approved weight loss injection that suppresses hunger. The only difference is their names and FDA-approved use. Other weight loss injections like MounjaroTM are formulated differently but offer similar results and are in huge demand.
While side effects of both Ozempic and Wegovy are the same, including stomach discomfort, diarrhea, cramping, and constipation, it is one side effect in particular, the lessening of appetite, which has resulted in significant weight loss in those taking these drugs. Although Ozempic has been on the market since 2020 for diabetes management, the recent approval of Wegovy and an ensuing social media storm drew particular attention to the weight loss side effects of Semaglutides. Before-and-afters, celebrity endorsements, and an ongoing heated debate have made this a hot topic in medicine and an option for those always looking for an “easy way” to shed pounds.
Why This Matters
To fully understand the ramifications of the off-label uses of Ozempic or Wegovy, we have to dig deeper to understand more about the expectation of instant gratification weight loss and the larger, layered conversation about prescription drug misuse, abuse, and the almost inevitable triggering of mental and social disorders as a result.
First, it is essential to understand that Ozempic, Wegovy, and other prescription medications were not created to be accessible to the mainstream public as a method to shed extra pounds. These are prescription-only medications indicated for real, clinical medical issues – Type Two Diabetes and Obesity, respectively. But as the weight loss benefits became more apparent to the medical community and the general public, the Internet touted the ease of use and how our medical system, with the right doctor, can provide prescriptions to those who do not necessarily qualify under FDA guidelines. What has happened is, and should be, alarming to both doctors and mental health professionals.
“The off-label use of diabetes and weight loss drugs (and the hysteria and hoarding that comes with their scarcity) in patients that can otherwise control their weight through hard work is concerning on many levels. From a medical standpoint, these patients disregard those needing the drugs to maintain their health. From a mental health standpoint, how some use these drugs shows me that the depth of our mental health and substance use disorder concerns in the US is greater than I thought. We are teaching the next generation that it is OK to take the easy path, no matter the ramifications.”
~ Ben Brafman, Co-founder of The Sylvia Brafman Mental Health Center
The Medical Concerns
Due in part to demand from those not indicated to take the injections, supplies of these drugs have dwindled for those in need. This has led to serious problems and considerations for those that rely on these drugs for their lifestyle- or life-saving benefits. While some may say that there are plenty of other diabetes drugs on the market, switching medications is not easy or predictable. If we do not see a drop in demand, or if the manufacturer is not able to ramp up production soon, we could see a wave of severe medical problems stemming from poorly treated diabetes and obesity as a result of limited or non-existent access to their medications.
The Mental Health Concerns Associated With This New Trend
Insurance companies will not cover the drug for patients who do not qualify under FDA guidelines. The drug costs upwards of $1000 per month, with some reports finding a gray market for selling the drug above its list price. It has been dubbed “the addiction of the 1%.” Financial and availability considerations aside, many also fear that its use in individuals who can achieve similar results with hard work (those needing only to lose a little weight) can lead to a slippery slope. The results skew the reality that these drugs are not sustainable long-term. So, the drugs move from being an easy way out to becoming a crutch for some. This is where we must be honest about how the “easy way” can trigger more profound mental health concerns.
Eating disorders are all-consuming. Not only are thoughts of food, calories, and eating constant, but the reality is that weight loss fads, crutches, and “miracles” like these are sometimes enough to send a person into relapse or manifest in tremendous mental health strain or self-harm. The pressures of being thin enough are sufficient to degrade mental health, but the dependence on a drug to satisfy that need, and uncertain availability in the future can cause even more anxiety.
The Mental Health Concerns Associated With These Drugs
While we know that some components of mental illness may drive the demand for these drugs in otherwise healthy people, one of the potential side effects of Semaglutide medicines is depression and suicidal ideation. While this is a relatively rare side effect, we don’t fully understand the drug’s effects on demographics not initially in the clinical trials. We also don’t fully understand the effects of these drugs on those with an existing and underlying concern, such as an eating disorder. With addiction and other mental illnesses, self-regulating and understanding that there may be a problem is often difficult, if not impossible, as the individual chase their next “high.” The potential for medical practitioners not trained in recognizing the underlying mental health struggles of patients seeking these avenues for weight loss creates an even bigger area of concern.
Why The Fad Won’t Last
Another concern with taking any weight loss medication, including Semaglutide, is that the weight loss continues only while you are on the drug. Still, most people will regain their weight within several weeks or months unless it is stopped unless they genuinely change their lifestyle to support their new, lower weight. This is unlikely, however, because the medication offers the weight change without the typically necessary lifestyle changes that result in prolonged weight loss. This new feeling of “freedom” adds stress and can push a person to continue injections even when medical advice recommends the contrary. The possibility of immediate weight gain sets the stage for an intense emotional roller coaster and the love/hate emotions that come with weight loss and regain. It is a vicious cycle that may push the user to secure the drug by any means possible while ignoring medical advice and caution.
Cultivating a Sense of Community and Fulfillment
“Eating disorders do not exist in a vacuum. Complex causal factors include genetics, environment, and other mental health concerns like depression. Family and one’s circle of friends can create a strong support base to close the void that pushes the individual toward their eating disorder. Creating a sense of community and fulfillment allows the individual to feel safe and can start the process of healing. Social ties that do not include alcohol or drugs, but rather deep and meaningful conversations and connections, can create a two-way street for honest discussion. We all want to belong, and finding that spiritual fulfillment through religion or the community of supporters around you is often the first step towards understanding there is a problem and seeking appropriate help.”
~ Peter Marinelli, Founder, Through the Archway
As mental health experts, we are always concerned about the triggers and situations that expose us to unhealthy patterns and behaviors. The case of these drugs and how consumers are clearing the shelves are reasons for concern. This is not a discussion about weight loss but rather a warning about the impulse to “medicate” these urges and the unfortunate circumstance of having a readily available “fix” at your fingertips.
If you suffer from an eating disorder or self-image issue, if you feel you are taking these injections and cannot stop despite uncomfortable side effects or doctor’s recommendation, consider speaking with a mental health professional to understand and treat what could be an underlying eating disorder.