Carlos Campos spends most of his days as a family physician, seeing patients for all manner of conditions, especially obesity and diabetes. But he has built a steady side gig beyond his practice in south-central Texas.
Over the past seven years, drug manufacturers have paid Campos nearly $1 million to spread the gospel of weight-loss and diabetes drugs known as GLP-1s to colleagues in his home state and beyond.
“I’m a lot like an evangelical preacher man,” Campos said. “They hire me to sell the science.”
Whether speaking in a private dining room at a fancy steakhouse or over bags of Chick-fil-A in a primary care office, Campos is part of a vast effort by drug companies to build sales of their revolutionary weight-loss drugs by targeting the prescribers who act as the gatekeepers to the American healthcare system, according to an analysis of public federal government data by The Washington Post and interviews with six physicians involved in the marketing program.
The analysis shows that Eli Lilly and Novo Nordisk, the largest manufacturers of the weight-loss drugs, have made at least one payment to more than a quarter of a million individual doctors and other prescribers including nurse practitioners since 2018, the first full year that Ozempic, Novo Nordisk’s blockbuster medicine, was on the market. No other class of prescription drugs was promoted as heavily over this period.
In total, companies spent more than $270 million on these promotional efforts, according to the data, which is reported to the federal government by the manufacturers. The spending — which the federal government says encompasses both direct payments and in-kind payments for food and beverages — was spread among 140,000 individual prescribers in 2025 alone, the most of any year in the Post analysis.
The GLP-1 craze stoked by TV advertising and word-of-mouth for the novel class of drugs — including Wegovy and Zepbound — has generated abundant patient demand. But the lesser-known spending on doctors, which is legal and disclosed publicly, represents promotional efforts — largely hidden from consumers — of the drugs’ success that some medical experts say pose a conflict of interest.
Physicians paid by the drug companies say they are helping colleagues overcome hesitancy and even skepticism among practitioners who may not be familiar with how the drugs work or still view obesity as a matter of patient willpower. In interviews, they said payments don’t influence their views of the drugs, opinions they said have been shaped by phenomenal results in their own patients. They described how in meetings with other doctors, they observe government limits on what claims can be made while sharing unbiased, evidence-based data about benefits and side effects.
But some doctors warn that these sessions, and the money that physicians receive as direct payments on the side, carry a number of risks — both to patients and to the health system at large.
The costly drugs, which most users have to take for life to maintain their results, are relatively new, with underappreciated side effects in some patients, the critics say.
“The patient comes in saying, ‘I want it,’ and if they don’t give it to them, they will find another doctor who will,” said Robert Lustig, a doctor and professor emeritus at the University of California at San Francisco who advocates for reducing sugar and processed foods in the American diet.
“The problem is getting worse,” he said, “and now people have taken their eye off the ball: ‘Oh, I can just take a drug, a shot, and eat whatever the hell I want.’ It’s just a Band-Aid.”
Spending to purchase the drugs by consumers and health insurance companies has exploded. Total sales (excluding rebates and discounts) in 2025 eclipsed all other drugs, with Eli Lilly’s Mounjaro and Zepbound leading the way at $63 billion, and Novo Nordisk’s Ozempic and Wegovy close behind at $59 billion.
Private health plans are cracking under the burden, and some are beginning to cancel coverage. Federal costs are poised to shoot into the billions now that Medicare, as of July, is covering the drugs for weight loss.
Nearly 1 in 5 U.S. adults has reported having taken one of the drugs for diabetes or weight loss, according to a survey by KFF, the independent healthcare policy organization.
The drug companies defended their promotional practices as appropriate and important for health.
“This responsible interaction and collaboration between industry and the medical community benefits patients by advancing care and science,” Novo Nordisk spokeswoman Liz Skrbkova said. “In all our engagements with the medical community, we follow the highest ethical standards as well as all legal and regulatory requirements.”
Eli Lilly said its programs are grounded in science.
“These interactions, from medical education to clinical consultation, help ensure healthcare professionals have accurate, current information to make informed treatment decisions,” the company said. “All such engagement is conducted under Lilly’s rigorous compliance standards and disclosed transparently.”
Lectures over steak dinners
The drugs, initially rolled out years ago for diabetes, are seeing their fastest prescription growth outside of diabetes clinics. Providers at internal medicine and cardiology practices are writing prescriptions at the highest rate, according to IQVIA, a pharmaceutical data and consulting firm, which called GLP-1s the “Swiss Army knife” of healthcare.
In addition to diabetes and weight loss, the drugs are now also approved for reducing cardiovascular risk and sleep apnea, and many other indications are being researched.
The Post tracked how Eli Lilly and Novo Nordisk are using the traditional pharmaceutical marketing playbook to boost sales behind the scenes. They are making payments to doctors who serve on the boards of the prominent diabetes and obesity medical societies; those boards shape how medicine is practiced. They are dispatching hundreds of doctors — whom they pay tens of thousands of dollars a year each — to help discuss the drugs at medical conferences and in private meetings with doctors in every corner of the country.
A “key opinion leader,” as industry insiders calls these paid ambassadors, Campos said he visits with doctors and physician assistants in their offices over takeout or at local restaurants, often traveling to other states. He is typically accompanied by a sales representative, whose job is to market the drug while Campos explains how it works, he said. His payments placed him among the most handsomely compensated physician GLP-1 promoters in the country, according to the Post review.
A review of invitations to doctors to attend promotional dinners shows the broad geographical reach of these efforts. Physician promoters such as Campos extolled the benefits of the drugs over plates of pasta in Lancaster; in the “unmatched grandeur” of a Pittsburgh waterfront steak-and-seafood house; and over Mexican-inspired fare at a brewpub in Missoula, Mont. The gatherings often occurred in the private dining rooms of upscale chains such as Ruth’s Chris and Capital Grille.
The Post review drew from mandatory federal reports by drug companies, data that is posted online for public examination by the Centers for Medicare and Medicaid Services. In addition to doctors, the data includes spending on nurse practitioners and physician assistants, who also prescribe drugs.
The Food and Drug Administration’s instructions for use of the drugs say they are supposed to be taken in tandem with a reduced-calorie diet and increased physical activity. Marketing materials for Eli Lilly’s Zepbound aimed at doctors and obtained by The Post show those elements are mentioned as part of the prescribing regimen, but they are not emphasized as key pillars of treatment, even though a joint advisory from major medical groups in 2025 said doctors should make those elements a priority.
The marketing materials display side effects, including nausea and constipation, which cause large numbers of patients to stop taking them. But what is not discussed is a major subject of concern in the medical community: the metabolic dangers of “weight-cycling,” when the fat returns if patients stop taking the drugs (a common occurrence) and the risk of cardiovascular events increases. Eli Lilly said that its promotional materials carefully adhere to the FDA-approved label and that it views obesity as a chronic disease that may need continuous treatment, otherwise the weight can return.
The drugs also are being prescribed to people with eating disorders, as well as the elderly, who are at risk of falls and fractures if they lose too much bone and muscle mass — a serious concern with the rapid weight loss driven by GLP-1s.
The drugs carry “black box” warnings from the Food and Drug Administration that they can cause cancer in rats and state that they could cause thyroid cancer in humans. Those warnings are prominently displayed in marketing materials.
Campos said he believes in the revolutionary nature of the drugs, which are remarkably effective at reducing weight and simultaneously bringing down blood pressure, lowering cholesterol, and reducing inflammation. From his home practice in New Braunfels, Texas, near San Antonio, Campos travels to states such as Ohio, Kentucky, and Tennessee to meet with groups of doctors, he said.
Many of his colleagues did not learn how to treat obesity in medical school, Campos said. When he asks for a show of hands, he said, about a third of doctors in a room indicate they do not believe obesity is a disease, even though the American Medical Association recognized it as one in 2013.
“You need to know this,” he said he tells other doctors, “to develop a tremendous empathy for this patient that needs your help. Now we have tools in our toolbox that we can use to help them.”
Expounding on a clinical trial finding that semaglutide, the key ingredient in Novo Nordisk’s Wegovy and Ozempic, can reduce heart attacks, Campos said, “cardiologists should be writing [prescriptions for] this with both hands.”
Drug companies have marketed medicines directly to doctors for decades. It is even recognized by the Food and Drug Administration as an important source of information for prescribers. FDA rules require that promotional claims stay within the boundaries of scientific evidence contained in a drug’s label. But the dangers of the practice emerged during the opioid crisis that began in the 1990s, when Purdue Pharma, the manufacturer of OxyContin, and other companies were found to have heavily marketed addictive opioids while minimizing risks.
Doctors say the trips to the Caribbean and free booze of the past are no longer common, but free steak dinners and in-office lunches continue to be a staple of the trade. Nowadays, if doctors at the dinners want an alcoholic beverage, they have to purchase their own, participants said.
“When a drug company is financing it, they present it in the best possible light,” said Bruce Rowe, a Wisconsin physician who recalled attending an event about Wegovy led by a colleague at Mr. B’s steakhouse outside Milwaukee. “Any time you go to one of these presentations, you have to have a little bit of skepticism.”
He said the clinical trial data in the event’s slide deck was encouraging, but what really won him over were results in patients, who lost weight and had better glucose control. About 25% of his patients are now taking one of the drugs, he said. “It’s a really important tool in our tool kit right now.”
Medication for life
Paying physicians has raised questions of conflict of interest. Decades of research has shown that financial relationships between physicians and pharmaceutical companies are associated with higher prescribing rates of the sponsoring company’s drugs. Even relatively modest financial relationships can potentially create unconscious bias, making industry payments to influential doctors a persistent ethical issue in medicine, according to researchers who have examined the question.
In interviews about GLP-1s, some physicians paid by Eli Lilly and Novo Nordisk said a part of their effort has been helping other physicians overcome hesitancy. Many providers are wary of prescribing a costly new drug that a patient probably will need to take for many years, if not for life, to keep their weight under control.
Doctors also ask how and when they can wean patients off the drugs.
“The first question is always, ‘When do you stop the medication?’” said Ethan Lazarus, an obesity medicine doctor who practices outside of Denver and has been paid about $585,000 to promote the drugs.
He said he tries to reset their expectations: “We should go into this with our eyes wide-open, that these are long-term treatments.”
He added, “If they want to have a successful practice, they need to understand how to use these drugs.”
Responding to critics of paid arrangements for key opinion leaders, Lazarus cited American Medical Association ethical guidance that he said “permits legitimate consulting and educational programs, provided the physician offers genuine, objective scientific services.”
Interviewed by phone recently from his car, Long Island obesity medicine doctor Michael Kaplan said he was on his way to meet with four doctors over lunch to promote Foundayo, Eli Lilly’s oral GLP-1. He said he would meet an Eli Lilly sales representative for a pregame huddle 10 minutes before the meeting.
Kaplan disputes that drugs such as Wegovy and Foundayo are overprescribed. On the contrary, he said just 11% of people with a body mass index (BMI) over 40 are being treated with a GLP-1.
“The market is gigantic,” he said.
Obesity doctors say their field has long been neglected by the medical establishment. Now, Kaplan said, promotional efforts by Eli Lilly and Novo Nordisk are helping educate physicians on how to treat obesity. Weight-loss clinics once operated on the fringes of healthcare, but that began to change after the American Medical Association recognized obesity as a disease in 2013.
“The medical establishment hasn’t stepped up. The pharmaceutical industry has been the only ones trying to make sure the providers have knowledge,” said Kaplan, who was paid about $648,000 between 2018 and 2025 by GLP-1 manufacturers.
Critics of these practices say the paid physician ambassadors may not be giving a full, objective picture of the drugs and their side effects.
“They are generally chosen for their charisma and their willingness to say what the drug company wants them to say,” said Steven Brown, a family physician in Phoenix who has urged doctors to refuse drug company largess, including meals and free samples, which he said distort physician decision-making.
“The drugs sell themselves,” he said of the GLP-1s. “The reason for all this marketing is the competition between the companies to sell more of theirs compared to the others.”
Doctors interviewed by The Post acknowledged competition between Eli Lilly and Novo Nordisk may be boosting the number of meetings, but said competition also is driving innovation and bringing down prices, which is improving clinical outcomes. They disputed the contention they are parroting corporate talking points.
“‘Pay-to-play’ prescribing or accepting compensation just to say what a company wants is unequivocally unethical,” Lazarus said, again citing AMA guidelines.
Many of the 50 doctors who have received the most money from the drug companies are also among the country’s most influential voices on obesity and diabetes.
They include leaders of the nation’s most prominent medical societies in endocrinology and obesity, who write or help shape clinical guidance. Physicians who lecture in continuing medical education programs, and a few who have helped shape the conversation around GLP-1 drugs though their public platforms on YouTube and podcasts, also are part of the marketing push.
Medical practice remains deeply local and hierarchical. Physicians look to respected colleagues to help interpret new evidence, establish standards of care, and signal which treatments are worth adopting — whether a patient’s best option is a new drug, an older generic medication, a lifestyle intervention, or watchful waiting.
John E. Anderson, a former president of medicine and science for the American Diabetes Association who held substantial leadership roles in the organization for more than two decades, received nearly $1 million from 2018 through 2025, the fifth-highest-paid doctor, according to The Post’s analysis.
He was the lead author of an ADA journal article in 2022 about optimizing the use of GLP-1 drugs in Type 2 diabetes and moderated an ADA educational series about the drug class that same year.
The 2022 GLP-1 article states that Anderson served “as an adviser, consultant, and/or speaker” for Eli Lilly and Novo Nordisk, among several other drug or device companies. The educational materials were funded by a grant from Novo Nordisk, which was disclosed. The ADA said in a statement that Anderson did not serve as a subject matter expert or peer reviewer for the organization’s guidelines on care for diabetes or obesity for 2017 to 2026.
Anderson, an internist and diabetes specialist at the Frist Clinic in Nashville, a medical group affiliated with TriStar Centennial Medical Center, declined to comment. TriStar did not respond to questions and declined a request to interview Anderson, but said in a statement that many of its physicians “may share their knowledge through educational, advisory, or consulting work with pharmaceutical and medical device companies” in compliance with federal laws and regulations, as well as the company’s processes.
The Obesity Medicine Association’s past president and chief science officer, its president-elect, and three trustees all received payments ranging from $14,000 to $95,000 during the time period studied, with some receiving multiple payments over that time.
The OMA declined to comment on specific individuals but said in a statement that it requires all those involved in continuing education to disclose their financial ties and that they are reviewed by a separate committee.
“Industry funding never gives a company control over topics, faculty, content, or evaluation. We believe this process is effective, and we continue to strengthen it as the standards and the evidence evolve,” the group said.
Aaron Kesselheim, a professor of medicine at Harvard University who studies relationships between doctors and drug companies, said influencing a relatively small network of highly respected clinicians can have ripple effects throughout the medical community, making these relationships a powerful part of the industry’s marketing strategy.
“While there’s nothing wrong with professionals talking among each other, and sharing business practices and approaches to prescription drugs, this system can be fudged to market drugs,” Kesselheim said. “There’s the question of how much of their recommendations are driven by review of science and how much by industry’s marketing.”
Many medical societies have adopted conflict-of-interest policies intended to insulate clinical recommendations from financial influence. But Meredith Rosenthal, a professor of health economics and policy at the Harvard T.H. Chan School of Public Health, said research suggests those policies are unevenly enforced.
“So when you see a recommendation, you want to believe they are based on best evidence and not financial conflict, but you really don’t know,” she said.
A unique U.S. model
The United States is unusual in allowing pharmaceutical companies to make direct payments to physicians for activities such as speaking, consulting, and advisory work. In many other countries, the dissemination of information about new treatments is more often coordinated through independent professional bodies, academic institutions, or organizations funded by governments or nonprofit groups.
Efforts to move the United States toward a similar model have repeatedly failed.
Doctors who participate in the system said they saw no ethical dilemma. Robert Busch, who treats diabetes patients at Albany Med Health System in New York, topped the list of doctors receiving payments related to GLP-1 drugs from 2018 to 2025, with $1.2 million. He also conducts research, which allows him to speak to doctors about clinical trials that he helped lead.
“I’m educating my peers. I feel very good about that,” he said, “and I hope that leads them to benefit their patients, as I do my own.”
A review of the content of promotional material for Zepbound, Eli Lilly’s blockbuster weight-loss drug, shows how the promotional and educational missions are intertwined. A slide deck presented to doctors by paid peers and obtained by The Post is largely dedicated to clinical trial results, interspersed with more colorful depictions of actors posing as patients.
“When patients like Andrea and Alan are ready to take the next step, how do you get them off to a good start?” says one of the slides, showing the actors alongside a fine-print disclaimer that mentions the potential for thyroid cancer associated with Zepbound.
The doctors interviewed by The Post declined to discuss or share specific slide decks, citing confidentiality agreements with the drug companies. In general, they said the materials strictly observe FDA rules, and reflect prescribing information and clinical studies cited in the product label.
The Post asked a leading researcher and critic of drug company promotional activities, Georgetown professor Adriane Fugh-Berman, to review the slide deck.
What the 75-slide presentation leaves out is telling, Fugh-Berman said. It does not substantially discuss the weight people often regain when they stop taking the drug, and does not include any information about how common it is for people to stop in the real world, outside of clinical trials, she said. Adherence rates to GLP-1 drugs for weight loss in the United States have been shown to be 60% or less.
“Of course the company would like it to be taken indefinitely, but no evidence supports either efficacy or safety for long-term use,” she said.
The presentation is an example of how Eli Lilly is using its promotional savvy to directly influence the medical community’s views, Fugh-Berman added.
“They have controlled the discourse on weight and health so that people equate thinness with health, and that is just wrong,” she said. “You can be fat and healthy. You can be thin and unhealthy.”
Eli Lilly did not respond directly to Fugh-Berman’s critique. It said Zepbound has been shown to be safe and effective in clinical trials, including one that tracked 13,000 patients over four years. Its promotional slide deck, on Page 61, contains information about weight regain among subjects in a clinical trial who were switched to a lower dose as well as a placebo.
Specialists said more study of the drugs is needed. David Ludwig, a Harvard University professor and endocrinologist at Boston Children’s Hospital whose work focuses on improving people’s diet, said he has struggled to scrape together money for a clinical trial to test, in combination with GLP-1 use, whether a low-sugar, low-carbohydrate diet can reduce obesity and cardiometabolic outcomes.
He said he has asked the major manufacturers of GLP-1s for funding, with no success. Eli Lilly and Novo Nordisk did not confirm or discuss the request but said they review all grant requests.
“If your only tool is a hammer,” Ludwig said, “then you are going to want to make an argument to keep hammers available for lifelong use.”
Methodology
The Washington Post analyzed data from the Centers for Medicare and Medicaid Services’ Open Payments program for 2018 through 2025, the most recent year available. The analysis covers general payments — the category that includes payments pharmaceutical companies make to doctors and other licensed prescribers for meals, travel, speaking fees, consulting and similar services.
To identify classes of drugs and the conditions they treated, The Post matched each drug’s national drug code to a standardized identifier called an RxCUI. This was used to link a medication’s brand name in the Open Payments data to its generic ingredient (for instance, Ozempic to semaglutide). The Post then matched each RxCUI to a drug class as defined by the World Health Organization’s Anatomical Therapeutic Chemical (ATC) Classification System — such as GLP-1s, blood thinners and antipsychotics. Where no ATC classification was available, other federal drug-classification sources were used to fill gaps. Nearly 450 drug groups were identified in the CMS Open Payments data. The drugs included in the GLP-1 group were: Bydureon, Byetta, Mounjaro, Ozempic, Rybelsus, Saxenda, Soliqua, Trulicity and Zepbound.
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