For many decades companies and medical professionals have sold weight loss treatments to dieters. However most either didn’t work, were actively harmful, or both. But several new types of drugs have now been triumphed as game-changers in the fight against obesity. Known technically as GLP-1 receptor agonists, the most recognised is Wegovy, but is actually called semaglutide, and it has been developed by Danish pharmaceutical company Novo Nordisk. Initially released in the mid-2010s, the treatment was aimed at patients suffering from type-2 diabetes under its original name Ozempic. But many patients reported significant weight loss and a reduction in appetite as a side-effect of their diabetic treatment. Soon it was being used unlicensed as an aid to weight loss. Variety magazine called it “the worst kept secret in Hollywood” and newly skinny celebrities were described as having “Ozempic face”. After trials, the drug was released officially as a monthly weight loss injection, with a higher dose and with a new name: Wegovy. In February of this year, it was approved for use in the UK.
How do they work?
The drugs imitate a hormone that we normally release after eating, which travels to the brain and creates a feeling of being full. The hormone is called GLP one – glucagon like peptide one – and it stimulates the production of insulin, while suppressing the production of glucagon, which raises blood sugar. GLP – one also slows the rate at which food empties out of the stomach, and the drugs also imitate this effect. Patients describe a freedom from cravings and an inability to overeat without starting to feel unwell. Comments like “I’m convinced this replaced a signal my body has been missing my whole life” are common online amongst users. Interestingly the name semiglutide was inspired by venomous lizard found in Arizona, the Gilia, which produces a hormone called extendin-4, which allows it to slow down its metabolism and maintain constant blood sugar levels when it hasn’t eaten for a long time.
Do they have side effects?
Most people taking this new class of weight loss drugs don’t suffer from any serious side-effects, but minor ones are common. These include feeling unwell, nausea, diarrhoea, tiredness and dizziness. For many these mild side effects can be offset by a careful diet that doesn’t contain too many high-fat foods as they take longer to digest. Some more serious conditions have been reported though, and there have been warnings of more serious, gastrointestinal issues and that the drugs can lead to loss of lean muscle and fat. This comes with associated health risks, including loss of strength and coordination. Wegovy also comes with a warning that it could increase the risk of thyroid cancer. Interestingly, some users stop taking it because it diminishes their enjoyment of food. But obviously losing weight can have huge positive side-effects, and in August Novo Nordisk released a study showing the drug reduces the risk of heart problems by 20% in some patients.
Are Ozempic and Wegovy game changers?
They could be. The world health organisation reports that more than 1 billion people in the world are obese and it is estimated that over 50% of the world’s population will be overweight or obese the year 2035. Being overweight is the fifth cause of death globally and has links to many serious conditions including diabetes, heart disease and many types of cancer. In the UK, obesity costs the NHS around six billion pounds annually. However, it is worth noting that obesity and weight are complex issues to fix (as we know from our 20 years in the business). Scientists now believe that dieting alone cannot control the drive some people have to bounce back to their heaviest weight – so some users of these drugs will find it hard to keep weight off, especially when coming off them. Still, according to government figures in the UK, Wegovy users can achieve up to 15% weight loss over one year, around the same as bariatric surgery.
Is Wegovy a long-term solution?
Although the pharmaceutical companies may say yes, at this point in time the scientific evidence says no. When patients stop taking Wegovy their appetite returns within a week or two, and they tend to regain weight at a fast pace. Even a study by the drug’s producer Novo Nordisk showed that within a year of stopping the injections, clients regained two-thirds of the weight that they had lost. So it can seem as a short-term fix, leaving the age-old reasons for weight gain, and the sometimes challenging ways of solving them, ever present. Continued availability of cheap, easy to prepare fatty, sugary foods coupled with sedentary lifestyles and lack of exercise, along with the human drive to crave these foods, remain at the root of weight gain and obesity. It’s not the first time the contradiction of one set of companies profiting from making us fat while another set of companies profit via the promise of permanent weight loss. But, for some people with chronic severe obesity remaining on Wegovy for life might indeed be better than the alternative.
A huge potential market
The company that makes Wegovy, Novo Nordisk has become Europe’s biggest company this year based on its stock market valuation. Its valuation of £330 billion now exceeds the GDP of its home country, Denmark. Its impact is such that the central bank of Denmark has been able to keep interest rates lower than other EU countries, as Wegovy sales have pushed up the value of the kroner. However other pharmaceutical companies are developing treatments, and this market dominance may not last. An injection designed to help with diabetes called tirzepatide works in a similar way to Wegovy and is expected to be approved by regulators soon as an obesity injection. Some studies suggest it to be twice as effective in helping weight loss. Pfizer is also working on a GLP-1 based treatment.
How do you get it?
In the UK it is available on prescription (along with diet and exercise) through NHS weight management services, overseen by the National Institute for health and care excellence (NICE). However, it is supposed to be only available to those with a BMI of over 35 and at least one weight related illness. The loophole of course is that it can be prescribed privately at a cost of about £250 a month. Owing to high demand Wegovy is in extremely short supply and there have been reports of fraudulent purchases from people who do not qualify for the drug. Some online companies are now demanding full body length photographs with a matching passport photograph to show proof of qualification through obesity. Novo Nordisk says that supplies will be constrained in the medium term due to high demand.
The sorry tale of the history of obesity cures
The medical profession and weight loss make up along and sorry tale. The ancient Greeks believed obesity was caused by unbalanced humours which should be treated with purgatives and laxatives. By the early 20th century thousands of Americans were told to use Dinitrophenol, a toxic formula that causes cataracts and sometimes death – up to 25,000 people were blinded by this particular treatment which was subsequently banned. Later in the same century the pharmaceutical industry invested huge sums into diet drugs based on amphetamines, until of course they realised they were highly addictive and had terrible side-effects. As recently as the 1990s Fenfluramine (fen-phen) become hugely popular before being taken off the market as it had links with manic episodes a heart valve damage.
And what’s the future?
A new generation of GLP-1 agonists are being developed, alongside new methods that will look at the source of obesity in our genes. AstraZeneca and Regeneron are working on a gene therapy treatment which are hoped will prevent obesity in the dispositioned to it for life.
And the healthiest solution?
The healthiest solution remains a healthy diet and regular exercise, including strength training. For less than the cost on Wegovy you could have a personal trainer guide you through the easiest and most effective way to lose weight and get fitter.