Jonathan Hill (2:33)

Okay. I'm, I'm also a woman in my 30s with the Internet. And so I've been just told so many different ways to hate my body and this also means that I get a ton of ads from companies like hers and Ro telling me that they have cheap GLP1s ready and available for me whenever I want them.

Weight Loss by Hers Representative (2:54)

The quality of your healthcare shouldn't depend on where you live, what you do or whether you have insurance. It should be personalized to your unique needs. That's why we created Weight Loss by Hers.

Jonathan Hill (3:03)

That's why we created weight loss by hers with ro.

Dr. Sarah Lavelle (3:06)

Get the online coaching and care you need to lose 15% of your body weight.

Sydney Lupkin (3:10)

Charles Barkley wants to lose 65 pounds with GLP1s.

Jonathan Hill (3:14)

Are these companies legit? What's going on with that?

Sydney Lupkin (3:17)

That is a great question. I think I'm going to back into this answer and tell you that, you know, when we're seeing these competitor GLP1s, the assumption, because this is the way things have always been, is that they're offering generic drugs. And that's actually not what's happening here. Basically this is not a generic. This is what is called a compound drug, which means that the drug is made instead of in a manufacturing drug company's facility by a drug company going through FDA approval. It is made by a special kind of pharmacist. A compounding pharmacist. They're sort of bread and butter is that they make custom drugs for people that need them. So the example is like, okay, you need a pill, but the brand name commercial version has a preservative in it that you're actually allergic to, but you still need that pill. So you would go to a compounding pharmacist and then they would custom prepare the version for you that you are not allergic to because you obviously need that. And it's a crucial part of healthcare. They're generally not supposed to make what are called, quote, essentially copies, and I'm using air quotes for those who can't see me. Essentially copies of existing commercial brand name drugs. But there's an exception. The exception is when that brand name drug is in shortage, then the compounding pharmacies can pitch in. Now, these GLP1s that we've been talking about, their popularity, in fact, they were so, so, so popular that the drug companies didn't make enough supply.

Weight Loss by Hers Representative (5:05)

Accessing semaglutide injections is challenging for thousands of people who live with diabetes.

Dr. Sarah Lavelle (5:09)

And the demand for the drug is high as people around the world have turned to it for weight loss. These weight loss drugs, they've exploded in popularity. So much so that these drug makers simply can't keep up with the Demand.

Sydney Lupkin (5:21)

And all of a sudden, you know, compounders were like, well, we can actually do this for cheaper than. The list price for WeGovy is like $1,400 a month. So all of a sudden people could get it for cheaper. Telehealths were helping connect them with physicians. And that's sort of where this boom is coming from. Now the shortages have ended the companies. It took them a couple of years to, you know, catch up on the manufacturing side, but the shortages have ended. And the thought was that the compounding would also end. But what is now happening is a lot of companies are saying, well, what we'll do is we will make you a custom version of this drug. And then they think that they're at least some that I've spoken to have said, you know, then I think that we're working within the parameters of the law. And there's some definite debate about whether that's true. But that's sort of why we're still seeing a lot of compounding.

Jonathan Hill (6:17)

The other big news in glp, one world is that you can now get it in pill form. You know, it's been an injection up until recently. When it comes to these compounding pharmacies, are they offering the pills now too?

Sydney Lupkin (6:30)

So, well, there, as far as we know, there isn't a shortage of the pill, but we are seeing, you know, the pill is brand new pill came to market about a month and a week ago. So it was just approved at the end of last year by the fda. It's now just now on the market where you can actually go to a pharmacy as of the beginning of January and pick it up if you had a prescription. So seeing last week that Himss, the telehealth company and hers were offering their own version of the compounded pill raises sort of a lot of questions. Like, can they do that? Is sort of the question. And they will say, and initially they said, yes, we can. However, very quickly Novo Nordisk, which as you know, makes the brand name version of it, said, you know, we're preparing to take legal action because that's illegal. It's mass market compounding, which is kind of not the, you know, what compounders are supposed to be doing. And, you know, we're gonna, we're gonna take action on this. And hims response was, you know, that's, that's false, that's not true. Then the commissioner of the Food and Drug Administration, Marty Makary, tweeted, FDA will.

Weight Loss by Hers Representative (7:46)

Take swift action against companies mass marketing illegal copycat drugs, claiming they are Similar to FDA approved products, the FDA cannot verify the quality, safety or effectiveness of non approved drugs.

Sydney Lupkin (8:00)

And then that was swiftly followed by an HHS general counsel saying that they were going to refer this issue to the Justice Department. So that changed things.

Jonathan Hill (8:12)

Wow.

Sydney Lupkin (8:12)

And hims response was, since launching the.

Dr. Sarah Lavelle (8:15)

Compounded semaglutide pill on our platform, we've.

Jonathan Hill (8:18)

Had constructive conversations with stakeholders across the industry. As a result, we have decided to.

Dr. Sarah Lavelle (8:23)

Stop offering access to this treatment.

Sydney Lupkin (8:26)

So now the compounded pill, at least for now, is no longer on the table.

Jonathan Hill (8:30)

Do we know if these compounded versions of GLP1s, are they safe?

Sydney Lupkin (8:36)

The short answer is it depends. It depends on who is making it. It depends on whether they were making it in a sterile environment, whether they're licensed. You know, in the case of compounding, it's not. The FDA doesn't typically inspect your sort of small compounders. It'll inspect your bigger ones. But a lot of these are made and they're regulated by state boards of pharmacy. You know, when a drug goes generic, something called a USP monograph gets made and it's basically a recipe for like how, here's the standard for how you're supposed to make that ingredient. And because this drug hasn't gone generic, there is no recipe like that. So are they making it in a way that is safe and not going to have any like extra junk that you don't know about? And like, is there going to be a long term side effect that we're not seeing today?

Jonathan Hill (9:42)

What about effectiveness? Are the compounded versions effective?

Sydney Lupkin (9:45)

I have definitely heard from people who have said, you know, like, I, my insurance coverage for Ozempic went away, so I went the compounded route. And it's been great for me. I've heard from a lot of people like that, but there are definitely real risks. And most of the time what when I hear from like emergency physicians and when I ask them about it, they'll say, you know, the issue is they either they miscalculated or perhaps it was too potent or it wasn't potent enough and it did nothing. So like that's probably not going to send you to the emergency room. But like, if it's too strong and you don't know it, that can be really risky.

Jonathan Hill (10:23)

Do you think we're about to see a big explosion in the use of these drugs? I mean, I think if I get on Instagram, I see an ad, I watched the super bowl and saw ads like, yeah, I wonder, are we gonna see more and more people use GLP1s.

Sydney Lupkin (10:39)

We'Re already seeing a lot of people use them. The ads. Actually at one point I looked at Facebook ads over time for compounded drugs and they were only growing. But I do think we're gonna see more people using them if they can get cheaper. There are still going to be a lot of people who can't afford a couple hundred dollars a month and don't have health insurance coverage. Because one of the things I'm now hearing from people is also like, even if they do have coverage, it's very restricted. Like I've heard from several people, I can't get it covered for weight loss unless I have a bmi of over 40, which is interesting because a BMI of 30 is considered obese. So like I've heard from people be like, wait, am I supposed to gain weight to get coverage? Are you kidding?

Jonathan Hill (11:31)

NPR's Sydney Lupkin so more people are likely to get on these drugs compounded or the OG version. But what if losing weight also means losing interest in the things that used to excite you? That's next. Eczema is unpredictable, but you can flare less with epglis, a once monthly treatment for moderate to severe eczema after an initial four month or longer dosing phase. About 4 in 10 people taking EBGLIS achieved itch relief and clear or almost clear skin at 16 weeks.

Dr. Sarah Lavelle (12:09)

And most of those people maintain skin.

Jonathan Hill (12:10)

That'S still more clear at one year with monthly dosing.

Weight Loss by Hers Representative (12:13)

HempGlass Lebricizumab LBKZ, a 250 milligram per 2 milliliter injection, is a prescription medicine used to treat adults and children 12 years of age, age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema, also called atopic dermatitis, that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies. EBGLIS can be used with or without topical corticosteroids. Don't use if you're allergic to ebglis. Allergic reactions can occur that can be severe eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with ebglis before starting ebglis. Tell your doctor if you have a parasitic infection.

Jonathan Hill (12:46)

Ask your doctor about evglis and visit evglis.lilly.com or call 1-800-LilyRx or 1-800-5-5979. I'm Jonquill Dr. Sarah Lavelle is a clinical psychologist. She works with people who struggle with food eating disorders, emotional eating, that kind of thing. And she spends a lot of time thinking about how this impacts society. A lot of her patients have tried GLP1 drugs and she recently started noticing a new kind of symptom popping up for them.

Dr. Sarah Lavelle (13:26)

You know, I think I first started looking to this about a year ago, but it was kind of the same conversation of three different patients in the same week. And I started noticing, you know, they all kind of have this kind of flat affect. And none of them were depressed, but each one of them was saying things like, well, what's the point? Maybe I don't even care about that job promotion or, you know, yeah, I have kids, maybe it's the kids. I don't know what it is, but I'm not even excited to go out with my friends. And I thought about it and I was like, what's so different about these patients? And these three in particular had been on DLP1s. And of course, you know, you, you can't make an inference based on three people. But it is what motivated me to start looking into more the psychological effects, particularly around what we do and do not know about how DLP1s affect dopamine and motivation seeking behavior. They never put two and two together that this could be from the DLP1s. They always. So you don't have a lot of reports on it because these three patients, they would have never thought about it. It was more as me, an outside observer, thinking, wait a minute, what's this common thread? They always make sense if it's something else. Right. So it's very hard to study. The other thing is that there's a big difference between a person being depressed, which they have started looking into. Does it affect suicidality and depression? However, you have to think about depression in, yes, it can be that kind of apathy kind of feeling. However, depression really implies a negative affect. Right. Like, I'm no good, I don't feel like existing. Right. That's very different than a flatness.

Jonathan Hill (15:12)

Yeah. So it sounds like it's not even like sadness, it's just sort of nothing.

Dr. Sarah Lavelle (15:18)

Yeah. Like the same excitement you might get from like, oh, I'm gonna eat this pizza later. You're also not getting this, oh, I'm gonna see my friend later, or ooh, I can't wait to go to this concert. You know, you're kind of dampening this anticipatory response. Right. So one of the theories in the literature is that it's not just changing your appetite and metabolism. Right? Because think about it, if it's also helping gambling and shopping addictions, that can't be just about metabolism. Pharmacological activation of GLP1 receptors appears to reduce alcohol intake in preclinical models and early human studies, possibly by dampening reward signaling in the brain. This suggests GLP1 based therapies may influence not only food cravings, but also substance use, highlighting a broader role for these drugs in regulating reward driven behavior. So how are we making sense of this? That it is helping with people not being as motivated to eat as much, they're not getting that food noise, but they're also not gambling and shopping. And of course we look at all three of those as kind of negative. But what kind of positives might that be dulling? What I find interesting is that people are starting to come out of the woodwork and kind of noticing that, right?

Jonathan Hill (16:41)

I'm definitely feeling this like flat, like just kind of like blah feeling. When it came to doing certain things like my hobbies, going to the gym, cooking, baking, I lost complete interest in doing any of those. Like, it all just seemed like a chore.

Dr. Sarah Lavelle (16:57)

That's why more journalists are starting to look into it than maybe people in the medical field.

Jonathan Hill (17:05)

By altering their desire for food, some people say they've lost their desire for everything else. And what's left is a long lasting state of meh, blech, numb, flat, take it or leave it. The cut. November 2025.

Dr. Sarah Lavelle (17:21)

Because again, it's not. It doesn't seem like it's leading to something clinically diagnosable like depression. That there's more. These personal reports coming out of people saying, I feel flat.

Jonathan Hill (17:33)

I wonder how you think of GLP ones. I don't know. I love the idea of looking forward to food. Like I'm thinking about the little Mediterranean bowl I'm gonna have from a local spot after this interview. I love looking forward to like, ooh, I'm gonna go hang with some friends. Or like, I don't know, is this a net negative, a net positive? Like, how do you think of these? Because I'm like, I don't know, I.

Dr. Sarah Lavelle (17:58)

Have to think of it very nuanced. You know, I really hate the people who are on the like, Pro or negative GLP1 camp. Right? I see very positives in terms of mental health for some people. I've worked with so many people with a history of binge eating disorder that might be a hundred pounds overweight and it's not Just about them losing weight or looking good or being healthier. But those people have lost all psychological hope that it could ever change.

Sydney Lupkin (18:24)

Right.

Dr. Sarah Lavelle (18:25)

If you are 100 pounds overweight and you're extremely upset about it and you've given up all Hope, I think GLP1s can be not just this physical lifesaver, but this like light at the end of a tunnel for you. Right? But then we can't talk about that person. The same as the person who's struggles with anorexia, who is abusing it because it's their dream drug. It makes them not think about food. People with anorexia traditionally hate even thinking about food. They hate feeling hungry. It scares them. So if you're already £100, you hear that, oh, now I can take a pill that's going to make me not think about food or feel hungry at all. You know, to me that's a huge problem. So net positive, net negative within society, probably equal. Whereas I think there'd be a net positive in some populations and a very net negative in others.

Jonathan Hill (19:25)

You know, there are lots of physiological things. We're still learning about weight gain and weight loss, but the psychological impacts seem just as complex and difficult to manage.

Dr. Sarah Lavelle (19:36)

They're really complicated. Really complicated. But because you think about is, is obesity, do we as a society think of obesity as strictly metabolic or do we think of it as strictly psychological? Right. Like a binge eating disorder. But what you're finding, even with GLP1s, is that if there is a psychological component to it, that it's more emotional eating stress as opposed to in response to the psych or taste of food, it's not going to be as effective while on them. And you're more likely to go back to the same behaviors right after going off of them.

Jonathan Hill (20:16)

If you have a client that's taking GLP1s, what's something you want them to look out for? I'm thinking, you know, emotionally and psychologically.

Dr. Sarah Lavelle (20:24)

I have very mixed feelings about it. There are patients, I would recommend going on them for psychological reasons. Sometimes people do need a break from that food noise. It is so overwhelming. However, you want to do a lot of prep work if they're ever planning on going off of them, because especially a person who's kind of frantic at the idea of that food noise, of those cravings, thinking something's wrong with them if they get them when you go off, that's going to be, you know, I don't know, two to four times more intense than prior to even going on them. Right. And what you'll find is then if they go off of them, they don't remember what they were like before, and they go, oh, see, I was always like this. And it can then reinforce this idea that there's something wrong with them. So I think a lot of preparation about going off of them and what it's going to be like for you when your cravings return. And what are you going to do if those actually feel quite intense? And normalizing the fact that it's going to be intense so that they know to prepare for that.

Jonathan Hill (21:27)

One out of eight adults say they're taking these drugs, and that number's probably gonna grow in the future. You're seeing clients, and we're seeing more and more stories about people losing their spark on these drugs. Do you worry that we're gonna live in a society where, like, 80% of people have that sort of flat, beige, nothing feeling?

Dr. Sarah Lavelle (21:49)

You know, could it get so normalized within society that. That it creates this large impact? I'm not willing to be fearful of that. I think it would find its place the way that we had a lot of fear that Prozac would do that to everybody. And maybe it was overprescribed at a certain point, but it kind of found its place within society. And there are some just like Prozac. Not everybody should be on it, but there's some people who are gonna be really benefit from it. I do have concerns about the health impact. Like, one of the things that I think about, if it is kind of dampening that anticipatory dopamine, right, that kind of like rush. Okay, so does it really make sense? Doctors are saying, okay, well, take your GLP1s and this is going to make you less motivated for food. But we somehow expect you to have more motivation to change your diet and to exercise. If it's going to dampen your desire to kind of eat, isn't also going to dampen your desire, like, that high you get from working out or that, hey, I want to be healthier, maybe I should go for a salad. So, you know, I don't know how much of, like, muscular atrophy is a direct correlation of the medication itself versus actually the medication itself is doing two things. A, making people just not as motivated to want to get out. But also, you'll find that a lot of people who've struggled with food for a long time can overestimate the importance of being thin in eating. Well, if you think the only reason to eat better is to lose weight and something else is making lose weight that might actually give you inherently less motivation to eat better.

Jonathan Hill (23:42)

Sarah Lavelle, Clinical Psychologist Today's show was produced by Kelly Wesinger, edited by Jolie Meyers, Fact checked by Andrea Lopez Crusado and engineered by Patrick Boyd and David Tadashore. The rest of the team includes Hadi Mwagdi, Miles Bryan, Peter Balanon Rosen, Danielle Hewitt, Ariana Ospuru, Dustin de Soto, Asted Herndon, Noel King and Sean Ramis. Firm Our supervising team is Avishai Artsy and Aminah Al Saadi. Our executive producer is Miranda Kennedy. We use music by Breakmaster Cylinder. Hi, I'm Jonathan Hill. Today Explained is part of the Vox Media Podcast network. For more award winning podcasts, visit podcast voxmedia.com youm can listen ad free by signing up@vox.com members and check out Today Explained Saturday this week we talked to J.B. pritzker, the billionaire governor taking on Trump. Find it right here in your feed or you can watch the interview@YouTube.com Vox.

Dr. Sarah Lavelle (24:43)

Sam.