As New Data Disclose Side Effects of Prolonged GLP-1 Use, Doctors Raise Concerns Over Demands To Be Skinny at Any Cost

As an array of celebrities from Oprah Winfrey and Serena Williams to Demi Moore and Kelly Osbourne display increasingly gaunt physiques, new medical research accompanying the GLP-1 craze discloses alarming skeletal side effects from prolonged use of the injectable diet drug. Recent research shows that up to 40 percent of weight lost on GLP-1 medications comes from lean body mass — bone, muscle, and connective tissue — rather than fat alone. For older adults already facing age-related muscle decline, this poses serious health risks.The new data are forcing regulatory bodies to crack down on over-prescribing and medical ethicists to question whether physicians are fulfilling their duty of care when they write prescriptions for patients who don’t need to lose weight. “Doctors can prescribe almost anything, as long as it’s been approved for some general use,” the head of the Division of Medical Ethics at New York University Grossman School of Medicine, Arthur Caplan, told The New York Sun. “The standard is that you can make a drug that is intended to control diabetes and prescribe it to someone because it may reduce their appetite and allow them to maintain weight.”Bone Loss and Fracture Risks EmergeThe research presented at the American Academy of Orthopaedic Surgeons’ annual meeting in early March delivered sobering findings. After analyzing nearly 150,000 patients over five years, investigators found those taking GLP-1 medications faced a 29 percent higher risk of osteoporosis, a 12 percent increased risk of gout, and a 150 percent jump in osteomalacia cases compared to matched controls.The skeletal consequences appear tied to rapid weight loss. Up to 40 percent of the weight shed with semaglutide comes from lean body mass, including bone, muscle, and connective tissue. Physicians point to the physiological shock of sudden weight changes on the skeletal system, particularly for individuals who have carried significant weight for years before rapid loss.Professor of medicine at Tufts University, Clifford Rosen, who studies GLP-1s and bone health, told the Sun that while the data warrant attention, “the abstract was not a peer-reviewed paper, so we await more information.” Still, Dr. Rosen emphasized the importance of informed consent, particularly for postmenopausal women.“There should be clear information provided to the patient describing potential risks,” he said.Despite an estimated 12 percent of American adults — roughly 30 million people — currently taking GLP-1 medications, state medical boards and insurance companies have taken relatively little action against physicians who prescribe the drugs without proper medical justification. In June 2023, Anthem Blue Cross Blue Shield sent approximately 150 warning letters to prescribers in three states after finding more than 60 percent of patients prescribed Ozempic lacked sufficient evidence of diabetes. The Mississippi State Board of Medical Licensure suspended a physician’s license for three months for prescribing Ozempic via a telehealth platform without an audio or video examination.For physicians, the stakes are high. Misrepresenting patient conditions to secure insurance coverage exposes prescribers to potential fraud claims, which carry civil and criminal penalties. Yet the gap between widespread use and regulatory oversight is growing wider, with enforcement focused primarily on telehealth marketing violations rather than individual prescriber accountability.The most vexing question facing physicians concerns patients who seek GLP-1 medications despite having normal or below-normal body mass indexes. Harvard Medical School assistant professor, Dr. Florencia Halperin, wrote in a February essay for STAT that her “most troubling clinical dilemma” involves “trying to slow down runaway trains” of patients seeking to reach “an unhealthy and likely unsustainable body weight.”A board-certified orthopedic surgeon at the University of Pennsylvania, Dr. Gabe Horneff, told the Sun that providers should adhere to a fundamental principle.“Providers should be held to a standard of prescribing any medication by following the first rule in the Hippocratic Oath, which is, ‘First, do no harm,’” Dr. Horneff said. “Personally, at this time, I think it is really only indicated for patients with diabetes, obesity, or Syndrome X. The benefits for those patients can far outweigh some of the adverse side effects.”An obesity medicine physician and associate professor at Harvard Medical School, Dr. Fatima Cody Stanford, told the Sun that prescribing GLP-1 drugs to patients with normal weight “raises significant ethical concerns because it lacks evidence, exposes patients to known harms, and diverts resources from those who need them.”Dr. Stanford emphasizes that physicians have clear responsibilities. “Physicians have a duty to decline such requests and should instead provide counseling, address body image concerns, and consider referral for eating disorders or body dysmorphia,” she said.The concern extends beyond personal perspectives. The first GLP-1 medication, Byetta, was FDA-approved for the treatment of diabetes in 2005. Ozempic followed in December 2017, also for diabetes. Wegovy, the first GLP-1 explicitly approved for weight loss, didn’t arrive until June 2021. Yet off-label prescribing of Ozempic for weight loss began almost immediately after its 2017 approval, creating a nearly decade-long experiment in unapproved use.The director of the Masters of Bioethics Program at Columbia University, Dr. Robert Klitzman, told the Sun that insufficient informed consent poses a major problem.“I don’t see enough informed consent happening,” he said. “The provider responsibility is very large if they’re not disclosing the off-label use.”Dr. Klitzman added that even when presented with warnings about off-label use, more research has yet to be done.“We don’t know the long-term side effects. These drugs haven’t been around long enough to know what the effects will be for people who take them every day for 15 years,” he said.The consequences of muscle loss as initiated by rapid weight loss pose particular dangers for aging populations. Sarcopenia — the age-related loss of skeletal muscle mass and strength — affects up to half of adults over age 80 and increases risk of falls, fractures, and disability. Studies show GLP-1 users can lose 15 to 40 percent of total weight from lean body mass, potentially accelerating sarcopenic obesity — a condition where patients achieve “normal” BMI but lack functional strength to navigate daily life.A Celebrity-Fueled PhenomenonThe medical implications extend well beyond aesthetics, as celebrity culture drives demand.“The number of prominent people all over social media who say, ‘Yes, I’m on it, and I use it, and it really helped me, and it’s great,’” said Dr. Caplan. “The wellness industry endorsements are over the top. There’s nobody regulating that or controlling that. It’s a celebrity mass movement, part of the trillion-dollar wellness industry”The profit margin is measurable. Ms. Williams lost 34 pounds using the drug. Her August 2025 partnership with the telehealth company Ro drove a 27 percent increase in GLP-1 appointment bookings. Oprah Winfrey’s December 2023 disclosure caused an 18 percent spike in prescription requests. Social media has become saturated with GLP-1 content — the hashtag #Ozempic has garnered millions of views on TikTok, while 22 percent of millennials and Gen Z report seeing celebrity endorsements of these medications. Dr. Caplan highlights a new emerging dynamic resulting from the social shift.“It wouldn’t surprise me” if the phenomenon triggers eating disorders in people who aren’t even taking the drugs, he said. “People in wealthy areas will start putting their daughters on it too.”The United States and New Zealand are the only two developed nations that permit direct-to-consumer advertising of prescription drugs. Novo Nordisk began promoting Ozempic in 2018, expanding from cable television to streaming audio, social media, and high-profile campaigns. In January 2026, the company launched its “There’s Only One Ozempic” campaign featuring actors Justin Long and John Hodgman. Telehealth companies have plastered posters depicting people injecting Wegovy in New York City subway stations. The saturation is complete and has spawned an entire industry of scammers using fake AI-generated celebrity endorsements to sell counterfeit products.“Patients see those ads and ask doctors to prescribe them,” Dr. Klitzman said. “So, it’s not just doctors pushing these drugs. Patients are asking for them.”Dr. Klitzman added that some physicians have built entire practices around these medications.“There are certain doctors who do this all they do,” he said. “You set up a Zoom meeting, and they write you a prescription for these drugs.”Regulatory Response and System StrainSome health care systems strained by the demand have made hard financial decisions. Effective January 1, 2026, California’s Medi-Cal discontinued coverage of GLP-1 medications when prescribed solely for weight loss to individuals age 21 and older. The FDA issued 30 warning letters in early March to telehealth firms marketing compounded versions in ways suggesting equivalence with FDA-approved therapies.Medical Ethics Researcher at the University of Pennsylvania, Johan Dellgren, told the Sun that the regulatory framework faces challenges.“There is reason to be cautious” about using licensing boards as the primary enforcement mechanism, Mr. Dellgren said. “‘Clear medical indication’ is not always obvious; a patient presenting with a BMI just below the obesity threshold, for instance, may still have legitimate clinical reasons to receive treatment.”Dr. Stanford, however, argues for stronger accountability.“The current regulatory framework is insufficient. Stronger oversight is needed to prevent inappropriate prescribing, with licensing boards holding physicians accountable for non-evidence-based use,” she said.“Regulations should probably be implemented,” added Dr. Horneff. “Most importantly is that these medications should remain in the prescribing control of only medical professionals.”The unfolding debate over GLP-1s parallel past pharmaceutical controversies. “Years ago, there was a drug called fen-phen,” Dr. Klitzman recalled, referring to the weight-loss drug that came out in the early 1990s but was pulled from the market in 1997 after causing heart valve problems. “It didn’t show up for a while, and then ultimately people realized it was way too risky. So, we could face that again,” he said. Dr. Caplan, on the other hand, argues that market forces are working against any slowdown. The shift from injections to pills is already accelerating adoption. Within three weeks of Wegovy pills launching in January 2026, roughly 170,000 prescriptions were written — outpacing the adoption rate of injectable versions.“Companies are making billions of dollars from these drugs,” he said. “Two-thirds of Americans are obese or overweight, and those numbers have basically tripled over the past few decades.”As skeletal side effects accumulate and regulatory scrutiny intensifies, the era of consequence-free GLP-1 prescribing appears to be ending. The question is whether medical licensing boards will move beyond warning letters to actual accountability measures for physicians who prescribe powerful metabolic drugs to patients who don’t medically require them.“The largest take-home point for these patients is realizing that these are real risks that can occur with these medications,” Dr. Horneff said. “As such, other diet, nutrition, exercise, and lifestyle changes should be encouraged.”

As New Data Disclose Side Effects of Prolonged GLP-1 Use, Doctors Raise Concerns Over Demands To Be Skinny at Any Cost

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