Weight loss drugs show some promise

But are they going to ensure keeping weight off long term...
25 April 2023

Interview with 

Adam Collins, University of Surrey


Syringe and needle for administering injections


So what is the solution to losing weight and keeping it off? Diet and exercise, as we’ve heard, play some part. But many, including the National Institute for Health and Care Excellence or NICE, believe that the weight loss drug semaglutide, which is marketed as Ozempic and Wegovy, could be a game-changer in the fight to bring down levels of obesity. The drug, which is delivered via an injection into the skin, makes people feel full, so they eat less. But are drugs like Wegovy really a silver bullet? Chris Smith spoke with University of Surrey nutritionist Adam Collins...

Adam - Well, it's certainly very effective. It was originally designed as a treatment for type 2 diabetes, but as a side effect it got people to lose a lot of weight and hence it was rebranded as a weight loss drug. So it's definitely very effective.

Chris - How does it work?

Adam - It mimics a gut hormone that's released after you've eaten that makes you feel full. So it's an artificial version of that that you are injecting.

Chris - So when you are taking the agent, what are the side effects? Because some people have said that they are quite significant.

Adam - Yeah, I mean what you've heard, and some of this is anecdotal at the moment, but people's relationship with food really changes. It's so effective that actually people are almost repulsed by eating. They find it a real chore to eat because their appetite is so suppressed. And then the other effects that you get is, because you are obviously eating far less and you are losing weight relatively rapidly, that that can make you look very gaunt and physically your appearance might not actually be much better even though you have lost that weight.

Chris - People are saying that you go scrawny from the neck up, it's called Ozempic neck or something, isn't it? You get a very gaunt looking face?

Adam - That's right. And it's almost like a badge of honour. I think some people are saying because it's not a diet, it's a bit more masculine that you can go on these drugs and admit it and almost be proud of it rather than go on a diet to lose the weight.

Chris - You were just listening to what the two ladies were saying to me just now and much of the conversation dwelled on the fact that people yo-yo and they do relapse. And is this just a substitute for another diet plan and without the lifestyle modification that the two ladies were talking about to make sure you don't relapse, is there a real danger that when people come off this drug they're back to square one or worse just as they are with a diet?

Adam - Yes, absolutely. I think it is too early to see what effectiveness it has in the long run, but even the NICE guidelines are limiting it to two years. But certainly the fact that you are replacing what you would naturally produce after eating with this artificial drug means that when you stop taking it your appetite is going to come back with a vengeance. My prediction is that people are going to be ravenously hungry once they stop taking this drug. And like any other diet, if you don't have anything else in place to sustain that weight, then that weight's going to come back again.

Chris - I think I read somewhere that most people gain back a significant amount, three quarters of the weight they lose, within a year of stopping it?

Adam - Yeah. And I would say that that's probably an underestimate because what you tend to see in the scientific literature is the success stories. In reality, people are not only regaining that weight, but often overshooting their original weight. So it's almost like dieting is making them fatter. That yo-yo effect is almost like driving an increased need to diet even more, which is obviously not sustainable and in the long run it's going to make you metabolically worse.

Chris - It's not cheap either, is it?

Adam - It's certainly not cheap. I mean it's a very effective way of getting from A to B, but as your two guests before stressed, it's not about just losing the weight, it's about keeping that weight off. That's the real challenge. And that requires doing something that's sustainable and something that's going to be supported, whether that's support with a group or with your family and support network around you, and obviously incorporating other lifestyle changes ike exercise.

Chris - So what in your view does work? Do you think that this is just an of the moment thing and it will join the ranks of other interventions, but with flaws?

Adam - What I would say is the positive is that you've got a very effective tool to get people to lose weight. Now that is a challenge in itself, but in a way that's not the main challenge because the challenge is getting people to maintain that weight once they've lost it.


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