A 30-year-old company employee was filled with self-loathing every time she saw a thin woman on a tic-tac train and realized “how fat I am.”
The Hokkaido resident visited a cosmetic clinic and had liposuction done on almost her entire body. She still felt that these procedures were too slow to produce the desired effect on her appearance.
Around spring of last year, a desperate woman came across a prescription drug on social media that was billed as “making you lose weight like crazy.” She reached out to the medical facility’s account to prescribe medication through the Line messaging app.
After registering himself on the app and receiving less than 10 minutes of instructions from a doctor via video chat, the patient purchased four 2.5 mg syringes of the drug — a one-month supply — for 15,000 yen ($98).
She checked out a video to learn how to use it and then injected the prescribed medication into her lower abdomen.
The woman quickly realized that she no longer felt the “desire to eat” when she saw food. Her body didn’t even accept the confections available in convenience stores, although she had always enjoyed the sweets made famous in Japan for their quality.
She lost 3.7 kg from her 56 kg weight in nine days. She started looking to step on the scale every day.
As soon as she started feeling hungry again after a week, the woman administered the next dose.
“I can’t bear the thought of leaving it,” she said. “It’s a magic agent.”
This drug was developed by the US pharmaceutical giant Eli Lilly and is called Monjaro.
This agent was approved as a treatment for type 2 diabetes in Europe, the United States and elsewhere in 2022. Versions of the same in Japan began in 2023.
Monjaro is so popular as a diabetes drug that mass media in North America and Europe sometimes tout it as a candidate for the next Nobel Prize.
The use of monjaru for food, as in the case of the Hokkaido woman, however, falls outside the scope of its approval in Japan and thus constitutes an “off-label” use.
An academic association with experts warns that improper use of monjaro can cause adverse symptoms such as the threat of premature labor and muscle weakness.
With this warning in mind, some doctors continue to prescribe monjaro for dietary purposes outside of Japan’s health insurance framework.
On social media, Monjaro is therefore dramatically praised as a “weight loss drug”, as the rapid growth of related posts appears online.
Easy but dangerous solution
A cosmetic surgery clinic in a busy commercial area in Tokyo’s Shinjuku Ward is full of young people who want to “get slim.” People in remote areas can receive counseling through video conferencing.
Diabetes drug Monjaro is also prescribed to such patients.
A male dentist who runs several cosmetic surgery clinics emphasized that Monjaro is a “superior” solution.
“Some may advise that people should go to the gym (to get slim), but they don’t have time to do that,” he said. “This agent will enable such patients to lose weight safely as long as they follow a properly managed regimen.”
A 40-year-old male pediatrician, who works in several medical institutions in the capital, similarly admitted that one of his employers was involved in negligent practices.
“A skin clinic where I work part-time buys monjaro for 2,000 yen and sells it for 8,000 yen,” the doctor admitted.
He said that Munjro had once written a prescription in his name at the counter of a medical institution without his knowledge, while the prescription required the signature of the doctor in charge.
“I can’t speak strictly because I’m an employee,” said the part-time doctor.
Eli Lilly’s Japanese arm expresses a sense of crisis in response to the misuse of this advanced drug for dietary purposes.
“The possibility that unforeseen health risks could arise cannot be ruled out,” the Japanese arm stressed in a statement last summer about Monjaro’s application outside of its legal uses.
Ryo Suzuki, vice president of the Tokyo Medical University Hospital, pointed out that administering Monjaro to women without diabetes symptoms alone to control the diet could pose a risk.
These include susceptibility to bone fractures associated with low body weight as well as conditions such as irregular menstruation and sarcopenia, characterized by muscle weakness at a young age.
“Reckless use of monjaro for dietary purposes will lead to significant risks,” Suzuki said.
A male doctor who runs a beauty clinic in Nagoya is also wary of prescribing monjaro for weight-loss dietary restrictions.
“Leaving the problem to the ethics of doctors alone will not change anything forever,” said the doctor. At the same time, he added that the government should put legal rules in place to properly buy Monjaro.
Time to review physician privilege
The Japanese Medical Association issued an opinion in October 2023 arguing that the administration of Monjaro, along with other GLP-1 receptor agonists, “should be prohibited” in patients who only want to lose weight.
How is it possible that doctors continue to dispense diabetes medications for off-label diets under such circumstances?
Medicines are approved by the government after target patients and doses have been determined through rigorous clinical trials.
However, doctors are privileged based on their high level of expertise and are allowed to prescribe drugs that do not have official government approval. Doctors can legally provide medicines to patients outside of the national health insurance system.
Authorities have little legal basis to interfere with these decisions of doctors, unless violations of the Medical Care Act, including false or unsubstantiated advertising, or violations of the criminal code, such as causing serious disability through treatment, are reported.
Yusuke Inoue, a professor of medical ethics at Kyoto University, called for reform. He noted that many medical institutions could face financial difficulties and henceforth rely on risky options beyond the public health insurance framework.
“It’s not like doctors are allowed to do whatever they want, they just have the right to issue prescriptions not yet approved outside the national insurance system,” said Anu. “It’s time to give a second thought to the doctors’ option.”
Inoue continued, “How uninsured treatments differ from insurance-covered treatments should be clearly explained to patients. Evidence-based explanations are expected at the same time to be provided about treatment goals, anticipated benefits, and risks, as such explanations are vital for patients to make informed decisions.”
(This article was written by Kazuya Goto and Ryuta Sometaya.)
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