Evie Gardiner tries hard to avoid advertisements for weight-loss injections, but they seem to crop up everywhere. The 28-year-old Sydney PhD student says treatments that include the drugs are “marketed quite aggressively”, even if the ads seem “kind of vague”.
“There should be stricter guidelines and restrictions on that sort of advertising,” Gardiner says. “I’m definitely lucky to be in a place now, personally, where I have a much better relationship with food and my body and health.”
The ads are for digital healthcare companies – not drug manufacturers – which typically offer “treatment plans” for weight loss that include the GLP1 class of drugs – semaglutide, known by brand names Wegovy and Ozempic, or tirzepatide, known as Mounjaro. Most of the advertisers do not refer explicitly to drugs, instead offering “medical weight treatments” or “modern weight loss treatments”.
Most of the telehealth companies invite people who respond to their ads to fill out an online questionnaire. They may have a consultation with a GP working for the company by phone, video or even text in at least one case. If they are approved for treatment, the drugs are prescribed and posted to them.
The ads are commonly seen on buses, and as sponsored posts on social media.
The number of ads targeting consumers for weight loss treatments has raised questions about the regulation of semaglutide promotion – it is illegal to advertise prescription drugs in Australia, including on the internet, but health services can be advertised subject to certain restrictions.
Rules on advertising
The Therapeutic Goods Administration (TGA) does not regulate the promotion of health services, but advises that such promotions may breach regulations if they are also considered to be advertising therapeutic goods. To ensure they do not, “it is best not to refer to any therapeutic goods used in the delivery of the service in the advertisement”, the TGA says. And businesses “advertising health services where the available treatment(s) involve the use of prescription-only medicines … should only refer to the type of consultations the service offers”.
The TGA advises that “almost all references to a prescription-only medicine in the context of an advertisement for a health service” will risk the promotion being considered an advertisement for prescription products.
“This applies to terms that act as a substitute for direct references to prescription-only medicines such as … ‘weight loss injections’,” its website states.
Between February and August, the TGA issued more than 70 infringement notices worth more than $1m to 19 entities for alleged unlawful advertising of prescription-only medicines. Of the fines, $319,260 related to weight-loss drugs.
Guardian Australia sent the TGA examples of social media advertisements posted in recent weeks by five digital healthcare companies offering weight loss services: Juniper, Youly, Moshy, Get Lean and ModPeptiHub – only ModPeptiHub mentioned drugs in its ad.
The TGA would not say whether it considered any of the ads to have breached the ban on advertising prescription medications. A spokesperson said it did not comment on individual matters, including whether they may be subject to investigation or compliance and enforcement action.
Speaking generally, the TGA said websites could also be considered advertising if they “contain information that would draw a consumer’s mind to a particular therapeutic good and encourage them to seek out that good”.
The companies that responded to Guardian Australia’s request for comment said they advertised within the rules.
Juniper’s advertising offers a “comprehensive medical weight-loss program” and says “medical weight loss is not cheating”. Included in a customer’s first order is a “sharps disposal bin”, the ad passed to the TGA says, but it does not refer to prescription drugs.
Juniper’s website offers “health coaching and support” as well as “medically backed weight loss treatments” and does not mention any medications by name before a consultation “due to Australian Therapeutic Goods regulations”.
Juniper is owned by the digital healthcare company Eucalyptus, which is backed by Woolworths and the Blackbird Ventures investment fund, and markets primarily to women.
Its chief executive, Tim Doyle, said: “We advertise the overall program offering rather than any individual prescription medications and strive to comply with TGA advertising rules.
“The decision whether to prescribe a particular medication (if any) rests with the patient’s practitioner.”
He said it was “important to remember that medication alone is never a silver bullet. Long-term weight loss and health outcomes are improved by changing lifestyle habits such as understanding nutrition and exercise, which is a core part of the comprehensive treatment offered by Juniper.”
A smaller, Sydney-based company, Get Lean Pty Ltd, has been running ads on Facebook and Instagram.
One ad active in late September stated: “Yes … we have it, the weight loss treatment everyone is raving about.” It did not name the treatment. That ad appears to have been taken down after the company was contacted by Guardian Australia in mid-October. Get Lean did not respond to questions about the advertisements or what specific medicines it was prescribing.
Midnight – backed by the private insurer NIB – told Guardian Australia it sold medicines including Wegovy, Mounjaro, Saxenda and Contrave through its platforms hub.health and Youly. The ad for Youly sent to the TGA did not refer to prescription drugs, but offered “discreet shipping”.
Hub.health’s website refers to “prescription medications” and “injectable treatments”.
A spokesperson for Midnight said customers were not guaranteed a prescription and the company was focused on “educating Australians about health issues … rather than promoting specific treatment pathways or prescription medications”, which “ensures compliance with TGA guidelines”.
The company’s chief executive officer, Nic Blair, said it was the responsibility of businesses like Midnight to ensure only eligible patients received treatment.
“At Midnight Health we consider it critically important that those who have experienced eating disorders or disordered eating cannot access our service and as such include evidence-based eating disorder screening tools as part of our pre-consultation questionnaire,” he said.
Moshy, which markets weight-loss treatments for women, was running 23 ads across Meta’s social media platforms in early November. Some of the ads promise “modern medicines and expert tailored plans available 100% online and delivered to you”. The ads did not refer to prescription drugs.
Its website does not name specific medications, but says prescription treatments “may come in tablet or injection form”. The company, which also runs Mosh Health – geared towards men – did not respond to Guardian Australia’s request for comment.
ModPeptiHub, which directly promotes a semaglutide “skinny shot” and appears to sell directly to customers on its website, did not respond to a request for comment.
Not judging consumers
Eating disorder experts have urged the TGA to introduce tougher advertising restrictions.
Gardiner says she developed and overcame disordered eating after being bullied for “growing up in a larger body”. Now working on a thesis about how to make public health more weight-inclusive, she says she wouldn’t judge anyone for considering weight-loss injections.
“I just want people to have the opportunity to make informed decisions,” she says.
“I think it would be much better if they could have an informed discussion with a health professional that isn’t linked to a company selling the medication.”
Some medical experts say the drugs are life-changing for people struggling with obesity and they may have other health benefits, such as helping people break free from nicotine and alcohol addiction. Others argue not enough is known about the potential long-term side-effects.
The use of Ozempic may cause serious side effects such as possible thyroid tumours, low blood sugar, kidney problems and inflammation of the pancreas. In October last year, the TGA began investigating reports of potential bowel dysfunction linked to the drug.
The Butterfly Foundation’s Melissa Wilton says she is concerned that telehealth companies may not have enough safeguards to stop vulnerable people, of any weight, from getting a prescription.
“In terms of advertising and … accessibility, there definitely needs to be stricter regulations, because it’s just too easy now to have it prescribed and delivered to your door,” she says.
“If someone isn’t being screened for an eating disorder or disordered eating, it can be very dangerous.”
Wilton believes the companies should be banned from advertising altogether.
Dr Terri-Lynne South, a GP and dietitian who chairs the obesity management group of the Royal Australian College of General Practitioners, says direct-to-consumer marketing means people with obesity could be missing out on holistic care.
“A lot of the … hype around the injectable medications is that people are thinking they’re a miracle drug that is a short-term fix,” she says.
“They have been the most effective medical intervention for some time, but people are not understanding that this is only one part of a complex management and that in general they are expected to be taken long-term, if not indefinitely.”
Dr Jennifer Hamer, a former endurance runner who lived with an eating disorder for 17 years and is now a sports science academic, says it is difficult not to notice the volume of ads.
“If there ever was a place for any of these medications … I really do think the only time they should be discussed is in a consulting room,” Hamer says.
“They are not a lifestyle choice. We need regulation on where they are shared, who is managing these discussions, how they are promoted – which they shouldn’t be – and who has access to them.”
Do you know more? Email catie.mcleod@theguardian.com
In Australia, the Butterfly Foundation is at 1800 33 4673. International helplines can be found at Eating Disorder Hope
