It’s easy to find your contact on a used buy and sell site. He says his name is Wilson, he has no profile picture and his status is a generic “Hi, I use WhatsApp”. He immediately responds to the message: “Thank you for contacting us regarding our medicine. A box costs 160 euros”. The box you’re talking about contains a single dose of Ozempic, the type 2 diabetes drug that’s been shown to help you lose weight. In Spain it is available on prescription in pharmacies, financed for diabetics: four doses for 4.24 euros. Without funding, the same presentation costs 130 euros for patients with obesity and related health problems.
Wilson’s asking price is totally off the market, but it offers other benefits as he starts explaining at breakneck speed, “No, you don’t need a prescription, safety and customer satisfaction are our priority.” “We’ll take care of delivery to your door .” “We accept payments via Bizum”. “After this first transaction, you will be happy to do business with us again. That’s a promise”. A Google search for his phone number gives access to a bizarre back office scattered in various ads on second-hand websites. It’s got Rohypnol, Trankimazin, Elvanse… It’s got everything and something for everyone, but for a few months it promotes the most Ozempic.
They call it the “Hollywood drug,” and it’s the best-known of a class of drugs, the GLP-1 receptor agonists, that could end obesity in the world. Ozempic is a weekly injectable medication that has been shown in clinical trials to “promote approximately 15% weight loss.” Despite being approved in Spain and being prescribed since 2017, its fame seems to have skyrocketed in recent months, leading to shortages and an obsession with sourcing these prized injections.
The drug jumped from recipe books onto social media after rumors said Kim Kardashian used it to dress Marilyn Monroe’s dress at the 2022 MET Gala. Then the fever broke. The same magazines that criticized the bodies of the famous began speculating about who (and how) had lost weight suspiciously fast. Social media is spreading obsession with the drug. The Ozempic hashtag launches videos on TikTok with more than 674 million views. “It’s true that people talk about it in the gym,” confirms Teresa (fictional name), personal trainer at an exclusive sports center in Madrid. “There is one client who uses it and I know a trainer at the center who uses taps to accompany her routines,” she explains. He points out that this is a background rumor imported from the US that is not openly discussed. But it’s a deafening rumor. No drug has sparked such interest since the days of Botox and Viagra.
Diabetes is an epidemic. According to the International Diabetes Federation, it affects one in seven adults in Spain. The associated health expenditure exceeds 13,430 million euros. Obesity, in turn, affects millions of people and is the gateway to more than 200 diseases and cardiovascular problems. Complications caused by excessive weighing account for 9.7% of total healthcare spending in Spain, according to the OECD. The use of GLP-1 receptor agonists could mark a turning point in the fight against excess fat that we’ve been leading (and losing) for decades. But the promise of effortlessly losing weight with one shot a week is not only of interest to people with health problems.
Maria (not her real name) is overweight, but not enough to be prescribed Ozempic, which she obtained through methods she prefers not to disclose. “The first day was awful, I got bitten too badly and got sick, nauseous and deadly,” he explains in an audio exchange. But then things got better. She had been on diets before, she had lost weight because of her willpower. Salads, sweat and tears. But this time it was different: “I lost the desire to eat, and especially dirty food,” he explains. “I order food on Glovo, and usually when I’m on a diet, I’ll gossip through the app and think, ‘I’ll ask or I won’t ask, maybe I shouldn’t…’ And I end up doing it. When I turned I didn’t even look at Glovo because I was thinking about a hamburger and it disgusted me. María did not go along with the injections with a change in her routines. His body demanded “less and healthier food” from him, but he neither dieted nor exercised. Despite this, he lost five kilos. Two months later, he stopped stabbing himself and recovered.
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“If we take these drugs without making any lifestyle changes, we’re doing absolutely nothing,” Juan Jose Gorgojo, head of nutritional services at Fundación Alcorcón University Hospital, said over the phone. Weevil is extremely critical of people who use these drugs for cosmetic purposes. “The cult of the body means that perspective is lost. These medicines that save lives, it seems to me an aberration to use them in such a frivolous way,” he judges.
The case of María contrasts with that of Javier Díaz, 45 years old. When Ozempic began injecting, he weighed 250 pounds, had transaminase injections, and was developing type 2 diabetes. He accompanied the treatment with a diet and gym routine. “What happened to me is wonderful, that’s clear,” he says on the phone. “Before, I could hardly walk down the stairs at my house, and this morning I did 100 squats.”
Javier Díaz, in a park near his home in Seville Paco Puentes
Díaz has been on a diet since he was 16. Dissociative, pronocal… Nothing worked for her, or at least not consistently. Last May he was placed in the hands of an endocrinologist and at the moment he has a more than positive record. And expensive. Díaz recognizes that not everyone can afford his treatment. In the year he’s been using Ozempic, he’s lost 50 pounds and spent over €1,500. The struggle of many endocrinologists is that the state funds cases like yours.
Such is the case of Dr. gorgonjo. “It seems that we reward the patient who becomes diabetic and then we fund the drug,” he laments. “If you have problems with obesity, we don’t fund it. But if, over the years and because of that obesity, the patient develops cardiovascular complications, for example, we fund a coronary stent, we fund heart surgery. Do we really have to think about it? Wouldn’t it be better to invest in advance and prevent these complications?” asks the endocrinologist. Weevil is fighting for obesity to be recognized “as a real disease”. Pharmaceuticals, meanwhile, are in a different battle. They promise breakdowns for everyone. And to do that, they embark on a lucrative career that promises to line their pockets and empty our fridges.
Cristóbal Morales is an endocrinologist at the Virgen de la Macarena Hospital in Seville. He has conducted more than 120 clinical studies on the GLP-1 receptor, giving him a glimpse of the future. He brings good news on the phone: “In the future, the molecules we will have will be three times as effective as the ones we have now,” he says. Morales mentions the case of Wegovy, a higher-dose version specifically designed for people who are overweight and obese. It became hugely popular in the US after Elon Musk spoke about its benefits. Denmark and the UK are already marketing it. “We are waiting to launch it in Spain, we are the next country,” says the doctor.
There is another GLP-1 agonist drug, tirzepatide, that is already on the market (and already facing shortage problems) in the US. And another known as CagriSema that combines Semaglutide with another drug and can make you lose more weight than its predecessors. Denmark’s Novo Nordisk (owner of Wegovy and Ozempic) is leading the race, ensuring it will double its past sales this year. Investors believe it: Its market cap has doubled in two years, reaching $326,000 million, making it the second largest pharmaceutical company in the world. The third and fourth, Pfizer and Eli Lilly, are also developing new drugs.
Analysts are calling an “obesity gold rush” and predicting that the GLP-1 market could reach $150,000 million by 2031 (a figure similar to the profit of the world’s largest oil company or what drives cancer drugs).
According to Morales, the next three years will be crucial in this area. And they could change not only our weight, but our relationship with food. The doctor is a member of the Spanish Obesity Society (SEEDO) and therefore knows exactly how medicine and society deal with overweight people. He assures that there is a tendency to blame the patient for a social, psychological, environmental problem… A complex problem that affects specific people but has global consequences. According to the latest World Atlas of Obesity, the annual cost of obesity to the international economy could reach $4 trillion in 2035 (2.9% of global GDP, compared to 2.2% in 2019). The impact of these new drugs could be critical to not reaching those numbers. And to improve, even save, the lives of millions of people.
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