The most body-conscious cities are not in Los Angeles or New York, but in small towns in the South!
Bowling Green, KY., located about an hour north of Nashville, Tennessee, has gained a reputation for having the highest rate of use of prescriptions for diabetes treatment (Ozempic) in the United States.
However, the practical use of these diabetes drugs is as a primary tool for weight loss. The abuse of the drug has even led to an unprecedented “diet drug” movement in the region.
Hot market
Bowling Green is located in the U.S. state of Kentucky and is known for its history, educational institutions and industry, and is also the home of Western Kentucky University.
Bowling Green is perhaps best known for being home to a General Motors assembly plant that produces the Chevrolet Corvette. The city was once the birthplace of mid-20th century food guru Duncan Haynes. Ten years ago, the suburbs were dotted with farms. Today, Bowling Green, Kentucky’s third-largest city with about 74,000 residents, has been replaced by shopping malls and freeways. While there are a few bus services and bike lanes, most people still rely on cars to get around, and traffic can be very congested during rush hours. Residents say there isn’t much to do for entertainment other than eat, while restaurant options are so plentiful that the city is even rumored to have more restaurants per capita than any other city in the United States.
The median household income in Bowling Green is about $46,000. Although the city is small, it is leading a special health “trend” across the country. Bowling Green has the highest number of Ozempic prescriptions in the country, with 6.8 percent of residents using the drug. Ozempic, an injectable drug with semaglutide as its main ingredient, was originally approved for blood sugar control in people with type 2 diabetes. However, because of its remarkable weight loss effect, the drug is now also widely used for weight loss.
By comparison, metropolitan areas such as Brooklyn and Miami in New York City use only about 1 percent. This shows that Bowling Green is not only the “front line” of diabetes treatment, but also a rapidly growing market for drug weight loss.
Surge in demand
Bowling Green is now known as the Ozempic Capital. According to PurpleLab Inc., which tracks prescriptions covered by most insurance companies, Kentucky has the highest rate of use of diet pill prescriptions in the country. In Bowling Green and the surrounding area, at least 4 percent of residents received a prescription for such drugs within the past year, ahead of other major population centers in the state. Notably, these figures do not include people who get generic drugs out of pocket or through small pharmacies, online telemedicine providers and medical spas, which have become an important part of the Bowling Green weight-loss drug market. The popularity of such drugs in Bowling Green is all the more striking given that Kentucky’s Medicaid program does not cover them.
In Bowling Green, stores such as pharmacies, clinics and even GNC have seen a surge in demand for drugs. However, this tendency to rely on drugs to solve the problem of obesity has also brought some negative effects. The boom in the market has led to the emergence of a variety of quick-acting imitations. Local resident Candace SIMS ‘son once became ill after using a generic supplement. “He just wanted to try it because all his friends were doing it,” she said.
In addition, medical spas and weight loss clinics have been quick to join the drug weight loss “storm.” By prescribing products like Ozempic, these agencies have attracted a large number of consumers looking to lose weight. Bowling Green resident Mary Ellis managed to lose 80 pounds after using Mounjaro, a similar drug. She said: “I suspected it was only for ‘Hollywood’ people, but now I can lose weight this way too.”
Bowling Green’s drug fad is not just a health trend, it’s a cultural shift. Residents began seeking cheaper alternatives, and some medical spas began offering them, attracting crowds. Ellis notes that the traffic is so heavy, “if you go at 8 a.m. or earlier, you won’t find any parking.”
Almost everyone in Bowling Green knows a friend who is using drugs like Ozempic, or they are using them themselves. The Doctors Diet Program, a weight-loss clinic that offers injectable drugs, always has a packed waiting room. The phone at the local pharmacy kept ringing to see if the medicine was in stock. “All I hear is Ozempic and Wegovy,” said Brianna Tooley, a pharmacist at a Walgreens in town. Denmark-based Novo Nordisk A/S, the maker of Ozempic, has at least six sales representatives in Bowling Green and regularly hosts events in partnership with local pharmacists.
New challenge
The phenomenon in Bowling Green reflects a broader national trend: Certain specialty drugs are being used not only to treat diseases but also as a means to improve lifestyle. While such drugs have been effective in weight loss, their widespread use has also raised concerns about potential side effects and abuse, especially among people who do not have diabetes but are using the drugs solely for weight loss.
Reasons Bowling Green has become a weight-loss drug capital include Kentucky’s higher obesity rate and insurance plans offered by several large employers that cover the cost of injections that would otherwise cost up to $1,000 a month. Even locals without insurance are willing to pay out of pocket. “We rednecks are fat, but smart enough to do something about it,” said Mary Sanson, a recently retired teacher. Remarkably, she had not received any vaccinations, but she was willing to take Ozempic.
Similar situations exist around the world. Billions of people worldwide suffer from obesity, many of them with associated health problems. In just a few years, the needle spread so fast that drugmakers could not keep up with demand and had to limit supply to countries outside the United States. While tens of millions of Americans are using diet needles, considering them or discussing their effects with doctors, friends and neighbors, this relatively unknown city in southern Kentucky is a harbinger of what is to come in other communities.
In Bowling Green, family-run pharmacies began mixing their own drugs and profiting from them. Medical spas and weight-loss clinics, which write prescriptions for anyone who wants to lose weight, have increasingly competitive businesses – sometimes within blocks of each other. Keith Hewitt, a local obstetrician and gynecologist, began advertising on Bowling Green’s main street after one of his chief medical assistants was poached by a nearby medical spa. “They poached her straight from my staff,” he said. “They knew she had a lot of experience with weight loss injections.”
This new economy is so large that it is difficult to sustain itself. The high demand prompted many regional employers and some insurance companies to stop covering the drugs. Supply shortages have forced those most in need to turn to loosely regulated combination drugs, which are readily available at medical spas and weight-loss clinics. And even those drugs are getting harder to find.
On the other hand, the widespread use of diabetes drugs can lead to tight drug supplies and increase the risk of adverse reactions. Side effects include nausea, vomiting and diarrhea, and long-term use can lead to more serious health problems.
Health care experts say the Bowling Green phenomenon is a microcosm of obesity and metabolic disease management in the United States. In this small city, drugs have become the preferred solution to the problem of obesity. However, whether this over-reliance on drugs is sustainable is still a question worth pondering. In the future, Bowling Green and other areas like it across the country will face new challenges in balancing drug use with health management.