Unless you’ve been under a rock, you’ll have seen the recent news that UK residents will have access to a new, once-weekly jab that's proven to aid with weight loss, called Wegovy.
Obesity is a huge strain on wellbeing… So that's a good thing, right? Well… yes and no.
This jab, known as Ozempic in the US, was designed to treat diabetes patients. Consequently, it’s been found to have impressive efficacy in the world of weight-loss, too.
Trials show that people using Wegovy lost on average 14.9% of their body weight over 68 weeks, compared with just a 2.4% loss in a placebo group.
In June of 2023, the UK government announced a £40m pilot to expand access to weight-loss jabs. Ostensibly this budget is to tackle obesity, but in reality it seems more focused on easing the strain on an overworked, underfunded NHS. Safe to say, this won’t be the last we hear of this.
Obesity costs the NHS a reported £6.5 billion per year, and in the year 2019/2020 alone there were over 1,000,000 admissions to UK hospitals where obesity was a factor.
More clearly needs to be done, for the sake of our population and infrastructure.
So, how does Wegovy work?
Essentially, Wegovy mimics the action of a hormone that we produce naturally, called GLP-1, which makes people feel fuller, and less hungry, for longer, so they eat less.
It’s a small protein, known as a peptide, and binds to receptors all over the body – in the pancreas to aid in insulin management for diabetes, and in the brain to provide satiety without additional consumption.
Due to it being a natural peptide, it has to be injected rather than swallowed as it would be broken down by our stomach acid. It’s similar to Saxenda, which has been available in the UK since 2017, except Wegovy is injected once per week, instead of once per day, and stays active for around 165 hours compared to Saxenda’s 15 hours.
If a person’s BMI is over 35 and they have at least one weight-related health condition, they may be eligible for Wegovy via the NHS. If not, they can buy it privately from places like Lloyds or Boots for around £200-£300 per month.
What’s the problem?
If something sounds too good to be true, it almost always is.
One year after stopping Wegovy, one report found that participants regained on average two-thirds of their prior weight loss.
A different study found that just 27% of people (4,255) surveyed on GLP-1 drugs like Wegovy remained on the drug after 12 months.
Another trial, of 338 people, found that 13.5% of Wegovy users stopped treatment due to side effects, and 80% of them reported “lesser” issues, like gastrointestinal, stomach and intestine problems.
Instead of flogging a dead horse and saying “the only solution is good diet and exercise,” which is mostly true, but also not particularly helpful in an obesity epidemic, it’s entirely understandable why a drug like Wegovy is being championed as a weight-loss accelerant.
Pounds, Pounds, Pounds.
It’s also completely unsurprising that there’s a mountain of money to be made here. So much so that Novo Nordisk, the company behind Wegovy, just became the most valuable company in Europe this month, overtaking luxury fashion conglomerate LVMH.
In fact, this sole company’s stock market value (£340bn) now exceeds Denmark’s entire economic output, estimated at £323bn this year.
Novo have been selling diabetic treatments for decades, but the recent permission to offer their wares as treatments for weight loss has skyrocketed their financial success. So much so that Denmark is in the process of creating economic analyses of their output independent of Novo’s contribution. Akin to how Norway strips out oil from certain analyses.
Yes, weight loss drugs are now, to the DK economy, comparable to oil for Norway.
The global market for weight-loss drugs is predicted to reach around $150 billion by 2031, a similar size to the market for all cancer drugs. Safe to say this isn’t a flash in the pan, we need to get used to medical weight loss interventions that don’t involve surgery.
Far From A Miracle
Medicating our way out of a bad diet seems like a slippery slope. Given the level of weight-regain after stopping taking the drug, as outlined above, it’s not a stretch to consider the mental-health implications that may arise from a precipitous drop, then rapid gain, in body weight. Given the recommendation is to take Wegovy for a two-year maximum, this isn’t a long term solution.
Tell a struggling person that they can turbocharge their efforts by adding an injection to their weekly routine, of course they will try it… but it addresses the symptoms, not the cause. It chalks health down to weight rather than performance. Not all weight loss is equal; just because someone is a healthy weight doesn’t make them a healthy person.
Irrespective of the efficacy of the jab, people need to remember that diet, exercise and lifestyle changes are required in order for their weight to drop. Wegovy is an accelerant, not magic.
Reports of reductions in muscle mass highlight the critical need for education as weight loss drugs rise in popularity. People may be less hungry, but they still require a balance of nutrition, and resistance training, in order to function properly and avoid early onset sarcopenia.
Suffice to say, though, that the “boring, long and effective” option of weight loss without drugs avoids more dangerous complications like “stomach paralysis,” as noted as a potential side-effect of Wegovy.
Becoming reliant on drugs as a vehicle towards weight loss simply places a bandaid on the issue. You either take the drug forever or deal with the possible complications and inevitable rebound.
Where’s The Good Side
A 2019 Health Survey for England estimated 28% of adults in England were obese. This is a number that’s doubled since the early 90s, and it’s not slowing down.
According to the World Obesity Atlas 2023, over half of the global population is expected to be overweight, and a quarter of the entire world will be obese by 2035 – based on published trends from 1975 to 2016, including over 180 countries.
These figures show that the current line of “move more, eat better,” isn’t cutting through. The ailments and morbidities that arise from obesity are both impacting and destroying the lives of countless people across the country and indeed the world. The advent of new drugs to benefit individuals who aren’t losing weight through conventional means isn’t necessarily a bad thing.
Through the lens of wellbeing, we can’t let perfect be the enemy of good. Yes, in a utopian world people wouldn’t need medication to assist their weight loss. Wake up, look at the numbers: people need help.
Progress Over Prejudice
People are busy, sad, stressed, exhausted, ill, whatever, and they need all the assistance they can get in shifting the pounds so that they can live a healthier life.
If people lost on average 15% of their body weight, and regained ⅔ of it after stopping Wegovy, they still weigh 5% less than they did to begin with. The health benefits of dropping 5% of your total weight might be life-changing for certain people, we can’t discount that.
There are also so many individuals who are totally dejected by their previous attempts to lose weight. Something like Wegovy that accelerates the initial weight loss could, and will, open peoples’ eyes to the lifestyle benefits that emerge from a life unburdened by obesity.
After all, what’s the alternative for someone who’s tried the usual routes of weight loss? Bariatric surgery, with a potential complication risk of around 20%. The operation also lasts around two hours, not accounting for pre/post care, taking far more time and resources from an overstretched NHS to facilitate than a self-administered jab.
Which brings us to the final point: finances.
The £200+ price point makes this a risk of becoming a medical intervention option that favours the wealthy. The recent influx of attention in 2023 for this, and similar drugs, is causing individuals who actually need it, to be unable to get it.
Essentially this amounts to taking medication from those with diseases, in favour of accelerating weight loss for people who could achieve similar, albeit slower results, by changing their lifestyle.
This shouldn’t be, but already is and will continue to be, an option for privileged people looking to lose a couple of kilos. The seriousness of playing with your metabolic system is one that can’t be overstated.
In closing, it’s important to underline the fact that as weight loss drugs become more popular, anyone who uses them requires a plan in order to thrive in the long term.
Initially, the users have to figure out how to alter their lifestyle outside of the jab. Afterwards, they need to think about how to maintain their lifestyle, and new weight, once the drugs are no longer supporting them.
Wegovy as well as its predecessors and successors are tools to be added to the arsenal of weight loss. None of these are, nor ever will be, a silver syringe that solves the deeply embedded societal issues which have caused ballooning obesity the world over.
As Professor Carel Le Roux, a Consultant in Metabolic Medicine at Imperial College London says:
“Thirty years ago, if you had depression people would be telling you to cheer up. But now we treat depression as a chronic disease, and we don’t discriminate against people on that basis. We’ve done well before. Now we need to do the same for obesity.”