Skinny and sad on GLP-1s

Our greatest living athlete is Hawking GLP1s. I'm on row, 34 pounds down on GLP1s. [MUSIC] She wasn't alone. Just about all the major players for these weight loss drugs had commercials during the Super Bowl. >> Weight loss treatments that can be Michael Dose to fit your goals. >> Big news America, where Gov'e now comes in a pill. >> So a Dose with obesity can lose weight and keep it all along with diet and exercise. >> Yes, thank you, DJ Khaled. >> Another one. >> And most of those ads, including serinas, were for companies that offer knockoff versions of the popular drugs. So how is that legal exactly? I'm John Gwynhill sitting in today. The sort of sketchy world of compound pharmacies and the GLP1 symptom that people didn't see coming. That's coming up on today, explained from Vox. >> And another one. And another one. [MUSIC] >> When the political winds chain, will there be accountability for those who bent the knee for the Trump administration? >> If these corporations think that the Democrats, when they come back in power, are going to play by the old rules and say, oh, never mind, we'll forgive you. I think they've got another thing coming. >> I'm Pete Barara. In this week, Ambassador Susan Rice joins me to discuss leadership, decision-making, and the state of the rule of law in America. The episode is out now. Search and follow Stay Tune with Prite, wherever you get your podcasts. [MUSIC] [SOUND] >> Ready, go get the world's most angels morning, Joe. Today, explain. >> My name is Sydney Lepkin, and I am the pharmaceuticals course bonded at NPR. >> Okay, Sydney, I don't know if you watched the Super Bowl, but I did. And it seems like drug companies really want us all to get on GLP1s. Has the industry continued to grow or have we reached peak GLP1 consumer? >> I don't think that we've reached the peak of GLP1s by a long shot. And when you say, does the industry want us to be taking them? I mean, yeah, sure, they do because when we take those drugs, we pay for those drugs. But also, I mean, as someone who's talked to hundreds of patients who have taken both brand name and compounded GLP1s, they want to be taking them. I've talked to people who have said, I have struggled to lose weight my entire life. And this changed my life. And we can talk about stigma and whatnot, which is not gone yet. But they'll say, this is a tool and it's really helped me. >> Okay, I'm also a woman in my 30s with the internet. And so I've been just told so many different ways to hate my body. >> [LAUGH] >> And this also means that I get a ton of ads from companies like hers and Ro telling me that they have GLP1s ready and available for me whenever I want them. >> The quality of your healthcare shouldn't depend on where you live, what you do, or whether you have insurance. It should be personalized to your unique needs. That's why we created Weight Loss by HERS. >> That's why we created Weight Loss by HERS. >> And Ro get the online coaching and care you need to lose 15% of your body weight. >> Charles Barkley wants to lose 65 pounds with GLP1s. >> Are these companies legit? What's going on with that? >> That is a great question. I think I'm going to back into this answer and tell you that when we're seeing these competitor GLP1s, the assumption, because this is the way things have always been, is that they're offering generic drugs. And that's actually not what's happening here. Basically, this is not a generic. This is what is called a compounded drug, which means that the drug is made instead of in a manufacturing drug company's facility by a drug company going through FDA approval. It is made by a special kind of pharmacist. The compounding pharmacist, their sort of bread and butter, is that they make custom drugs for people that need them. So the example is like, okay, you need a pill, but the brand name commercial version has a preservative in it that you're actually allergic to. But you still need that pill. So you would go to a compounding pharmacist and then they would custom prepare the version for you that you are not allergic to because you obviously need that. And it's a crucial part of healthcare. They're generally not supposed to make what are called, quote, essentially copies, and I'm using air quotes for those who can't see me, essentially copies of existing commercial brand name drugs. But there's an exception. The exception is when that brand name drug is in shortage. Then the compounding pharmacies can pitch in. Now these GLP ones that we've been talking about their popularity, in fact, they were so, so, so popular that the drug companies didn't make enough supply. Accessing semi-glutide injections is challenging for thousands of people who live with diabetes. And the demand for the drug is highest. People around the world have turned to it for weight loss. These weight loss drugs, they've exploded in popularity so much so that these drug makers simply can't keep up with the demand. And all of a sudden, you know, compounders were like, well, we can actually do this for cheaper than the list price for Wagovies is like $1,400 a month. So all of a sudden people could get it for cheaper telehealths, we're helping connect them with physicians. And that's sort of where this boom is coming from. Now the shortages have ended. The companies that took them a couple of years to, you know, catch up on the manufacturing side, but the shortages has ended. And the thought was that the compounding would also end, but what is now happening is a lot of companies are saying, well, what we'll do is we will make you a custom version of this drug. And then they think that there, at least some that I've spoken to have said, you know, then I think that we're working within the parameters of the law, and there's some definite debate about whether that's true, but that's sort of why we're still seeing a lot of compounding. The other big news in GLP One World is that you can now get it in pill form. You know, it's been an injection up until recently when it comes to these compounding pharmacies. Are they offering the pills now too? So well, there, as far as we know, there isn't a shortage of the pill, but we are seeing, you know, the pill is brand new. The pill came to market about a month and a week ago. So it just, it was just approved at the end of last year by the FDA. It's now just now on the market where you can actually go to a pharmacy as of, you know, the beginning of January and pick it up if you had a prescription. So seeing last week that hymns, the tell-out of company and hers, were offering their own version of the compounded pill, raises sort of a lot of questions like, can they do that? Is sort of the question and they will say, and initially they said, yes, we can. However, very quickly, no-vonortiske, which as you know, makes the brand name version of it, said, you know, we are preparing to take legal action because that's illegal. It's mass market compounding, which is kind of not the, you know, what compounders are supposed to be doing. And, you know, we're going to, we're going to take action on this. And hymns' response was, you know, that's false, that's not true. Then the Commissioner of the Food and Drug Administration, Marty McCary, tweeted, FDA will take swift action against companies mass marketing, illegal copycat drugs, claiming they are similar to FDA-approved products. The FDA cannot verify the quality, safety, or effectiveness of non-approved drugs. And then that was swiftly followed by a HHS general counsel saying that, they were going to refer this issue to the Justice Department. So that changed things. Wow. And hymns' response was, since launching the compounded Semicluid PIL on our platform, we've had constructive conversations with stakeholders across the industry. As a result, we have decided to stop offering access to this treatment. So now the compounded PIL, at least for now, is no longer on the table. Do we know if these compounded versions of GLP ones are they safe? The short answer is it depends. It depends on who is making it. It depends on whether they're making it in a sterile environment, whether they're licensed. You know, in the case of compounding, it's not. The FDA doesn't typically inspect your sort of small compounders. It will inspect your bigger ones. But a lot of these are made and they're regulated by state boards of pharmacy. You know, when a drug goes generic, something called a USP monograph gets made. And it's basically a recipe for like how. Here's the standard for how you're supposed to make that ingredient. And because this drug hasn't gone generic, there is no recipe like that. So are they making it in a way that is safe and not going to have any like extra junk that you don't know about? And like, is there going to be a long-term side effect that we're not seeing today? What about effectiveness are the compounded versions effective? I have definitely heard from people who have said, you know, like I. insurance coverage for ozempic went away. So I went the compounded route and it's been great for me. I've heard from a lot of people like that. But there are definitely real risks and most of the time what I when I hear from like emergency physicians and I when I ask them about it they'll say you know the issue is they either they miscalculated or perhaps it was too potent or it wasn't potent enough and it did nothing so like that's probably not going to send you the emergency room. But like if it's too strong and you don't know it that can be really risky. Do you think we're about to see a big explosion in the use of these drugs? I mean I think if I get on Instagram I see an ad I watch the Super Bowl and saw ads like yeah I wonder are we going to see more and more people use GLP once? We're already seeing a lot of people use them. The ads actually at one point I looked at Facebook ads over time for compounded drugs and they were only growing. But I do think we're going to see more people using them if they can get cheaper. There are still going to be a lot of people who can't afford a couple hundred dollars a month and don't have health insurance coverage because one of the things I'm now hearing from people is also like even if they do have coverage it's very restricted. Like I've heard from several people I can't get it covered for weight loss unless I have a BMI of over 40 which is interesting because a BMI of 30 is considered obese. So like I've heard from people be like wait am I supposed to gain weight to get coverage? Are you kidding? NPR's Sydney Lepkin. So more people are likely to get on these drugs compounded or the OG version. But what if losing weight also means losing interest in the things that used to excite you? That's next. This week on Networking Chill we're joined by Zarna Garg and her daughter Zoya for a mother daughter conversation about money, ambition and reinvention. Zarna proved it's never too late to chase your dreams from practicing law to building a matchmaking business to becoming one of comedy's most exciting voices. Her unconventional path has led her to Hulu comedy specials sold out tours with Amy Poler and Tina Fey and her memoir This American Woman. Meanwhile Zoya's been watching learning and carving out her own path as a young professional. Get ready for a hilarious and honest conversation about immigration, money, late blooming success and what it really means to build a big authentic life on your own terms. Listen wherever you get your podcasts or watch on youtube.com/yourrichbf. I'm John Colenhill. Dr. Sarah Lavel is a clinical psychologist. She works with people who struggle with food, eating disorders, emotional eating, that kind of thing. And she spends a lot of time thinking about how this impacts society. A lot of her patients have tried GLP1 drugs. And she recently started noticing a new kind of symptom popping up for them. I think I first started looking to this about a year ago. But it was kind of the same conversation of three different patients in the same week. And I started noticing they all kind of have this kind of flat effect. And not of a word depressed, but each one of them was saying things like, well, what's the point? Maybe I don't even care about that job promotion. Or, yeah, I have kids. Maybe it's the kids I don't know what it is, but I'm not even excited to go out with my friends. And I thought about it. And I was like, what's so different about these patients? And these three in particular had been on GLP1s. And of course, you know, you can't make an inference based on three people, but it is what motivated me to start looking into more of the psychological effects, particularly around what we do and do not know about how GLP1s affect dopamine and motivations seeking behavior. They never put two and two together that this could be from the GLP1s. They always, so you don't have a lot of reports on it because these three patients that they would have never thought about it. It was more as me an outside observer thinking, wait a minute, what's this common thread? They always make sense of it's something else, right? So it's very hard to study. The other thing is that there's a big difference between a person being depressed, which they have started looking into, does it affect suicidality and depression. However, you have to think about depression in yes, it can be that kind of apathy kind of feeling. However, depression really implies a negative affect, right? Like I'm no good. I don't feel like existing, right? That's very different than a flatness. Yeah, so it sounds like it's not even like sadness. It's just sort of nothing. Yeah, like the same excitement you might get from like, oh, I'm going to eat this pizza later. You're also not getting this, oh, I'm going to see my friend later. Or, oh, I can't wait to go to this concert. You know, you're kind of dampening this anticipatory response, right? So one of the theories in the literature is that it's not just changing your appetite and metabolism, right? Because think about it. If it's also helping gambling and shopping addictions, that can't be just about metabolism. Pharmacological activation of GLP1 receptors appears to reduce alcohol intake in preclinical models and early human studies, possibly by dampening reward signaling in the brain. This suggests GLP1-based therapies may influence not only food cravings, but also substance use, highlighting a broader role for these drugs in regulating reward-driven behavior. So how are we making sense of this? That it is helping with people not being as motivated to eat as much. They're not getting that food noise, but they're also not gambling and shopping. And of course, we look at all three of those as kind of negative, but what kind of positives might that be dulling? What I find interesting is that people are starting to come out of the woodwork and kind of noticing that, right? I'm definitely feeling this flat, just kind of like blah feeling. When it came to doing certain things, like my hobbies, going to the gym, cooking, baking, I lost complete interest in doing any of those. It all just seemed like a chore. That's why more journalists are starting to look into it than maybe people in medical field. By altering their desire for food, some people say they've lost their desire for everything else. And what's left is a long lasting state of me blech, numb, flat, take it or leave it. The cut, November 2025. Because again, it doesn't seem like it's leading to something clinically diagnosable, like depression, that there's more of these personal reports coming out of people saying I feel flat. I wonder how you think of GLP ones. I don't know. I love the idea of looking forward to food. I'm thinking about the little Mediterranean bowl I'm going to have from a local spot after this interview. I love looking forward to like, I'm going to go hang with some friends or like, I don't know, is this a net negative, a net positive? How do you think of these? Because I'm like, I don't know. I have to think of it at a very nuanced, you know, I really hate the people are on the like pro or negative GLP one camp, right? I see very positives in terms of mental health for some people. I've worked with so many people with a history of binge eating disorder that might be a hundred pounds overweight. And it's not just about them losing weight, looking good or being healthier. But those people have lost all psychological hope that it could ever change, right? If you are a hundred pounds overweight and you're extremely upset about it and you've given up all hope, I think GLP ones can be not just this physical life saver, but this like light at the end of a tunnel for you, right? But then we can't talk about that person the same as the person who struggles with anorexia, who is abusing it because it's their dream drug. It makes them not think about food. People with anorexia traditionally hate even thinking about food. They hate feeling hungry. It scares them. So if you're already a hundred pounds, you hear that, oh, now I can take a pill that's going to make me not think about food or feel hungry at all. You know, to me, that's a huge problem. So net positive, net negative within society, probably equal. Whereas I think there'd be a net positive in some populations and a very net negative in others. You know, there are lots of physiological things we're still learning about weight gain and weight loss. But the psychological impact seem just as complex and difficult to manage. They're really complicated, really complicated because you think about is obesity? Do we as a society think of obesity as strictly metabolic? Or do we think of it as strictly psychological, right? Like a binge eating disorder. But what you're finding even with GLP ones is that if there is a psychological component to it, that it's more emotional eating, stress as opposed to in response to the site or to taste of food. It's not going to be as effective while on them, and you're more likely to go back to the same behaviors right after going off of them. If you have a client that's taking GLP ones, what's something you want them to look out for? I'm thinking, you know, emotionally and psychologically. I have very mixed feelings about it. There are patients I would recommend going on them for psychological reasons. Sometimes people do need a break from that food noise. It is so overwhelming. However, you want to do a lot of prep work if they're ever planning on going off of them. Because a specially a person who's kind of frantic at the idea of that food noise, of those cravings, thinking something's wrong with them if they get them. When you go off, that's going to be, you know, I don't know, two to four times more intense, than prior to even going on them, right? And what you'll find is then if they go off of them, they don't remember what they were like before and they go, "Oh, see, I was always like this." And it can then reinforce this idea that there's something wrong with them. So I think a lot of preparation about going off of them and what it's going to be like for you when your cravings return and what are you going to do if those actually feel quite intense and normalizing the fact that it's going to be intense so that they know to prepare for that. And out of adult say they're taking these drugs and that number's probably going to grow in the future. You're seeing clients and we're seeing more and more stories about people losing their spark on these drugs. Do you worry that we're going to live in a society where like 80% of people have that sort of flat beige, nothing feeling? And I know, could it just so normalized within society that it creates this large impact? I'm not willing to be fearful of that. I think it would find its place the way that we had a lot of fear that Prozac would do that to everybody and maybe it was overprescribed at a certain point, but it kind of found its place within society and there's some just like Prozac, not everybody should be on it, but there's some people who are going to be really benefit from it. I do have concerns about the health impact. Like one of the things that I think about, if it is kind of dampening that anticipatory dopamine, right, that kind of like rush, what, okay, so does it really make sense? Doctors are saying, okay, well, take your JLP ones and this is going to make you less motivated for food, but we somehow expect you to have more motivation to change your diet and to exercise. If it's going to dampen your desire to kind of eat, isn't it also going to dampen your desire like that how you get from working out or that, hey, I want to be healthier. Maybe I should go for a salad. So, you know, I don't know how much of like muscular atrophy is a direct correlation of the medication itself versus actually the medication itself is doing two things. A, making people just not as motivated to want to get out, but also you'll find that a lot of people who've struggled with the food for a long time can overestimate the importance of being thin in eating well. If you think the only reason to eat better is to lose weight and something else is making lose weight, that might actually give you inherently less motivation to eat better. Sarah LaVelle, Clinical Psychologist. Today's show was produced by Kelly Westinger, edited by Jolly Myers, factored by Andre Lopez Cursado, and engineered by Patrick Boyd and David Tattasor. The rest of the team includes Hadi Mawagdi, Miles Bryan, Peter Balanon-Rosen, Daniel Hewitt, Ariana Spurru, Dustin DeSoto, A Stead Herndon, Noel King, and Sean Rommes Firm. Our supervising team is Avishai Artsy and Amina Alsadi. Our executive producer is Miranda Kennedy. We use music by Brickmaster Cylinder. I'm John Quinhill. Today explained is part of the Vox Media Podcast Network. For more award-winning podcasts, visit podcast.voxmedia.com. You can listen ad-free by signing up at Vox.com/members. And check out today explained Saturday. This week we talk to JB Pritzker, the billionaire governor taking on Trump. Find it right here on your feed or you can watch the interview at youtube.com/vox. [Music]