Recently, after I delivered a lecture to a group of frum women on the Torah perspective on weight-loss medicine, a slim woman named Chani came over and said, “My sister, Dina, weighed 250 pounds. Her health was terrible. Ozempic is a miracle drug—she is now a size 4. Her diabetes disappeared, and her blood pressure and cholesterol are normal.” She paused, then added, “Can you write a prescription for me? I want to fit into a size 2 for my daughter’s wedding.”
Chani and Dina have different reasons for seeking weight-loss medication, illustrating two sides of a complex issue.1
Obesity is a public health crisis in the US. In 2020, nearly 75 percent of Americans were overweight, and 42 percent were obese. One in five children is obese. Orthodox Jews are not immune. Our rates of obesity are similar to—or perhaps even higher than—those of the general population.2 Moderate obesity reduces life expectancy by about three years; severe obesity cuts it by about ten.
Excess weight increases the risk of high blood pressure, high cholesterol, diabetes, heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, asthma, cancer, Alzheimer’s, depression and infertility among other health issues—as well as overall mortality. The longer one is obese, the greater the risks. Losing just 5 to 10 percent of one’s total body weight (10–20 pounds for a 200-pound person) can make a real difference.3
Dina had long struggled with her weight. The cycle of losing pounds only to gain them back was frustrating. Diet and exercise were not enough. In fact, 80 percent of people who lose weight regain half of it within five years.4 She wasn’t lacking willpower; rather, to lose weight and keep it off, she needed to overcome her body’s set point—the weight range your body naturally tries to stay at.
Ozempic is part of a new class of drugs, which mimics a naturally occurring hormone, that decreases appetite, delays gastric emptying, and creates a feeling of fullness to help sustain weight loss.5 These drugs were originally developed to treat diabetes but have been found to trigger weight loss in many people.6 Medical organizations recommend weight-loss medicine—as part of a comprehensive plan that includes nutrition, physical activity and behavioral counseling—for individuals with a BMI of 30 kg/m2, or 27 kg/m2 with comorbidities, who have failed to achieve significant weight loss.
Dina’s program ensured that she met eligibility requirements and screened her for medical issues that could make her ineligible for the drug.7 She suffered no side effects—neither the common ones, like nausea, vomiting and abdominal pain, nor the less common ones, such as allergic reactions and gallstones.8 Her results were astounding.
Beyond dramatic weight loss, these medicines also decrease blood pressure, cholesterol, and triglycerides, and improve glucose regulation. They reduce the risk of heart attack, stroke, and cardiac death by 20 percent in obese adults with pre-existing heart disease but without diabetes. Since these drugs are still relatively new, their full impact on disease prevention is not yet known. One study anticipates they could prevent 46 million heart attacks over ten years.
To maintain the benefits, Dina will need to continue these medicines and lifestyle interventions indefinitely. People who discontinue them typically regain two-thirds of their weight loss and lose the associated health benefits.9
Weighty Matters: Taking Ozempic for Cosmetic Purposes
While Dina uses the medication to manage her chronic health conditions, the cosmetic use of weight-loss medicine is on the rise. One expert speculates that millions of healthy-weight individuals may now be using these drugs.10 Some in the Orthodox community who are not obese use them for quick weight loss before a simchah or to improve their prospects for a shidduch.11
In general, prescribing an FDA-approved drug off-label—for uses other than those for which the drug was approved—is legal. However, physicians strongly disapprove of using weight-loss medicine as a quick fix because these drugs have not been studied in healthy-weight individuals and may pose dangerous side effects for this population. They can cause healthy-weight people to become underweight and reduce muscle mass to dangerously low levels. Additionally, they might contribute to the development of eating disorders.12
As these drugs become more common, how will they affect fat stigma and our ongoing obsession with thinness?
Those who use these medicines off-label often obtain them through telehealth platforms or medical spas that do not rigorously evaluate patients, screen for potential contraindications, or monitor for complications.13 Furthermore, the surge in public demand for these medicines reduces their availability for those who need them to treat diabetes or obesity, exacerbating already difficult supply shortages. For these reasons, the American Medical Association (AMA) has stated that these medicines are approved for the treatment of obesity and not for cosmetic weight loss.14
Eli Lilly, one of the leading manufacturers of weight-loss drugs,15 explicitly states that these medicines “were not studied for . . . and should not be used for cosmetic weight loss.” This condemnation from a company that stands to profit from off-label use reinforces the medical community’s distaste for the drugs’ cosmetic application.16 Insurance companies have threatened to report suspected inappropriate or fraudulent prescribing practices to state licensure boards as well as federal and state law enforcement agencies. Florida restricts the prescription of weight-loss medicine to patients who meet strict BMI requirements. The English Joint Council for Cosmetic Practitioners calls prescribing weight-loss drugs for cosmetic purposes a public safety hazard and warns that prescribers may face regulatory scrutiny.17
As the cosmetic use of weight-loss medicine becomes increasingly common, the medical-legal community must clearly define the consequences. In the meantime, prescribing Ozempic for Chani may not be illegal, but depending on the jurisdiction, it could carry medico-legal implications.
Halachic Perspectives
Despite the fact that Dina is using weight-loss medication for legitimate health reasons, her doing so raises several halachic questions. First, may she take a medication that might cause long-term harm?
In two teshuvot, Rabbi Eliezer Waldenburg permits a terminally ill patient to take pain medication that does not treat the underlying disease and might hasten death. He reasons that as long as a physician administers the medication and its purpose is to relieve terrible suffering, verapo yerapeh—the physician’s license to heal—justifies any untoward effects that might arise.18 Based on these teshuvot, one might conclude that halachah permits Dina to take the drug despite its known risks, even without long-term safety data, since it has regulatory approval and is prescribed for a medical purpose.
Secondly, because weight-loss medicine is administered by injection, is Dina violating chovel—the prohibition against causing a wound? In this case, the injection may be permissible, as halachah generally rules leniently regarding injection wounds;19 the prohibition may not apply to wounds that result from a medical procedure20 or are inflicted for a purpose; according to Rambam, chovel only applies to wounds intended to humiliate.21 Pharmaceutical companies are developing oral formulations of these drugs—which would eliminate chovel concerns altogether.22
Finally, does the restriction of food intake caused by these medicines violate the prohibition against self-harm? Rabbi Moshe Feinstein permitted a woman to diet,23 arguing that the prohibition against self-harm obligates people to follow medically prescribed diets, since failure to do so would cause extreme suffering from obesity-related diseases. For Dina, Ozempic arrested this risk, preventing debilitating complications and adding years to her life. Thus, drawing on Rav Moshe’s teshuvah, halachah not only permits Dina to take Ozempic but requires it. Here, weight-loss medicine falls under the mitzvah of v’nishmartem me’od l’nafshoteichem (the obligation to preserve one’s health) and the general duty to prevent disease. If a doctor recommends weight-loss medicine, halachah obligates the patient to comply as part of the broader obligation to follow medical advice.24
Cosmetic Conundrums
While Jewish law embraces the use of weight-loss medicine to manage obesity, its response to cosmetic use is less clear-cut. One potential parallel lies in teshuvot addressing the halachic permissibility of cosmetic surgery, which tests the boundaries of what is allowed in the pursuit of improved appearance. Cosmetic procedures may violate chovel, interfere with G-d’s design and expose individuals to risk for nonmedical reasons—raising the question of whether verapo yerapeh even applies.
Rabbi Eliezer Waldenburg takes the most stringent view, prohibiting cosmetic surgery on these grounds and arguing that it implies G-d’s creation is flawed.25 However, he does distinguish between procedures purely for aesthetic reasons and those that restore the body to its original state.
In contrast, the Chelkat Yaakov, Rabbi Yaakov Breisch, permits a young woman to undergo cosmetic surgery to improve her appearance in order to find a spouse, since it is done to relieve tza’ar (mental anguish).26 He cites Shabbat 50b, which allows a person to remove scabs if they cause pain. Tosafot (s.v. bishvil) add: “If the only pain he suffers is the embarrassment of walking among people, it is permitted—because there is no greater pain than this.” Rabbi Breisch suggests that Tosafot’s definition of pain includes psychological distress.
He concludes that, since the risks are low, one may undergo surgery for a non-life-threatening condition, particularly because shomer peta’im Hashem—the principle that one may engage in potentially dangerous activities that society has demonstrated a willingness to accept—might justify any residual risk.
Fifty percent of thirteen-year-old girls are already unhappy with their bodies; by age seventeen, that number rises to 80 percent. Will these drugs lead to eating disorders among Orthodox Jews?
Rabbi Menashe Klein permits a young woman to undergo plastic surgery to correct a facial imperfection that interfered with her ability to find a spouse,27 citing Talmudic precedents that allow medical interventions to improve one’s appearance.28 Rav Moshe also permitted such procedures,29 when it alleviates suffering or embarrassment, invoking v’ahavta l’rei’acha kamocha. It would seem that the reasoning is that improving one’s appearance—when it removes distress—constitutes an act of chesed and is consistent with the Torah’s mandate to love and respect others (including oneself). It is unclear whether Rav Moshe’s teshuvah is limited to cases of significant need. Finally, Rabbi Shlomo Zalman Auerbach asks rhetorically why halachah would prohibit surgery aimed solely at restoring a normal appearance. He writes, “If the plastic surgery is done to prevent suffering and shame caused by a defect in his looks . . . this would be permitted based on the Tosafot and the Gemara, since the purpose is to remove a blemish.”
Nevertheless, he adds, “If the only reason is for beauty, this is not permitted.”30
Do the teshuvot that permit cosmetic surgery also apply to the cosmetic use of weight-loss medication?
The risks associated with these drugs may be lower, since they do not involve surgery. Even Rabbi Waldenburg’s categorical prohibition against plastic surgery might leave room for the cosmetic use of weight-loss medication, since it can be viewed as restoring the body to its original, thinner form. On the other hand, one must ask: why does Chani want to use Ozempic? Does she meet Tosafot’s definition of tza’ar—psychological distress so severe that she is embarrassed to “walk among people”? Is she truly uncomfortable in her current state to the point of not wanting to be seen at her daughter’s wedding?
Furthermore, in order to receive Ozempic for cosmetic purposes, Chani would either have to lie about her weight to a telehealth provider or find a healthcare provider who disregards the clinical guidelines—raising several halachic concerns. These include prohibitions against sheker (lying), geneivat da’at (being deliberately misleading), mesayei’a l’dvar aveirah (enabling another to sin) and lifnei iver (placing a stumbling block before the blind).
If these medicines are in short supply, the halachic implications intensify: is it permissible to use them for non-medical, cosmetic reasons when doing so may deprive those who genuinely need them to treat diabetes or obesity?
Although the medical community generally views cosmetic surgery as an acceptable intervention, the AMA disapproves of using weight-loss medications for purely cosmetic purposes.31 This disapproval may undermine halachic comparisons between cosmetic surgery and the cosmetic use of weight-loss drugs. Can the principles of verapo yerapeh and shomer peta’im Hashem justify the risks, given the medical community’s condemnation of this practice?
If halachah prohibits the cosmetic use of these drugs, might it distinguish between different types of users—such as between men and women, or between young women hoping to improve their shidduch prospects and already-married women seeking to enhance their appearance for a family simchah? Conversely, if halachah permits such use, should Torah-observant Jews still avoid it due to the unresolved halachic, ethical and societal concerns?
As the use of these medications becomes increasingly common in the Orthodox community, posekim will need to consider these issues and determine whether such use parallels that of cosmetic surgery, which halachah generally permits. The introduction of medicines for treating obesity and obesity-related diseases also requires us to consider their broader implications for our community. Rabbi Auerbach’s teshuvah raises questions about what we consider normal. Does body size define that? And if it does, what size do we view as normal? As these drugs become more common, how will they affect fat stigma and our ongoing obsession with thinness? On the one hand, if these medicines make thinness easy to attain, perhaps we will desire it less. Perhaps they will increase our compassion for those who are overweight, since the drugs highlight the difficulty of maintaining weight loss. On the other hand, if becoming thin is so easy, we may begin to see it as a basic aspect of self-grooming—leading to the expectation that those who are overweight should take these medicines. This perspective could reinforce weight stigma and undo decades of efforts to promote body positivity.
In a society where appearance holds such importance, many of us will feel compelled to do more. Fifty percent of thirteen-year-old girls are already unhappy with their bodies; by age seventeen, that number rises to 80 percent.32 Will these drugs lead to eating disorders among Orthodox Jews?33
These questions are critical as our community grapples with the role of weight-loss medicines. Doctors, pharmaceutical companies, the healthcare industry and patients must work together to prevent the misuse of these drugs and ensure that those who need them receive them.34 Moving forward, we must heed Rabbi Waldenburg’s warning that our obsession with beauty contradicts Torah values: “Beauty is vain. A woman who fears G-d—she is to be praised.”35
My conversation with Chani evoked conflicting emotions: awe at the miracle drug that could reverse the obesity epidemic; hope for those like Dina who struggle with obesity; and fear that our medical ability to induce weight loss will reinforce weight stigma, an overemphasis on external appearances, and eating disorders. Dr. David Kessler, the former FDA commissioner who led the fight against the tobacco industry, states, “The fight against tobacco . . . has been the great public health success. Obesity has been the great public health failure.”36 Armed with these new medicines, we stand at a defining moment in the battle against obesity-related diseases. If we use them judiciously, we have the potential to save countless lives and fulfill Hashem’s mandate to eradicate illness.
Notes
1. For a complete discussion of obesity and its management in Jewish law, see my forthcoming book,The Cure Before the Illness: Disease Prevention in Jewish Law(Maggid Books). I would like to thank Dr. Jody Dushay, assistant professor of medicine at Harvard Medical School and attending physician in the Division of Endocrinology and Metabolism, for taking the time to discuss weight-loss medicine with me and for reviewing the manuscript. Her input greatly enhanced this article.
2. Katelyn Newman, “Obesity in America: A Public Health Crisis,”US News & World Report, Sept 19, 2019; Craig M. Hales et al., “Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age,2007–2008 to 2015–2016,” JAMA 319, no. 16 (Apr 2018): 1723–25, https://doi.org:10.1001/jama.2018.3060. Obesity is defined as having a body mass index (BMI) of 30.0 or higher. Severe obesity is defined as having a BMI of 40.0 or higher. https://www.cdc.gov/obesity/adult-obesity-facts/index.html; https://www.cdc.gov/obesity/childhood-obesity-facts/childhood-obesity-facts.html; Maureen R. Benjamins et al., “A Local Community Health Survey: Findings from a Population-Based Survey of the Largest Jewish Community in Chicago,” Journal of Community Health 31 (Dec 2006): 479–95, https://doi.org./10.1007/s10900-006-9025-5; https://www.cityhackneyhealth.org.uk/wp-content/uploads/2019/08/Orthodox-Jewish-Health-Needs-Assessment-2018.pdf.
3. https://www.cdc.gov/diabetes/living-with/healthy-weight.html;
https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#what-is-known-about-the-relationship-between-obesity-and-cancer-. The American Cancer Society attributes 11 percent of cancers in women, approximately 5 percent of cancers in men, and 7 percent of all cancer deaths to excess body weight—about 40,000 deaths each year. (This figure does not include deaths from other obesity-related illnesses and conditions.) https://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/health-effects/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497590/.
4. https://www.sciencedirect.com/science/article/abs/pii/S0025712517301360?via%3Dihub.
5. https://health.clevelandclinic.org/set-point-theory/.
6. These weight-loss medications are part of a class of drugs known as glucagon-like peptide-1 receptor agonists (GLP-1s). Semaglutide is a GLP-1 agonist, while tirzepatide is a dual agonist, acting on both the GLP-1 receptor and the glucose-dependent insulinotropic polypeptide (GIP) receptor. At lower doses for treating diabetes, semaglutide is marketed as Ozempic; at higher doses for treating obesity, it is sold under the nameWegovy.Tirzepatide is marketed as Mounjaro for diabetes and as Zepbound for obesity.
7. This is the recommendation of the Obesity Society, the EndocrineSocietyand the American Association of Clinical Endocrinologists. https://www.ncbi.nlm.nih.gov/books/NBK279038; https://time.com/6285055/wegovy-teenagers-weight-loss-risks/.
8. Liyun He et al., “Association of Glucagon-Like Peptide–1 Receptor Agonist Use with Risk of Gallbladder and Biliary Diseases: A Systematic Review and Meta-analysis of Randomized Clinical Trials,”JAMA Internal Medicine182, no. 5 (May 1, 2022): 513–19, https://doi.org/10.1001/jamainternmed.2022.0338.; E Pérez et al., “A Case Report of Allergy to Exenatide,” Journal of Allergy and Clinical Immunology, Practice 2, no. 6 (Nov–Dec 2014): 822–23; and https://eposters.ddw.org/ddw/2024/ddw-2024/414874/piyush.nathani.incidence.of.gastrointestinal.side.effects.in.patients.html.
9. https://www.acc.org/Latest-in-Cardiology/Articles/2023/08/10/14/29/SELECT-Semaglutide-Reduces-Risk-of-MACE-in-Adults-With-Overweight-or-Obesity;https://www.nejm.org/doi/full/10.1056/NEJMoa2307563; https://pmc.ncbi.nlm.nih.gov/articles/PMC9542252.
10. Personal communication with Dr. JodyDushay, August 2025.Thirty percent of plastic surgeons reported having used weight-loss medicine; of these, 70 percent indicated that they did so for cosmetic weight-loss alone. https://pubmed.ncbi.nlm.nih.gov/38085071;
Nathan D. Wong, Hridhay Karthikeyan, and Wenjun Fan, “US Population Eligibility and Estimated Impact of Semaglutide Treatment on Obesity Prevalence and Cardiovascular Disease Events in US Adults,” Journal of the American College of Cardiology, Aug 2023, https://doi.org/10.1016/S0735-1097(23)02259-3; https://www.today.com/health/celebrities-on-ozempic-rcna129740.
11. https://jewinthecity.com/2025/03/does-judaism-allow-you-to-take-ozempic-and-other-weight-loss-drugs/.
12. Personalcommunication with Dr. JodyDushay, August 2025. https://www.medscape.com/viewarticle/983004#vp_2; D.C.D. Hope and T.M.M. Tan, “Skeletal Muscle Loss and Sarcopenia in Obesity Pharmacotherapy,” Nature Reviews Endocrinology 20 (2024): 695–96 (2024), https://doi.org/10.1038/s41574-024-01041-4; https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14725; and https://time.com/6290294/weight-loss-drugs-ozempic-demonization-essay/.
13. Personalcommunication with Dr. JodyDushay, August 2025. Some telehealth platforms accept patients based on patient report. https://www.newyorker.com/magazine/2023/03/27/will-the-ozempic-era-change-how-we-think-about-being-fat-and-being-thin; https://magazine.ucsf.edu/weight-loss-drugs-too-good-to-be-true.
14. https://www.ama-assn.org/public-health/chronic-diseases/what-doctors-wish-patients-knew-about-anti-obesity-medication. Despite these concerns, some doctors are writing prescriptions for weight-loss medicine purely for cosmetic purposes.https://beverlyhillscourier.com/2023/11/16/the-real-skinny-on-weight-loss/; Personal communication, Dr. Jody Dushay, August 2025.
15. https://www.cbsnews.com/news/2024-oscars-eli-lilly-ad-weight-loss-drug-mounjaro-ozempic.
16. https://www.youtube.com/watch?v=zYsU9ltnH8w.
17. https://www.washingtonpost.com/business/2023/06/11/weight-loss-ozempic-wegovy-insurance/?utm_campaign=KHN%3A%20First%20Edition&utm_medium=email&_hsmi=262066865&_hsenc=p2ANqtz-9rIvynBptFsvvj0doDkQYFbvNOgwtFzvPvqY3Lam5feDA5V4gdYZuELna20MTZAFOD_wqPN6lJvzvminl;https://www.lilesparker.com/2024/10/28/audits-and-investigations-of-semaglutide-and-other-glp-1-claims/?utm_source=chatgpt.com; https://www.jccp.org.uk/NewsEvent/prescribing-weight-loss-procedures-in-the-cosmetic-sector-1.
18. TzitzEliezer 13:87; 14:103.
19. MinchatShlomo 1:32.
20. Rema,YD241:3.
21. Rambam, Hilchot Chovel u’Mazik 5:1; Minchat Shlomo 1:32.
23. IggerotMoshe, Choshen Mishpat 2:65.
24. HaRefuahKeHalachah, v. 3, pp. 66–69; personal conversation with Rabbi Dr. Avraham Steinberg, July 2023.
25. TzitzEliezer 11:41.
26. ChelkatYaakov, Choshen Mishpat 31.
27. MishnehHalachot 4:426.
28. Ketubot72b discusses a case of a man who betroths a woman on the condition that she does not have a mum—a blemish that would disqualify a kohen from serving in the Beit Hamikdash. Tosafot on Ketubot 74b explain that if a physician had corrected the defect before the engagement, the marriage would still be valid. Since many of these blemishes include cosmetic facial imperfections (see Bechorot and Mishneh Torah, Bi’at Hamikdash 8), Rabbi Klein concludes that one may undergo cosmetic surgery to correct their appearance.
29. IggerotMoshe, Choshen Mishpat 2:66.
30. Cited inNishmatAvraham (YD, p. 62 and Choshen Mishpat, p. 113).
32. https://www.psychologytoday.com/us/blog/perfect-me/202310/will-weight-loss-drugs-change-our-ideal-bodies;https://now.org/now-foundation/love-your-body/love-your-body-whats-it-all-about/get-the-facts.
33. Althoughthe exact rate of anorexia in the Orthodox community is unknown, partly due to reluctance todisclose for fear of discrimination in shidduchim, its existence is acknowledged. A 1996 study found that the rate of anorexia among Orthodox Jewish girls in Brooklyn was 50 percent higher than that of the general population; however, the study was never published in a peer review journal. See https://www.nytimes.com/2011/04/12/health/12orthodox.html. A 2008 study found higher rates of anorexia in Jewish girls compared to their non-Jewish peers. Leora Pinhas et al., “Disordered Eating in Jewish Adolescent Girls,” Canadian Journal of Psychiatry 53, no. 9 (Sept 2008) 601–8, https://journals.sagepub.com/doi/10.1177/070674
34. https://oxsci.org/the-science-of-skinny.
35. Mishlei31:30.
Dr. Sharon Grossman is a writer and lecturer on medicine, public health and halachah. She has published widely in journals such as Tradition, Hakirah and the Lehrhaus as well as in medical literature. She is the author of the forthcoming book The Cure Before the Illness: Disease Prevention in Jewish Law (Maggid Books) and has lectured extensively to diverse audiences in Israel, as well as in Australia, Great Britain and the United States.