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Earlier this year, the NHS licensed a drug that had previously been used by diabetics for many years to control their blood sugar for the purposes of weight loss to those who met certain criteria.   This drug (Semaglutide) has rapidly entered the general vernacular; it is known by brand names Ozempic and Rybelsus.  It has quickly been adopted by many who see it as the answer to their struggle with weight.  The licensed drug name for weight loss is Wegovy.

Hopefully, this article will give you some answers as to what the drug is and how it works, along with some information as to whether this is something you may wish to consider.

What is the drug?

Semaglutide is in the family of drugs known as a GLP1-RA (Glucagon like peptide 1 receptor agonist).  This means that it switches on the receptor for GLP1, which is part of the body’s normal hormonal system. This hormone is responsible for a number of things however, in the context of weight loss, it is relevant as it promotes the feeling of being full and slows down the speed at which the stomach empties food. It also increases insulin production and, thereby, the speed at which glucose is absorbed into the peripheral tissues.

Is it effective?

In short, the answer to this is yes.  Studies show that versus a placebo, people who used Semaglutide lost 12% more body weight.  Not everyone gets the same results, of course – some will lose more and others less.

Who is it currently recommended for?

For many years type 2 diabetics have used the drug to help control their blood sugar levels. However, it has recently been licensed for use as a weight loss agent in the UK.  It is available to those who meet specific criteria through specialist weight services within the NHS.  The criteria include a BMI of 30-35 (kg/m2) and at least 1 weight-related co-morbidity such as hypertension or high cholesterol.

Is there a shortage?

Semaglutide has now been licensed for weight loss in the UK under the brand Wegovy.  Despite this occurring over a year ago, it is still not actually available in the UK.  I suspect this is down to its popularity in the USA. In the UK, the generic medication Semaglutide is being prescribed instead, however, this doesn’t come in doses as high as Wegovy, so isn’t quite as effective.

Because of the sudden popularity of the medication, there is also currently a shortage which is having an impact on the ability of diabetics to get hold of the medication. Generally, with some hunting around, it can be located. However, because of the lack of Wegovy and the difficulty of obtaining semaglutide, now may not be the best time to start taking this.

Should I have it?

At Sloane Street Surgery, we feel that no conversation surrounding the topic of weight loss is complete without a thorough assessment of one’s current lifestyle.  While medicines increasingly have a role for some in addressing the often very significant difficulties with achieving meaningful weight loss, especially for those with complexities associated with obesity, such as pre-diabetes, lifestyle is still front and centre here.

Understanding the role of both diet and exercise in a healthy lifestyle is key, and whether you end up on a weight loss injection or not, this will remain central to your ongoing success with weight loss and general health.

If, despite attempts to alter one’s lifestyle, perhaps with the help of a nutritionist and/or personal trainer, you continue to feel unable to lose unwelcome weight and particularly if you have medical problems attributable to excess weight, then you may well benefit from these medications alongside your ongoing attempts at a healthy lifestyle.

Are there any side effects?

It is important to mention that the medication is still fairly new, and as such, we still don’t have a full understanding of all the side effects. What we know currently is that side effects are possible, although most are short-lived, and the idea of starting with a low dose and slowly increasing is to try to mitigate these. Possible side effects are nausea, diarrhoea, vomiting, bloating, and heartburn.   

Potentially more significant but as yet not fully understood are the increased risk of gallstone disease, inflammation of the pancreas and a potential risk of a rare form of thyroid cancer.  

It is not advisable that those who have previously suffered from either medullary thyroid cancer (a rare form of thyroid cancer) or pancreatitis (inflammation of the pancreas) start this medication.

Those who have diabetes and are known to have diabetic eye disease (retinopathy) should be closely monitored for worsening associated with starting this medication.  

There are reports of people losing their desire to smoke, vape or drink alcohol as a result of the medication, although this is currently not a reason to start the medication and remains an interesting anecdotal piece. 

How long should I take it for?

This is a difficult question. The NHS will only prescribe it for 2 years currently.  The difficulty with this approach to weight loss is that most people find that when they stop taking it, they quickly put the weight back on.  This is clearly one of the significant drawbacks of this method of weight loss and why the 2-year NHS approach is going to be difficult to manage.  It further underlines the importance of making lifestyle changes alongside the medication. Currently, outside of the NHS, there is no recommended ‘maximum’ time that someone should take this medication.

How much weight will I lose?

Ultimately the effectiveness will depend on individual circumstances.  In a major clinical trial, people on the maximum dose lost 12% more of their body weight compared to those who were not on the medication.  Both groups were following similar lifestyle advice at the same time.

Can Sloane Street Surgery prescribe it?

We are happy to prescribe this medication to our patients. It is important that it is started gradually and that all patients are seen, and the various risk factors are discussed. We don’t supply the medication, and it can, from time to time, be difficult to source.

Currently, in the UK, there is no supply of the higher dose of Wegovy medication, so patients are taking the generic Semaglutide.

Will I need regular monitoring?

Once patients are established on the maximum tolerated dose, no further monitoring besides an annual review is required.

If you’d like to find out more or discuss weight loss with one of our doctors, book an appointment now.

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