“Weight Loss Miracle Drug” Semaglutide Faces Misuse in China, Leading to Emergency Hospitalizations Due to Dehydration

It offers high cost-effectiveness. People who meet the criteria for its use can purchase it in hospitals through medical insurance. A 1.5ml injection of semaglutide, containing about 2mg of the drug, costs 478 yuan. On e-commerce websites, the same 1.5ml injection costs between 650-850 yuan. To put it in perspective: losing 10 kilograms through exercise requires running for 231 hours, burning 115,500 kilocalories; but with semaglutide, it only takes a few minutes. Liposuction of 2000ml costs about 10,000 yuan, equating to 2500 yuan per pound lost, while semaglutide costs only 65 yuan per pound.

Semaglutide, produced by the Danish pharmaceutical company Novo Nordisk, was approved by the U.S. Food and Drug Administration (FDA) twice, in 2017 and 2020. The first approval was for treating adult type 2 diabetes, and the second added obesity. It obtained permission to enter China in April 2021, but only for one indication: adult type 2 diabetes. This means that in China, it has not been approved as a weight loss drug—a fact that many users are still unaware of.

Throughout his more than a decade in medicine, Zhao Mingli has been dealing with weight loss. He is an attending doctor in the Department of Weight Loss and Metabolic Surgery at Southern Medical University’s Nanfang Hospital, witnessing the gradual increase in demand for weight loss treatment. Accordingly, the weight loss clinic where he works was recently separated into its own department.

Starting last year, as a weight loss doctor, he frequently encountered semaglutide. According to him, due to the high incidence of obesity in China and the complex drug approval process, semaglutide has shown certain efficacy and safety in clinical settings. In some provinces’ medical associations, it has been included in the “off-label use list.” This means that qualified, experienced doctors have the authority to decide, in the absence of more suitable drugs and methods, to use semaglutide for patients needing weight loss.

Of course, the standards for off-label use are strict. For example, the Guangdong Provincial Pharmaceutical Association stipulates that semaglutide can be used off-label only in two scenarios: when a patient’s BMI—Body Mass Index (weight in kilograms divided by height in meters squared) is greater than 30; or when they already have obesity-related comorbidities such as hypertension, hyperlipidemia, fatty liver, gout, sleep apnea, polycystic ovary syndrome, etc., while also having a BMI greater than 27.

But just like two sides of a coin, because of semaglutide’s accessibility, relative safety, and effectiveness, it is being “misused” more often without restrictions:

Du Xiaoyue works as a DJ in a bar and is recognized by friends for her “good figure,” even considered skinny. DJs need to promote themselves on camera, but she never dares to open videos others have taken of her, feeling fat and determined to use the “miracle drug” to slim down to a weight where “everyone can freely take photos”: 167cm, 90 pounds.

Zhang Miaomiao, a post-90s executive at a cross-border e-commerce company, is 165cm tall and weighs 120 pounds, slightly overweight but not obese. Frequently representing her company at large events, she aims to lose 20 pounds with the “miracle drug” to “at least have a chest and a waist, some curves, to look better on stage and on camera.”

Baoma Tian Ziyun, 167cm tall and only 105 pounds, often appears in photos wearing long dresses that make her look slender and tall. But like others, she feels it’s not enough, “Being thin and looking good on camera are two different concepts. To have more three-dimensional facial features, you indeed need to weigh less than 100 pounds.” She heard from her husband about a pharmaceutical researcher friend who was using semaglutide to lose weight and even sent her an article titled “Average Weight Loss of 36 Pounds in 68 Weeks!” She was intrigued and decided to try it.

These users share similar profiles: by medical standards, they are not overweight, but they have another standard, shaped by social and cultural aesthetics. It is precisely such individuals, who are not overweight, who are more eager to use semaglutide for weight loss.

In stereotypes, women are more motivated to lose weight, but semaglutide breaks this rule, with many men among its misusers:

For example, post-90s Song Zihao, an employee at a medium-sized advertising company, gained weight up to 170 pounds in 2021 due to work stress. Although overweight, his BMI was just on the border of qualifying for semaglutide use, at 29.4. When he went to a weight loss clinic to register, the doctor told him he did not meet the criteria for the drug. Eventually, he found a way to buy semaglutide at the hospital under the guise of getting medicine for his diabetic grandmother.

Male executives and entrepreneurs might also be fans of semaglutide.