Can drugs really cure the obesity epidemic?
Credit: Slimming World/Paul Buller
In a significant change of direction, the Government has switched its obesity strategy to a £40 million drug pilot. Carolyn Pallister, Registered Dietitian and Head of Nutrition, Research and Health from the UK's leading weight loss organisation Slimming World, looks at what this means for people who need support to lose weight.
The Health Survey for England 2021 estimates that 26% of adults in England are living with obesity and a further 38% are overweight. The cost to the NHS for treating obesity-related health conditions was estimated to be an astounding £6.1billion in 2019.
However, since the UK’s last general election in 2019, the obesity landscape, and the Government’s approach to treatment, have changed significantly.
The pandemic raised the nation’s awareness of the dangers of obesity, and the Government’s response was both swift and bold. In March 2021, former Prime Minister Boris Johnson announced that over £70 million would be invested in weight management services based on a healthy diet, improved physical activity and proven behavioural change techniques enabling up to 700,000 adults a year to get support to help them to lose weight.
Then, just one year later this pledge was cancelled.
Since then, initiatives that the Government had previously recognised as being essential in tackling the obesity crisis, like banning ‘buy one get one free’ deals on junk food, have been abandoned in favour of an injectable drug.
A Miracle Cure?
In March 2023, the National Institute for Health and Care Excellence (NICE) approved the use of semaglutide, brand name Wegovy, a GLP-1 (glucagon-like peptide-1 receptor agonist) for weight loss for adults. It is recommended for use in adults with a BMI of at least 35 and with one weight-related health condition, such as diabetes or high blood pressure.
Just three months later, Prime Minister Rishi Sunak announced a pilot that would see the drug rolled out beyond specialist hospital settings.
Slimming World’s mission is to help people to manage their weight and live happier, healthier lives, and we welcome any innovation that genuinely makes it easier to achieve that safely and effectively. The pilot faces many uncertainties though and there has been a boom in black market drugs. Even when the drug is genuine it has serious side effects including headaches, vomiting, diarrhoea, and there have even been links to poor mental health, including suicidal thoughts.
There’s a big question mark as to the ‘wraparound’ support patients will receive. It’s not clear how these lifestyle services will be incorporated for patients, or how they’ll be monitored and evaluated. And it’s worth noting that of course, those combined lifestyle changes can bring about both weight loss and successful weight maintenance without the use of medication – and without the unpleasant side effects!
The answer to people losing weight safely hasn’t changed
The use of semaglutide on the NHS is limited to two years and trials have shown that, once people stop taking the drug, they regain most of the weight they’ve lost. So, what happens after those two years? We worry that we are simply ‘kicking the can down the road’ because the reality is that the only way to lose weight, and keep it off, is by making sustainable healthy changes to what we eat and drink and by becoming more active.
There was cross-party support for the post-pandemic obesity strategy that focused on providing the support people need to lose weight. And although the funding to provide this support was cut – leaving a void in support for more than three years – the fact remains the same, that healthy diet, physical activity, and expert support are the answer to people losing weight safely, for the long term and without relying on drugs.
Slimming World supports around 700,000 people every single week to adopt these new healthier habits and to take control of their food and activity choices without having to inject themselves. That said, we welcome with open arms anyone who’s struggling with their weight, including people who are taking semaglutide. They, like anyone trying to lose weight, need vital behaviour change support to adjust their mindset around their weight and their eating and activity levels, as well as powerfully motivating peer support from other members, and our programme provides just that.
Looking at the long-term
If the pilot fails to offer suitable wraparound support for those patients taking semaglutide, then weight could be regained, and conditions associated with obesity would only continue to put pressure on the NHS, both financially and in terms of treatment pathways. Alternatively, those people would be condemned to a life of injecting drugs to manage their weight funded by the NHS. Is it a realistic expectation that the NHS can prescribe drugs to the millions of eligible patients when we already know that the total cost of prescription medicines to the NHS in England reached a new high of £17.2 billion in 2021 – 2022 before Wegovy was even introduced?
Research1, presented at the UK Congress on Obesity in Belfast (UKCO 2023), which followed up with more than 100,000 adults who’d joined Slimming World in 2016 between two and seven years later, found on average people had lost around 11% of their body weight (21lbs) at two years, and those attending for seven years had lost 14%. Losing and keeping off 5% of your body weight has been shown to have clinically significant benefits, such as reducing your risk of developing type 2 diabetes or lowering your blood pressure.
If appropriate wraparound care isn’t provided as part of the pilot and healthy habits not implemented, then there is no knock-on effect, we won’t see levels of obesity reducing and a vicious cycle occurs as more people grow up to rely on medication.
On 15th August 2023, NICE released draft guidance outlining four digital programmes that will support the pilot to deliver weight management services alongside the drug in England.
From the evidence provided, it appears only one of the four proposed digital programmes has any evidence of working with patients who have been prescribed weight management medication previously, and NICE says it will gather the evidence as the pilot develops.
There has also yet to be any extensive research into the nutritional intake of people taking appetite suppressing drugs, and those being supported by digital only programmes. We know that a good nutritional intake plays a crucial role in the body’s ability to function and repair. A balanced diet – as recommended by the Government’s Eatwell plate – helps to prevent chronic diseases and maintain overall wellbeing. Semaglutide suppresses the appetite, and we are very concerned about the lack of evidence given to the diet quality of people taking these medications, as this could have wider healthcare implications way beyond obesity.
It’s the specialist and real-life support and motivation people receive that helps them to lose weight and maintain their loss. A drug is not able to change mindsets or develop healthy habits. This is why Slimming World will always welcome members who are using semaglutide – providing them with peer-on-peer support, week after week, to make healthy habits long term and maintain their weight loss long after the injections stop.
1. Secondary analysis of a dataset of 1.1 million self-funding adults who first joined Slimming World in 2016. Weight records for those who had their most recent attendance between January 2018 and January 2023 were extracted and analysed using last observation carried forward.
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