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

Song Zihao had similar experiences. In high school, he was nicknamed “Fat Ding”; after work, he adopted a cute Shiba Inu, and when he had conflicts while walking the dog, opponents would first attack his weight and appearance. Once, when job hunting, everything seemed fine online, but the feedback after an in-person interview was, “You look completely different offline than online, there’s a big discrepancy.” He suspected that in addition to not looking good enough, his physique made him timid, affecting his overall performance.

Regarding weight loss, Song Zihao set a rule for himself: either be a good-looking slim person or a refined overweight person. “If you don’t become a refined overweight person, when you go out to do things, people will think you’re sloppy, and your physique makes people doubt your reliability as a worker.” He sensed that obesity is often associated with sloppiness, laziness, irregular life, and lack of willpower. The world we live in “praises thinness as beauty,” thinness signifies self-discipline, a demand on oneself, and even suggests better work capability.

The world represented by thinness tempts them. Zhang Miaomiao felt that in addition to her capabilities, her figure helped her reach an executive position in her early 30s. At her previous company, which she used as a stepping stone, “I became the top sales in less than a year.” As an executive, she needed to attract investment and negotiate with investment institutions. “When you look good and have a good figure, you can drink less. I drink half a cup, they drink a full cup; I drink a glass of wine, they drink two glasses of liquor.”

She remembered once participating in a national award presentation, wearing her most expensive coat, with delicate makeup, standing on stage, attracting everyone’s attention. She was one of the few women there, and certainly the most beautiful, “When you’re attractive, the sharpness of the questions from the judges is actually a bit different, you know?”

After tasting these benefits, it’s hard for them to give up the advantages brought by being thin. Du Xiaoyue said, “I’m not greedy,” all she wanted was to lose that extra fat, about a dozen pounds, to look a bit more toned. Zhang Miaomiao also expressed similar sentiments, feeling that her weight loss wasn’t excessive or exaggerated, just wanting to be “a bit better”—they are subtly changed by societal demands, unaware of this change, thus powerless to resist.

Zhao Mingli feels that societal concepts play a significant role in the misuse of semaglutide. From a scientific perspective, there are clear diagnostic criteria and treatment methods for obesity. Medically, a body mass index over 24 but less than 28 is considered overweight; a body mass index of 28 or more is considered obese; a body mass index of 32 or more is moderate obesity, and 36 or more is severe obesity—but these are not the standards of social aesthetics.

For overweight individuals, the main recommendation is to lose weight through diet and exercise, which is the foundation of all weight loss methods. For obese individuals, medication can be used, and if they meet the criteria mentioned earlier, semaglutide injections can be administered. If they have type 2 diabetes with a body mass index over 27.5, or a body mass index over 32.5, they can undergo surgery, such as laparoscopic sleeve gastrectomy.

An interesting phenomenon is that in economically developed countries like Europe and America, only about 1% of patients who meet the criteria for surgery and are severely obese are willing to undergo gastric reduction surgery. In China, this percentage is less than 0.1%. Zhao Mingli noticed a contradiction: when thinness is a societal aesthetic, people cannot accept obesity; but when obesity is a disease, people have a high tolerance for it.

The misuse of semaglutide reflects a lack of public awareness of obesity as a disease and shows a wide gap between science and social psychology, with a vast number of people standing outside this chasm, looking in.