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Is weight loss injection Wegovy the answer to UK obesity?

Too busy to read in full? Here are the take-home messages:

  1. Semaglutide is sold as Wegovy, a weight loss injection, for people with or without type 2 diabetes and works by suppressing appetite

  2. The use and availability of Wegovy are causing controversy due to its unknown long-term effects and fuelling the rise of eating disorders and body image concerns

  3. Always speak to your doctor before taking any weight loss medications to talk about the risks and benefits

Bonus message: please be discerning about who is promoting any weight loss medications even if it has been approved to use safely


UPDATE (published on 07.01.2024)

On the 4th of September 2023, the NHS started to offer Wegovy as an option for weight loss. You can read the government press release here.

(For clinicians, NICE’s guidance on Semaglutide (Wegovy) for managing overweight and obesity can be found here.)


Left hand in white glove holding a syringe filled with yellow liquid

Weight loss is a common goal for many individuals. The motivations to lose weight can differ from person to person but there is one thing that’s the same for all: weight loss is challenging and complex for many reasons, and keeping the weight off is even more of a battle.

Unless you’ve had no internet access, I’m pretty sure you’ve heard and seen the hype around the ‘miracle’ weight loss injection or the ‘’skinny jab’’, Wegovy. In this blog, I’m going share what Wegovy is, its impact on the body, its side effects, and how to decide if it’s right for you.


What is Wegovy and how does it work?


Semaglutide is a medication that’s suggested for people living with type 2 diabetes (known as ‘ozempic’) and also for those that are seeking weight management support with or without type 2 diabetes (known as Wegovy). The latter is manufactured by Novo Nordisk, a pharmaceutical company based in Denmark.


A systematic review published in The Lancet concluded that semaglutide might be the most effective in reducing weight in adults with overweight and obesity compared with other weight loss medications [1].


Wegovy is a glucagon-like peptide 1 receptor agonist (GLP-1RA). It works by reducing appetite and makes you feel full most of the time so you eat a lot less than before.


Who is Wegovy recommended for?


The National Institute of Health and Care Excellence (NICE) has recommended the use of semaglutide (Wegovy) ''alongside a reduced-calorie diet and increased physical activity to adults'' [2]:

a) Who has a least 1 weight-related comorbidity and a BMI of least 35kg/m2

or

b) A BMI of between 30-34.9kg/m2 with 1 weight-related comorbidity who are eligible for referral to specialist weight management services

A weight-related comorbidity could be prediabetes or type 2 diabetes, high blood pressure, dyslipidaemia (abnormal balance of good versus bad cholesterol), obstructive sleep apnoea (OSA), or cardiovascular disease.


Who shouldn’t take Wegovy?

  • Wegovy is not recommended for children or pregnant or breastfeeding women

  • Wegovy should not be used by people living with an eating disorder such as anorexia or bulimia.

According to Novo Nordisk, the efficacy and safety of Wegovy have not been investigated in patients:

  • Limited experience in patients aged 75 years or more.

  • Treated with other products for weight management

  • With type 1 diabetes

  • With severe renal impairment

  • With severe hepatic impairment

  • With congestive heart failure New York Heart Association (NYHA) class IV.

Wegovy side effects

  • Wegovy may cause nausea, vomiting, diarrhoea, constipation, headache, fatigue, dizziness, flatulence, and bloating. These side effects are mainly due to the action of the medication (it delays gastric emptying).

  • Like with most medications, it may interact with other medications so always check and ask your doctor.

  • It may also lead to drug dependency and cause withdrawal symptoms, so again, it’s crucial to talk to your doctor about the risks and benefits to help make an informed decision.

left hand holding a measuring tape wrapped around fingers

Weight loss goals and Wegovy


In a randomised, double-blind clinical study, the STEP 1 clinical trial, showed participants on the maximum dose (2.4mg, weekly injections) lost on average 12% more of their body weight in comparison to those with a placebo [3]. All participants in the clinical study also received dietary advice and support to increase exercise.


Depending on your circumstances, the duration of which you take the medication and the support you receive all will impact the amount of weight lost.


What to consider before using Wegovy

  • Is it just a short-term effect? Part of the STEP clinical trial concluded that after stopping Wegovy for 1 year, participants regained two-thirds of their prior weight loss [4]

  • What are the long-term implications? The long-term safety is still unknown so while there might be improvements in blood sugar levels, blood pressure, and cholesterol levels; there is still not enough evidence to indicate how these variables may change in the long run.

  • How long should I use Wegovy? Some medical professionals recommend it needs to be taken continually to ensure that the weight does not return. The National Health Service is offering Wegovy for only two years.

  • Is this contributing to body image issues and eating disorders? Another consideration is the added pressure on people, especially young women, to look a certain way. With ''patient influencers'' on TikTok, ''what I eat in a day Instagram influencers,'' the availability of weight loss injections privately through online consultations, and its impact on eating disorders are also fuelling questions.


Final thoughts on Wegovy and UK obesity...

  • Wegovy is not a ''miracle drug'' and should not be used as a substitute for healthy lifestyle changes including physical activity

  • Healthcare professionals must consider an individual’s overall health and well-being before suggesting the use of Wegovy.

  • Are we doing enough at a population level to understand the root causes of obesity? With highly processed foods widely available and at a lower cost compared to whole foods, many people are tempted by food and overeat, leading to excess weight linked to type 2 diabetes, heart disease, and some cancers.

  • Wegovy is recommended for people living with (severe) obesity that’s complicated by pre-diabetes, type 2 diabetes and/or heart disease. It’s not to just lose a few pounds but for those with significant complications of obesity and a significant amount of weight to be lost.

It’s not black and white when it comes to deciding if Wegovy is right for you. It’s useful to deeply reflect if you’ve tried therapy, nutritional counselling, understand your relationship with food, assessed your sleep, stress and quality of nutrition and questioned your mindset. Research confirms ongoing dietary and lifestyle changes are required to maintain good health and improvements in weight once Wegovy is stopped. Clinical obesity is more than just about having strong willpower. I’ll finish here by sharing the wise words of George Bray, Professor Emeritus and obesity researcher, ''Genes load the gun and the environment pulls the trigger.''


This article is written for informational purposes only and does not replace advice from your doctor.


Maybe you're tired of yo-yo diets and confused about how to lose weight in a sustainable way. You also know that comfort eating and your habits with food and exercise are making you feel more stuck in a vicious cycle! Book your free 15 minute discovery call to find out how I can help.


References

[1] Shi Q, Wang Y, Hao Q, Vandvik PO, Guyatt G, Li J, Chen Z, Xu S, Shen Y, Ge L, Sun F, Li L, Yu J, Nong K, Zou X, Zhu S, Wang C, Zhang S, Qiao Z, Jian Z, Li Y, Zhang X, Chen K, Qu F, Wu Y, He Y, Tian H, Li S. Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials. Lancet. 2022 Jan 15;399(10321):259-269. doi: 10.1016/S0140-6736(21)01640-8. Epub 2021 Dec 8. PMID: 34895470.


[2] NICE recommended weight-loss drug to be made available in specialist NHS services [accessed March 2023 via https://www.nice.org.uk/news/article/nice-recommended-weight-loss-drug-to-be-made-available-in-specialist-nhs-services]


[3] Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar 18;384(11):989-1002. doi: 10.1056/NEJMoa2032183. Epub 2021 Feb 10. PMID: 33567185.


[4 ] Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, Lingvay I, McGowan BM, Oral TK, Rosenstock J, Wadden TA, Wharton S, Yokote K, Kushner RF; STEP 1 Study Group. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022 Aug;24(8):1553-1564. doi: 10.1111/dom.14725. Epub 2022 May 19. PMID: 35441470; PMCID: PMC9542252.


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