WYGOVY GIVES THE USER A CONSTANT FEELING OF SATIETY THEREFORE CALORIE INTAKE IS MASSIVELY REDUCED


New England Journal of Medicine, measured the effectiveness of Wegovy over 68 weeks. Wegovy patients lost 14.9% of bodyweight compared to 2.4% loss in the placebo group. Both groups had intense advice on nutrition and exercise and were given behavioural support. This result is significant as it makes Wegovy about twice as effective as other weight-loss medicines such as sibutramine and rimonabant where studies recorded 5% to 9% of bodyweight loss. Lifestyle advice plus behavioural support got a 3% to 5% loss. Studies suggest the Wegovy is largely safe and it is currently licensed for 2 years use but there are studies soon to be published that might extend this to 5 years.


Medicine or behaviour change? Whereas debate may continue on whether obesity is a disease, a syndrome or a natural response to an abnormal environment there remains little disagreement on the causal link between obesity and illness. Logically therefore, as with other conditions such as raised blood pressure, effective drug intervention should be effective and provided.


Yet for obesity, to date, the question whether a drugs or a lifestyle intervention is superior has been in favour of lifestyle intervention; better diet and increased activity, have proven effective in reducing morbidity but too many people struggle to achieve meaningful targets.


Whereas the risks associated with obesity increase alongside weight-gain in a linear fashion, the risk reduction with weight loss, with or without medication, is much more dramatic in scale than the actual degree of weight lost. A loss of 10% of body weight equates to a loss of 3% of visceral fat, which is accompanied by a dramatic improvement in overall health risk.


Yet it must be remembered, particularly with regard to older drugs, now no longer used, that even where a drug is capable of effecting a 5% or 10% weight loss this does not necessarily mean an individual’s disease risk drops by the same percentage. A side-effect of the drug might increase a patient’s cardiovascular risk to offset the health benefit and therefore use of the drug cannot be justified. For this reason, many drugs


effective in reducing weight are no longer licensed for the management of obesity.


Losing weight is difficult. Individuals with insulin resistance, face greater challenges in weight loss. NICE recommends considering drug therapy for patients who have not achieved their target weight loss, or have reached a plateau with dietary, activity and behavioural change alone. Currently only Orlistat and Liguratide (Saxenda) are licensed and available for weight loss as previous drugs like Sibutramine (Reductil ®) and Rimonabant (Acomplia®) were withdrawn soon after launch due to side effects.


A rocky road Some of the most toxic substances known have historically been used to induce weight loss including; mercury, arsenic, strychnine and dinitrophenol. Notably amphetamines (e.g. Dexamyl, Eskatrol, Dexedrine, Didrex) gained infamy, some of which were combined with barbiturates (Ambar) in order to minimise side- effects. In the US, the noradrenergic appetite suppressants Phentermine and Diethylpropion are still used for short-term weight loss, but their use is limited to a few weeks, due to adverse effects.


Despite over 40 years of use, they lack an evidence base for long-term obesity management and are not prescribed by the NHS. However, they are, still prescribed privately, albeit expensively, through a regulatory loophole. Phentermine, commonly used for rapid short- term loss, presents challenges of rapid rebound weight gain. While Wegovy shows promise, concerns remain regarding taxpayer cost, weight rebound upon cessation, and potential unidentified side effects suggesting a challenging road ahead for Wegovy’s panacea claim.


WEGOVY PATIENTS LOST 14.9% OF BODYWEIGHT COMPARED TO 2.4% LOSS IN THE PLACEBO GROUP


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