With more than one billion people worldwide now living with obesity, and on World Obesity Day (4 March), we spoke to Professor Amanda Daley and Dr Claire Madigan, experts in behavioural medicine, about what is missing from the current conversation.
Commenting on how long people may need to take the medication, Professor Daley said:
“If you want to start on the drugs then you probably need to accept that you will need to take them for life, because studies have shown that as soon as you come off them, the weight goes back on, as people aren’t learning how to manage their weight. People think the drugs will do the work for them, and of course, they don’t.
“As use of the drugs continues to grow, it feels as though we are approaching something of a tipping point, with increasing scepticism being felt around whether they are as much of a miracle cure for obesity as initially sold. Drugs like this do have the potential to change people’s lives, but only if managed correctly. The work to maintain your health still needs to be done. As with most things, there is never a quick fix, and this is certainly the case, with or without anti-obesity medication, when it comes to losing weight and keeping it off.”
Last week, GPs were offered incentives to prescribe anti-obesity medications - covering 220,000 courses over three years. While designed to prevent disease, Dr Madigan says eligibility criteria limit that impact.
“To access the medications your BMI must be greater than 35 kg/m2 and you must have four health conditions. Therefore, these medications will unlikely be helping to prevent disease in the patients that are receiving them on the NHS as they already have co-morbidities.
“We still need to offer people support to manage their weight. Finding what support is available is difficult for people to do. GPs don’t know which services are available. We need clear care pathways with ongoing support and follow-up. Obesity is a chronic relapsing condition that cannot be cured with a drug alone.”
Professor Daley added: “We need to develop and invest in more support for lifestyle changes while people are on the medication, to ensure they can come off them without the rapid weight regain and to protect people’s mental health too. This should also apply to those accessing the medication privately, where rigorous checks and support seem less readily available.”
Both experts stress that medication alone is not enough, and that physical activity and healthy eating must remain central.
Dr Madigan said: “Physical activity needs to be considered. Exercise is like a magic pill that can help prevent and manage many chronic diseases. It is also one of the key things reported to help people maintain weight loss.”
Professor Daley added: “When you take GLP-1 weight loss drugs, you must still do your 150 minutes of physical activity per week, plus strength-muscle based exercises. Yes, the drugs will help you lose a considerable amount of weight relatively quickly, but they will not give you all the other health benefits that physical activity provides.”
The experts also emphasised prevention.
“Medicating after an individual’s weight has already negatively affected their health should not be our focus. We need to be intervening and providing strong support before that point” said Professor Daley.
“Childhood obesity is a rapidly rising issue, with an estimated 400 million children and adolescents living with overweight or obesity in 2025. When developed in childhood, obesity often continues into adulthood, increasing the risk of serious non-communicable diseases such as diabetes, heart disease and some cancers. This is why early intervention is so important.”
Professor Daley also highlighted the economic case for prevention.
“The estimated global economic impact of overweight and obesity in 2030 is $3.23 trillion dollars. Although weight loss medication is giving people a kickstart in their weight loss journeys, if not managed correctly, it can lead to weight being put back on and individuals ending up where they first began, at a cost to the NHS.
“By investing in care to help people manage their weight and prevent weight gain before it happens, the cost savings would be huge.”
ENDS
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