Recent Subway advertisements showing models injecting themselves in their stomachs, arms and thighs raise questions regarding the ethics of large-scale, consumer-facing campaigns for prescription weight loss medications.

The ads are for telehealth platform Ro (also known as Roman) to promote its Body Program, which allows people to obtain subscriptions for FDA-approved weight loss injectable Wegovy via telehealth visits.

Subway advertisements in cities like New York give brands the opportunity to reach a substantial audience of over two million daily weekday riders. 42nd Street Times Square, one location plastered with Ro’s Wegovy campaign, clocks around 180,000 daily visitors.

That expansive reach offers a huge bump in brand awareness, but there is concern from riders, eating disorder recovery experts and even celebrities that mass advertising of weight loss products may not be a net positive for society. There’s worry that promoting weight loss undoes progress made with the body positivity and body neutrality movements. Plus, the ads may be triggering for those who have or are recovering from eating disorders.

It’s not wrong for folks to want to explore weight loss options, and reaching those consumers via mass transit advertising guarantees brand recognition for Ro. But the question remains: Are there ethical issues to consider when advertising weight loss products on a large scale?

The ads

Wegovy is a name-brand semaglutide — the same active ingredient used in Ozempic, which is primarily used to treat type two diabetes. Both drugs inhibit the appetite and slow stomach emptying, resulting in users feeling fuller for longer. Users typically eat less food since their appetites are suppressed, and lose weight as a result.

Ro’s ads for Wegovy are formatted with a clean, minimalist aesthetic and show plus-size models injecting themselves with unbranded shots. A tagline describes the offering as “a weekly shot to lose weight” in large font and, in smaller font below, adds, “with coaching, care and healthy lifestyle changes to make it last.”

Certain panels, though not all, give more detail about the drug, its intended uses and its potential side effects.

Adam Hessel, CCO of Ogilvy Health, says that in general, mass transit advertising is a great marketing strategy for building awareness, especially for a new product. “Subway advertisements are one of the smartest mediums because you can’t avoid it — you’re stuck there,” he says.

Specifically, the weight-loss sector “has always thrived” with Subway ads, “whether it’s been Jenny Craig or current weight loss products,” he says.

The brand advantages and potential risks

Others worry that the messages of these ads don’t consider people suffering from eating disorders and body image issues. 

“The advertisements and social media storm surrounding the new medications [Ozempic and Wegovy] are highly triggering for people with eating disorders,” says Kimberly Dennis, M.D., C.E.D.S., co-founder and CEO of SunCloud Health and member of the National Eating Disorder Association’s Clinical Advisory Council.

Eating disorder rates have increased sizably during the pandemic. especially among adolescents,” she notes. “This will make things worse for those folks.”

As a result, the nature of a product like Wegovy requires a thoughtful strategy. “A high level of sensitivity and educational information is required to effectively advertise products like this,” says Rob Canales, CCO of health and wellness ad agency The 3rd Eye.

“As marketers, our [responsibility] is simply to highlight the opportunity these products present in an ethical manner,” he adds. “So as long as we understand the audience and their needs, and offer up educational resources and a credible solution to those needs, we are fine.”

The fact that the models represent the target audience and don’t feature thin people who don’t need the product is an important distinction for Ogilvy’s Hessel, which he says gives the campaign a level of authenticity. According to Ro, the models featured in the campaign are all eligible for Wegovy prescription, which means they either qualify as obese or overweight by BMI standards with a weight-related health issue.

“If the marketing is not targeting folks with an image that’s unrealistic and supermodel-like, then there’s room for it,” he says.

But the models, though diverse in size, are ultimately represented as a “before” stage – the end goal is for them to lose weight and therefore no longer look as they do in the ads. And this could worsen already prevalent self-image issues.

“Focus on weight and weight loss is particularly problematic for people with eating disorders who live in larger bodies or average sized bodies,” says Dr. Dennis. “This is the majority of folks with eating disorders and the groups who are less likely to be diagnosed and treated by eating disorder experts.”

What’s lost in these ads is also the fact losing weight isn’t the only way to get healthier – and presenting the option in a highly visible, consumer-facing campaign can be harmful.

“Body appearance alone isn’t indicative of overall health and well-being,” notes The 3rd Eye’s Canales. 

Creating more responsible ads

Wegovy is a relatively new product, approved by the FDA in 2021. Side effects include a risk of developing a type of thyroid cancer called medullary thyroid carcinoma, gallbladder disease, kidney disease and suicidal thoughts.

Dr. Dennis worries the gravity of these side effects is not properly underscored in the subway campaign – nor is the possibility of developing or worsening an eating disorder as a result of using the drug.

Canales argues that ads for weight loss products shouldn’t depict unattainable ideals and should include educational aspects in order to properly inform consumers.

“When advertising a product that may result in weight loss for consumers, it is important that marketers consider incorporating an educational communication and marketing strategy,” he says. “When it comes to health and wellness, transparency and authenticity are key to gaining a consumer’s trust. In a case like this one, consider defining this medication’s role and purpose, and perhaps even define obesity.”

“I’d like to see a warning on all of these ads that says, ‘use of this medication may cause you to develop a lifelong and potentially fatal eating disorder; if you now have or ever had an eating disorder, things may get worse or reoccur; and as soon as you stop this expensive medication you will gain weight back, so if you are taking it for weight loss plan to depend on it forever,’” adds Dr. Dennis.

Some of this information is noted on the landing page for Wegovy on Ro’s website – near the bottom, in an FAQ section that must be clicked on and expanded by users. There is a small warning that notes the potential for developing thyroid cancer nearer to the top of the page.

More prominent on the page is a sliding scale widget which, when adjusted to the user’s current weight, will show how much could be lost by using the drug. The scale goes down to 140 pounds; a person at that weight would have to be 4’9” to be considered obese by BMI standards, or 5’0” to be considered overweight with “excess weight.”

Definitions of the target consumer, including definitions for obese and overweight BMI, is not clearly visible in the ads or on the site.

The bottom line

Experts note there should be no shame in looking into weight-loss medications or otherwise trying to lose weight or achieve satisfaction with one’s body.

“You can’t wrong folks for wanting to be thinner and not have that mindset that you are beautiful the way you are,” says Hessel.

A problem arises, though, in failing to stress the fact that healthy bodies come in myriad sizes – and promoting an “easy” solution without adequately disclosing the potential risks can make matters worse. This, in turn, can result in further harm when ads that can trigger people with eating disorders are prominently placed in the public sphere.

“’Obesity,’ the so-called enemy that we are waging a war on, is not getting any better – nor has it with other weight loss meds that have been on the scene,” says Dr. Dennis.

A consumer-facing advertising campaign for weight loss medication “is problematic for many reasons, but especially for something like weight loss given how rampant body dissatisfaction, dieting and weight stigma are in the U.S.,” she adds.

Ro did not respond to requests for comment.

This story originally ran on Campaign US.