A growing trend of off-label prescriptions for semaglutide, a drug originally intended for diabetes treatment, is gaining momentum as a weight-loss aid. Sales of the drug have surged by 78 percent, fueled by endorsements from celebrities and high-profile figures, including Italian politicians like Clemente Mastella who report important weight loss. While thes medications are typically reserved for patients with diagnosed medical conditions, a rise in demand within influential circles is raising questions about access and appropriate use.
The use of semaglutide, a drug initially developed for diabetes, is surging among individuals without a medical need for it, driven by its weight-loss effects. Sales have increased by 78 percent, highlighting a growing trend of off-label prescriptions. Italian politician Clemente Mastella reports losing 20 kilograms while using the medication.
Data from the Italian Medicines Agency reveals a significant increase in the number of Italians using semaglutide and similar drugs for weight loss, despite not being diagnosed with obesity or diabetes. This isn’t a fleeting trend, but a substantial boom: the agency recorded a 78.7 percent increase last year in sales of GLP-1 receptor analogs prescribed with a standard, non-specialist prescription.
This data points to a growing phenomenon, rather than a public health need, as individuals with legitimate health concerns typically obtain these costly medications through a specialist prescription covered by the national healthcare system. A course of the daily or weekly injectable medications, which work by suppressing appetite, can cost between 170 and 300 euros per month.
The practice is largely occurring in secrecy, as officially, these drugs should only be prescribed to patients who meet specific medical criteria. However, within circles of influence – in fashion, design, finance, and politics – word of mouth is driving demand. It’s a case of “try it, it’s amazing” and “it works, trust me.”
Political Figures
In Parliament, one party leader reportedly experimented with semaglutide a couple of years ago, achieving unexpected gains in public approval and attracting bipartisan interest. While not reaching the level of the mayor of Rio de Janeiro, who last year promised free Ozempic to all citizens if re-elected, the use of these drugs for weight loss is becoming increasingly common among politicians, though few are openly discussing it.
Clemente Mastella admits to having used an earlier generation of semaglutide and now uses Mounjaro, but clarifies that he is diabetic: “It’s good for me and has allowed me to lose twenty kilograms in five or six months,” he says. “It’s ontological proof that these drugs help you get in shape. I’ve regained my effect on women of a certain age. Now that I’m campaigning in Campania for Roberto Fico with the Noi di Centro list, people stop me on the street and tell me I look better in person. And I say: better in person than dead.”
Senator Michaela Biancofiore, president of the Civici d’Italia – Noi moderati parliamentary group, also takes Mounjaro, but for medical reasons: “I am insulin resistant, and it was prescribed for that, but the pleasant side effect is that I have lost 17 of the 20 extra kilograms I had gained in a year and a half.” She doesn’t believe there’s a boom for aesthetic purposes beyond what’s already happening in Italy. “Personally, I explain to the curious that these drugs should only be taken if there is an indication, not lightly.” Semaglutide and liraglutide are becoming the new elixirs of slimness for “those who can” – those with power and purchasing power.
From Musk to Williams
The surge in sales has been fueled by high-profile figures in Hollywood and beyond. Oprah Winfrey has described the new drugs as “a gift”; Elon Musk has confessed to losing 13 kilograms; Robbie Williams attributed his slimmer physique to a “miracle” (though he later stated he was experiencing eye problems potentially linked to the injections); and Serena Williams lost 14 kilograms and became a spokesperson for a campaign promoting the “conscious use” of GLP-1s. Hollywood celebrities’ embrace of these medications has raised concerns about body image and the pursuit of unrealistic beauty standards.
“This trend can be explained by two factors,” observes Professor Annamaria Colao, a leading Italian endocrinologist. “First, we live in an ‘aesthetic society’ where thinness is valued over being overweight; second, these drugs effectively target ‘hedonic hunger’ – the kind experienced by very busy, stressed people who eat to cope. They reduce food dependency and can be helpful even for those who frequently have work dinners and cocktails.”
In fact, the Financial Times recently questioned whether appetite-suppressing drugs are impacting restaurants in major cities (“they help people order less, skip courses, and limit business meals”).
Millions Spent
In Italy, the 2024 report from the Italian Medicines Agency quantifies private spending (not covered by the national healthcare system) on semaglutide at 55.3 million euros and liraglutide at 13.4 million euros. This equates to roughly 300,000 to 400,000 prescriptions filled. These figures do not include Wegovy, a higher-dose semaglutide, which became available in mid-2024 and hasn’t yet been included in the top 30 best-selling drugs, but is already experiencing rapid growth in the US and UK.
These drugs can only be sold with a prescription. If a patient doesn’t have the medical conditions indicated on the label, a doctor may still prescribe them “in good conscience,” explaining the off-label use, potential risks, and side effects, and assuming professional and legal responsibility for the decision. Many doctors do so, “for example, for patients for whom being overweight causes significant psychological distress,” explains Colao.
Restrictions on prescriptions and high costs have fueled illegal sales online, often of products that don’t contain GLP-1s and are harmful, as happened recently to a 31-year-old woman in Padua who fell into a coma after injecting counterfeit Ozempic. The new elixir of slimness is becoming a sort of forbidden status symbol, used clandestinely or sought on the black market. The new collective delusion is believing that losing weight is easy, but at what cost?
