How China got hooked on Ozempic: The world’s most obese country – where 200 million people are overweight – fuels a ‘grey market’ of weight-loss drugs

Ozempic has become synonymous with Hollywood, where it has helped a number of stars lose weight – but there is a secret booming market in China.

Despite being cut off from Instagram and much of Western culture, the drug has become mainstream in Chinese internet culture, with stars showing off their slim physiques and promoting its effects on social media.

It’s technically only available to diabetics with a prescription, but a “gray market” of e-commerce websites have started selling it to people who self-report their diabetes without a doctor’s note.

And weight loss appears to be big business in China.

The US is often called the “fattest country in the world” because 40 percent of adults have a body mass index of 30 or higher.

But the sheer size of China’s population means there are actually 200 million obese people, compared to America’s 139 million.

Another 400 million people in China are overweight, compared to the 103 million US residents who are overweight.

The result of the obesity epidemic in both countries has spawned a multi-billion dollar weight loss industry, which recently includes the successful weight-loss drug Ozempic.

In 2022, sales of Ozempic in China reached $2.2 billion and analysts predict that sales of the drug will reach $5.6 billion by 2031.

While US sales of Ozempic were $8.4 billion, the weight-loss drug industry is expected to grow to $100 billion by 2030.

Demand for Ozempic has increased by more than 300 percent in the US since 2020. In China, GLP-1 drugs, which also include Wegovy and Victoza, are a $1.7 billion market.

Ozempic is a GLP-1 agonist and contains the active substance semaglutide. It works by suppressing hormones involved in hunger, keeping you feeling full for longer and reducing appetite.

As in the US, Ozempic is only approved for the treatment of diabetes in China, which has a much larger diabetes population: 89 million compared to America’s 38 million.

And while the majority of Chinese Ozempic sales are for diabetes patients, there are still large numbers of people buying it on websites to use off-label for weight loss, creating a “gray market” for the drug.

The rise in off-label demand for Ozempic in China is fueled by posts on Chinese social media apps in which users show off slim bodies, which they attribute to Ozempic use.

On Xiaohongshu, an app similar to Instagram, Ozempic is claimed to be a “miracle drug” that will help you lose weight without “diet or exercise.”

Although doctors in the country cannot write prescriptions for weight loss, people seeking the drug for off-label use are turning to e-commerce websites to purchase Ozempic.

These websites allow people to declare that they have been diagnosed with diabetes and purchase Ozempic without providing proof or taking someone else’s prescription.

Some websites allow people to pay as little as $140 for a month’s supply, compared to the $1,000 Americans pay out of pocket.

Reports from state media claim that the rising popularity of Ozempic for use in weight loss has led to a shortage of the drug for people who are actually prescribed it for diabetes management.

Similar medications such as Wegovy and Mounjaro are not approved for use in China, making Ozempic the only choice for those seeking diabetes control or off-label weight loss.

Ozempic’s maker, Novo Nordisk, has applied to China’s drug regulator to broaden the use of its semaglutide products and sought permission to sell Wegovy in China.

Although details about the application have not been revealed, industry experts believe the manufacturer is seeking permission to offer Wegovy specifically for weight loss, as is permitted in the US.

The request is being assessed.

In an effort to increase Ozempic’s supply and enter the market with a diabetes and weight-loss drug, Chinese pharmaceutical companies have begun developing their own versions, hoping that new products will grow the industry in China .

However, Novo Nordisk has a patent on semaglutide until 2026, the first Chinese company that could sell its own generic brand.

In 2023, China gave the green light to its own drug, beinaglutide, which is similar to the current GLP-1 drugs on the market.

A 2019 study found that the drug showed a “significant weight loss benefit” in diabetes patients.

However, it is a less powerful drug and requires three injections per day, compared to the once-daily products already on the market in the US.

Before beinaglutide, Chinese drugmaker Innovent Biologics Inc. and Eli Lilly collaborated on the development of mazdutide.

That medicine targets two receptors in the body to increase metabolism and the companies said in 2023 that a clinical trial showed patients taking mazdutide lost about 19 percent of their body weight.

Obesity is a growing problem in China, but it is not a new problem. Experts attribute the rise in obesity to increased access to energy-dense foods after the country joined the World Trade Organization in 2001 and living standards rose.

In 2017, China’s health commission launched a campaign to tackle obesity. The plan called on people to reduce their intake of salt, oil and sugar.

The plan was also aimed at tackling the childhood obesity crisis in the country, where obesity rates among children and adolescents are high.