Episode Overview

Podcast: Endocrine News Podcast
Episode: ENP107: Compounded Obesity Medications
Date: December 3, 2025
Host: Aaron Lohr
Guest: Dr. Michael Weintraub, Endocrinologist, NYU Langone; Exam Writing Committee, American Board of Obesity Medicine

This episode explores the increasing prevalence and complexities of compounded obesity medications—particularly GLP-1 agonists like semaglutide and tirzepatide—in a landscape marked by past drug shortages and ongoing high costs. Dr. Michael Weintraub clarifies what compounded medications are, discusses their benefits and dangers, and weighs in on current safety, efficacy, and regulatory concerns, while suggesting how future changes might yield better, more equitable care.

Key Discussion Points & Insights

1. What Are Compounded Medications? (01:22–02:28)

• Definition: Compounded medications are customized drugs created by combining, mixing, or altering ingredients to meet individual patient needs—not commercially available from standard manufacturers.
• Examples:
  • Liquid forms for children or tube-fed patients when only pills are offered.
  • Removing allergens from preparations.
  • Dr. Weintraub cites prescribing "magic mouthwash" or "GI cocktail" as familiar compounded treatments.
• Quote:
  • “Compounding is creating a medication not commercially produced by a pharmaceutical manufacturer.” — Dr. Weintraub (01:32)

2. Benefits & Risks of Compounded Medicines (02:28–03:44)

• Benefits:
  • Customization when mass-produced drugs don’t suit a patient.
  • Fill supply gaps during shortages—exemplified in the COVID-19 pandemic.
• Risks:
  • Lack of FDA oversight in compounding pharmacies, so quality, sterility, and dosing can vary.
  • History of contamination and infection outbreaks linked to poorly regulated compounding.
• Quote:
  • “The FDA does not oversee or perform any quality control to individual compounding pharmacies and this has led to issues in the past.” — Dr. Weintraub (03:18)

3. Supply, Demand, and Shortages of GLP-1 Obesity Drugs (03:44–04:48)

• Shortage Timeline:
  • Semaglutide placed on FDA shortage list in March 2022 after insufficient supply post-approval for obesity.
  • Both semaglutide and tirzepatide shortages largely resolved by early 2025.
• Quote:
  • “Thankfully I haven't had patients have any issues attaining these medications due to shortages for many months.” — Dr. Weintraub (04:45)

4. Prevalence and Nature of Compounded Obesity Meds (04:48–05:48)

• Usage:
  • Estimated 2 million Americans received compounded semaglutide in 2024 (Outsourcing Facilities Association).
  • Heavily advertised online with variable descriptions and specificity—some use vague labels, some offer unapproved drugs, and some don’t specify ingredients at all.
• Quote:
  • “If you go on social media, you’ll see dozens of companies advertising compounded GLP-1 medications with varying specificity.” — Dr. Weintraub (05:06)

5. Safety & Efficacy Concerns (05:48–08:11)

• Composition Issues:
  • Industry organizations warn many compounded GLP-1s aren’t as advertised (may use salt forms or supplemental chemicals absent from trials).
  • Studies reveal up to 40% variance in active drug content compared to labeling; often lower purity.
• Dosing Confusion:
  • Instructions may be in inconsistent units; syringes/batch variance; patients sometimes must reconstitute powders themselves.
• Patient Risk:
  • Confusion and poor provider guidance possible.
  • Poison center calls and ER visits for GLP-1 overdoses up 1,500% since 2019.
  • Compounded products linked to 49% greater prep errors and 3x increased risk of complications/hospitalizations/cholecystitis compared to manufactured drugs.
• Quote:
  • “There’s been a rise in poison control calls in ED visits for overdoses of GLP-1s on the order of 1,500% since 2019.” — Dr. Weintraub (07:36)

6. Equity, Cost, and Patient-Provider Decisions (08:11–09:19)

• Motivation to Use:
  • With shortages resolved, lower cost is the main draw.
• Equity Dilemma:
  • Compounded meds are cheaper and seemingly enhance access, but in Dr. Weintraub’s view this is “false equity” because patients may get inferior, riskier care.
• Quote:
  • “Patients getting compounded formulations are actually, you know, receiving inferior care. ... They’re getting medicines that are unverified and have a higher potential for adverse effects.” — Dr. Weintraub (08:59)

7. Long-Term Consequences & The Way Forward (09:19–10:44)

• Downstream Impact:
  • Compounded meds’ questionable reliability may lead to poor adherence, lost trust, and worse long-term health outcomes for chronic disease.
  • Their availability distracts from “the primary issue”—the original drugs’ cost and lack of insurance coverage.
• Outlook:
  • Dr. Weintraub is optimistic:
    • Recent announcements suggest out-of-pocket cost reductions are coming.
    • Potential legislation may expand insurance coverage (e.g., Medicare).
    • New drugs in development may foster price competition and further improve access.
• Quote:
  • “We soon could attain what I would call truly equitable access—both affordability and safety—so full, comprehensive care can be delivered to our patients.” — Dr. Weintraub (10:31)

Notable Quotes & Memorable Moments

• “Compounding is creating a medication not commercially produced by a pharmaceutical manufacturer.”
  — Dr. Weintraub (01:32)

• “The FDA does not oversee or perform any quality control to individual compounding pharmacies and this has led to issues in the past.”
  — Dr. Weintraub (03:18)

• “If you go on social media, you’ll see dozens of companies advertising compounded GLP-1 medications with varying specificity.”
  — Dr. Weintraub (05:06)

• “There’s been a rise in poison control calls in ED visits for overdoses of GLP-1s on the order of 1,500% since 2019.”
  — Dr. Weintraub (07:36)

• “Patients getting compounded formulations are actually, you know, receiving inferior care. ... They’re getting medicines that are unverified and have a higher potential for adverse effects.”
  — Dr. Weintraub (08:59)

• “We soon could attain what I would call truly equitable access—both affordability and safety—so full, comprehensive care can be delivered to our patients.”
  — Dr. Weintraub (10:31)

Timestamps for Key Segments

• Definition of Compounded Medicines: 01:22–02:28
• Benefits and Risks: 02:28–03:44
• GLP-1 Shortage Timeline & Resolution: 03:44–04:48
• Prevalence and Market Circumstances: 04:48–05:48
• Safety and Efficacy Issues: 05:48–08:11
• Patient Equity & Decision Making: 08:11–09:19
• Downstream Impacts & Solutions: 09:19–10:44

Tone & Takeaways

The discussion, while technical, remains accessible. Dr. Weintraub strikes a cautious, evidence-based tone—advocating for patient safety and regulatory oversight, and warning against the “false equity” of cheaper, riskier compounded drugs when safer, regulated options should be made affordable for all.

Main takeaway: While compounded obesity medications can bridge access in a crisis, persistent cost and coverage barriers should be solved without compromising quality and safety. Dr. Weintraub is hopeful about ongoing steps to make proven anti-obesity therapies both accessible and safe in the near future.