The demand for GLP-1 medicines, such as Wegovy (semaglutide; NovoNordisk) and Mounjaro (tirzepatide; Eli Lilly), continues to rise among patients seeking weight loss. While these treatments are clinically indicated for individuals with obesity or specific metabolic conditions, we are increasingly seeing patients with a healthy BMI applying for treatment online.
Many of these requests are motivated by cosmetic or body image goals rather than health needs, and as pharmacists, we of course have a responsibility to ensure these medicines are used safely and appropriately.
One area that has become particularly challenging for us, as an online pharmacy specialising in GLP-1s, is image verification. In the past six months, in particular, we have seen a significant rise in patients using AI tools to manipulate photographs submitted as part of online consultations.
These alterations are often very subtle, designed to exaggerate abdominal size or adjust body contours to meet perceived eligibility criteria. At first glance, the images may appear entirely plausible, but careful inspection can reveal inconsistencies that all pharmacists need to identify.
Straight lines in the background like door frames, window edges or tiles in manipulated images may appear slightly curved around the midsection. Shadows and lighting can also reveal inconsistencies; artificially enlarged areas often lack natural depth, with flat shading or highlights that do not correspond to the room’s light source. The patient’s skin texture also may appear unusually smooth or blurred in edited areas, in contrast with the rest of the body.
Proportion is another important factor. Arms, hands and facial features are actually pretty difficult to manipulate convincingly. A midsection that appears larger than limbs or a torso that seems out of balance with clothing can indicate digital alteration. The fabric on clothing should crease and stretch naturally, so overly smooth areas where the body has been ‘reshaped’ also suggests editing.
More advanced manipulations involve fully AI-generated images. These can look highly realistic but often lack small imperfections, such as asymmetry, natural posture shifts or minor blemishes. In these cases, the background may appear generic, slightly blurred or disconnected from the subject.
We have had to learn the fine balance between remaining vigilant and being accusatory. When there’s any uncertainty, requesting additional images, short video verification or confirmation through the patient’s GP is entirely appropriate.
The growing pressure to access GLP-1 medicines makes careful screening more important than ever, so learning to recognise the signs of image manipulation helps pharmacists to protect patient safety and ensure treatments are prescribed appropriately.
Ahsan Bhatti, superintendent pharmacist at Quick Meds
