Taylor Hubler went to pull up TikTok on her phone one day last month and saw she was logged out. “That’s weird,” she thought. She’d been continuously logged in for a couple of years.
“I had no prior violations, no warnings,” said Hubler, a stay-at-home mother who supplements her family’s income with commissions from a telehealth firm.
TikTok has emerged as a go-to hub for information on how to obtain GLP-1 drugs, such as Ozempic, that have become blockbusters and cultural sensations thanks to how they help people lose weight. Seeking to rein in promotional videos, the company says the new rules are intended to block body-shaming imagery and related harmful messages. The changes are disrupting a commercial ecosystem that set off concerns about inappropriate weight-loss messages as it exploded in size. Some users are changing the way they talk about the medications and switching to other social platforms.
The practice of of boosting prescription drugs to consumers on social media falls into murky regulatory territory. Some lawmakers have raised concerns that influencers are not giving consumers a full picture of the risks of the drugs, which are injected. In another controversial practice, many influencers are using their own weight-loss experiences to drum up sales of GLP-1 drugs that are imitations of brand-name versions, made by compounding pharmacies and prescribed by telehealth companies.
TikTok would not directly address why it is making the changes now, beyond saying that it regularly updates its policies. It already restricts a variety of posts under its “disordered eating and body image” guidelines, including promotion of certain fasting techniques.
The new rules “do not allow … facilitating the trade or marketing of weight loss or muscle gain products,” according to the guidelines. They do allow “showing or describing” what they call “medically necessary health interventions” under the care of a health-care professional.
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A TikTok spokesperson said it hasn’t changed its enforcement practices ahead of the new community guidelines, which took effect May 17.
“We want TikTok to be a place that encourages self-esteem and does not promote negative social comparisons,” TikTok says in a preface to the rules.
The connection between social media use and eating disorders and mental anguish has become a liability for tech companies. Meta Platforms, the owner of Facebook, is facing litigation over harms to youth and government investigations into “alleged mental and physical health and safety impacts on users,” according to securities filings.
Among social media apps, TikTok is seen as especially sensitive to public criticism as its Chinese parent company faces a legislative ultimatum, passed by Congress and signed by President Joe Biden, to sell the popular app or face a ban in the United States.
In response to the new rules, many weight-loss influencers are trying to shift their TikTok followers to other platforms like Meta’s Instagram, Google’s YouTube and a video service called Clapper, according to interviews with seven TikTok users who have large followings and post about GLP-1 drugs.
A Meta spokesperson said the company limits posts that attempt to sell health-related products and services, and that it will remove weight-loss material “that contains a miracle claim.”
Google and Clapper didn’t respond to requests for comment.
Ashley Dunham, who promotes weight-loss medications for her stepfather’s clinic and has more than 95,000 TikTok followers, said the platform has been cracking down on weight-loss posts over the past year, even before the new guidelines were announced. She believes that the company is suppressing her content, providing screenshots of analytics that show her posts for most of April had 71.5 percent fewer views than the previous 28 days.
“We’ve all had to start talking in code,” she said, out of fear that TikTok will remove posts with certain terms.
Jennifer Harriger, a psychology professor at Pepperdine University who studies the intersection of body image and social media, said TikTok’s new guidelines “can be very protective, particularly for young users,” citing research that image-focused posts can negatively affect their well-being. Still, she said, “when I read through the community guidelines, there’s a lot of ambiguity.”
In the first three months of this year, there were nearly 450,000 posts across social media platforms about GLP-1 drugs or anti-obesity medications, with TikTok accounting for the largest share, according to Real Chemistry, a health-care marketing and data analytics firm. That number, up 76 percent from the previous three months, far outpaces the volume of posts on other popular medicine topics, like mental health and multiple sclerosis, the company said.
Amble Health, a telehealth platform registered last year, has told prospective TikTok influencers that some of its partners have made $30,000 in a month by promoting GLP-1 medications, according to correspondence seen by The Washington Post.
Amble was incorporated last fall by Joseph Stiver, an entrepreneur who also founded telehealth platform MinuteMD. He didn’t respond to requests for comment.
It’s generally legal to endorse pharmaceuticals for money as long as the promoter makes claims that can be substantiated, discloses the relationship with a sponsor and — if the sponsor is a drugmaker — provides information about risks, according to Raqiyyah Pippins, a lawyer at Arnold & Porter. When influencers talk about medications working well for them, “those are low-risk representations. They’re not performance claims that are likely to trigger enforcement,” Pippins said, referring to the Food and Drug Administration.
In one widely cited example, the FDA went after a social media post on Instagram and Facebook by Kim Kardashian in 2015 that heaped praise on a drug for morning sickness without disclosing any risks. Notably, the agency targeted the drug manufacturer that hired Kardashian, not Kardashian herself or the social media sites, because its regulations largely are built around holding the maker of a medication accountable.
Carly Pflaum, an FDA spokesperson, said that the agency’s regulations require drug promotions to be “truthful, non-misleading and balanced” regardless of the platform, and that they may apply to telehealth providers depending on the situation.
Adding to this complexity, much of the GLP-1 buzz on TikTok isn’t just about FDA-approved drugs like Ozempic, Wegovy, Mounjaro and Zepbound. Many in the community have found off-brand versions made by compounding pharmacies, which mix up their own injectable weight-loss drugs.
These specialized pharmacies are permitted to make copies of FDA-approved drugs that the agency lists in shortage, as is the case for the most popular GLP-1 medications on the market, and many have pivoted into the weight-loss business.
To do so, compounding pharmacies have to obtain their active ingredients from FDA-registered facilities, among other requirements. The agency has cautioned that it can’t vouch for the safety or effectiveness of compounded semaglutide, the active ingredient in Ozempic and Wegovy. Eli Lilly and Novo Nordisk have sued several compounding pharmacies for making copies of their drugs, with mixed results.
Despite the litigation, numerous clinics and telehealth firms offer pharmacy-made weight-loss drugs for a fraction of the cost of the brand-name medications, which have list prices above $1,000 a month.
Among providers who aren’t comfortable with compounded GLP-1 drugs is Jennah Siwak, a doctor specializing in obesity medicine who posts on TikTok as @weightdoc and has more than 277,000 followers.
“I get why they would have some concerns,” Siwak said of TikTok’s new policy, but “wiping out everyone’s voices is not a great way to handle it.”
It was Siwak’s posts on Mounjaro, a diabetes drug that — like Ozempic — also promotes weight loss, that Rachael Gullette credits with changing her life.
Gullette was scrolling TikTok when she came across a video by Siwak about a coupon from drugmaker Eli Lilly to get Mounjaro for $25 a month. Taking the medication was transformative for Gullette, a 41-year-old interior designer who lives in Lexington, Ky. and has struggled with obesity for much of her life.
“If there was no TikTok, I would not be down 172 pounds right now, I would not be pregnant. I would be blaming myself,” she said.
Gullette now promotes compounded GLP-1 medications for Amble.
For Chace Franks, a nurse practitioner, posting on TikTok led him to connect with Ivím Health, a telehealth platform specializing in weight loss, which offered him a job in December. Franks said he is trying to navigate the new guidelines by being “very strictly medical-based,” such as saying “obesity treatment” instead of “weight loss.” But he’s building up an Instagram following, too. “People want that content,” he said, “so they’re going to find it.”
Ivím didn’t respond to requests for comment.
Even as many in TikTok’s GLP-1 community branch out to other platforms, some are hoping to stay.
The first thing Taylor Hubler did after her account was banned was to start a new one. “I felt like that’s where I had my friends, people I felt safe with,” she said.
She came across GLP-1 drugs on the app about a year ago, when she was a new mom and struggling to lose weight. She spent a couple of months researching options on TikTok before making an appointment with her doctor to ask about a prescription.
The doctor “wasn’t big into these weight-loss medications,” Hubler said, and the advice she got was to “try diet and exercise and see how that works.”
Instead, Hubler got a prescription from a telehealth firm and paid $827 a month out of pocket for Wegovy. Then she discovered the compounded version and switched to MinuteMD, where it was less than half the cost. She now has a contract to promote Amble’s products and is trying to craft a way forward on TikTok.
She plans to talk about Amble “in a very specific way,” but isn’t yet sure how. Maybe she will tell users to “check my link in my bio about this company,” she said.
