Curvy influencers post a lot about body positivity. But what happens when they use Ozempic?

When Ella Halikas’ doctor suggested an off-label prescription of Ozempic to manage her polycystic ovarian syndrome symptoms, her first thought wasn’t about her health.

Halikas was more worried that her 267,000 followers on Instagram would be disappointed if she took the medication. She, like many other plus-size influencers, has built her brand around embracing body confidence at any size.

“It does feel sometimes when you do things for your health, it can feel like a betrayal to your community, or a betrayal to the body positivity movement,” Halikas said. “And that can be a slippery slope that I don’t want to go down.”

As more people — from WeightWatchers members to A-list Hollywood celebrities — embrace the new class of wildly popular weight loss drugs, some body positive influencers who have started weight loss journeys with the help of the medication have faced intense backlash from their followers.

It’s a sentiment that echoes broader concerns in the body positivity movement that the drugs have halted and even reversed hard-fought societal changes in the way people talk and think about their bodies.

But for some, it’s not about appearance. The drugs are now often prescribed for some medical issues that they are not explicitly approved for — so-called off-label prescriptions — for people whose weight is a factor.

Earlier this month, influencer Kiki Monique told her 137,000 Instagram followers that for all the hate comments she receives about using weight loss medication, she receives even more messages of people thanking her for speaking out.

Monique began taking the medication after she was diagnosed as pre-diabetic, she said in the video.

“I’m doing this so people understand these drugs aren’t just because people want to get skinny,” Monique said while sharing some of her medical records in the video. ”It’s so that we feel better and if there’s anything about the body positivity movement that I’ve learned, it’s like, I want to feel good in my own body.”

The “bopo” movement — a belief system of self-acceptance regardless of body type — began to take its current form on social media around 2012, when it first began popping up on Instagram, according to research from the National Library of Medicine. It continued to grow online, with the pandemic helping give rise to more creators who post about everything from plus-size fashion tips to body confidence advice.

But amid a boom in demand for this new crop of semaglutide-based weight loss drugs, some creators feel body positivity has once again taken a back seat to attitudes they consider to be part of diet culture. This has manifested both on- and offline, as fashion trends like “heroin chic” resurge and brands like Old Navy roll back their inclusive sizing.

Some pharmaceutical companies have reportedly targeted plus-size and fat influencers for brand deals, according to The Washington Post. WeightWatchers also recently garnered backlash for creating a GLP-1 “hype house” marketing event for its new prescription obesity drug service, Bloomberg reported.

“It seems like overnight that a lot of our body positive, fat positive accounts on Instagram have turned into weight loss accounts, you know, or they [the creators] have just quietly lost weight,” said Lauren Hope Krass, co-host of the podcast “Diet Starts Tomorrow.” (“Diet Starts Tomorrow” will be changing its name in the coming weeks, Krass said).

Many creators have acknowledged weight loss is a triggering topic. But some feel the backlash over a personal choice — particularly one related to health — can be unwarranted and antithetical to the mission of body positivity.

Rosey Beeme, a plus-sized influencer, has been candid about her weight loss journey on Instagram, where she has 187,000 followers. But her openness around her use of Mounjaro has prompted blowback.

“Online communities bring us so much validation in experiences we felt were isolating and ultimately find out are common and shared. I love that,” Beeme wrote in a recent Instagram story. “I found that intinitially when I found the body positive community online. But eventually I noticed that if anyone wanted to lose weight for health, personal desire or any other perspective they were met with swift and cruel feedback. This to me feels un-healthy and dare I say culty-y.”

Beeme declined an interview request.

Krass said she is not entirely surprised by the negative response directed toward some body positive creators who have changed course.

But two things can be simultaneously true, she said: People should not police how one another’s bodies look, and fat people are hurting.

“We have people recovering from eating disorders. We have people in bigger bodies who have been fighting to survive, who have been fighting for their self-worth and to love the body that they’re in,” Krass said. “And when all of these accounts turn into weight loss accounts, or into thin people, all of a sudden, it just is triggering. … It’s complicated, you know … the fat community is suffering here.”

Halikas said she decided not to take Ozempic and is managing her health with diet and exercise. But she still thinks about what it would mean to her audience.

“I think when it comes to health concerns, where does body positivity come in now?” she said. “You know, are they there to support me and my health concerns and the goals that I need to do … to be healthy? Or are they there to keep me in the same box and not allow for me to change regardless of if it’s health related.”

This article was originally published on NBCNews.com