For hundreds of thousands of failed dieters, the arrival of Wegovy — a ‘miracle’ remedy providing a assured slimming impact — looks as if the invention of the Holy Grail.
Almost two in three Britons live with weight problems or unhealthy further weight, with one in 4 kids, youngsters or younger adults affected.
As properly as fast issues reminiscent of arthritis on account of carrying extra weight, there are critical long-term issues of weight problems — coronary heart illness, most cancers and a threat of kind 2 diabetes (ladies with a physique mass index, or BMI, of 35 are as much as 90 instances extra prone to have kind 2 than somebody of a wholesome weight, in line with a examine final 12 months by Aberdeen University).
Clinical trials of weekly injections of semaglutide (Wegovy is the model title) discovered that folks might lose as much as 20 per cent of their physique weight in 17 months. The Step 1 research concerned 1,961 severely overweight sufferers from world wide, together with the UK.
Two-thirds of the group acquired weekly injections of semaglutide, whereas the rest had dummy injections. All went on a barely lower-calorie weight-reduction plan and adopted a prompt train programme of two hours of weekly walks, in addition to present process month-to-month counselling periods. None of these concerned knew whether or not they had been receiving the energetic drug.
Alex Guevara (pictured left at his heaviest, 19 stone and proper after losing a few pounds) first took weight-loss drug semaglutide (Wegovy is the model title) three years in the past. He quickly misplaced weight however says that when he stopped taking it he put kilos again on. After restarting remedy, up to now 5 months he has shed 7 lb
Semaglutide (Wegovy is the model title) reduces extra urge for food and stops folks feeling hungry
At the top of the trial, the semaglutide group had misplaced a mean of just about 34 lb (15 kg), with appreciable enhancements in coronary heart illness threat elements reminiscent of blood strain (the management group misplaced simply 5.7 lb, or 2.6 kg).
Other research, known as Step 2 to Step 8 trials, have proven important weight reduction in 20 weeks and dramatic reductions within the threat of kind 2 diabetes.
Last week, the National Institute for Health and Care Excellence (NICE) really helpful that semaglutide needs to be made out there on the NHS for 2 years via specialist weight-loss administration centres, to folks with a BMI of 35 and not less than one weight-related situation reminiscent of hypertension (or, exceptionally, to these with a BMI of 30-34.9).
The NICE steerage additionally stated semaglutide needs to be prescribed alongside a reduced-calorie weight-reduction plan and elevated exercise.
According to the newest well being survey of England in 2021, about 26 per cent of us match into this overweight class (BMI 30 and above) however, total, virtually 70 per cent of us are too heavy and the inhabitants is getting steadily bigger.
With such dramatic trial outcomes, it’s unsurprising that semaglutide and a stream of comparable weight-loss medication within the pipeline are being seen as providing actual hope for a lot of dwelling with weight problems.
Last week, it was reported that authorities officers are drawing up plans for drug corporations to bid for multibillion-pound contracts to offer the remedy far more broadly.
Semaglutide was first developed greater than ten years in the past by the Danish pharma firm Novo Nordisk to deal with kind 2 diabetes. Marketed as Ozempic, it’s already out there on NHS prescription (though at barely completely different, normally decrease, doses to Wegovy).
Studies in sufferers with diabetes confirmed it additionally led to weight reduction, elevating the query of whether or not it will profit folks dwelling with weight problems who had not but developed kind 2 diabetes.
Semaglutide works by mimicking the impact of a hormone in our our bodies known as glucagon-like peptide-1 (GLP-1), which is launched from the gut after consuming to sign fullness. The drug subsequently reduces extra urge for food and stops folks feeling hungry.
It additionally slows down abdomen emptying and digestion; stimulates the manufacturing of insulin, a hormone that removes extra sugar within the blood after consuming; and reduces manufacturing of one other pure hormone known as glucagon, which can be concerned in blood sugar regulation. These results curb the signs and harm brought on by kind 2 diabetes.
Wegovy is run by a weekly injection into the abdomen with a pre-loaded pen (which customers do themselves), with doses growing progressively till you attain the total dose — and is already out there privately, with costs beginning at £73 a month for individuals who can afford it.
These reportedly embody Kim Kardashian, who is alleged to have used it to squeeze herself right into a costume worn by Marilyn Monroe for final 12 months’s Met Gala in New York.
The house billionaire Elon Musk stated he’d shed weight utilizing it (alongside fasting); whereas Jeremy Clarkson has additionally admitted he’s taking semaglutide, which he had ordered on-line.
For everybody else, regardless of the current NICE suggestion, the possibility of an NHS prescription stays slim. That’s as a result of there was a surge in folks in search of it for weight reduction, resulting in a worldwide semaglutide scarcity.
NICE had really drafted its semaglutide approval steerage in June final 12 months, however delayed publication as a result of Novo Nordisk couldn’t meet the demand till it had expanded its manufacturing.
Tam Fry, a spokesman for the National Obesity Forum, stated he has little doubt semaglutide is a game-changer, however that ‘phrase has received spherical that it’s a incredible drug which is able to take kilos off you’.
Yet ‘Novo Nordisk hasn’t actually taken discover of that and solely manufactured a comparatively small batch’, he provides. ‘It will imply morbidly overweight individuals who actually need it — and for whom it’s an actual lifesaver — received’t be capable to get it.’ The drug’s reputation following superstar use will not be the one issue limiting entry to it.
Ahmed Ahmed, a bariatric surgeon and medical senior lecturer in bariatric surgical procedure at Imperial College London, says solely half the UK affected person inhabitants has entry to the specialist weight-management centres that may prescribe the drug on the NHS, and ready lists may be longer than a 12 months.
That implies that though 4 million folks match the standards to obtain weight-loss remedy, realistically solely about 35,000 folks will get it. ‘At the second there’s very excessive demand from folks and no provide,’ he says. ‘NICE has been very intelligent; it has made semaglutide laborious to get.
For hundreds of thousands of failed dieters, the arrival of Wegovy – a ‘miracle’ weight-loss jab – has given them a brand new hope
‘If it made it attainable for GPs to prescribe then demand could be via the roof, however it could solely be given after referral and session at a “tier 3” specialist weight-loss clinic. They are few and much between and solely half the inhabitants has entry to them.’
He provides: ‘Some [doctors] shall be sceptical anyway. There has all the time been inherent prejudice and stigmatisation of weight problems. Half the medical occupation don’t agree it’s a illness.’
And whereas he says semaglutide presents real advantages, he believes medication won’t present the reply to our weight problems disaster.
‘They solely actually produce a weight lack of 5 or 10 per cent in apply, even when the trials confirmed a lot better outcomes,’ he says.
‘If you’ve somebody with a BMI of 35 to 40, then a weight lack of 5 or 10 per cent shall be fairly good for his or her diabetes however not sufficient to ease their arthritic knee ache.
‘You can get 30 per cent weight reduction with bariatric [i.e. weight-loss] surgical procedure — that’s nonetheless the best remedy and we have to deal with providing it extra broadly.’
However, others disagree.
‘We are coming into a brand new period wherein efficient and secure medication for treating weight problems can be found,’ stated Nick Finer, an honorary medical professor on the National Centre for Cardiovascular Prevention and Outcomes at University College London (who has beforehand labored for Novo Nordisk).
‘Overwhelming proof over many years reveals that with present approaches few folks can shed some pounds and keep weight reduction.
‘Results from one other semaglutide trial involving 17,000 folks and its impression on lowering coronary heart illness, stroke and loss of life are due out later this 12 months.’
He provides: ‘Real proof of the worth of the drug shall be when it’s proven that this weight reduction reduces weight problems issues. We know that the identical drug in decrease doses for folks with [type 2] diabetes reduces mortality, stroke and coronary heart assault threat, so hopefully this can even translate to folks with weight problems.’
With weight problems anticipated to have an effect on half of the worldwide inhabitants aged over 5 by 2035, drug market analysts predict that the world marketplace for GLP-1-type medication (reminiscent of semaglutide) will quickly be value greater than the £155 billion spent yearly on most cancers therapies. Another pharma big, Eli Lilly, is poised this summer season to launch a rival to semaglutide: tirzepatide, branded as Mounjaro, which appears to have produced even higher weight-loss leads to trials.
NICE is reviewing this proof and is because of publish its conclusions in July. Excited funding analysts from the financial institution UBS have described tirzepatide as ‘the largest drug ever’.
Health Secretary Steve Barclay has launched a £20 million fund to analysis new weight problems therapies, which, in addition to medication, will embody apps and distant screens to assist folks with weight-reduction plan and train tricks to go alongside remedy.
However, different consultants level out that quite a few anti-obesity medication have exploded on to the market, solely to be quietly withdrawn within the face of main side-effects after they have been given to giant numbers of individuals.
These results have included, at finest, uncontrollable diarrhoea and, with some medication, strokes, coronary heart assaults and loss of life.
An urge for food suppressant drug known as sibutramine (branded as Reductil) was related to elevated threat of stroke — and it was withdrawn in 2010; the usage of fenfluramine, an amphetamine spinoff, for weight reduction was stopped within the late Nineteen Nineties after it was linked to heart-valve harm.
Another slimming drug known as rimonabant was withdrawn in 2008, two years after it was launched, due to potential psychiatric side-effects together with suicidal ideas.
Even the weight-loss medication which can be secure and nonetheless in use, reminiscent of orlistat, usually are not with out their very own issues, with disagreeable side-effects reminiscent of ‘oily discharge from the anus’.
In animal research, semaglutide has been linked to thyroid most cancers — however there is no such thing as a knowledge on whether or not this threat would possibly lengthen to people.
Semaglutide has solely been out there for 2 years, which is partly why NICE has really helpful to restrict its use to the identical interval.
‘No knowledge exists on the longer-term impacts of taking this drug,’ warns Dr Simon Cork, a senior lecturer in physiology at Anglia Ruskin University.
Another query is what occurs when you cease taking it. For occasion, a examine within the Journal of Pharmacology and Therapeutics discovered {that a} majority of people that take semaglutide acquire a lot of the weight again inside a 12 months of stopping it.
Dr Cork stated final week: ‘A follow-up to the preliminary medical trial, the place members had been monitored after stopping semaglutide, confirmed that every one regained virtually all the weight they’d misplaced over the course of the next 12 months.
‘This demonstrates the truth that weight problems is a lifelong situation and that semaglutide is a remedy reasonably than a treatment.’
‘The historical past of earlier weight-loss medication reveals critical side-effects — from coronary heart issues to suicide — that had been hid,’ provides David Healy, a professor of psychiatry at Bangor University and writer of Pharmageddon, which exposes conflicts of curiosity between drug corporations and researchers working for them.
‘We are left to hope that medical use will present this new drug works for some and is comparatively free of significant issues. It could be finest for each docs and sufferers to strategy its use judiciously till we all know extra, however the lure of the advertising might make ready to see a troublesome stance to take.’ There isn’t any suggestion that side-effects of Wegovy have been hid.
Chris van Tulleken, an affiliate professor at University College London, who has written books highlighting the hyperlink between the rise of weight problems and Britain’s more and more unhealthy weight-reduction plan, can be to be satisfied by semaglutide.
‘We realize it received’t be practically pretty much as good because the drug firm says it’s as a result of no drug in historical past has ever lived as much as the promise of the headlines,’ he says.
‘It received’t be a treatment for weight problems for most individuals who take it; it’s simply the most effective instruments we’ve in the intervening time. It can be interfering with a really elementary a part of the mind that will get reward from meals and fullness.
‘What issues me is that we haven’t been capable of deal with prevention. We know the first explanation for pandemic weight problems is ultra-processed meals — predatory firms promoting addictive meals that does monumental hurt to folks’s our bodies, particularly kids, and we’ve to restrict the advertising of that meals.
‘It’s nice to have a brand new drug we will spend billions on, however we have to match that with not less than as a lot on prevention.’
A Novo Nordisk spokesman instructed MailOnline final week: ‘We repeatedly acquire and analyse knowledge on the usage of our medicines post-marketing authorisation, and observe worldwide pharmacovigilance requirements to report and analyse any antagonistic occasions skilled by folks taking our medicines.
‘We work intently with the Medicines and Healthcare merchandise Regulatory Agency to make sure that healthcare professionals have an intensive and full understanding of the security profile of our medicines.’
Yes, it really works – however as quickly as I ended, I piled on the kilos
Alex Guevara, 47, a paramedic practitioner from Milton Keynes, in Buckinghamshire, first took semaglutide three years in the past after his weight rocketed following a extreme lung an infection that left him housebound for months.
‘In 2017, my weight began to balloon after I fell unwell,’ says the daddy of three. ‘At 5 ft 11, I used to be already about 15 st earlier than I received unwell — about 1½ st obese.
‘But by April 2020 I used to be touching 20 st [giving him a BMI of over 39]. I couldn’t go to work, couldn’t train. I simply felt so low.
‘All I might do was eat. Playing with the youngsters was not possible as a result of my joints had been so sore. I even developed sleep apnoea [where you stop breathing momentarily during sleep].
‘I will need to have been spending about £250 every week on snacks from the storage. I used to be on a barrage of remedy, since I had despair and had developed bronchial asthma. I even felt suicidal.
Alex Guevara (pictured left at his heaviest, 19 stone and proper after losing a few pounds) first took semaglutide three years in the past and up to now 5 months he has shed 7 lb
‘I simply couldn’t see a means out of this vicious circle of consuming and distress. I attempted all the pieces, together with going to the gymnasium and varied restrictive diets.
‘But there’s solely a lot train you are able to do in every week when you have a job and a household. I simply didn’t have that type of time on my arms.’
Alex determined to strive semaglutide after it was really helpful to him by a colleague. Feeling that he had nothing to lose, his desperation vanquishing any scepticism, he didn’t baulk on the £200-a-month price ticket.
The outcomes had been virtually prompt. Within a number of days of beginning the remedy, he says he ‘stopped feeling hungry’.
Within a month he had misplaced a stone and his sleep apnoea had gone.
All the identical, there have been side-effects together with nausea, constipation and diarrhoea. These had been at their worst when he began the remedy and settled down after a number of weeks.
One different side-effect of semaglutide is that it could make meals much less interesting, probably ruining the enjoyment of consuming altogether.
Yet Alex says that, given the burden loss, these side-effects didn’t trouble him.
In December 2021, his weight now down to fifteen st and feeling mentally and bodily capable of sustain a more healthy routine with out the drug’s assist, Alex stopped taking the remedy.
But by the next November, having placed on a stone once more, he felt compelled to restart it.
‘It was a mixture of issues,’ he says. ‘Working within the NHS — particularly now — is so nerve-racking and I can work lengthy hours, so I used to be grabbing snacks or junk meals. I additionally wasn’t sleeping properly.
‘Slowly the burden crept again on till I used to be horrified to get on the scales and discover I’d placed on over a stone.’
Self-funding his remedy, up to now 5 months Alex has shed 7 lb however is 1½ st obese (giving him a BMI of 30); his splendid weight is 14 st.
‘It’s nice that the drug shall be far more out there, however the standards are too restrictive,’ he says.
‘For instance, your BMI needs to be 35 to be eligible — there’s virtually an incentive to turn out to be actually obese, simply so an individual can get the drug, which is ridiculous, in fact.’
He provides: ‘Some folks may even see semaglutide because the lazy possibility, however I don’t agree.
‘I wanted one thing dramatic to assist me break the cycle and cease me hurtling in direction of kind 2 diabetes and the danger of cardiovascular ailments and stroke.
‘Anyway, restrictive diets have an enormous failure fee. And when junk meals can typically be cheaper than fruit and greens, is it any surprise it’s so laborious to shed some pounds by your self?
‘As far as I’m involved, semaglutide is a miracle. It needs to be out there to anybody who wants it.’
INTERVIEW: ANGELA EPSTEIN
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