Several recent studies have found a possible connection between semaglutide use and a rare condition that causes sudden vision loss.

One of Dr. Mo Sarhan’s patients was experiencing intense cravings for opioids and alcohol when the Florida-based doctor offered him a striking solution: the Eli Lilly weight-loss drug Mounjaro.

“Within days, all of his cravings were gone and he was much more effective in his engagement and treatment. He’s done great since,” Sarhan says.

Sarhan and his colleague Steven Klein at the Caron Treatment Centers in Florida and Pennsylvania have prescribed a range of so-called glucagon-like peptide-1 receptor agonists (GLP-1s) to treat addictions, using them alongside traditional therapies, to around 75 patients.

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• Novo Nordisk scientist Lotte Bjerre Knudsen paved the way for popular GLP-1 drugs like Ozempic.
• Her work in the 1990s was instrumental in turning short-acting hormones into long-acting drugs.
• Her 'product mindset' is what keeps her going, she said.

Inventor and scientist Lotte Bjerre Knudsen has spent her entire career at Novo Nordisk.

"I started here fresh out of university," she told Business Insider from the company's glass-walled headquarters outside Copenhagen. She's sitting just across the road from where her career began in the late 1980s, developing color-safe laundry detergent.

It would have been impossible to predict then that she'd become instrumental in the development of the popular class of injectable diabetes and weight loss drugs like Ozempic and Wegovy that have become a roughly $47 billion global market.

It was her research and development of Novo Nordisk's first daily GLP-1 shot for diabetes (liraglutide, approved in the US in 2010) that would spur the development of those more powerful, longer-lasting weekly shots, which she also oversaw.

For years, scientists had known that the GLP-1 hormone played a key role in regulating appetite. But these hormones were so fleeting in the body, almost nobody in the diabetes world was convinced they'd make a successful drug. As Novo Nordisk tells the story now, the company was less than a year out from closing down the entire GLP-1 program when she had her breakthrough.

Today she's proudly wearing her new Lasker Prize lapel pin, as a 2024 recipient of the science award widely seen as second only to a Nobel Prize. It's in recognition of the pivotal role she played in developing the first long-acting GLP-1 drugs.

Here are the three key guideposts she said have helped her succeed with business breakthroughs for 35 years.

Develop a 'product mindset'

Knudsen's cardinal goal, she says, has always been to develop products that "help people at an everyday level" — a tenet she's held onto from her early days experimenting with laundry detergent.

"I've only ever had one job," she said.

She calls it a "product mindset," or "enterprise mindset" and says she learned it first from her dad. It's a type of energy, a way of being driven to solve problems, to make something that will be useful.

"It's the same mindset I have used in everything I've ever done, to just say, 'actually I want to help, make a product that can help' — either in society, or people with disease," she said. "That mindset is exactly the same whether you are making laundry detergents, which certainly help people, or you are making medicines to help people in a very different way, but still help people at an everyday level."

She's clear-headed about the fact that the approach only sometimes ends with success, but is not deterred by the failures, she says. Instead, they press her on to find new ways to solve the problems that pop up.

"I'm okay with being challenged, I don't mind," she said. "But it doesn't make me give up. I listen to the critique, or the feedback, and then I go think about whether there's something I should be doing differently."

Focus on what you know

Knudsen says her training at "Denmark's MIT" (actually called the Technical University of Denmark, or DTU) helped her chart a path toward a drug development solution rooted in biotechnology. Specifically, she focused her research on injectable peptides. This wasn't because she thought peptides were superior to pills. It was what she knew best.

"I think there's some kind of synergy between the background that I had and the problem that needed to be solved," she said. "I was very comfortable with peptides as a potential medicine."

To make the GLP-1 hormone "long-acting" her team found a way to attach a fatty acid to the molecule. She compares this structure to a steak — it's a one-two punch of protein and fat, protecting the hormone-mimicking shot from rapid degradation in the body.

Stay humble and curious

Even though Knudsen and her teams at Novo Nordisk invented an entirely new class of diabetes and weight loss drugs, she's still level-headed about these relatively new medicines.

She says more scientific studies of the drugs are essential to better untangle how they work, and reveal all the different aspects of our health they impact, from inflammation and addiction to dementia.

While she acknowledges there are serious concerns about muscle loss in many people taking GLP-1s, she says drug developers should exercise caution in combining GLP-1s with other medications, like those designed to help combat muscle loss.

"You can't start combining left, right, north, east, west unless you really understand what the foundational part of the biology means," she said.

Now a chief science officer at Novo Nordisk, her executive role is far more focused on mentorship and governance than technical knowledge. But she still aims to explore the basic science that can steer new discoveries. In 2021, she took a job rotation at Novo Nordisk's research site inside Oxford University to learn more about genetics, hormones, and machine learning.

"There's all these things that need to happen in the body after you've eaten," Knudsen said. "GLP-1 is involved in that, and that's why it has both effects on different organs, and the brain, and everything that needs to happen after you eat."

Earlier this fall, the Centers for Disease Control and Prevention reported data showing that adult obesity rates—long trending upwards—had fallen modestly over the past few years, from 41.9 to 40.3 percent. The decline sparked discussion on social media and in major news outlets about whether the US has passed so-called “peak obesity”—and whether the growing use of certain weight-loss drugs might account for the shift.

An opinion piece in the Financial Times suggested that the public health world might look back on the current moment in much the same way that it now reflects on 1963, when cigarette sales hit their high point and then dropped dramatically over the following decades. The article’s author, John Burn-Murdoch, speculated that the dip is “highly likely” to be caused by the use of glucagon-like peptide-1 receptor agonists, or GLP-1s, for weight loss.

It's easy to see why one might make that connection. Although GLP-1s have been used for nearly two decades in the treatment of type 2 diabetes, their use for obesity only took off more recently. In 2014, the Food and Drug Administration approved a GLP-1 agonist named Saxenda specifically for this purpose. Then in the late 2010s, a GLP-1 drug named Ozempic, made from the active ingredient semaglutide, began to be used off-label. The FDA also authorized Wegovy, another semaglutide-based GLP-1 medication, explicitly for weight loss in 2021.

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MIT engineers have revealed a new gastric balloon design that can inflate on demand to make you feel full before meals.

Kelly is aware that she should have been more careful when she signed up for a weight-loss medication online. She knows she should have looked into the company selling it, but, as she puts it, "desperate times call for desperate measures." She had gastric-bypass surgery in 2011, and that worked for a while, but then she started to gain the weight back after the "food noise" returned. "It's not like alcohol where you can abstain," she says. "You have to eat."

In May, she signed up for a subscription with Zealthy, a telehealth company she found through Google. It seemed simple enough: She was charged a subscription fee and a fee for the medication she ordered, semaglutide, which is basically generic Ozempic. She quickly noticed her food cravings and appetite had decreased. About six weeks later, she noticed she was losing weight. But then the billing got weird. Screenshots of the company's billing portal show that in September she was charged three times for one medication on top of the subscription fee and a separate "manual entry" charge of nearly $400. In October, her medication never arrived; the company blamed shipping delays on hurricanes in Florida. She tried to resolve the problem through the company's chat service and emails, trying to get the medication or a refund, but eventually, she gave up after failing to make progress on either front. She canceled the card she had on the account to prevent further charges. After filing a complaint with the Better Business Bureau, Kelly, which is a pseudonym, has gotten some of her money back, but she's still out hundreds of dollars. Zealthy didn't respond to a request for comment.

The topic of embarrassment came up throughout our conversation. Kelly has been overweight her whole life, and many people aren't particularly nice about it — they don't understand why she can't manage with just diet and exercise. "My pants don't fit if I so much as look at a cookie," she says. The experience with Zealthy only added to this sense of ostracism. Kelly's ashamed that she gained the weight back, that she let her guard down, and that she was taken for a ride.

But Kelly isn't alone: The explosion of new weight-loss medications has opened the door for all sorts of questionable business practitioners and outright scams. Drugs promising to help people lose weight are everywhere, and the fact that society prizes being thin — and punishes those who aren't — makes vulnerable people susceptible to tricks.

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The diabetes and weight-loss drugs semaglutide and tirzepatide — which are generally referred to as GLP-1s and which you probably know by the names Ozempic or Wegovy, made by Novo Nordisk, and Mounjaro or Zepbound, made by Eli Lilly — have been game changers in obesity treatment and management. For people struggling with their weight, these drugs can seem like a miracle. But because the brand-name medications are so expensive and difficult to get, many people, like Kelly, are turning to other sources, buying copycats from online telehealth companies and sellers that have very little, if any, oversight.

Compounded versions of the drugs have been effective for many people, even if the Food and Drug Administration doesn't approve them and has warned against taking them. But not everyone has been so lucky. In Kelly's case, she's out a chunk of money. (She's not the only one with issues with Zealthy: The federal government has sued the company, alleging unfair and deceptive conduct including billing customers for things they didn't knowingly agree to and misleading people about their subscriptions.) For others, the consequences are not only financial but medical. Poison-control centers reported an enormous jump in semaglutide-related calls last year. One recent study looking at websites advertising semaglutide without a prescription found that 42% of the sites belonging to online pharmacies were part of illegal operations.

"We're a little bit in the Wild West," said John Hertig, an associate professor at Butler University's College of Pharmacy and Health Sciences. "It's just exploded so fast. There's so much money to be made here."

The marketplace is awash in companies trying to ride the Ozempic wave by selling compounded semaglutide, knockoff drugs, and similar-sounding supplements. Last year NBC News found that there were more ads on Instagram and Facebook mentioning semaglutide than there were ads for Viagra on the platforms. Semaglutide content is all over TikTok, much of it dubious. Phishing scams that use the medications as the hook have increased, as have other schemes designed to get people's data or payment information with the promise of access to the drugs. Reddit and the Better Business Bureau's website are filled with complaints about telehealth companies offering GLP-1 products — people describe unwittingly signing up for pricey subscriptions, never receiving medication, or finding it impossible to quit. It can be hard to discern a safe, legitimate offer from a dupe. Complicating things is that the FDA hasn't clearly established what's OK here, leaving consumers to figure things out for themselves. Even big-name telehealth companies are sending medications to patients without a lot of supervision.

It's very clear that there are still a lot of people who — medical issues aside — really want to be thin.

"Every medication carries a risk, and they don't affect everyone equally," said Jessica Bartfield, a clinical associate professor at Wake Forest University's Bariatric and Weight Management Center. "So when you see these images and testimonials and stories about people who are on it for maybe inappropriate purposes or who are losing tremendous weight or who aren't being monitored the right way, then it normalizes it, and people think that that's OK."

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The body-positive movement has spread the message over the past decade or two that you can and should love your body at any size and that health and beauty are not synonymous with thinness. That movement isn't necessarily a failure, but the rush to get semaglutide shows that American culture's preference toward skinny never went away, said Natalia Mehlman Petrzela, a history professor at The New School who wrote the book "Fit Nation: The Gains and Pains of America's Exercise Obsession."

"It's very clear that there are still a lot of people who — medical issues aside — really want to be thin," she said.

As much as the FDA and doctors might tell people that off-brand semaglutide and other products are risky, people aren't necessarily deterred from seeking them out. They see others getting results, and they want the same.

"You don't see this with cancer treatment. You don't see this with blood-pressure medications. You don't see this with antibiotics," Bartfield said. "This is a very unique field, and I can appreciate the appeal."

The rush of gray-market semaglutide and scams riffing on the desire for the drugs are a confluence of market need and market want — some people who really do need to lose weight for medical reasons are turning to alternative methods because they can't get or afford the "official" stuff, while others are using the medications more out of vanity. After all, the pursuit of dubious miracle products in the name of being thin and attractive has existed forever.

"I mean, Jane Fonda tells stories of mailing away for tapeworms," Mehlman Petrzela said. "In the '90s — and this is an approved thing — Olestra was a fat substitute, and the warning was anal leakage. And people were like, 'OK, whatever, if it makes you skinny.'"

The promise of being thin is an incredibly effective marketing tactic and one that's hard to resist, especially with this new class of drugs. My Instagram feed is filled with nearly indistinguishable ads for weight-loss medications that show a little vial of some clear substance, list facts and figures about weight loss, and mention how expensive the real stuff is. Sometimes it takes me a second to realize I'm looking at an ad, because it's just a person talking to the camera. Mehlman Petrzela told me she often sees ads for supplements promising to be "nature's Ozempic" on her feed. An acquaintance recently mentioned that after seeing all the ads, she signed up with a telehealth company to see if she qualified to get compounded semaglutide. After a consultation, she was denied. (She's quite thin and pretty clearly didn't need them.) But then, months later, she noticed the company had been quietly withdrawing $30 from her bank account each month. She'd missed it because the purchases were categorized as "groceries."

Eric Feinberg has researched Ozempic scams on TikTok in his role as vice president of content moderation at the Coalition for a Safer Web. He told me the social-media platform's algorithm is good at sending people down a "rabbit hole" of content once it figures out they might be interested in losing weight. "I'm not searching TikTok videos on Ozempic; it's coming right through my feed," he said. "That's the danger."

Fraudsters are very attuned to cultural moments and what is attractive to consumers.

As part of his research, Feinberg engages with people purporting to be selling Ozempic or some version of it on TikTok. He sent screenshots of one of his recent exchanges with an account called Ozempicweightloos0 where the seller sent over a list of prices ranging from $90 for 0.25 milligrams of Ozempic to $110 for 1 mg. (For comparison, Novo Nordisk's website lists the price of 1 mg of Ozempic as $968.52.) The account stopped responding after he asked where the medication shipped from. It's a type of conversation he's had often — and alerted lawmakers and TikTok to.

Michael Jabbara, a senior vice president and global head of fraud services at Visa, said it saw a huge spike in chatter on the dark web about weight-loss scams in May and June. He posited that it was tied to the World Health Organization's warning around that time about fake semaglutide: The WHO noticed enough nefarious activity to issue an alert, triggering more conversations among bad actors about how well the scams are working. He said they realize that "this is a successful fraud scheme that is yielding a good return on investment for us, so we're going to continue to pursue it."

May and June are also the start of beach season, when people are looking to get their summer bodies — and maybe realizing it's too late unless they take some extreme measures. "Fraudsters are very attuned to cultural moments and what is attractive to consumers," Jabbara said. "They're very keen marketers."

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One can't paint all the operators in the compounded-semaglutide and GLP-1 markets with a broad brush, because there's a lot of variation. There's a difference between major telehealth companies like Ro or Hims doling out prescribed medication and illegal pharmacies and scammers on WhatsApp or Telegram sending medications willy-nilly, if at all. But the reality is that everyone is operating in a bit of a gray area.

Except for the really sketchy stuff, compounded semaglutide and tirzepatide are generally coming from compounding pharmacies that make customized medications. Most of the time these pharmacies make medications for people with unique needs: You have an allergy to a certain dye usually used in the name-brand drug, so they make the drug without it for you. But when there's a shortage of the drugs — as there has been for GLP-1 drugs — the rules for compounding get a little looser, and the FDA allows copying.

There are some confusing wrinkles. For one thing, shortages don't last forever, and when they end, the copying is supposed to stop. The FDA took tirzepatide off its shortage list in the fall, which should have meant no more compounding. But after a compounding trade group sued the FDA over the decision, it said it would reevaluate.

Novo Nordisk and Eli Lilly both have patents on their drugs, and they're not eager to give up their secret sauce — meaning it's not clear how close the compounded concoctions are to the real stuff. And though the FDA has warned people that all the compounded drugs are risky, it's at the same time somewhat greenlighting them, people are being inundated with ads for them, and people are trying them out. The cat's already out of the bag.

"We're in somewhat of a no-man's-land in terms of no clear regulation, reduced government oversight, and a straight lab-to-lap delivery model," said Anthony Mahajan, a founding partner at the Health Law Alliance, a healthcare-focused law firm.

He added that telehealth and direct-to-consumer GLP-1 sales circumvent many of the checkpoints in traditional prescribing. Because these prescriptions aren't covered by insurers and are instead paid for directly by the consumer, there's no inspection by the government or insurers reviewing whether a drug is medically necessary and deciding whether to authorize payment. Compounds are also generally exempt from a federal law meant to stop harmful drugs from getting into the US's supply chain, meaning checkpoints for product sourcing and supply-chain integrity are missing. "Oversight agencies are cut out," he said.

It's tough to blame consumers or the companies distributing compounded semaglutide for getting into this business, given how expensive and difficult it is to get the name-brand drugs. Insurers generally won't cover Ozempic or Mounjaro unless a patient has diabetes, meaning that to get the medications, people who want to use them for weight loss have to cough up thousands of dollars a year. That's assuming their doctors will prescribe them, which, some won't.

"If you don't price it appropriately, if you don't have enough supply, then people are always going to find another way to get it," Hertig said. "And sometimes that other way to get it is safe, but in many examples it's not."

To ward off telehealth companies, Eli Lilly cut the price of Zepbound for certain patients who order directly from the company, though the drug is still pricey.

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To some extent, this is a tale as old as time: People want to be thin and will go to great lengths to achieve that, and businesses are happy to oblige. But GLP-1 medications do seem to have put this dynamic into overdrive. These drugs really are everywhere — in commercials, on social media, in the news, in conversations. And everyone's getting into the semaglutide game: diet companies, gyms, even grocery stores.

We turn a blind eye to the risks.

Maybe this will all turn out fine. The regular versions of the drugs will become more available, and the generic ones will, by and large, work fine. Sure, there will be scams; that's true of everything. But that's not the only possible outcome. Many people may wind up not only losing money but also harming their bodies by injecting medications that aren't safe. And these medications are so new that it's hard not to worry that in five or 10 years we'll wonder why we allowed online companies to send compounded injected drugs around the country to people who were prescribed a medication after completing a five-minute survey.

Hertig said he expects tighter and clearer regulations on GLP-1s in the years ahead, which is good, though it doesn't help people trying to sort things out now. In the meantime, the miracle drug has people looking for miracles everywhere, including in places they shouldn't.

When people fall for traps or scams, they're often hesitant to admit it or advertise it. That's especially true for weight-loss products — the message American culture sends is that you're supposed to be thin and fit but you're not supposed to talk about how you do it. Society often treats being overweight as a moral failure and using a medication to take off pounds as cheating.

Kelly hasn't given up on semaglutide altogether. She's switched providers — she's now getting her medication from Hers — and continues to shed weight. The experience is "night and day." Her mom is nervous about her taking medication and worries about the unknowns, but that hasn't deterred Kelly. She hasn't told many people about the Zealthy experience, and she doesn't advertise that she's taking a weight-loss drug, though she'll be honest if people ask. Her doctor has been reluctant to prescribe her a GLP-1 medication, meaning she's still paying out of pocket. She thinks the reluctance was part of what landed her in a bad spot in the first place.

"That makes patients like myself especially vulnerable for fraud in the telemedicine world. We want and need to lose weight, have tried everything, and this is working for so many people," she said. "So we turn a blind eye to the risks."

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Emily Stewart is a senior correspondent at Business Insider, writing about business and the economy.

• This year brought us another slate of words to butcher in the popular discourse.
• Fast-fashion company Shein and Ozempic's active ingredient, semaglutide, both made the list.
• Here are the top 10 most mispronounced words that dominated conversations this year, according to Babbel.

It's "SHE-in" — not "sheen."

2024 brought us another year of mispronounced names and words in the popular discourse, from brands to popular medicine to politicians and high-profile celebrities.

Since 2016, the closed-captioning company The Captioning Group has compiled the list on behalf of the language platform Babbel, bringing together all the terms that newscasters, politicians, and public figures struggled to pronounce correctly on TV.

Esteban Touma, a linguistic and cultural expert at Babbel, told Business Insider this year's words were a snapshot of the political, cultural, and musical zeitgeist.

Ready to test your pronunciation chops?

In no particular order, here are the top 10 most mispronounced words of the year, according to Babbel's report.

A study of 14,000 WeightWatchers participants is the latest to suggest that Ozempic and similar obesity drugs could be adapted into treatments for substance use disorders.