Semaglutide and the future of obesity care in the UK

Firstly, what is Semaglutide? It’s a new generation of obesity medications called GLP-1 (Glucagon-like Peptide-1) analogues, which is administered by weekly injections for up to 2 years. These drugs work by increasing the activity of the GLP-1 receptor in the brain which can help the body regulate insulin and glucose (sugar) released by the liver, slow the rate the stomach takes to digest and empty food, and reduce appetite[1] – in a nutshell it helps you feel less hungry, more full, and eat less.

Secondly, does it work? And the answer is yes, when tested in a two year randomised controlled trial the patients taking Semaglutide lost on average 15% of their body weight compared to 3% who did not take the drug[2]. But like any drug it can have side effects and these commonly include feeling sick, diarrhoea, bloating (excess gas), and fatigue. There are also some less common but serious potential side effects such as pancreatitis, which is why careful monitoring is so important.

So why are we concerned? Our commentary in the Lancet highlighted the following concerns we have about Semaglutide:

1. It’s approved for use on the NHS but it’s only available through specialist weight management centres, and currently not every area in the country has these centres which creates a postcode lottery in terms of potential access to treatment.
2. Semaglutide is currently available privately but not on the NHS due to supply shortages, which again creates an inequality, with access only available to those who can afford it.
3. Private purchases of the drug are driving shortages, and there is some evidence of unsafe and inappropriate private prescribing. This is a concern as it could lead to the people who don’t need the drug being prescribed it, or people not being safely monitored and supported whilst taking the drug.
4. We don’t yet know the long-term effects of taking Semaglutide, and in different population groups, as the trial patients were mainly white women followed over two years.
5. Some GPs have not had sufficient training in the nutrition and the medication management required whilst caring for patients taking the drug. This could lead to unintended harms such as poor nutrition, weight regain, low blood pressure or low blood sugar.
6. Obesity is a chronic relapsing disease, therefore weight regain will be inevitable when patients come off the drug, unless they are provided with appropriate person-centred care. This is non-stigmatising care that is tailored to an individual, that addresses the root causes of obesity (for example providing psychological support) and safely manages co-morbidities (other illnesses that patients have in addition to living with obesity).
7. A focus simply on the use of medication, does not address the complexity of obesity which requires a system wide approach. This includes local and national policies and action that promote opportunities to eat a healthy diet and be physically active.

In summary, obesity is complex chronic disease. Obesity medication can be a useful aid to weight management, providing it is safely and equitably prescribed. However, it will only ever be a sticking plaster unless it is delivered as part of a life-long programme of person-centred care that addresses root causes, manages co-morbidities and is supported by societal and policy actions that enable positive behaviour change.

[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01083-8/fulltext?dgcid=twitter_organic_comment23_lancet&utm_campaign=comment23&utm_content=251877892&utm_medium=social&utm_source=twitter&hss_channel=tw-27013292

[1] https://www.gov.uk/government/news/new-drugs-pilot-to-tackle-obesity-and-cut-nhs-waiting-lists

[1] https://www.diabetes.co.uk/diabetes-medication/semaglutide.html

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