Last week, pioneering weight-loss jab Wegovy was given the green light for widespread NHS use, a move hailed as a turning point in the battle against ever-rising obesity rates.
In studies, it has helped those who use it lose up to a fifth of their weight through a weekly, self-administered injection.
Also known as semaglutide and made by pharmaceutical company Novo Nordisk, it works by suppressing the appetite and, having been involved in obesity drug research, I have seen first-hand the power it has to transform lives.
Putting aside eye-catching stories about celebrities such as Elon Musk and (allegedly) Kim Kardashian using it to stay slim (not what the drug is meant for), wider availability is something I and other experts in the field of obesity treatment have long been calling for.
This is due to its potential to combat life-shortening, obesity-related illnesses – from type 2 diabetes to heart disease.
Professor Alex Miras, pictured, believes the new anti-obesity jab is great value for money costing the NHS £20-a-week per patient
Last week, pioneering weight-loss jab Wegovy was given the green light for widespread NHS use, a move hailed as a turning point in the battle against ever-rising obesity rates
It’s good value for the NHS, too, costing about £20 a week per person. Of course, many of you will have questions, so here’s what you need to know…
Q It sounds great, but who’s going to get the jab on the NHS?
A Spending watchdog the National Institute for Health and Care Excellence (NICE) says Wegovy is recommended for patients who have a body mass index (BMI) of 30 or more. As a rough example, this could be a man who is about 5ft 10in and weighs 15 stone or more. Alternatively, it could be a 5ft 3in woman weighing just over 12 stone.
They must also have at least one weight-related health condition – such as pre-diabetes (where blood sugar levels are high and there is a significant risk of the patient getting full-blown type 2 diabetes) or high blood pressure.
It also covers sleep apnoea – night-time breathing difficulties that are often due to excess fat around the throat and airways.
Even less obvious obesity-related diseases that cause poor self-esteem due to weight issues, such as osteoarthritis or depression, could mean some patients are eligible for the drug.
Polycystic ovary syndrome (PCOS) may also warrant it. This is a very common condition – affecting up to one in ten women in the UK – that causes irregular periods, swollen ovaries, excess body hair and infertility.
Obesity can trigger PCOS and the condition might also lead to further weight gain. A small number of NHS patients are already on a similar, injectable drug to treat type 2 diabetes that is not well controlled with other medicines.
Also known as semaglutide and made by pharmaceutical company Novo Nordisk, it works by suppressing the appetite and, having been involved in obesity drug research, I have seen first-hand the power it has to transform lives
Q These diet drugs usually don’t live up to the hype. Does this one really work?
A Yes. In trials, patients lost an average of 16 per cent of their body weight (about 35 lb, or 15.9kg). Once you drop weight to this degree, you start to see major improvements in medical conditions such as diabetes and, potentially, heart disease.
Some did even better; almost a third managed to shed 20 per cent of their overall weight.
There have been many drugs hailed as major breakthroughs in the past.
However, none has proved to be as effective as this, or came with nasty side effects that put patients off taking them and prompted drug regulators to halt their use.
Q OK, sign me up. Will I be able to get it from my GP?
A Based on the NICE guidance, roughly one in seven adults in the UK would qualify for treatment with Wegovy, if not more. But it also states that prescribing of the drug can be initiated only by hospital-based, specialist weight-management teams – doctors and dieticians who help those who are severely obese tackle their problems.
It was hoped that GPs would be able to prescribe the drug once it has been started by the specific hospital teams, but this doesn’t seem to be the case yet. This means access to the drug will actually be severely limited – it’s estimated that only half of the country currently has these NHS management teams in place.
My worry is we will end up with waiting lists for people trying to get on the drug that are even longer than those we already have for obesity surgery. We should be letting GPs take the lead in tackling this disease, not hospitals.
Q What does the drug actually do inside the body?
A It mimics the effects of a hormone called glucagon-like peptide-1 (GLP-1) which is released by the gut after we have eaten, to tell the brain we are full.
The drug directly targets appetite sensors in a part of the brain called the hypothalamus, ‘tricking’ them into curbing hunger pangs.
But this takes a while. During the first week, you probably won’t notice much of an effect.
In trials, patients lost an average of 16 per cent of their body weight (about 35 lb, or 15.9kg)
But as levels of the drug accumulate in the bloodstream, your appetite will decline and you will start to feel full with less food.
Some people will start to eat smaller meals, whereas others may just go longer between them.
Most people inject Wegovy into the abdomen but you can also put it straight into the upper arm or thighs.
It’s a once-a-week, do-it-yourself jab through a device that looks a bit like a pen. It is also subcutaneous, which means you inject just beneath the skin, rather than deep into a muscle.
Q I’ve read I’ll still need to exercise and eat healthily even if I’m on it. Is that true?
A Yes, because the weight loss results are better when you combine the drug with a healthier lifestyle. It’s not that exercise makes Wegovy work better, but more that it provides an additional overall benefit.
Thankfully, you don’t have to run marathons or survive on nothing but lettuce leaves.
You just need to keep sticking to the recommended levels of physical activity. This amounts to 150 minutes a week of moderately intense exercise or 75 minutes of vigorous activity.
Eating a healthy diet which is rich in fruit, vegetables, fish, eggs, lean meat, nuts and beans will also help you to keep the weight down.
Q I’ve also heard it stops people enjoying food…
A Most people on Wegovy still like to eat the food they enjoy – they just want less of it.
But a small number – perhaps about 15 per cent – will notice that some things don’t taste quite as pleasant as they used to.
The rewarding feeling they get from eating them may also diminish slightly.
Anecdotal reports from the US, where the drug has been in more widespread use, suggest that some patients become ‘repulsed’ by food and drink that they previously craved, such as sweets or coffee.
One theory for this is that the drug alters the brain’s ability to tell what is going into a person’s mouth, causing a taste disorder known as dysgeusia. This can make certain foods taste abnormally sweet, sour, bitter or metallic.
If after five months of weekly injections you have lost less than five per cent of your body weight, you will probably be classed as a non-responder
Q How long does it take for Wegovy to work?
A If after five months of weekly injections you have lost less than five per cent of your body weight, you will probably be classed as a non-responder.
The treatment will be stopped and you’ll be switched to some other weight-management programme.
But up to one in three people will be ‘super-responders’, shedding more than 20 per cent of their body weight in the first 12 months.
Q I hate needles. Can I take a pill instead?
A Sadly, no. A tablet version of a similar drug containing semaglutide is already being used on the NHS for the treatment of type 2 diabetes. Unfortunately, it is not licensed for use in obesity.
However, there’s every possibility that, in a few years’ time, the manufacturers of Wegovy will also come up with an oral version for the needle-phobes out there.
Q What about when I stop taking it – won’t the weight pile back on?
A This is the controversial part. NICE has ruled that NHS patients should only be prescribed the drug for a maximum of two years as studies show that weight loss, while initially very significant, eventually begins to plateau.
This means that although the drug is still clinically effective (stopping you putting weight back on), NICE believes it’s less cost-effective in terms of value to the NHS.
It’s very important that patients do not stop the injections when weight loss slows down or stops because they mistakenly think the drug is no longer working. Trials have found that approximately 90 per cent of volunteers regained almost all the weight they lost once they came off the drug.
Most were unable to maintain their weight loss because, similar to any other medication, the drug works only if you keep taking it.
In no other chronic illness would you stop someone’s medication after two years. If you take someone off their blood pressure pills, for example, it will go back up.
It’s exactly the same with obesity, because the drug is having a biological effect on the body.
Personally, I think these patients should be on the drug for life, and the regulators have said there is scope for treatment to be extended if it is shown to be justified.
Q Are there any nasty side effects?
A Between 20 and 45 per cent of patients taking part in clinical trials experienced some side effects.
These were mostly mild – nausea, vomiting and diarrhoea – as well as temporary, wearing off after just a few weeks.
About seven per cent of volunteers pulled out of the studies, finding the side effects too unpleasant.
In a very small number of cases, patients developed inflammation of the gall bladder or pancreatitis (inflammation of the pancreas, a small organ behind the stomach that helps with digestion and releases insulin into the bloodstream).
But these instances were very rare.
DR PHILIPPA KAYE: Obesity is a disease – so I’m all for this treatment
A few weeks back, in these pages, I wrote about the new medical view that obesity is a disease – for some, changes in the brain mean they eat more than others and gain weight.
Research into semaglutide, the drug in Wegovy, has been key in changing our understanding of this illness. Targeting these brain changes has shown you can stop the desire to overeat and effectively control the issue.
The result is weight loss – and patients say it’s life-changing.
I think it’s a hugely positive development. Fewer people with obesity means fewer lives ruined by illnesses such as type 2 diabetes and heart disease. But, as Prof Miras says, local GPs won’t be able to prescribe it.
If you want Wegovy you’ll need to be referred to a hospital-based obesity clinic. These services don’t just offer medication and surgery, but also provide support with lifestyle measures and psychological treatment.
It’s also important with a new drug like this that specialists are able to closely monitor patients for any side effects or complications, even though it seems to be a very safe option.
As with so much in the NHS right now, though, waits for these clinics are long.
But as we learn more, we might see a situation where GPs are allowed to start patients on Wegovy. If and when that’s decided, I’ll be all for offering it.
From years of experience, I know that most diets fail and having a treatment like this will help relieve some of the guilt, shame and self-blame people with obesity are burdened with.
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