The failure of many citizens to control their burgeoning body weights, coupled with the steadily increasing numbers of the overweight and obese in Britain, are impairing the nation’s health and wellbeing, as well as lowering productivity in the economy. According to a commentary from the Tony Blair Institute, published in November 2023, almost three-quarters of people between 45 and 74 in England are either overweight (BMI between 25 and 29.9) or obese (BMI 30 or more). For the record, BMI (Body Mass Index) links body weight to height and is considered a ‘surrogate marker’ for obesity, despite its limitations. Either way, obesity-related illness is estimated to cost the NHS as much as £11 billion a year.
On 14 October 2024, Health Secretary Wes Streeting thus contributed an opinion piece for The Telegraph, entitled ‘Widening waistbands are a burden on Britain’, in which he advocated the use of “weight-loss jabs” to “ease the demands on our NHS” and confirmed an investment of £279 million from Lilly, the world’s largest pharmaceutical manufacturer, to take matters forward. The following day, while talking to the BBC, Prime Minister Sir Keir Starmer endorsed Mr. Streeting’s proposals for weight-loss drugs.
In line with current opinion, many, if not most, healthcare professionals consider obesity to be a disease, which on occasion benefits from medical or surgical treatment. Weight-loss injections, complementing reduced-calorie diets and regular physical exercise, are a relatively recent innovation. Currently, two branded weight-loss injectable medications are available on the NHS. Saxenda (liraglutide) and Wegovy (semaglutide) are both produced by Danish manufacturer Novo Nordisk. Wegovy was launched in the UK on 4 September 2023, after receiving the go-ahead from NICE. A third drug, Mounjaro (tirzepatide) is on its way, having been approved by NICE in 2024. It is a product of the world’s largest pharmaceutical manufacturer, Eli Lilly.
Liraglutide, semaglutide, and tirzepatide are GLP-1 receptor agonists, which mimic the action of GLP-1, or glucagon-like peptide. GLP-1, a natural hormone, is released from the gut while eating and induces a feeling of fullness or satiety, thereby suppressing appetite and preventing overeating. Mounjaro also acts on another hormone, glucose-dependent insulinotropic peptide (GIP). Several randomised clinical trials have demonstrated the weight-reducing potential of these drugs.
Liraglutide was launched in the UK in January 2017. It is injected daily, while semaglutide and tirzepatide are injected weekly, on the same day each week. These prescription-only products come in pre-filled pens and are injected directly under the skin, in either the upper arm, thigh, or abdomen. Wegovy should only be prescribed by specialist weight management services, either NHS or private, is not available over-the-counter, and must not be ordered online from sources of unknown provenance. Eligible recipients have a BMI of 35 or over, and at least one weight-related health condition, such as high blood pressure or cardiovascular disease.
Semaglutide is better known as Ozempic, which is licensed only to treat Type 2 diabetes. Its use for weight loss is thus considered “off-label”. Ozempic improves blood sugar control in diabetics, lowers the risk of heart attack, stroke, and death, while also reducing weight. Unfortunately, celebrities and social media influencers have also endorsed Ozempic as a weight-loss drug, leading to shortages and denying diabetics access to the medication.
Many problems lie ahead. The distribution of specialist weight management services is patchy, with some sectors across England, Scotland, and Wales not provided for. Existing services are overloaded. The injections are not cheap, and the long-term implications of treatment have yet to be ascertained. Reported side-effects of semaglutide include minor and self-limiting gastrointestinal complaints, such as nausea, vomiting, heartburn, diarrhoea, constipation, cramps, bloating, and flatulence. More serious complications, such as pancreatitis, changes in vision, kidney damage, and thyroid tumours are much less common but also more concerning.
Obesity is a complex condition, with no quick-fixes for treatment, and that includes injections. It is right, however, that efforts are made to reduce the numbers of the obese, improving their health and wellbeing and reducing the impact of their condition on society and on the wider economy. Prevention, as always, remains preferable to the various expensive medical and surgical “cures” for overweight and obesity.
Ashis Banerjee