Obesity isn’t a choice, it’s a disease: how do we move beyond the ‘skinny jab’?

Glucagon-like peptide-1 agonists (GLP-1) are the key ingredient in weight loss injectables that suppress appetite and delay stomach emptying, which restricts your calorie intake, and encourages weight loss.

And, the molecule has never been more popular. In amongst exhaustive media coverage of “Hollywood’s worst-kept secret”, and endless TikTok transformations, lies the burning question: can these polarising weight loss injections solve a global obesity crisis? 

A quick biology lesson

GLP-1 is a naturally-occurring hormone produced by your digestive system in response to eating food. It acts on both the brain and the digestive system to regulate how full you feel after a meal, as well as slowing down the emptying of your stomach. It also regulates insulin secretion so your blood sugar is better controlled — even lowering blood sugar levels and reducing your appetite by signalling to your brain that you’ve eaten a meal.

GLP-1 is also a class of medications that include semaglutide (brand names include Ozempic, Rybelsus, and Wegovy), liraglutide (Victoza or Saxenda), dulaglutide (Trulicity) and tirzapetide (Mounjaro). While semaglutide was originally used to treat type 2 diabetes, its miraculous side effect of encouraging weight loss in patients warranted further development of the drug to treat obesity.

Thus, Wegovy was born, which you can access in the UK now. In fact, Juniper's Weight Reset Programme prescribes both Wegovy (GLP medication) and Mounjaro (GIP and GLP-1 medication) alongside lifestyle changes supported by our team of clinicians.

As these medications increase in popularity (whilst decreasing in availability), can we rely on these treatments to curb the obesity crisis?

Can GLP-1s cure obesity?

In the UK, Ozempic is licensed for the treatment of diabetes, while Wegovy and Mounjaro injections are prescribed for weight management and the treatment of obesity. As well as BMI requirements, patients must demonstrate that they have exhausted other methods of losing weight in the past. 

We know that losing a moderate amount of weight is proven to lower risks of increased blood pressure, heart disease, common cancers (colon, liver, pancreas, kidney), chronic back and joint pain, and importantly, decreases the risk of hospitalisation or death [1]. 

But the key to losing weight is more complex than just pumping iron and counting calories. 

More than two thirds of adults in the UK are overweight or obese [2], and the average Brit has tried (and failed) 189 diets in their lifetime. When these patients seek help from their doctors, only 19% of people find their GP’s advice useful [3].

Their advice ranges from generic, biassed and ineffective, mostly communicating an ‘eat less, workout more’ approach. This record player of regurgitated platitudes demoralises overweight and obese people, and shifts the blame to the patient for not being able to manage their own size. 

What’s the alternative?

For people living with severe obesity, GLP-1s can also be recommended as a precursor to bariatric surgery, with operations that range from gastric balloons and bands (to physically compress the stomach) to gastrectomies (where a section of your stomach is removed to shrink its size).

Understandably, these invasive surgeries are costly, risky and can be irreversible, with NHS waitlists spanning 12 months or more. Bariatric surgery, also referred to as metabolic surgery, contradictorily does not change a patient’s metabolism sufficiently for them to then eat freely without weight gain [4]. Where lifestyle interventions such as diet and exercise fail, these surgeries are considered the ‘gold standard’ of weight management [5].

Once we stop demonising semaglutide as a vanity drug and start appreciating the life-saving improvements for a growing population of overweight and obese people, we’ll begin to treat obesity for what it really is: a medical condition that requires medical intervention.

What happens beyond the medication?

A real concern for prospective patients is what will happen when you stop taking medications like semaglutide. The recommendation from manufacturers Novo Nordisk is that patients don’t continue beyond two years, as there isn’t enough clinical data to demonstrate long term side effects. Additionally, Novo Nordisk’s Wegovy trial showed that participants regained two-thirds of their prior weight once they were off semaglutide. And disturbingly, similar reversions in cardiometabolic variables were observed [6]. 

What this study did not highlight was how lifestyle interventions were also removed: monthly dietary counselling advocating for 500 kcal dietary deficits, and 150 minutes of physical activity every week.

Research suggests that tailored diet and exercise plans including meal replacements, as well as behavioural and psychological techniques, should be used in conjunction with anti-obesity drugs to improve weight-loss maintenance [7]. One study found that health coaching obese adults improved weight loss (15.7% with health coaching versus 2.5% in controls) [8]. 

These drugs are a vital tool in the holistic treatment of obesity, but they are just that: one tool. You don’t choose to be hungry. And nobody chooses obesity. It’s a condition caused by a complex combination of biological, environmental, and social factors. Medication can tackle one of these components: your biology. Behavioural changes like informed healthy eating choices and realistic exercise routines can influence this too.

But, until there is an overhaul of the healthcare system to create equal access to higher quality care, a reimagining of the Western diet and sedentary lifestyle, and stricter regulations on the promotion of the ultra processed foods that the global population subsists on, obesity will not be cured through diet or exercise alone.