Compounded Weight-Loss Drugs Persist at Medical Spas Despite Shortage End

Even after federal shortages of GLP-1 weight-loss medications like Wegovy and Zepbound ended, many medical spas and weight-loss clinics continue to sell compounded versions of semaglutide and tirzepatide, according to a University of Colorado Anschutz study published in JAMA Health Forum. Using a…

Study Uses Secret Shopper Method to Assess Market

Lead author Michael J. DiStefano, an assistant professor at the University of Colorado Anschutz Skaggs School of Pharmacy and Pharmaceutical Sciences, and his colleagues employed a "secret shopper" approach to investigate brick-and-mortar weight-loss clinics and medical spas in Oklahoma and West Virginia. They contacted these businesses to inquire about available products, patient monitoring procedures, and where the medications were sourced. The team identified 75 clinics and medical spas that were offering compounded GLP-1 medications.

DiStefano noted that many expected the compounded GLP-1 market to shrink after the federal shortages ended and the FDA resumed enforcement against routine copies of commercially available products. "Our findings suggest this market didn't shrink after the shortages ended as many expected," he said. "Instead, it has remained remarkably robust, raising important questions about how these products are regulated and how patients can know whether they're receiving medications that meet appropriate quality standards."

Added Ingredients and Pharmacy Licenses Raise Concerns

Instead of disappearing, the researchers found evidence that many compounded products now include additional ingredients, such as vitamin B12. These additions may be presented as individualized formulations. "One concern is whether we're seeing clinically meaningful personalization or changes that primarily allow compounded products to remain on the market," DiStefano said. "For many of these added ingredients, we simply don't have good evidence showing they improve safety or effectiveness."

Among the 23 compounding pharmacies that supplied these businesses, four lacked the licenses required for sterile compounding. Additionally, several pharmacies had recent disciplinary actions or FDA warning letters related to sterile compounding practices. The study highlights that this market has grown so large and diffuse that it is difficult for regulators to oversee every pharmacy supplying these medications.

Balancing Access with Quality Standards

DiStefano emphasized that compounded GLP-1 medications have helped expand access for patients who cannot afford brand-name drugs or whose insurance does not cover obesity treatment. However, he said patients should not have to choose between affordability and quality. "This market has grown so large and diffuse that it's difficult for regulators to oversee every pharmacy supplying these medications," he said. "Our findings suggest there's a need for regulatory innovation that preserves access while giving patients greater confidence that the products they're receiving are safe and appropriately manufactured."

The researchers hope their findings will encourage clinicians and patients to ask more questions about where compounded medications originate and whether the pharmacies producing them meet appropriate standards for sterile compounding. The study was published in JAMA Health Forum with the DOI: 10.1001/jamahealthforum.2026.2207.

DiStefano is an assistant professor at the University of Colorado Anschutz Skaggs School of Pharmacy and Pharmaceutical Sciences. The study is peer-reviewed and fact-checked, and it appears in the journal JAMA Health Forum.

Peptides referenced: Semaglutide, Tirzepatide, GLP-1.