Firms are spending hundreds of millions of dollars to convince US doctors to prescribe GLP-1 drugs, with most medical specialists apparently seeing nothing wrong with this, reports The Washington Post.
Carlos Campos, a family physician, sees patients for all manner of conditions, especially obesity and diabetes. But he has built a steady side gig beyond his practice in Texas.
Over the past seven years, drug manufacturers have paid him nearly $1m to spread the gospel of weight-loss and diabetes drugs (GLP-1s) to colleagues in his home state and beyond.
Whether speaking in a private dining room at a fancy steakhouse or over takeaways in a primary care office, Campos is part of a vast effort by drug companies to build sales of their revolutionary weight-loss drugs by targeting the prescribers who act as the gatekeepers to the American healthcare system, according to an analysis of public federal government data by The Washington Post and interviews with six physicians involved in the marketing programme.
The analysis shows that Eli Lilly and Novo have made at least one payment to more than a quarter of a million individual doctors and other prescribers, including nurse practitioners, since 2018, the first full year that Ozempic, Novo’s blockbuster medicine, was on the market.
No other class of prescription drugs was promoted as heavily over this period.
In total, companies spent more than $270m on these promotional efforts, according to the data, which are reported to the federal government by the manufacturers.
The spending, which the federal government says encompasses both direct payments and in-kind payments for food and beverages, was spread among 140 000 individual prescribers in 2025 alone, the most of any year in the analysis.
The GLP-1 craze for the novel class of drugs, including Wegovy and Zepbound, has generated abundant patient demand. But the lesser-known spending on doctors, which is legal and disclosed publicly, represents promotional efforts, largely hidden from consumers, of the drugs’ success that some medical experts say pose a conflict of interest.
Physicians paid by the drug companies say they are helping colleagues overcome hesitancy and even scepticism among practitioners who may not be familiar with how the drugs work or still view obesity as a matter of patient willpower.
They said payments don’t influence their views of the drugs, opinions they said have been shaped by phenomenal results in their own patients.
They described how in meetings with other doctors, they observe government limits on what claims can be made while sharing unbiased, evidence-based data about benefits and side effects.
But some doctors warn that these sessions, and the money received by physicians as direct payments on the side, carry a number of risks, both to patients and the health system at large.
The costly drugs, which most users have to take for life to maintain their results, are relatively new, with under-appreciated side effects in some patients, the critics say.
“The patient comes in saying, ‘I want it’, and if they don’t get, they will find another doctor who will prescribe it,” said Robert Lustig, a doctor and professor emeritus at the University of California-San Francisco who advocates for reducing sugar and processed foods in the American diet.
“The problem is getting worse, and now people think: ‘Oh, I can just take a drug, a shot, and eat whatever the hell I want’. It’s just a Band-Aid.”
Spending on the drugs by consumers and health insurance companies has exploded. Total sales (excluding rebates and discounts) in 2025 eclipsed all other drugs, with Lilly’s Mounjaro and Zepbound leading the way at $63bn and Novo’s Ozempic and Wegovy close behind at $59bn.
Private health plans are cracking under the burden, and some are beginning to cancel coverage. Federal costs are poised to shoot into the billions now that Medicare, as of July, is covering the drugs for weight loss.
Nearly one in five American adults has reported having taken one of the drugs for diabetes or weight loss, according to a survey by KFF, the independent healthcare policy organisation.
The drug companies defended their promotional practices as appropriate and important for health.
“This responsible interaction and collaboration between industry and the medical community benefits patients by advancing care and science,” Novo spokeswoman Liz Skrbkova said. “In our engagements with the medical community, we follow the highest ethical standards as well as all legal and regulatory requirements.”
Eli Lilly said its programmes are grounded in science, that “all such engagement is conducted under Lilly’s rigorous compliance standards and disclosed transparently”.
The Post tracked how Eli Lilly and Novo are using the traditional pharmaceutical marketing playbook to boost sales behind the scenes – making payments to doctors who serving on the boards of prominent diabetes and obesity medical societies. Those boards shape how medicine is practiced.
Eli Lilly said its promotional materials adhere to the FDA-approved label and that it views obesity as a chronic disease that may need continuous treatment, otherwise the weight can return.
The drugs also are being prescribed to people with eating disorders, and the elderly, who are at risk of falls and fractures if they lose too much bone and muscle mass – a serious concern with the rapid weight loss driven by GLP-1s.
The drugs carry “black box” warnings from the FDA that they can cause cancer in rats and thyroid cancer in humans.
Drug companies have marketed medicines directly to doctors for decades. It is even recognised by the FDA as an important source of information for prescribers.
FDA rules require that promotional claims stay within the boundaries of scientific evidence contained in a drug’s label. But the dangers of the practice emerged during the opioid crisis that began in the 1990s, when Purdue Pharma, the manufacturer of OxyContin, and other companies were found to have heavily marketed addictive opioids while minimising risks.
Doctors say the luxury trips and free booze of the past are no longer common, but free dinners and in-office lunches are still a staple of the trade. Nowadays, if doctors at the dinners want booze, they have to buy their own, participants said.
Medication for life
Paying physicians has raised questions of conflict of interest. Decades of research has shown that financial relationships between physicians and pharmaceutical companies are associated with higher prescribing rates of the sponsoring company’s drugs. Even relatively modest financial relationships can potentially create unconscious bias, making industry payments to influential doctors a persistent ethical issue in medicine, say researchers who have examined the question.
Some physicians paid by Eli Lilly and Novo said a part of their effort has been helping other physicians overcome hesitancy.
Many providers are wary of prescribing a costly new drug that a patient probably will need to take for many years, if not for life, to keep their weight under control.
Doctors interviewed by The Post acknowledged competition between Eli Lilly and Novo, but said competition also is driving innovation and reducing prices, which is improving clinical outcomes. They disputed the contention that they are parroting corporate talking points.
Many of the 50 doctors who have received the most money from the drug companies are also among the country’s most influential voices on obesity and diabetes.
They include leaders of the nation’s most prominent medical societies in endocrinology and obesity, who write or help shape clinical guidance. Physicians who lecture in continuing medical education programmes, and a few who have helped shape the conversation around GLP-1 drugs though their public platforms on YouTube and podcasts, are also part of the marketing push.
John Anderson, a former president of medicine and science for the American Diabetes Association who held substantial leadership roles in the organisation for more than two decades, received nearly $1m from 2018 through 2025, the fifth-highest-paid doctor, according to The Post’s analysis.
He was the lead author of an ADA journal article in 2022 about optimising the use of GLP-1 drugs in type 2 diabetes and moderated an ADA educational series about the drug class that same year.
The 2022 GLP-1 article states that Anderson served “as an adviser, consultant, and/or speaker” for Eli Lilly and Novo, among several other drug or device companies. The educational materials were funded by a grant from Novo, which was disclosed.
The ADA said in a statement that Anderson did not serve as a subject matter expert or peer reviewer for the organisation’s guidelines on care for diabetes or obesity for 2017 to 2026.
Anderson, an internist and diabetes specialist, declined to comment.
The Obesity Medicine Association’s past president and chief science officer, its president-elect and three trustees all received payments ranging from $14 000 to $95 000 during the time period studied – some receiving multiple payments over that time.
The OMA declined to comment on specific individuals but said that it requires all those involved in continuing education to disclose their financial ties and that they are reviewed by a separate committee.
“Industry funding never gives a company control over topics, faculty, content, or evaluation. We believe this process is effective, and we continue to strengthen it as the standards and the evidence evolve,” it said.
Aaron Kesselheim, a professor of medicine at Harvard University who studies relationships between doctors and drug companies, said influencing a relatively small network of highly respected clinicians can have ripple effects throughout the medical community, making these relationships a powerful part of the industry’s marketing strategy.
“While there’s nothing wrong with professionals talking among themselves, and sharing business practices and approaches to prescription drugs, this system can be fudged to market drugs,” Kesselheim said. “There’s the question of how much of their recommendations are driven by review of science and how much by industry’s marketing.”
Many medical societies have adopted conflict-of-interest policies intended to insulate clinical recommendations from financial influence.
A review of the content of promotional material for Zepbound, Eli Lilly’s blockbuster weight-loss drug, shows how the promotional and educational missions are intertwined. A slide deck presented to doctors by paid peers and obtained by The Post is largely dedicated to clinical trial results, interspersed with more colourful depictions of actors posing as patients.
Specialists said more study of the drugs is needed. David Ludwig, a Harvard University professor and endocrinologist at Boston Children’s Hospital whose work focuses on improving people’s diet, said he has struggled to scrape together money for a clinical trial to test, in combination with GLP-1 use, whether a low-sugar, low-carbohydrate diet can reduce obesity and cardiometabolic outcomes.
He said he has asked the major manufacturers of GLP-1s for funding, with no success. Lilly and Novo did not confirm or discuss the request but said they review all grant requests.
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