The Heroin Chic Is Back
This time it comes with a prescription.
My Medium friends can read this over on Medium.
One in nine American adults is currently taking a GLP-1 for weight loss.
One in nine. Not one in nine celebrities. Adults. Regular people.
The phrase came back before the bodies did, by the way. In November 2022 the New York Post announced that heroin chic was back and curvy bodies were out. Jameela Jamil told them that bodies are not trends, a lot of people agreed with her, and that seemed to settle it.
Four years later, the drugs made that headline true after all.
One in nine
Gallup asked 5,065 US adults in June. 11 percent said they are currently taking a GLP-1 for weight loss. Two years ago it was 3 percent. 15 percent have tried one at some point, and 91 percent know by now that these drugs exist for that purpose.
And the number is not spread evenly. KFF counts 15 percent among women against 9 percent among men, and 22 percent among adults between 50 and 64.
More than one in five, in the age group that runs the companies, the studios, and the schools.
The surveys disagree on the exact numbers, I should say. KFF lands at 12 percent overall, and a RAND survey of 8,793 adults found 11.8 percent had ever used one. That's a wide spread for a simple question. The direction is the same in all of them, though.
The runways
Vogue Business analyzed 9,038 looks from the Spring/Summer 2026 shows in New York, London, Milan and Paris. About 97 percent went to models in the smallest size bracket. Regular sizes got 2 percent. Plus-size 0.9.
The menswear report is worse. Roughly 2,500 looks in Milan and Paris, 0.2 percent plus-size. Milan had none at all.
Body positivity never got much above one percent of the runway. Not even at its peak.
To be fair
One fact makes the easy version of this article impossible to write.
The US adult obesity rate peaked at 39.9 percent in 2022. Gallup now has it at 36.4, and new diabetes diagnoses have leveled off too. (Gallup calculates obesity from self-reported height and weight, so the exact number is soft. The direction has held for a few years now.)
If you want to call all of this pure vanity, you have to explain those 3.5 points. I can't. The drugs work, they work for people who spent decades being told it was a willpower problem, and it shows up in national health data for the first time.
That's a big deal. Any version of this story that skips it isn't fair.
But it breaks too
The share of GLP-1 prescriptions going to patients with neither diabetes nor obesity went from 4.5 percent in 2018 to 17 percent in 2023. The figure is from a New England Journal of Medicine perspective on GLP-1s and eating disorders, and it only counts retail pharmacies. Telehealth sites working off self-reported weight are not in there.
So inside that one in nine sits a growing group the drug was never meant for.
In June, JAMA Psychiatry published a survey of 436 people with eating disorders. About 32 percent had used a weight loss injection at least once. More than 10 percent said they misused it: higher doses, longer than prescribed, tampering with the injection equipment, sharing it with people who had no prescription of their own.
Around 35 percent of the participants in remission had used one.
The caveats: 94 percent women, 88 percent white, all self-reported. The authors think the real numbers are higher.
The psychiatrist Sarah Oreck made the point that stuck with me. Rapid weight loss makes a returning eating disorder harder to spot, because everyone around you congratulates you on it.
Think about that for a second.
The other injection
Everything up to here sounds like a story about women. These stories usually do.
But the men were busy too.
In December an FDA expert panel argued for expanding access to testosterone. Committee members called replacement therapy a cornerstone of preventive health and, in the phrase Nature reported, "a multibillion-dollar preventive-care opportunity."
A preventive-care opportunity. For a hormone. Wow.
NPR reported this month that social media is full of testosterone content, from low-T fears to t-maxxing tutorials. Joe Rogan talks about his own use openly. So does Health Secretary Robert F. Kennedy Jr. The administration wants wider access, although the FDA still limits approval to men whose low levels come from an identifiable medical condition.
The delivery looks all too familiar. This year both Hims and Rugiet, a telehealth company for erectile dysfunction, are adding injectable testosterone. Hims talks about twenty million men held back by stigma and cost. In the UK, testosterone prescriptions rose 135 percent between 2021 and 2024, and one NHS endocrinologist told The Guardian the industry has "invented a spurious pseudo-disease."
In 2022, researchers played secret shopper with seven online testosterone clinics. The shopper reported normal levels and said he wanted kids someday. Six of the seven offered him testosterone anyway. The medical guidelines ask for symptoms plus two separate blood tests first. And for younger men there is a real cost here, because testosterone suppresses sperm production. Sometimes permanently.
A form you fill out yourself, a subscription, a celebrity out front. Sound familiar?
The gray market
Up till now, we were talking "legal" stuff. But that's not the whole picture. Not even close.
Lifetime use of anabolic steroids is estimated at 6.4 percent of men worldwide, against 1.6 percent of women. All self-reported, so nobody knows the real number. Roughly a third of users develop a dependence.
Most of them are not athletes. They are young men who want to look lean and muscular, and some of them meet the criteria for muscle dysmorphia: you see yourself as smaller than you are, while your feed shows you what a male body is supposed to look like. Researchers estimate that one in three people with an eating disorder is male.
Below that sits the stuff teenagers can actually reach. SARMs, peptides, growth hormone from unregulated sites, with independent testing regularly finding mislabeled product. Influencers and podcasters have moved into that market.
I wrote about Hollywood's naturally unobtainable male body back in 2022. It looks like an actor problem. Every major movie role now (for men) is basically enhanced. And it has been for quite some time. The movie 300, Marvel movies, even comedy roles.
Same machine, different motor
Women are sold smaller. Men are sold bigger.
Both by subscription, both prescribed off a form the patient fills in himself, both with a famous face out front, and both called health, not looks.
Serena Williams announced a year ago that she was on a GLP-1, as part of a campaign with the telehealth company Ro. Disclosed right next to it: her husband is a Ro investor and board member. By February she was in a Super Bowl ad. Charles Barkley had signed with Ro months before her.
Barkley is interesting here. He is a man, and he is on the weight loss side. Nine percent of American men are on a GLP-1 right now, and some of them are on testosterone too. Shrink the middle, build the shoulders, pay for both.
It's one business. It sells whichever body you've been taught to want.
Just think about that: They're both on GLP-1 to get thin and on testo or steroids to get bulky. At the same time. And none of them compete for the Mr. Olympia.
They don't compete for anything. Other than attention.
The backlash
Plus-size creators who started taking these drugs got destroyed by their own audiences.
Ella Halikas, a plus-size model whose doctor suggested Ozempic for her PCOS, worried more about disappointing her followers than about the medication. Rosey Blair was called ableist and fatphobic for celebrating that she could move better on Mounjaro. Gabriella Lascano told the New York Times she went from championing the community to being a pariah in it.
I don't think the hypocrisy charge works.
Body positivity said: your body is your business. Well, if that was the claim, then the medication is your business too. An audience demanding these women stay fat was not defending them. It was keeping mascots.
The men had no movement to betray, and that might be even worse, if you think about it. Nobody ever made a public argument that an ordinary male body is fine. So there was nothing to walk back, nobody to accuse of hypocrisy, no words for the damage. It just ran, for twenty, thirty years.
If you want to be angry, be angry at the industry that sold women self-acceptance while acceptance was the product, and sells the injection now that the injection is. The same industry sold men supplements, then testosterone. It will sell whatever gets "approved" next.
The guessing game
Kylie Jenner, Khloé Kardashian and Ice Spice have all had to publicly deny using these drugs. Columns go down the red carpet naming actresses. On the male side the same game runs as "natty or not", aimed at every actor who puts on twenty pounds of muscle for a superhero contract. Obviously, most of them are not natty. But they still sell us they are.
At one in nine, the guessing is aimed at your colleague, your brother, the woman at the school gate. And scanning a stranger's body for signs of a drug is still scanning a stranger's body. We just call it commentary now.
Kate Winslet called the whole thing "terrifying" in December. Her worry was less about the actresses than about everyone else, I guess. The people saving up for it. They don't have the money.
About the name
The headline is sort of wrong, and I used it anyway. Because it's clickworthy, and that's important here. So let's talk about it.
"Heroin chic" became a label in the 90s, and it hardened after the photographer Davide Sorrenti died of an overdose at 20. His mother spent the years after urging magazines not to cast visibly "skinny sick" models. Reaching for the phrase in 2026 to describe a red carpet flattens a death into a style category.
And "thin is back" assumes thin ever left. It didn't. Even at the peak of the size-inclusivity push (aka body positivity), straight sizes were about 95 percent of runway looks.
In June 2025, under pressure from the French government, TikTok banned the #SkinnyTok hashtag. Typing it now redirects you to help resources, and the same content keeps running under misspelled tags. Looksmaxxing was never touched by any platform policy at all. And hell, people die because of this.
So maybe the aesthetic never went anywhere. It just had an ad campaign standing in front of it for about six years.
The bottom line
In the 90s it took the whole fashion machine to make a body type a trend. Magazines, agencies, photographers, a runway.
In 2026 it takes a form and a subscription.
One in nine, and climbing. At what point is that not a trend anymore, but just what we look like?
If you're struggling with food, eating, exercise or your body: the National Alliance for Eating Disorders runs a free helpline at 866-662-1235.
If you're not already, follow me on Medium.