- James Ghalaghar
- Health editor, BBC
Two versions of semaglutide are sold, one for weight loss and one for people with diabetes
You can’t avoid the hype around weight loss injections.
Social media is littered with before and following pictures of people using the injections. These images have become a source of wild rumors regarding Hollywood stars and whether they use them, and here is the British National Health Care Service “NHS” decides to buy these injections to give them to patients.
You can understand the attraction of those injections. Being overweight affects our health and sometimes leads to stigma. And the “diet and exercise” slogan simply fails to make most people lose weight.
But should we describe the semaglutide used in these shots as a “miracle” or a “skinny shot” when some doctors see it as a controversial treatment? Are his results worth the hype? Or have we failed to deal with the causes of obesity and have accepted that obese people spend the rest of their lives receiving medical drugs?
Jan, from Kent, England, was among the first in the world to participate in semaglutide trials. There are two copies of the drug, the first is sold under the name “Wegovy” for weight loss purposes, and the second is called “Ozempic” and it is intended for diabetics, but some people buy the second copy for the purpose of losing weight.
We all know someone like Jan who tried all kinds of diets and yet struggled with obesity her whole life.
Semaglutide mimics the hormone the body releases when we eat, makes the brain think we are full, reduces our appetite, and thus makes us eat less.
Once Jan started getting injections, her relationship with food changed so dramatically that she told me it was either the drug, or “aliens” that had abducted her.
For the first time, she might walk into a coffee shop and see a chocolate and caramel brownie without her body screaming, “I need this.”
“I don’t feel hungry…it’s my body telling me I don’t want food and not my willpower,” Jan says.
The results of semaglutide cannot be ignored – at least for a while.
On average, obese people lost regarding 15 percent of their weight when they took semaglutide in combination with a healthy lifestyle during the trials. Note that this is not a ‘skinny shot’ – 15 percent means that if you weighed 127kg it would drop to 107kg.
The study indicated that the weight decreased in the first year and then became stable over the remaining three months of the experiment. We don’t know what will happen when people take this drug over a period of years.
Jan lost 28 kilograms of weight. This made her enjoy her 60th birthday present, which was a flight in a Tiger Moth biplane, as she had previously been over the weight limit. “I felt like I was flying in more ways than one, and I really enjoyed it,” Jan says.
Jan following her biplane flight in 2019, which would have been impossible for her to participate in before losing some weight during the semaglutide trial
The results appear to be stronger than the usual results of the diet, which usually starts well, then depleted fat stores in the body send a signal to the brain to ask for food. This is why diets ultimately fail.
“More than 90 per cent of people tend to return to the same weight at which they started their dieting journey,” says Professor Sir Stephen O’Reheli, Director of the Metabolism Unit at the Medical Research Council.
He believes that such drugs constitute “the beginning of an exciting phase” during which drugs can help people who “suffer for a long time” from the problem of overweight, which is harmful to their health.
Jan’s trial ended, and she might no longer take Simgalutide. Without that drug, there is no longer that chemical that tricks the brain into feeling full.
“I was so sad that I was gaining weight once more,” Jan tells me, and that she would have done anything for someone who would give her the drug once more.
Jan tried other injections aimed at losing weight, but eventually decided to undergo sleeve gastrectomy to reduce her size, which makes her feel full faster when eating.
Jan does not regret taking part in the trial, and still describes the drug as “the best thing that ever happened to me”.
weight return once more
However, Jan’s experience is by no means unique. Weight gain following stopping semaglutide occurs very quickly. Our best long-term data shows that people gain two-thirds of the weight they lost within two years of stopping injections.
“There seems to be a need to continue taking this drug to ensure the weight loss doesn’t come back, and that, to me, is a big problem,” says Dr. Margaret McCartney, a GP and a proponent of strong evidence in medicine.
The National Health Care Service in Britain will provide the drug to people over a period of two years only, which is the period specified for treatment in the weight loss clinics affiliated with the device. But since the weight returns once more following stopping the drug, we have the right to ask: What is the benefit then?
“It’s a big problem for a lot of people who want to lose weight and usually fail to do so for years,” says Dr. McCartney. “If you find something that works for you, and then the NHS comes along and pulls it back, that seems like it to me.” Somewhat unfair.”
Of course, there are circumstances in which losing weight temporarily is beneficial. For example, the weight should not exceed a certain ceiling in order for patients to be able to undergo certain surgeries or receive certain treatments.
The drug is new, so its long-term safety is not yet known. It also has side effects that include vomiting, fatigue and pancreatitis.
Medical victory or societal failure?
Personally, I can’t decide whether we should celebrate medicine with a drug like this, or if the opposite is true: we have failed so badly in tackling obesity at the societal level that we need drugs to combat it.
“Many of us struggle with this problem,” says Professor Naveed Sattar, Professor of Metabolic Medicine at the University of Glasgow.
He adds that half of the planet’s population is expected to be either overweight or obese by 2035, and there is a link between excess weight and type 2 diabetes, heart disease and some types of cancer. Cheap calories also “affected human biology with regard to food cravings and binge eating.”
Many NHS patients “have 4 to 5 conditions as a result of their excess weight, and we are not taking any actual measures at the moment to address the problem,” he says.
Meanwhile, government policies aimed at tackling obesity — there have been 14 in the past three decades — have made no significant progress, with particularly harmful effects on the country’s poorest. There is a clear link between poverty and obesity.
Dr McCartney says we need to deal with how the world we live in is fueling obesity, rather than accepting that people will gain weight and then waiting for them to “accept medical intervention”.
Semaglutide has set out to change the landscape of the obesity problem, and some other alternatives are on the way.
Even if we eradicate the societal causes of obesity, Prof O’Raheli says, “there will still be people who are obese and will get sick”, so he thinks drugs will move us into a world where obesity is “properly treated, as a disease”.
However, these drugs remain controversial, and we have only discussed their use to improve health.
Some have raised other concerns regarding the effect on people, who are usually young women who are pressured to look a certain way when ‘beautiful’ is synonymous with ‘thin’.
The role of celebrity culture, the fact that semaglutide is available through private medical centers and medical consultations via the Internet, and the effect of the drug on eating disorders, all of these things raise some questions and concerns.
Whatever your opinion of semaglutide, it is clear that the controversy and hype sparked by this drug will not stop.
