Is Wegovy the answer to weight loss?
With a new study revealing that 1 in 10 adolescents have tried non-prescription weight loss pills,[1] its clear that society is increasingly approaching medicalised solutions to weigh gain.
Diet pills have been around for a while and the most common types include appetite suppressants, fat blockers, and thermogenics. Orlistat was the last prescription pill to be approved and is currently available with a prescription or at a lower dose from a pharmacy. However, the reported side effects have led to a decline in demand.
Demand for Wegovy is so high that there will be a shortage for the rest of the year
Enter Wegovy.
Originally developed for the treatment of type 2 diabetes, Wegovy is currently only available to be prescribed for obesity in the NHS by specialist weight management clinics, for people with a BMI of at least 35 and with weight-related co-weight-related conditions such as high blood pressure, heart disease or sleep apnoea[3].
Due to the use by high profile figures, the diabetes version of the drug is being privately used for weight loss and demand has outstripped supply, with the government is warning that the shortage will last until the end of the year .[2]
Wegovy works by signalling to the physiological receptors in the brain that you are not hungry and also reduces blood sugar levels.
Wegovy was studied in a clinical trial and was given alongside a reduced calorie diet (a reduction of 500 cals per day) and physical activity of 150 minutes a week. For every 2 patients in the trial who received the Wegovy regimen, one patient received a placebo drug as well as the reduced calorie diet and physical activity.
You still need to reduce your food intake and increase physical activity to lose weight with Wegovy.
The trial data show that over a period of 68 weeks 95% of the Wegovy lost weight but so did 65% of the placebo population[4].
Of course, you lose weight when you follow a reduced calorie diet and patients on Wegovy lost 12kg more over the course of 68 weeks.
Patients on Wegovy lost more weight than those who followed diet and exercise alone. On average patients lost 12 kg more weight in the Wegovy group over the 68-week period.
And now the bad news
Unsurprisingly, the patients who received the active drug lost more weight, but they also experienced more side effects.
The most common side effects were nausea (44% Wegovy patients vs 17% placebo), diarrhoea (31% wegovy vs 16% placebo), vomiting (25% wegovy vs 6% placebo) and constipation (23% vs 9%).
More patients receiving Wegovy experienced gastrointestinal disorders (typically nausea, diarrhoea, vomiting, and constipation) than those receiving placebo.
These effects last longer in the Wegovy group than the placebo on average. Considering these GI effects, not surprising that Wegovy patients lost more weight!
So, what happens after the treatment stops?
This study also had a 52-week follow-up after both the drug treatment and the diet & exercise regimen also stopped[5].
Participants regained two-thirds of their prior weight loss, and the cardiac benefits that were initially seen reverted to baseline.
Like dieting, once the treatment stops the lost weight returns
In a different analysis of pharmacy records of 13 million people in the US who have been prescribed Wegovy and researchers found that the two-thirds of those stopped taking Wegovy within a year.[6]
So it appears that drug treatment for weigh management, like dieting is short term solution to life-long challenge. Unless we address the reasons why we overeat in the first place, we are not going to solve our weight struggles.
The idea that we need drugs because of the world’s growing obesity problem is nonsensical. We need to stop weight gain rather than give pills to reverse it!
References
[1] JAMA Network Open. 2024;7(1):e2350940. doi:10.1001/jamanetworkopen.2023.50940
[2] https://www.bmj.com/content/384/bmj.q28
[3] https://healthmedia.blog.gov.uk/2023/09/04/accessing-wegovy-for-weight-loss-everything-you-need-to-know/
[4] N Engl J Med 2021; 384:989-1002 DOI: 10.1056/NEJMoa2032183
[5] https://doi.org/10.1111/dom.14725
[6] https://www.primetherapeutics.com/wp-content/uploads/2023/07/GLP-1a-obesity-treatment-1st-year-cost-effectiveness-study-abstract-FINAL-7-11.pdf
