Hot topic: Why it’s best not to ‘go it alone’ with GLP-1 weight loss drugs

OZEMPIC, Wegovy, Mounjaro, Zepbound: they’ve quickly become part of our vocabulary. 

In just a few years, powerful GLP-1 drugs, first introduced to control Type 2 diabetes but now much better known for their ability to help people rapidly lose weight, have become indispensable weapons in the Battle of the Bulge. 

In the UK alone, some half a million people are now thought to access them through private prescriptions – each paying around £200 a month to do so.  

Meanwhile, the NHS is currently using them to treat around 35,000 patients, although the Health Secretary, Wes Streeting, has made it clear he wants the NHS to expand capacity greatly to help combat the country’s obesity crisis. 

If provided by the NHS, GLP-1s should only be prescribed as part of a specialist weight management service, under guidance from the country’s National Institute for Health and Care Excellence (NICE). 

But with the vast majority – in Britain at least – currently getting GLP-1s via private prescription, there is a concern that many are relying on the injections alone to lose weight. 

While they have proved fantastically successful at helping people shed the pounds – with individuals losing on average around 15% of their body weight after 16 months on Wegovy, according to one study – using the drugs alone, without changing one’s lifestyle, is not without potential problems. 

NICE itself states: “It is appropriate to use semaglutide alongside lifestyle interventions that are provided in specialist weight management services (offered in the NHS for a limited time). This is because it is in keeping with the clinical trial, and there is no evidence of effectiveness if semaglutide is used as a single stand-alone treatment.” 

Semaglutide is the active component in Ozempic and Wegovy, while the active component in Mounjaro and Zepbound is another GLP-1 called tirzepatide. 

Many would argue that while there is no gold-standard clinical trial evidence that GLP-1s work alone to make people lose weight– because they have all been tested in conjunction with lifestyle interventions such as healthy diet and exercise – there is plenty of real world evidence that they do. Just ask your friends. 

Nonetheless, the Institute points out that “…the marketing authorisation specifies use [of semaglutide] as an adjunct to a reduced-calorie diet and increased physical activity”. 

In other words, strictly speaking, in the UK semaglutide should only be prescribed for weight loss as part of a wider healthy lifestyle programme. Clearly, that isn’t happening: people are just ordering GLP-1s online and injecting them, often without any significant advice or support. 

However, a number of healthcare companies are offering health lifestyle programmes to support those taking GLP-1s for weight loss. 

Among them, is Denmark-based Liva Healthcare which has a large user-base in the UK. In 2023, NICE recommended Liva’s digital weight management programmes as a safe, effective, and cost-effective way of managing complex obesity cases. NICE has similarly recommended digital programmes from six other providers: Ovivo, Roczen, Second Nature, CheqUp, Gro Health W8 Buddy, and Juniper. 

Hannah Pearman, Services Director of Liva, explained that while Liva offered its programmes digitally, through its app and website, patients always got the benefit of a dedicated human coach, who helped put their personal plan together and motivated them to keep going throughout their whole healthy lifestyle journey. 

Pearman, a qualified dietitian, said: “GLP-1s can be incredibly effective at helping people lose weight, by inducing a feeling of fullness and so suppressing appetite. 

“But while it can be tempting to ‘go it alone’, these powerful drugs should only really be taken for weight loss as part of a healthy lifestyle programme. 

“Firstly, it’s really important to make sure that you are maintaining a healthy diet while on GLP-1s – a diet that is giving you all the nutrients that your body needs.  

“That isn’t always easy when you are eating less than you usually do, as you have to make every meal count, in terms of nutritional density. 

“GLP-1s can also sometimes cause unpleasant side effects such as nausea, which put people off eating, especially in the first month or two. 

“Secondly, once an individual stops taking a GLP-1, for example because they’ve reached their target weight, it’s really important to stick to healthy eating habits.  

“If they don’t do so, they are liable to regain a lot of the weight they have lost as their appetite picks up. 

“In our experience, it’s much easier to keep to a healthy lifestyle after coming off GLP-1s, and keep the weight off, if you are on a programme – ideally one which provides personal support from a human coach.” 

A new study, just published in the journal eClinicalMedicine, provides hard evidence for the importance of adopting a healthy lifestyle if taking GLP-1s – especially in terms of minimising post-treatment weight gain. 

Those placed on a supervised exercise programme in addition to taking the GLP-1 liraglutide, were four times as likely to maintain weight loss of 10% or more a year after coming off the drug, compared to those on liraglutide alone.  

 

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