Weight loss drugs may be easy to buy online, but growing overdose and safety concerns have prompted health professionals to issue fresh warnings and a call for more awareness from consumers of the potential dangers, particularly when seeking medication via telehealth, reports NBC News.
Within 24 hours of injecting the first dose of a weight loss medication she received after consulting a telehealth doctor, Karleigh McClain (31) from Tennessee was admitted to the hospital.
She said she couldn’t stop vomiting. She added that she thought the dosage the telehealth company had prescribed seemed too high, and tried to contact her doctor, but when she didn’t get an immediate response, she called the company. A “care team” representative confirmed the instructions – which said to inject 2.21mg of the semaglutide medication once a week – were correct.
It turned out, however, that was nearly nine times the amount patients are typically told to take for their first dose.
Nearly a month after being diagnosed with an overdose, McClain said she was “still dealing with the residual side effects”, including an elevated heart rate and vision problems she felt were tied to the medication.
Most patients who have taken a GLP-1 received their prescription through a primary care doctor or a specialist, KFF polling data show.
But as telehealth inter-action has grown substantially since the start of the Covid pandemic, McClain is one of millions of Americans who have used online companies for their medical needs.
A number of these companies have started offering GLP-1 medications for weight loss as demand for these drugs has exploded. But certain medication errors have exploded too, according to a KFF Health News review of Food and Drug Administration data, and physicians and telemedicine researchers worry that adverse experiences tied to telehealth companies are becoming more common.
Bad outcomes aren’t unique to telehealth providers or to the compounded weight loss drugs offered by many of them. In fact, product liability lawsuits alleging patient injuries have been filed overwhelmingly against pharmaceutical giants Eli Lilly and Novo Nordisk, which manufacture name-brand weight loss drugs, court data show. The drugmakers have defended their products.
However, some critics are also concerned that getting a weight loss prescription online is often easier than getting one through an in-person appointment. Not only do many telehealth companies write quick prescriptions for GLP-1s, but they often sell the medications, too, allowing patients to bypass in-person pharmacy visits.
This one-stop shopping isn’t necessarily a good thing, note critics, who say some telehealth providers are writing scripts for people who should not be taking GLP-1s – and then providing little or no follow-up care.
“It gives a black eye to telemedicine,” said Elizabeth Krupinski, an experimental psychologist at Emory University who has conducted research on the effectiveness of telehealth.
“Telemedicine stands to benefit so many people,” she added, particularly when the technology is integrated within a larger healthcare system. That way, patients benefit from the convenience of telehealth while maintaining a connection with their in-person providers.
But some telehealth companies are marketing GLP-1s as an easy way to lose weight without emphasising the importance of healthy eating and exercise, she added.
They may be following the letter of the law, she pointed out, but writing prescriptions while skimping on care “is not in the Hippocratic oath”.
A ‘perfect storm’
From around 2020, many US states loosened restrictions on telehealth, allowing online companies to proliferate. This helped accommodate patients who could not, or chose not to, be seen in person at the height of Covid transmission.
Expanded telehealth access was also intended to lower barriers in rural communities, as well as mitigate doctor and nurse shortages.
Some companies require patients to meet virtually with a provider, like a doctor, nurse practitioner, or physician assistant, before they can get a GLP-1 prescription. But others may require nothing more of patients than an “asynchronous” evaluation, which does not include a live conversation with a healthcare provider.
Some experts are concerned that virtual care may be insufficient for prescribing weight loss drugs.
Patients with a history of pancreatitis, for example, should be counselled about potential complications, medical studies show. The same goes for people with gastroparesis, which affects stomach nerves and muscles, and those susceptible to medullary thyroid cancer.
But not all telehealth companies are adequately evaluating patients before writing prescriptions, said Marc-Andre Cornier, an endocrinologist at the Medical University of South Carolina and immediate past President of The Obesity Society.
When it comes to parsing the good from the bad, “whose job is it to police that?” he asked.
While the first GLP-1 was approved by the FDA more than 20 years ago, to treat type 2 diabetes, the use of these drugs took off in 2021 when Novo Nordisk received approval for a semaglutide drug to treat obesity: Wegovy. In a 2025 KFF poll, nearly one in five adults said they had taken a GLP-1.
In a recent paper in The New England Journal of Medicine, physician Amanda Banks noted that the proportion of GLP-1 prescriptions written for people who were not diabetic, obese, or overweight, increased from 4.5% in 2018 to 17% in 2023.
She called it “troubling” how easy it is to obtain a prescription for weight loss drugs and worried they might exacerbate existing eating disorders or cause new cases, including of anorexia.
Cornier echoed some of Banks’ concerns. “It’s not just filling out a form online and then having some random healthcare provider sign off on it,” he said. “There are concerns with some of these … that there’s not a proper evaluation, there’s not a baseline, and there’s not proper supervision.”
The American Telemedicine Association, which advocates for the expansion of “digitally enabled care”, has not addressed how telehealth providers prescribe GLP-1s, spokesperson Gina Cella said, calling it “a bit out of our scope”.
The lack of clarity makes choosing a company potentially confusing for patients, and the medical profession is partly to blame, said Jamy Ard, an obesity doctor and researcher at Wake Forest University School of Medicine in North Carolina.
Doctors have historically done a bad job of counselling patients about weight loss, and many people aren’t comfortable talking to their primary care doctor about it.
“Patients think, ’Why would I go to my doctor and have them say eat less and move more’, when I have heard that a million times and I don’t want to hear that again?” Ard said.
This problem, combined with past shortages of name-brand versions of GLP-1s, like Ozempic, Mounjaro, and Trulicity, has created a “perfect storm” for telehealth companies to flourish, said Ard.
While some telehealth companies prescribe only name-brand weight loss drugs, many also offer cheaper, compounded versions, acting as intermediaries between customers and mail-order compounding pharmacies, which create GLP-1s by mixing active ingredients like semaglutide with additives.
The ingredients for compounded drugs are commonly sourced from overseas suppliers, and the formulations are not reviewed by the FDA for safety.
“The environment is uncontrolled and poorly, if at all, regulated,” Ard said. “There is no standard of care.”
Understanding the risks
While weight loss drugs have helped millions of people lose weight, they’re not without risk, the data show.
A KFF Health News data analysis of the FDA’s Adverse Event Monitoring System found that medication errors made by providers or patients with weight loss drugs exploded from just more than 2 000 reports in 2020 to more than 25000 in 2025. Those involved semaglutide, tirzepatide, dulaglutide, and liraglutide.
Among frequent issues cited were administration of an extra or incorrect dose, problems with communication about a product, and prescribing errors.
Since 2019, the US National Poison Data System has fielded a nearly 1 500% increase in calls related to overdoses or side effects from injectable weight loss drugs.
Yet many issues are never reported to federal officials.
In a March warning letter, the FDA accused Novo Nordisk of failing to report some adverse events, including suicidal ideation and death.
Nobody knows how often adverse events occur, said Kristen Nixon, a Johns Hopkins University researcher who has studied posts about weight loss drugs on online forum Reddit.
Her team analysed hundreds of Reddit posts from 2020 until last August and identified frequent mentions of drug reactions and user errors, like patients not knowing how to correctly dose and inject the medication.
But another finding also stood out.
“A lot of people mentioned telehealth,” Nixon recalled. Commenters said they got GLP-1 prescriptions from scores of telehealth platforms, and also mentioned several dozen compounding pharmacies.
Pharmacies are typically required to counsel patients on medications they receive. But Nixon’s research found that telehealth companies often mail the medications directly, meaning patients don’t need to go to a pharmacy.
“Anecdotally, it seems as if the telehealth companies are really facilitating access to compounded medications,” she said.
The delivery system for injectable versions of weight loss drugs is more complicated than for a pill. In its National Poison Data System alert, America’s Poison Centres noted that some people reported “accidentally taking 10-times the recommended dose due to confusing measurement units while using a syringe”.
And those eager to lose extra weight – before a wedding or a holiday, for example – may self-administer a higher-than-recommended dose, said Arthur Caplan, a bioethics Professor at New York University’s Grossman School of Medicine.
Some telehealth companies aren’t doing enough, he said, to make sure patients understand the risks or the complex delivery system associated with injectables.
“The consent is not adequate,” Caplan said. “There’s no probing to see if you understood anything.”
Cella, with the American Telemedicine Association, said the group has not addressed the difficulty of educating patients about the risks of injecting weight loss drugs. But she pointed to the association’s “Principles of Practice”, which states that telehealth business models “must put the patient first.”
Proceed with caution
Pharmaceutical companies must list potentially harmful side effects when they advertise the name-brand versions of their FDA-approved medications, but telehealth companies have not historically followed the same rules that drugmakers have in disclosing medication risks in advertisements.
However, the FDA has started cracking down on misleading drug ads.
A national shortage of weight loss medications in 2022 opened the door for compounding pharmacies to manufacture these drugs. But since the FDA declared the shortage over last year, companies that offer compounded drugs are increasingly facing legal and regulatory challenges related to their marketing tactics.
Novo Nordisk, Mounjaro manufacturer Eli Lilly and other drugmakers are suing multiple telehealth companies for promoting compounded versions of their drugs.
Eli Lilly spokesperson Michael Jamison said those companies being sued threaten “patient safety by falsely promoting supposedly ‘personalised’ compounded tirzepatide” and “mislead consumers about the safety, clinical testing, and effectiveness of their compounded knockoffs’.
Meanwhile, Novo Nordisk has filed 130 lawsuits against “entities engaged in unlawful marketing and sale of knockoff semaglutide drugs”, said Liz Skrbkova, a spokesperson for the company.
One of those is iDexis in Pretoria, South Africa, the court case last week setting a precedent for compounding regulations in the country.
Skrbkova said Novo Nordisk was committed to “protecting patients from unapproved knockoff drugs made with foreign, inauthentic active pharmaceutical ingredients that pose safety and efficacy risks”.
See more from MedicalBrief archives:
Novo Nordisk sues local pharmacy over alleged 'knock-off' weight-loss jabs
SAHPRA and drug companies flag risks of compounded weight-loss drugs
US study finds serious side effects from weight-loss drugs
US hospital sued after man dies under ICU telehealth care
Doctors see benefits of telehealth — concerned some patients may get left behind