| Demi |
Fri, Aug-02-24 07:02 |
‘I believe weight loss drugs can fix obese Britain’
An interesting take on GLP-1 agonists by a British doctor:
Quote:
‘I believe weight loss drugs can fix obese Britain’
I lost all desire for sweet treats when I tried these drugs. As a doctor, I believe they are a great start to tackling the obesity crisis
For years doctors have worried about the obesity epidemic and debated how best to tackle it. We know that obesity is one of the biggest factors contributing to disability and premature death in the developed world. The mantra of eat less and move more simply doesn’t work for many people. Yet we had very little else we could offer when confronted with an overweight patient.
Then suddenly last year, this changed with the launch of a medication that offered a glimmer of hope: Wegovy. This is one of a group of medicines known as GLP-1 (glucagon-like peptide-1) agonists and has potential to change the way we treat obesity forever, offering hope to those battling with their weight. These drugs act like the GLP-1 hormone in the brain which causes people to feel less hungry and slows the clearing of food from the stomach – spurring weight loss.
I passionately believe that they hold the key to addressing the obesity epidemic. Why do I feel so strongly about it? Because a few years ago, aged 40, I tried this medication myself. I was on my way to lunch with friends when I slipped on some cobblestones and broke my foot.
After a series of failed operations, out of desperation my surgeon suggested I try human growth hormone to help the bones heal. I found a doctor who was willing to prescribe it for me privately and it worked. For the first time in over a year I could walk without limping. But this came at a cost. One of the side effects was an insatiable appetite. I would wake up in the middle of the night shaking with hunger and devour a loaf of bread, only to return to bed and feel ravenous again within an hour.
When I returned to my doctor, he explained this side effect would pass but in the meantime, suggested I try another drug that would suppress my appetite: Ozempic, another GLP-1 agonist, that is licensed for Type 2 diabetes, but had started to be used by some private doctors ‘off-licence’ for obesity and to control appetite. I tried it and it was astonishing. My hunger went.
What was strange though was that I’ve always had a sweet tooth and particularly loved chocolate. But it simply lost its appeal. Opposite my gym is a fancy patisserie and I would always walk past and torment myself by looking in the window at their cakes. But suddenly I noticed that they seemed to provoke absolutely no reaction in me, it was as if I was looking at lumps of plastic. It had flipped a switch in my brain and turned off any interest in these kinds of foods. I was only on the medication for two months but even now, several years later, cakes and chocolate hold little appeal for me.
This medication contains the drug semaglutide and has actually been around for over a decade as a treatment for diabetes. It occurred to me at the time that there was great potential for this drug to be used for those battling their weight and indeed, the drug I took has now been relaunched under the new name Wegovy, specifically as a treatment for obesity. Injected once a week, it helps to stabilise your blood sugar levels but also makes you feel fuller for longer, thus triggering weight loss.
A few months after Wegovy was given approval for treatment of obesity a rival, Mounjaro, which contains the drug tirzepatide, was released which works in a similar way. Mounjaro works on the same GLP-1 receptor as Wegovy but also another receptor, GIP, which is also involved in stabilising blood sugar levels and helping patients feel fuller for longer. We know that these medications don’t just curb hunger, they also work on the brain reward pathways. As my experience showed, this is why foods like cake and chocolate which stimulate these pathways can suddenly lose their appeal.
I am convinced that, finally, we have a powerful tool to help people battling the bulge. For the first time, I think we might win the fight against obesity. Although I still work in the NHS full time, my personal experience of taking these drugs inspired me to launch a start-up online weight management clinic specifically focused on middle aged and older patients. It provides an online assessment which is reviewed by a prescriber and, if the patient is eligible, Wegovy or Mounjaro is then delivered directly to their door.
I chose to focus on this group of patients because they really struggle when it comes to managing their weight. While official statistics published last year show that in 2021 to 2022, 63.8 per cent of adults aged 18 years and over in England were estimated to be overweight or living with obesity. For those in midlife the figures are even higher, a shocking 70 per cent of people aged 45-74 are either overweight or obese. I’ve seen this first hand as an NHS doctor. I ran a clinic for obese patients for 10 years. I’m now working in general mental health and see a great many overweight patients struggling with their weight, particularly in middle age.
They are desperate for help, worried about the impact it might have on their future health. They start to feel the odd twinge and realise they aren’t getting any younger or see friends struck down by chronic illness, but diets no longer seem to work. They cut calories but nothing much happens. Or it becomes a futile, Sisyphean task as they get so far, but soon fall back into long-established eating patterns. In this age group, each failed attempt to lose weight, not only represents a missed opportunity for someone to dramatically improve their health, but also often compounds feelings of guilt, shame and defeat. It’s easy to be disheartened and many people simply give up.
But this is a tragedy not just on an individual level but a societal level too. We are currently groaning under the weight of the obesity epidemic. The World Health Organization (WHO) has warned that we are facing an “enormous” crisis if it’s not tackled. By the end of the decade, obesity will be a bigger cause of liver failure than alcohol. An obese woman, for example, is 13 times more likely to develop diabetes, four times more likely to suffer hypertension and three times more likely to suffer cancer of the colon. In fact, a recent study has found that nearly half of all cancers are linked to obesity. Obesity costs the NHS £6.5 billion a year, and people who are overweight cost the NHS twice as much as those of healthy weight.
Why weight loss gets harder in midlife
But why is battling the bulge particularly difficult for people as they age? Hormonal changes mean that your metabolism drastically slows as you get older.
To compound things, in middle and older age, a loss of muscle – known as sarcopenia – occurs naturally as we get older. From the age of 30, muscle mass decreases at a rate of 3-8 per cent per decade, which slows our metabolism further. It also means doing strenuous exercise, which might help with weight loss, gets harder. Our appetite will often stay the same though. The result? Even people who were once a healthy weight in their youth find they can start piling on the pounds. Between the ages of 40 and 66, body weight in both men and women increases at an average rate of 0.3 to 0.5kg per year. If people were already overweight to start with, this means they face an seemingly impossible uphill struggle.
These medications offer real hope to people stuck in this rut. I do have concerns though. These drugs are open to misuse and are all too readily available to those who don’t need them. The demand for these drugs has also meant that some people have turned to buying them from the black market, often via social media, where they are being sold illegally and some have been found to be fake or counterfeit. The WHO issued an alert about this last month, warning that counterfeit weight loss drugs might contain other drugs, such as insulin. A number of people have been hospitalised after taking fake Ozempic and it’s been linked to several deaths.
But the other concern is that it’s all too easy to see these medications as a magic bullet: a simple answer to the complex question of obesity. Unscrupulous online pharmacies are dishing them out without providing additional psychological and dietary support that is essential if these drugs are going to work for patients in the long term. Instead, it needs to be seen holistically, with these drugs as only part of the solution.
Old habits die hard and people need support and guidance on how to address the underlying issues that resulted in them being overweight. Some people are using food for psychological reasons and of course there’s no way an injection will help with this. These people will continue to need emotional and psychological support.
As with any medication, there are possible side effects. The most common – nausea, diarrhoea, constipation, indigestion and tiredness – do tend to improve over time, but it varies in person to person and some might not be able to tolerate them. And, like any diet, weight loss drugs can cause muscle loss, so it’s important to counter that with exercise, particularly in midlife. But for many people who have battled with their weight it really does seem to help them shed the pounds. It can give them the kick-start they need to address their weight and take up regular exercise and healthy eating.
If you are affected by these issues please speak to your GP
Dr Max Pemberton the co-founder of getslimmr.co.uk
|
https://www.telegraph.co.uk/health-...-drugs-obesity/ |
