Weight-loss drugs are everywhere these days. At the Oscars earlier this year, host Jimmy Kimmel worked Ozempic into his opening monologue. Ads for Wegovy have become a regular feature of the New York City subway system. And Zepbound, a new weight-loss drug making its US debut any day now, is entering a market where it’s all but guaranteed to become an overnight success.

But the typical TV ads and catchy jingles aren’t what’s behind the frenzy over appetite-suppressing drugs from Novo Nordisk A/S and Eli Lilly & Co. Big Pharma, in fact, has hardly had to lift a finger.

Instead, a combination of pop culture, social media and third party marketers looking to cash in on the hype have helped turn weight-loss drugs into household brand names that rival Viagra and Prozac. US prescriptions for Ozempic, Wegovy and Mounjaro surged 300% in just two years, putting the drugs on track to become some of the best-selling of all-time. The drugmakers are struggling to keep up with demand.

It’s not that Lilly and Novo aren’t promoting their drugs at all. From January to late November, Lilly and Novo have spent a combined $218 million on commercials for Ozempic and Mounjaro, diabetes drugs that have become popular for weight loss, according to iSpot.tv. But together they account for just 3.7% of the whopping $5.8 billion pharmaceutical companies have spent on TV ads overall this year. Wegovy, Novo’s weight-loss drug, hasn’t even yet had its national TV debut, according to iSpot.tv. The ads that have run for Ozempic and Mounjaro describe the drugs as medical interventions for people suffering from diabetes — not a miracle diet drug that can help anyone get thin.

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