Karleigh McClain did everything she thought she was supposed to do. She researched her options, signed up with a reputable-seeming telehealth company, met virtually with a provider, and started a weight loss medication that had helped her lose 50 pounds just a few years earlier. Within 24 hours of her first injection, she was in the hospital, vomiting uncontrollably, diagnosed with an overdose.
Her prescription had instructed her to inject 2.21 milligrams of semaglutide. A standard first dose is typically around a quarter of that. She had taken nearly nine times the normal starting amount, exactly as instructed.
McClain’s story is not an isolated case. It is a symptom of a healthcare system struggling to catch up with a gold rush.
How we got here
The GLP-1 story begins modestly. The drug class was first approved by the FDA over 20 years ago to treat Type 2 diabetes. In 2021, when Novo Nordisk received approval for semaglutide as an obesity treatment under the brand name Wegovy, something shifted. By 2025, nearly one in five American adults had taken a GLP-1. Demand exploded, supply strained, and a market opportunity emerged.
Into that gap stepped telehealth. Already turbocharged by pandemic-era regulatory loosening, online healthcare platforms found GLP-1s to be a natural fit. Patients wanted the drugs. Doctors were hard to reach. Insurance often wouldn’t cover them. Telehealth companies offered convenience, lower prices via compounded versions of the medication, and a frictionless signup process. Some required only an online intake form.
Calls to the National Poison Data System related to injectable weight loss drug overdoses and side effects have risen nearly 1,500% since 2019. Companies like Mochi Health, Ro, and Hims & Hers began marketing GLP-1 prescriptions online, sometimes with celebrity endorsements. Some integrated their own compounding pharmacies, mailing medications directly to patients and bypassing the pharmacy counseling that might have caught a dosing error like McClain’s.
The problem with easy
GLP-1s are not straightforward drugs to prescribe. Patients with a history of pancreatitis face specific risks. So do those with gastroparesis or a family history of medullary thyroid cancer. Some patients benefit from blood work or muscle mass screening before starting. The injectable delivery system is more complex than a pill, and dosing errors have been common even among careful patients.
Yet many telehealth companies have made access maximally easy, which critics say is precisely the problem. Getting a GLP-1 prescription online is, in many cases, significantly easier than getting one through an in-person appointment. And ease, in medicine, is not always a virtue.
FDA adverse event data tells a stark story: medication errors involving popular weight loss drugs rose from just over 2,000 reports in 2020 to over 25,000 in 2025. The most common issues included incorrect dosing, communication failures, and prescribing errors. A great deal goes unreported entirely.
A regulatory vacuum
The legal landscape around compounded GLP-1s has grown increasingly contentious. When a national shortage of name-brand weight loss drugs emerged in 2022, compounding pharmacies were legally permitted to manufacture alternatives. Those pharmacies often source active ingredients from overseas suppliers, and their formulations are not reviewed by the FDA for safety or efficacy. When the FDA declared the shortage over last year, the legal footing for compounders began to erode.
Eli Lilly and Novo Nordisk have collectively filed over 130 lawsuits against telehealth companies and compounders. The Trump administration sent waves of warning letters to companies including Hims & Hers and SkinnyRx, accusing them of false or misleading claims. Hims & Hers subsequently announced a pivot away from compounded drugs entirely.
But a core problem remains: there are no established criteria, from any government agency or medical society, defining what appropriate telehealth prescribing of GLP-1s actually looks like. In the meantime, the onus has fallen almost entirely on patients, who are advised to approach anything on the internet with skepticism, as if that were an adequate substitute for regulation.
A perfect storm, still building
There is a fair case to be made for telehealth as a vehicle for GLP-1 access. Primary care doctors have historically done a poor job counseling patients on weight loss. Many people are uncomfortable having that conversation in an exam room. Rural communities face genuine barriers to specialist care. And there are telehealth companies doing this responsibly, with live provider consultations, lab work requirements, and genuine follow-up.
The problem is that the good actors and the bad actors are nearly indistinguishable to the average patient. The market has not developed the tools to tell them apart, and the regulatory system has not yet supplied them.
McClain, now dealing with residual side effects including an elevated heart rate and vision problems, has been offered a refund for her three-month membership, but only if she signs a document waiving her right to legal action. Her medical bills from the hospitalization are expected to total at least $900.
She lost 50 pounds on a GLP-1 prescribed by her regular doctor a few years ago. When her insurance stopped covering it, she sought a cheaper path. She found one. The costs, in the end, exceeded what she had hoped to save.
That tension, between access and safety, between convenience and care, is not going away. The drugs are too effective, the demand too high, and the business models too profitable. What is missing is accountability, and it is unclear who, exactly, is going to supply it.