Editors’ Note: The sources interviewed for this article requested to be identified by their first names or pseudonyms only to protect their privacy.
“It felt more like buying skincare cosmetics than getting a serious prescription drug,” 20-year-old Hannah Lee said, recalling her experience of buying Wegovy last December.
Lee’s BMI at the time was 21.1, well within the normal range by World Health Organization (WHO) standards, and far below the threshold at which Wegovy can legally be prescribed. The legal threshold at which Wegovy can be prescribed is 30 or between 27 and 30, in addition to at least one weight-related comorbidity, such as high blood pressure, type 2 diabetes, or dyslipidemia (high cholesterol).
Even with a BMI considered “normal” by medical standards, Lee, however, felt an urgent need to lose weight. “I saved up my part-time cafe money to try Wegovy,” she said. “My friends who weighed about the same kept body-shaming themselves. It’s hard not to feel fat in Korea, I think.”
Wegovy, a weekly injection that helps people lose weight, was developed by the Danish drugmaker Novo Nordisk and was approved in Korea in April 2023. When the drug launched in October 2024, the response from Koreans was almost immediate, with many young women in particular turning to it to ease their anxieties about weight. Several media outlets reported on the prevalence and dangers of such consumption.
The peril the drug poses, as reported by news in the past few years, is real. Wegovy’s active ingredient is semaglutide, a compound that mimics a hormone the gut releases after a meal: it tells the brain the body is full and slows digestion, so the feeling of fullness lasts. Its competitor, Mounjaro, mimics the same hormone and adds a second, GIP (glucose-dependent insulinotropic polypeptide), for an even stronger effect on appetite, though because the drug is newer, its long-term risks are less thoroughly studied than semaglutide’s.
Even though Wegovy was approved as a treatment for a medical condition, for people whose weight is making them ill, in practice, the checks have been far looser. Vivian Park, a 20-year-old university student in Seoul with a BMI of 20.5, described going to a well-known skin clinic in Gangnam after seeing Wegovy all over her friends’ Instagram feeds before summer break: “The consultation at the clinic took literally three minutes. The doctor barely looked at me, just asked if I knew how to inject it, and wrote the prescription right there on the spot.”
Such lenient prescribing is exactly what regulators have been trying to crack down on. But not every doctor agrees that harsher regulation is the right response.
“The issue isn’t just about doctors; the bigger problem lies in the attitudes of patients who exert financial and social pressure on doctors to obtain prescriptions,” said Professor Beom-taek Kim at Ajou University. That pressure, he argues, won’t go away just because the rules on physicians get stricter: “And it’s difficult to suppress demand. In the end, people will end up developing various routes through illicit means. Problems like illegal trading, overseas purchases, and counterfeit products will emerge if the regulations around Wegovy become tougher.”
Professor Kyu-rae Lee at Gachon University College of Medicine points to precedent as evidence that penalties alone don’t work: misuse of anesthetics like propofol “has persisted for a long time in plastic surgery and dermatology clinics” despite existing penalties, he says, which suggests that “social education of the general public and strengthening self-regulation alongside checking the prescribing authority are the real solution.” According to Professor Young-sang Kim at CHA Bundang Medical Center, restricting prescribing authority just because a drug is used outside its approved indication “could end up disadvantaging patients even more.”
Overlooking the BMI requirements, however, still has real consequences. The drug doesn’t know the difference between fat that is making someone sick and fat someone simply wants gone; it suppresses appetite and slows digestion the same way in everyone, regardless of their current weight. Professor Sun-hyun Kim, obesity director at the Korean Academy of Family Medicine, says that the drug’s most common side effects are stomach-related: nausea, vomiting, cramping, diarrhea and constipation.
The 20-year-old Park said that the first night after her dose felt like “a bowling ball was sitting in my stomach,” and that for four days she couldn’t eat without gagging. Additionally, Lee described a week of constipation severe enough that she thought she had appendicitis, and quit after a month when her hair began falling out in clumps.
Aju University professor Kim adds that digestive symptoms show up in 20 to 40 percent of patients. Most cases are mild, but fewer than 5 percent of patients develop pancreatitis or gallbladder problems, including gallstones. The risk is worse for the youngest users: Korea’s own health ministry has said that in clinical trials, teenagers on these drugs had higher rates of gallstones, gallbladder inflammation and low blood pressure than adults did, warning that rapid weight loss during a growth period can affect development.
That is exactly why the BMI cutoffs exist. Someone with a BMI of 32 and high blood pressure has a real medical reason to accept those risks. A healthy 20-year-old who simply wants to look different does not.
Kim says that young, image-conscious patients are driving the recent jump in demand for Wegovy, and that as celebrities and influencers with public followings show off their results, a prescription drug starts to be treated like a casual diet product rather than medicine requiring a doctor’s serious discretion.
Kim, the obesity director, makes a similar point: because the drug affects everyone differently, doctors should feel free to refuse a request rather than treat a prescription as owed on demand, something the clinic visits described above suggest is not happening consistently.
Regulators in Korea seem to agree that something is broken. They restricted telemedicine prescriptions for Wegovy starting in December 2024, after remote apps became a workaround for in-person checks, and the health ministry has since considered labeling these drugs as carrying a high risk of misuse.
None of this has happened in a vacuum. Korean culture places heavy weight on physical appearance—in hiring, in dating, in everyday life—and young people feel that pressure most acutely. Park put it plainly: “I feel like all the girls here are so skinny that if I don’t lose weight, I can’t get noticed or even be properly considered a person.”
Roughly a quarter of South Korean women in their twenties, and nearly a third in their thirties, said in a 2020 Gallup Korea survey that they had had plastic surgery, and researchers who study “lookism”—discrimination based on looks—connect it directly to hiring decisions. National health data reveals a striking paradox: while clinical obesity is heavily concentrated among middle-aged men, the frantic demand for blockbuster weight-loss drugs is overwhelmingly driven by women. 41.4 percent of men are clinically obese, compared to the 23 percent of women who fall into the same category. And yet, between 2020 and June 2025, women account for 71.5 percent of all prescriptions for Wegovy and Saxenda, another product injected for a weight-loss purpose.
Wegovy didn’t create this pressure; it handed people already under it a fast, barely checked shortcut, one with real risks to the stomach, gallbladder and pancreas that two healthy 20-year-olds in this story paid for in gagging, cramping and hair loss. Once a medical treatment is pulled into a culture already built around appearance, it stops being known as medicine and starts being bought like any other diet product.