New diabetes drugs do not tackle root causes of obesity, experts warn
The promise of breakthrough drugs to help people lose weight must not be used as an excuse to avoid tackling the root causes of obesity, experts have warned, as concerns grow over a scramble for the slimming jabs.
According to recent figures, the proportion of adults in England who are obese rose from 14.9% to 28% between 1993 and 2019, while NHS England data reveals that in 2019-20 there were 10,780 hospital admissions directly attributable to obesity.
With many finding keeping weight off through diet and exercise challenging, excitement is growing around diabetes drugs that have been found to help people lose large amounts of weight by mimicking hormones that help people feel full after consuming food.
One study involving the drug tirzepatide, alongside lifestyle changes, revealed participants had lost as much as 20% of their body weight in a 72-week trial.
But experts say that while the dramatic impact of such drugs is welcome, there are concerns it could detract from taking action to prevent obesity in the first place.
“Unhealthy food is the biggest cause of death and disability in the whole world,” said Graham MacGregor, a professor of cardiovascular medicine at the Wolfson Institute of Population Health in London.
“The question is, what are you going to do about it? Are you going to let the food industry go on feeding us this rubbish and promoting it … and then give drugs to try and stop the effects of all this unhealthy food? Or are you going to try and stop the food industry doing this?”
MacGregor said the growing number of people with high blood pressure as a result of eating too much salt, and high LDL cholesterol as a result of eating too much saturated fat, had led to a rise in prescriptions for blood pressure tablets and statins.
“I would think it’s also inevitable these [diabetes] drugs will be [similarly] widely used, because if you’re obese, it’s almost impossible to lose weight,” he said. But, he said: “It would be so much better to prevent this in the first the place.”
While the UK’s National Institute for Health and Care Excellence (Nice) has already approved the use of two diabetes drugs, liraglutide (brand name Saxenda) and the more effective semaglutide (Wegovy), for certain groups of people with obesity, there are hurdles to their use.
Experts say more work is needed around safety and side effects, and the drugs have drawbacks, including that they are expensive and can be administered only by injection.
Natasha Devon, a body image and mental health campaigner, said the arrival of the drugs would not help alleviate the already problematic pressure on people who are obese.
“Public health messaging has been really appalling on [obesity] because it’s become ‘lose weight by any means and that will automatically make you healthier’ – and that simply isn’t the case and it leads to a lot of issues around body image and eating disorders,” she said. “When we’re focusing on what we can change, it should be how we treat our bodies, as opposed to how our bodies look.”
Devon also questioned whether psychological support and help to change habits would be available for people given the weight loss drugs. “I really hope that we don’t get to a place like we’ve got to with antidepressants where it’s just a very surface-level [solution],” she said.
The company that produces the drugs, Novo Nordisk, has yet to provide stocks of Wegovy to the NHS. Novo Nordisk also produces the Ozempic brand of semaglutide, which – while only licensed for diabetes – can be bought through online pharmacies or private healthcare providers.
Shortages of the drug led the Department of Health and Social Care to warn doctors in September that no new prescriptions of Ozempic should be issued until full supplies becsme available, raising concerns that those buying it privately for weight loss could be jeopardising the availability of the drug for patients with diabetes.
A spokesperson for the company said: “While Novo Nordisk acknowledges that all licensed prescribers have the choice to prescribe treatments outside of their intended purpose, or approved parameters of use, Novo Nordisk does not endorse this in any way.”
A Department of Health and Social Care spokesperson said the government was taking a multifaceted approach to tackling obesity. “We recently announced £20m to trial new obesity treatments and technologies to help save the NHS billions, and remain committed to introducing restrictions banning adverts on TV for foods and drinks high in fat, salt, or sugar before 9pm, as well as paid-for adverts online,” they said.
While 2022 saw the introduction of controversial calorie labelling for food sold in large businesses and regulations on the placement of promotions for foods high in fat, salt or sugar in large retail settings, the government has delayed bans on adverts for such foods before 9pm, as well as “buy one, get one free” deals on junk food until 2025.
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Dr Simon Cork, a senior lecturer in physiology at Anglia Ruskin University, said policy changes matter. “You can’t really help the fact that you’re going to get obese to a large extent, because we live in this environment where food is available 24/7 and great swathes of the population maybe don’t have the funds to be able to pay for the healthiest foods,” he said.
“I do think these drugs are a really, really important weapon in the armoury to tackle the obesity crisis. But I think you have to use it in conjunction with changing the whole environment in which we live.”