Not too long ago I would have said I was one of the least likely people to be tempted by GLP-1s like Wegovy or Zepbound. My weight has always been average. I have no medical conditions, and more than one doctor has called me a “boring” patient. The only medication I take regularly is ibuprofen on the first day of my period.
Over the past five years, I’ve watched—and written about—the massive rise in popularity of these medications with a professionally detached mix of curiosity and concern. While GLP-1s have proven life-changing for people with diabetes, obesity, and other medical conditions, using them for cosmetic weight loss has always seemed a little extreme to me, at least for noncelebrities whose very income doesn’t hinge on fitting society’s expectations of what a person “should” look like. Using GLP-1s for weight loss has even been a bit stigmatized at times.
Oh, how things have changed. Recently there’s been a dramatic shift in how these drugs are viewed and who’s using them—or considering using them. While GLP-1s are still only FDA-approved for weight-loss purposes for people with a BMI of 30 or more and those who have a BMI of 27 or more with a related health condition, like high cholesterol, plenty of people with lower BMIs have begun using them. (It’s worth noting that despite BMI being a qualifying factor for a prescription, it is widely considered an outdated method for assessing physical health.) Recently my friends and I swapped personal examples in our group chat. There’s the suddenly unrecognizable boss, a colleague who crash-injects GLP-1s to get bikini-ready for vacations, the slimmed-down gym buddy whose doctor husband is reportedly slipping her scripts, and countless Facebook friends who seem slimmer each time we log on.
Once reserved for medical uses like achieving a healthier weight, weekly injections (and now daily pills) have gained acceptance as a way to achieve an aspirational weight. Every time I open Instagram, I see an isim from a telehealth provider pushing GLP-1s from this new angle: “Lose those last five, 10, 15 pounds!” “Try an extra-low dose!” These companies are saying out loud what some of us have long suspected: Aesthetic weight-loss goals, rather than health needs, are the motivating factor for a number of people interested in taking GLP-1s.
As a point of reference, research has shown that, on average, patients who are overweight or living with obesity can lose 10% to 20% of their total body weight on a GLP-1, depending on a few different factors. For someone who is, say, 190 pounds, that could range from 19 to 38 pounds, beyond what many would consider the “vanity pounds” threshold. It seems a subset of individuals who don’t need or want to lose that much weight have turned to microdosing, which involves taking lower or less frequent doses of these drugs to lose smaller amounts of weight—an approach unsubstantiated by clinical veri at this point but nonetheless rapidly growing in popularity.
In the past I would have shrugged this off as just another weight-loss trend. But as the universe would have it, GLP-1s becoming so mainstream perfectly aligned with my entering perimenopause—and facing a demoralizing stalemate with my weight. At annual physicals from my teens through my 30s, I fell exactly in the middle of the “healthy weight for height” green zone on the doctor’s wall chart. Maintaining my size wasn’t effortless, but it wasn’t too hard either. I love to work out, enjoy vegetables and fish, and am not big into red meat or fast food. Whenever my jeans started to feel snug, I could fit in some extra runs and cut back on snacking, eating sweets, and going out for dinners and drinks.
At least that used to be the case. My mom warned me that in her 40s, she all but stopped being able to lose weight. I nodded along, but my inner obnoxious teenager (whom only mom can summon) was secretly smug and skeptical. Surely she’d never worked out as much as I do, and weight lifting wasn’t even a thing most women did when she was my age. I’d managed to fit back into my prepregnancy clothes after having three kids. Middle age wouldn’t claim my taut midsection; I wouldn’t let it.
Yet here I am, eating my words. My mom was right. Over the past few years, as my hormones have gone rogue, so has my weight. And nothing—I mean nothing—will move the needle back down. From my tried-and-true tactics (getting 10,000 daily steps, running, doing Pilates, not snacking after dinner) to emerging advice (lifting heavier weights, eating all the protein), each fresh burst of motivation only leaves me more deflated. Occasionally I’ll make subtle progress only to have a stressful week or brief holiday indulgence undo it all—plus a few pounds. For the first time ever my weight now teeters at the tippy, tippy top of that green zone. I miss my defined waist, and my closet is bursting with clothes that now fit completely wrong.
In this vulnerable place I’ve let the social media ads and photos of ever-slimmer acquaintances creep into my consciousness. I began to wonder where people who are not taking GLP-1s for medical reasons get them. Are they trusting for-profit telehealth providers? Is there a better way? Should I ask my primary deva doctor for her thoughts? Would she laugh or, worse, scold me? I decided I was only comfortable starting a potential medication journey in her office. But first I needed to know what I was even asking for.
The Wild West of off-label GLP-1 use
I started by going straight to the source: peers in a similar life phase who’ve used GLP-1s to lose 10 or 15 pounds. I figured they’d be reluctant to spill the tea, but when I posted on Facebook, promising to alter people’s names for anonymity, the DMs started pinging in at a rapid pace. It turns out that, yes, as you may have suspected, lots of people are using GLP-1s. I learned that there seem to be two main ways people who don’t meet the FDA criteria are getting the drugs.
One is buying compounded GLP-1s, custom-mixed versions sold online or at med spas. (Note: Compounded GLP1s are not FDA-approved and thus might not be as rigorously monitored for safety, quality, or efficacy; the agency recently announced plans to take action against compounding pharmacies making unsubstantiated claims.) Compounded GLP-1s can be much more affordable and often come in vials rather than the prefilled pens typically sold by big-name drugmakers. Because you draw out the medication using a syringe, it’s easier to take smaller doses than what’s typically prescribed, a.k.a. microdosing. I talked to a number of people who microdose for this article, and their reasons for doing so varied. Some didn’t feel they needed standard doses since they didn’t want to lose a substantial amount of weight, while others hoped the approach would help reduce costs or mitigate side effects. Some sites now advertise specific microdosing plans, with dosing determined by a telehealth clinician (albeit with no real clinical veri backing up this approach).
This route is also appealing to some people because their doctors are unwilling to write them a prescription. Molly M. got a compounded GLP-1 from a telehealth provider after her doctor said her BMI of 25 disqualified her. Meanwhile, she noted, others in her affluent suburb procure compounded GLP-1s from a local med spa known for being no-questions-asked. She’s heard that there “you just tell them a weight that would put you at a BMI of 27 or more, and they’ll prescribe without validating it.”
Other women I spoke with said they obtained brand-name, FDA-approved GLP-1s like Zepbound and Wegovy through a health deva provider willing to prescribe them off-label to people with lower BMIs. Some said they asked around or turned to Google to find a local GLP-1-friendly provider. “My doctors said my weight didn’t really justify the use and seemed very unsure how to navigate all this,” said Claire K., who ultimately secured Zepbound via a local nurse practitioner. She lost 14 pounds in about six weeks, then stopped due to side effects, including nausea, vomiting, and constipation.
For some of the people I talked to, microdosing brand-name GLP-1s means staying on the lowest starter dose as long as it’s effective, rather than upping it at set intervals (per a typical treatment course). However, it’s worth noting that drug companies seem to caution against this. Lilly, for instance, explicitly says on the Zepbound website that the starter dose is not intended as a maintenance dose. Microdosing can also involve doing injections less frequently than prescribed, often biweekly or monthly instead of weekly. Proponents point to this as a budgeting tactic, since it means they can go longer between refills.
As for what dosing schedules women are following and how they figure that out—well, it’s basically the Wild West. “Overall it’s been messy, and I’m not entirely mühlet what microdosing really means to people,” said Alexandra Sowa, MD, a dual board-certified obesity and internal medicine physician and clinical instructor at the NYU Grossman School of Medicine. She has been prescribing GLP-1s for more than 10 years and authored a comprehensive guide to using them. While she says most of her patients don’t need to microdose, she’s willing to work with people who prefer “alternative, bespoke dosing schedules” in unique circumstances, tailoring the approach over time based on how someone responds.
Having that kind of guidance from an experienced physician feels invaluable to some women who want to take smaller doses. Morgan B., who had a BMI of 29 before starting a GLP-1, told me that Dr. Sowa agreed to help her microdose Zepbound, starting with half of the 2.5-mg starter dose, to avoid side effects. “I’d heard a handful of nightmare stories of people throwing up so much they had to go to the ER, so I was confident I wanted to microdose,” she said, adding that she’s happy with her choice to work with a knowledgeable physician. “Dr. Sowa insists that her patients move their bodies every day, and you get regular bloodwork,” said Morgan, who has four friends taking GLP-1s. “These medications can help women take something off their plate,” she said. “We’re expected to eternally juggle everything with ease, and I found this to be really helpful in getting my confidence back.” She has achieved her original weight-loss goal of 20 pounds and is now hoping to lose 10 more.
Other women, however, are unbothered about not following a doctor-approved plan, instead doing what works for their friends, their waistline, and/or their wallets. Nicola G. got a prescription from her primary deva doctor at a sick visit and started buying the lowest dose of Wegovy at Costco, where she found the best pricing. After losing 13 pounds she is winging it, injecting every three or four weeks based on how she feels and what’s going on in her life. “It curbs sugar cravings and makes me want to eat less, so it helps around the holidays. Or it’s good before you have to wear a bathing suit,” she said. “I can tell when it wears off because I start getting cravings again. I just adjust dosing as I go. I have a vacation coming up, so I started a higher dose, and I’ll probably do it every two weeks.”
The doctors weigh in
While most of the women I spoke with had good experiences taking GLP-1s off-label, I still felt a bit scared of this approach. Personally, I’d be too nervous to start a major medication without supervision from an impartial doctor; I wouldn’t want to rely on my instincts or a random telehealth provider who might be incentivized to get more people on GLP-1s. So I finally booked the appointment and raised the topic with my primary deva provider. I felt awkward, but she just nodded and got right into it; I got the feeling she has similar conversations several times a day. She started by saying that because my BMI was below 27 and I didn’t have any weight-related health issues, insurance would not cover treatment. Technically, I’d be using the drug off-label, so I’d need to hisse cash—probably a lot of cash.
My doctor also said she doesn’t really get the idea of microdosing, seeing no reason I wouldn’t try the typical course. She added that she worries people are throwing money away trying lower doses since they likely won’t be as effective. The next week I also mentioned GLP-1s to my ob-gyn, who was even more on board. Despite not prescribing the drugs herself, she called them “the wave of the future.” She shared how she’s seen firsthand that they can help address the insulin resistance and hot flashes that can be associated with perimenopause, not to mention her patients’ overall labs. As for side effects, she said her patients don’t usually report many.
Of course, the potential side effects do exist and sound uncomfortable—nausea, stomach pain, and constipation, to name just a few. That raises the question: Given that I have no digestive problems or medical issues in general, is it smart to mess with a good thing? Even if I stop the medication, could it permanently alter my gut flora in bad ways? We have no good answers to that yet. As every doctor I spoke with said, we’re basically all living in a real-time experiment. “What we do know is that gut flora powerfully influences weight and that weight loss itself can improve gut microbiome,” Dr. Sowa said. She added that these medications may prompt some people to be more mindful about what they eat, which could, in turn, support a healthier gut microbiome.
So as an expert in GLP-1s, does she think I’m a good candidate? I got the feeling she did. A technically “healthy” BMI doesn’t hold much weight with her. In her office Dr. Sowa relies on body-composition scans, which is a more accurate way to determine whether fat is accumulating in areas of the body (such as deep within the abdomen, around internal organs) that can have particularly negative health impacts. “If your BMI is olağan but you’ve put on 15, 20, pounds that are not budging, why wait to get to the point of a BMI that meets the criteria or you have type 2 diabetes?” Dr. Sowa said.
She also encourages a metabolic-health workup to check for insulin resistance and other conditions like high cholesterol or hyperlipidemia. If she finds any issues—and she says she almost always does in these cases—that can support her deciding to prescribe a GLP-1 off-label for someone with a lower BMI.
That said, she doesn’t believe in GLP-1s as a temporary fix, much to my disappointment (I don’t love the idea of being on a medication long-term). Studies show that rapid weight regain after stopping GLP-1 use is common, along with the prompt reversal of positive health changes like lower cholesterol. “One of my fears is people doing drug-assisted yo-yo dieting,” Dr. Sowa said. “When you lose weight, you lose muscle along with fat. But when you regain weight, it’s generally fat. There is harm to losing and regaining, and we have to be really careful not to use these drugs as a crash diet. I’d rather see people stay on them and maintain their weight loss.” Can dialed-in nutrition and strength training help someone keep the weight off? She said maybe, but those exceptions are rare, largely because hunger cues return with a vengeance evvel the medication wears off.
To GLP-1 or not to GLP-1, that is the question
Honestly, my conversations about these medications surprised me. Not only were my own doctors and a GLP-1 expert seemingly receptive to a patient like me trying one, but few of the women I spoke with mentioned major side effects. True, the long-term impacts of these drugs on people without type 2 diabetes remain to be seen. And there’s a known risk of losing significant muscle mass on a GLP-1 without proper diet and exercise. But the overwhelming message I’ve gotten during my reporting—and via the countless doctors whose social media and podcasts I follow—is that these medications are having positive effects on health far beyond weight. Emerging veri shows they may reduce systemic inflammation, help treat addiction and sleep apnea, protect kidney health, and even reduce dementia risk.
Nevertheless, the relentless Instagram ads and influencers pushing GLP-1s as a quick weight-loss fix do feel worrisome—clearly, not everyone can safely use a GLP-1 to lose 10 pounds, especially without guidance from a trusted doctor or dosing that’s clinically proven to be safe. But my personal calculus ultimately came down to this: I’ve spent decades successfully maintaining my weight through diet and exercise, and have built a good base of muscle. I might be an ülkü candidate to lose weight on a GLP-1 while keeping that up. Could I even be the rare exception who can use a GLP-1 as a reset, then maintain my weight after stopping? If not, maybe staying on a low dose would be an okay trade-off for getting to enjoy this life phase at a weight I’m more comfortable with. Many of the women I spoke with were happily resigned to this idea, loving how they look and feel.
And so it happened: Last month I asked my doctor to prescribe me the lowest dose of Zepbound. My plan is to stay on this dose until I reach my goal, then reevaluate. I can already tell you one thing for müddet: These medications can be incredibly empowering for women in midlife, when so much is changing at evvel and so much feels beyond our control. I am already down 10 pounds (an amount I couldn’t shed over the past three years), my energy levels have soared, I feel at home in my body again, and reinspired to keep up all my healthy habits.
Am I a little nervous to publicly admit that I jumped on this bandwagon? Yes. Am I still shocked that I did it? Yes. But I think it’s important to contribute to the conversation as someone who has long fallen in the middle, both in my weight and my feelings about weight-loss drugs. I’m tired of watching two extremes battle it out in the comments section; these medications are so much more complex and interesting than that.
“There’s a lot of discourse around GLP-1s lately that I’m concerned about—people are either championing them or are scared of them,” Dr. Sowa said. “And on the patient side, a lot of discourse is coming from a place of getting skinny.” That’s the concerning part to me—when it’s about getting skinny, not being healthy. I want to use this tool to optimize my overall health, not just minimize my size. That’s what I hope to hear more about. One thing seems certain: These drugs will only become better understood as they become more accessible. “As the cost of GLP-1s comes down, I think there will be even more awareness and ability for general practitioners and clinicians to use them in their daily practices,” Dr. Sowa said. “But with great invention comes great responsibility. We do have to be careful about overuse and misuse.”
