Weight loss drugs are sweeping Australia. At some online stores, they’re alarmingly easy to get

Ozempic is everywhere. Billionaire tech boss Elon Musk takes a version of the weight loss drug. Model Julia Fox denies using it. Commuters in New York’s Times Square Station don’t see posters for Broadway shows anymore. Instead, ads for a “weekly shot to lose weight” are plastered wall-to-wall. Sydney and Melbourne commuters are seeing the same thing on bus shelters around their cities, on TV and social media, where ads dovetail with the pressure to match influencers’ perfect physiques.

Australian start-ups see a goldmine in this global trend: selling a new generation of spectacularly popular injections that make people feel fuller on less food. A string of moneyed telehealth companies – backed by billionaires, a national grocery chain and a national health insurer – say they are tackling an obesity crisis that could cost the economy $87.7 billion within 10 years. But they face intense criticism from GPs.

Juniper artwork of its weight loss ads, published to its Facebook page.

Proponents say this new wave of drugs is the first to produce double-digit weight loss without crippling side effects, and these websites are making them more accessible given growing difficulties seeing a doctor during a looming obesity crisis. But critics see the powerful new medicines, which are only available with a prescription, being entrusted to nascent start-ups that have to sell ever-growing quantities to survive.

This masthead tried to buy weight loss drugs online from four major Australian telehealth websites and found their promise of convenience was true – to a fault. Some recommend weight loss injections in just minutes without ever speaking to a patient face-to-face. Others sent out powerful medication with scant verification of a patient’s identity. These practices have sparked warnings from the Medical Board of Australia that companies are falling short of its guidelines, and from experts who fear consumers are flocking to medication with serious side effects in pursuit of a beautiful body.

Weight loss drugs obtained with minimal checks.Credit: Alex Ellinghausen

The largest Australian start-up selling weight loss medication online is Eucalyptus, a $560 million company backed by Woolworths and the Mike Cannon Brookes-chaired Blackbird Ventures investment fund. It is mainly selling a drug called Saxenda, an Ozempic precursor, through its Juniper brand for women and Pilot for men. While it cannot name the drugs it sells due to advertising laws, Juniper is heavily advertising weight loss. It had 51 ads on Facebook and Instagram in the three weeks to April 24. Many capitalise on unfulfilled demand for Ozempic, which is in very short supply both in Australia and abroad because of huge demand. “Juniper’s Weight Reset Program offers a highly effective medication created for weight loss, not diabetes,” one of its ads reads. “Actually losing weight almost effortlessly,” another quotes an unnamed patient saying.

This masthead went through the process to get a prescription from Juniper, answering questions the way a patient would if they wanted weight loss drugs but did not actually need them. Juniper’s website asked about 40 questions on things including other medications, diet and body size. Depending on their answers, the company says users can be asked many more questions, but the overall process is quick – in this masthead’s case, less than 10 minutes. The Sydney Morning Herald and Age entered fictitious information about weight, inflating it from 55 to 95 kilograms and making the patient technically obese.

Eucalyptus’ doctors did not query the information or ask for photos when they responded with a standardised text message the next day and recommended Saxenda. (Across multiple attempts, we received identical communications from different Eucalyptus GPs.) The Sydney Morning Herald and The Age went through with a $395 purchase. A pharmacy partnered with Eucalyptus shipped out a month’s supply of Saxenda, and it arrived at our doorstep 10 days later. Inside the brown cardboard box were a branded scale, measuring tape, information pamphlets, sharps disposal bin and a pack of injection pens, all sent without this masthead supplying any form of ID.

Injection pens arrived in 10 days.Credit: Alex Ellinghausen

Telehealth boomed during the pandemic, offering patients in lockdown or regional areas a quick way to connect to their doctors and a discreet forum to talk about private health issues. But it has limitations, not least depriving doctors of the ability to see patients eye to eye. The Medical Board of Australia says its telehealth guidelines require practitioners to confirm their patient’s identity. “These requirements do not appear to have been met in the scenario that you have described,” the board’s spokeswoman says.

Dr Elizabeth Deveny, the chief executive of the Consumer Health Forum of Australia, a patient advocacy group, says the potential for someone with an eating disorder to access a weight loss drug without ever having to show their appearance could be dangerous. “If you walked into a GP or even had a telehealth, saying you wanted to try a new weight loss drug, they would say ‘hang on a minute’,” Deveny says. “This is the risk of this being done in isolation.”

The Royal Australian College of GPs’ obesity management group chair, Dr Terri-Lynne South, is similarly concerned. She says these new weight loss treatments are an unprecedented opportunity for people with serious health issues, but there’s a reason they aren’t available over the counter. “All potential medications are open to misuse, and that’s the concern with prescribers not being able to assess someone fully. [That person] may be trying to look at inappropriate fast weight loss on its own, and they’re risking significant secondary health consequences for that.”

An industry executive, who spoke anonymously to candidly discuss rivals, says of companies focused on Saxenda: “When all you have is a hammer, everything starts to look like a nail.”

Eucalyptus’ chief executive Tim Doyle defended his company in a statement, saying it had independent doctors, a rigorous process and rejected about 40 per cent of patients seeking telehealth treatment. Eucalyptus recommends Saxenda because of medical evidence, Doyle says. “It’s illegal in Australia to lie to a doctor in order to access prescription medication,” Doyle says. “Rare cases of deliberate and illegal deception to obtain safe medication for weight loss management need to be objectively balanced against the reality of the trust inherent in the healthcare sector and the fact that obesity is an epidemic which costs the Australian healthcare system billions of dollars.”

Eucalyptus chief executive Tim Doyle, photographed last year, has defended his company in comparison to the existing health system.Credit: Rhett Wyman

(This masthead entered fictitious information into Eucalyptus’ quiz as part of a public interest journalism project to test prescribing standards at a major telehealth business. None of the drugs that were shipped were consumed.)

Saxenda is part of a new generation of weight loss drugs that includes the headline-grabbing Ozempic – which is subsidised for type 2 diabetes in Australia but widely unavailable due to a global shortage – as well as Wegovy and Mounjaro, which are yet to hit shelves. They all work by mimicking hormones that cause the body to feel full, making it easier for people to stop eating after only a little food. And unlike past weight loss medications, some of which were amphetamines with severe side effects, the downsides of these new drugs are more manageable. Nausea, diarrhoea, constipation and dehydration are some of the most common. But Saxenda can also cause depression, its manufacturer warns, and Ozempic can trigger pancreatitis or severe allergic reactions in some. Even the more pedestrian side effects can be severe enough for some users to stop taking the medication. “The 3-4 days after the jab each week are a nightmare, with constant diarrhoea and vomiting!” says one online forum member, speaking for many.

Despite the side effects, medical studies back up the impressive before-and-after photos plastered on social media. Sixty per cent of patients on Saxenda, which has been approved in Australia since 2016, lost at least 5 per cent of their body weight, according to its maker (keeping it off is another matter). Wegovy, a newer and higher dose drug from the Danish pharmaceutical giant behind Ozempic, has been approved for weight loss treatment in Australia but was knocked back by the Pharmaceutical Benefits Scheme. Manufacturer Novo Nordisk, which claims about half of Wegovy patients in studies have lost 15 per cent of their body weight, is now deciding when to launch it in Australia as a non-subsidised product. American company Eli Lilly is generating even more hype with its Mounjaro product, which will be considered by the PBS for listing in July .

Both Novo Nordisk and Eli Lilly have seen their share price more than double in the last two years, and are now worth about $426 billion and $609 billion respectively.

Eucalyptus, which was founded by four men from Sydney’s start-up world in 2019, has zeroed in on the weight loss market and received about $150 million from its backers in a country where research firm IBIS World estimates about three-quarters of the population are overweight or obese.The most recent $50 million tranche came earlier this year despite an environment in which many startups are struggling to get funding. The Australian Financial Review reported that its investors – the kind who typically want 10 to 100 times return – see Juniper’s weight loss product as Eucalyptus’ “crown jewel”.

Patients on weight loss drugs, however, have had wildly different experiences. Some struggle to stay on them because of the side effects. US plus-size model Remi Bader (2.2 million followers on TikTok) told a podcast she had put “double the weight back” after she stopped using Ozempic amid struggles with binge-eating. “I was like, I bet the second I got off I’m gonna get starving again … I did,” she said.

Behaviour has long been recognised as one cause of obesity, but a person’s environment and genetics also play a major role. Those factors are much harder to change. University of Sydney Professor Louise Baur, an internationally recognised paediatrician and obesity expert, says some people with obesity might be able to change their habits while taking weight loss medication for a short period, but others will need years of support from professionals like dieticians or psychologists. “For many people, they will be on medications, potentially lifelong,” says Baur, who is also the president of the World Obesity Federation.

Specualtion is rife that Kim Kardashian achieved her newly trim figure, displayed at the Met Gala in 2022, with the help of Ozempic or similar medication.Credit: Jeff Kravitz/FilmMagic

Whatever their long-term effects, these drugs are having a cultural impact. The world seems to be in its Ozempic phase – one where beauty norms are shifting back to a thinner ideal after a decade of Kardashian-inflected bodies with fuller curves. (The Kardashians have hit back at reports they are Ozempic users with half-hearted denials.) University of NSW Professor Deborah Lupton, a sociologist of health, understands the argument that weight loss drugs might help obesity be seen more as a biological issue and less as a moral failing. But she thinks the way bariatric surgery was hyped in the 1990s is a more apt comparison. “The subtext [for that was] this is the last resort for people who can’t use their willpower,” Lupton says. “And I think there could be some kind of glimmer of that in these drugs as well.”

Eucalyptus is far from the only company capitalising on the cultural moment. Midnight Health, a start-up majority-owned by giant health insurer NIB Group, sells medications through its Hub Health, Stagger and Youly brands. It is also trying to grow quickly and disrupt an industry, with the backing of the $3.8 billion NIB behind it, which is expanding its business to providing treatments as well as paying for them.

This masthead purchased a month’s supply of Saxenda through Hub Health by filling out a questionnaire and inflating the weight given from 65 to 119 kilograms. The site did not require a Medicare number, photo ID or video. A Hub Health nurse called a day later, asked to confirm the stated birthdate, and, after running through some side effects, recommended Saxenda. It was shipped from a suburban Brisbane pharmacy five days later for $395.

Midnight Health founder Nic Blair says the company abides by all national guidelines and regulations, including a three-point identity check. Those clinicians are paid per consultation, whether or not they grant a prescription, and he says Midnight declines about a third of people seeking weight loss treatment. “Our clinicians operate independently and are free to make their own clinical decisions,” Blair says.

”Fraudulent provision of information by patients to obtain a prohibited drug, which is a criminal offence, is an issue across a range of patient care settings ... We review and strengthen our clinical governance frameworks and aim to improve our services as standards or guidelines change.” And he defends his business, saying it provides essential care, especially to people in regional areas. NIB would not comment about its oversight of the start-up.

Weight-loss drugs obtained over the internet without ID checks.Credit: Alex Ellinghausen

Another start-up, Mosh, is harder to cheat because it requires photographs of its customers after the payment stage, including one holding an identification card. Mosh says the latter feature came in about two months ago, “as a result of Mosh constantly evaluating processes and protocols as part of its clinical governance”. This masthead stopped the purchase process when we were asked for a photo with ID.

A fourth company, Burst Health, also requires a photograph of users, which it says is verified by a doctor after a patient makes payment. But its quiz is only 16 questions long and can be completed in a few minutes, with no queries on things like a patient’s family medical history. Some of its messaging is confusing, too. While its Google advertisements tell potential customers that there is “no doctor consult required”, the weight loss quiz says a doctor has provided you with “personalised treatment”.

A company representative, Ann, who did not provide a surname, says the company verifies all patient information through a phone call with a licensed doctor, a photograph and checks on Medicare information after the payment had been processed. “It really is not as easy as you think,” she says. Another representative, Chris, did not address the conflicting statements that Burst makes online. This masthead did not proceed with the Burst purchase because of the photo check.

The Medical Board of Australia has already moved to crack down on doctors handing out prescriptions based only on a customer’s written answers. Draft guidelines issued earlier this year would effectively ban the practice for patients that a doctor has never spoken with before, whether over the phone or in person. It is now reviewing submissions and deciding whether to put that rule into practice, saying it agrees telehealth is an important tool but “patient safety comes first”.

“A text-based health questionnaire completed by a patient and read by a doctor at a different time is not a doctor-patient consultation,” a board spokeswoman says. “Through our investigations we have seen some online models of patient care that fail to ensure the same standards of care are provided.” And while she says the board is unable to discuss individual cases or provide names, she confirmed it had banned some practitioners from doing telehealth prescriptions because of safety failures.

But the traditional medical system is facing a host of challenges, too. One estimate from Deloitte Access Economics predicts there will be about 600 too few GPs in Australia this year and a shortfall of more than 11,000 within a decade. There has also been a rise in corporate-owned medical clinics that can churn through patients in six minutes, sometimes via the phone, with the taxpayer picking up part of the bill through Medicare. In rural areas, the availability of doctors is worse, with the NSW Regional Doctors network warning last year that there could be 60 regions in coming years without a resident GP.

Eucalyptus and several other telehealth companies have hit back against the board’s proposed changes, arguing that they deliver medicine just as well as the mainstream health sector. Its lead investor, Blackbird, is firmly standing by the company as a way of addressing not just obesity, but other men’s, women’s and skin health issues. Woolworths, which has a smaller stake, declined to comment.

Doyle, Eucalyptus’ chief executive, argues that the public health system only offers fragmented care and forces patients to see lots of different and expensive professionals. “Unlike with a community GP, when the appointment ends our treatment doesn’t,” he says. “Medicine is never the only answer to weight loss – and we help patients with diet, exercise and motivation in ways that most community GPs don’t.”

Eucalyptus, which has not billed Medicare anything for the 700,000 consultations it says its doctors have done, has Facebook groups for its patients to talk to each other, recently introduced an app, and makes doctors and dieticians available to answer questions online. It claims its figures show its Saxenda clients lose more weight than those in clinical trials.

With a flailing primary care system and health sector lagging on digital convenience, telehealth start-ups can make a persuasive pitch: they have reduced the “friction” of getting a prescription, to customers’ delight. But the system they have set up has costs. The pharmacies that Eucalyptus directs business to paid it $25.6 million in fees last year, according to documents lodged with the Australian Securities and Investments Commission, blurring the line between two sides of the medical system that are supposed to be separate. Eucalyptus said that arrangement had no impact on the autonomy of its doctors and that patients could choose which pharmacy they wanted to supply the medication.

Baur, the University of Sydney obesity expert, sees the value of telehealth but believes patients should see a doctor in person regularly too. “ I see people who really need these medications. [But] these things can be abused… And I think you need to have systems that avoid people being able to abuse the system.”

Abused or not, the rush to get weight loss medication is making it hard for some users with genuine medical need to find it. Phil Ford – a 63-year-old man who has had type two diabetes for 23 years and found Ozempic the most effective treatment he has tried – can no longer get it. “I’ve given up asking my chemist,” Ford says. “He knows I need it, I just haven’t been able to get it.”

Desperation is driving others to dubious destinations. One website, Your Body Expert, which is recommended on Australian weight loss forums, tells shoppers they have to pay in cryptocurrency before it will ship Ozempic from somewhere overseas. (The website did not respond to inquiries).

Cryptocurrency payments cannot be reversed by a bank if the seller turns out to offer a faulty product, and overseas sellers are beyond the reach of Australia’s drug licensing regime, which tests products for safety and quality. The Therapeutic Goods Administration has had to warn of several Ozempic scams too. And while Saxenda is much more readily available, that may not last long. This week Eucalyptus began warning patients that there could be a shortage developing.

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