In recent weeks, Prime Minister Sir Keir Starmer and Health Secretary Wes Streeting have divided opinions about proposed plans to roll out weight loss drugs to the unemployed to enable a faster return to work. This is subject to the results of their five-year trial in Greater Manchester involving the drug Mounjaro. Discourse on social media regarding celebrities’ changing appearances is a frequent occurrence, with discussion of whether their weight loss is natural or attributed to Ozempic. However, it is not just celebrities that have a vested interest in weight loss drugs. More contentious forms of weight loss such as slimming teas or sourcing drugs online without the proper clinical advice have been popularised. What are these weight loss drugs and what significance do they have in a medical and wider societal context?
The Government’s proposal does highlight some of the economic pressures as a result of obesity. According to their statistics from 2021, over 63 percent of adults in England were overweight with 25.9 percent of those obese. Wes Streeting has said that illnesses relating to obesity cost £11 billion a year. The loss of productivity is significant, with research suggesting a loss of £98 billion a year, or four percent of the UK’s GDP.
Whilst it is clear that more is required to tackle obesity, these drugs alone are unlikely to fully be the answer. These drugs are only offered on the NHS for two years, with research suggesting that two-thirds of participants regain the weight they have lost, highlighting the short-termism of this proposal if the societal issues are not addressed. The link between deprivation and obesity is clear, with an increased prevalence of excess weight in the more deprived areas and those with low educational background (14 percent and 12 percent higher respectively). Wes Streeting also acknowledged a potential “dependency culture” may develop as a result of this drug roll-out.
Many celebrities and those accessing these drugs without the involvement of a doctor are victims to the greater societal pressures to adhere to set standards of beauty that often demonise those who are overweight. Being overweight should not just be ascribed to ‘laziness’. Weight gain may be as a result of medications such as antidepressants and antiepileptics, or medical conditions such as hypothyroidism and PCOS. Additionally, there is increasing evidence of a genetic link of obesity (for example, the MC4R gene). Rhetoric around obesity and the use of weight loss drugs must be nuanced to acknowledge the causes of obesity and that these drugs may not provide the ‘quick fix’ as anticipated.
There are many measures of adiposity (body fat) in adults, with the Body Mass Index (BMI) being a widely-used classification. It classifies being overweight as having a BMI of greater than 25 kg/m2 in people of white ethnicity and greater than 23 kg/m2 in people of non-white ethnicity. Obesity is defined as a BMI of greater than 30 kg/m2 in people of white ethnicity and greater than 27.5 kg/m2 in people of non-white ethnicity. The different cut-off values for ethnicity is accredited to the fact that certain ethnic groups are at greater risk of chronic health conditions at a lower BMI value.
Like with many other conditions, primary prevention may be of benefit in obesity. This involves preventing the onset of disease and therefore symptoms and complications. Obesity is linked to a plethora of medical conditions. It is the second greatest risk factor for the development of cancer after smoking. The association between obesity and Type Two Diabetes Mellitus is irrefutable, with a seven times increased risk. Type Two Diabetes presents its own health complications such as retinopathy causing visual changes, neuropathy (nerve damage) and podiatric issues often leading to lower limb amputations. Alongside this, obesity may further perpetuate a person’s psychiatric problems, with obesity linked with an increased risk of depression.
NICE (the National Institute for Health and Care Excellence) is the authoritative public body responsible for clinical guidelines and the approval of medications and technologies used within the NHS in England and Wales, taking into account cost-effectiveness and clinical efficacy. Under their current guidance, there are a limited number of drugs approved for obesity treatment including Orlistat, Semaglutide and Tirzepatide.
Orlistat (brand name Xenical) is a reversible inhibitor of lipase, the enzyme involved in fat metabolism. Semaglutide – brand names Ozempic (for diabetic management) and Wegovy (for weight loss) – is a glucagon-like peptide 1 (GLP-1) analogue, a hormone whose mechanism of action enables more insulin secretion, reduced glucagon secretion and most importantly in this context reduced gastric emptying and promotes satiety, the feeling of being full after eating. Tirzepatide (brand name Mounjaro) is a dual GIP (gastric inhibitory polypeptide) and GLP-1 analogue, with GIP acting in a similar fashion to GLP-1 as they are both part of the family of metabolic hormones known as incretins, released after nutritional intake.
There are strict eligibility criteria for these drugs and it is not solely based on body fat, but also the patient’s risk factors such as hypercholesterolaemia (high cholesterol levels in the blood) or if other environmental changes such as diet and exercise have been fruitless. In addition, there are common adverse effects such as nausea and diarrhoea and more severe effects such as pancreatitis. As these drugs have only been in the patient population for a relatively short period of time, the long-term effects are unclear.
