Weight loss drug

Sorry, I should have added that it's being heralded as a miracle drug by the media.

Obesity is a massive issue for the NHS and it will probably save lives.

I'm sure the cost of the drug will be repaid many times over in savings from reduced treatments.

Seems like a good idea to me.

Obesity is a massive issue

😀

Sorry, I should have added that it’s being heralded as a miracle drug by the media.

A columnist for The Times has been using it for a number of months and has done an article on it.

Basically he said it's the easiest thing to administer (almost anywhere on your body and no pain at all), does what it says on the box (makes you feel slightly full nearly all the time) and is quite remarkable.

The biggest problem he has found is that he's had to go and buy new clothes!

If people lose weight then maybe they're more likely to excercise more which can only be a good thing.

I sincerely hope that this drug won’t be abused by those just wanting to lose a stone or two without the effort and discipline required

Sounds a bit like you're worried it's going to make life too easy for those lazy old fatties. I don't know much about it but I'll take my info about its VFM from NICE rather than the tabloids.

Helen Knight, director of medicines evaluation at NICE, said: “For some people losing weight is a real challenge which is why a medicine like semaglutide is a welcome option.

“It won’t be available to everyone. Our committee has made specific recommendations to ensure it remains value for money for the taxpayer, and it can only be used for a maximum of two years.

Apparently there's more tests on it later this year and if it's shown to reduce deaths from heart disease then NICE may reconsider the 2 year limitation.

@sharkbait
Thanks for that perspective.
Not being clinical or "In the trade" and mebbe posting before thinking it through I didn't pick up on the costs of obesity to the NHS.

Can you buy it privately? Seems an easier/cheaper method of weight control than self-discipline/coke & hookers.

Yep.

Sign me up!

I could do with losing a few stubborn kgs which having a newborn at home is proving troublesome to shed.

I could definitely do with some of that; what’s its name and where can I buy privately & legitimately?

I sincerely hope that this drug won’t be abused by those just wanting to lose a stone or two without the effort and discipline required.

Do you have to earn skinniness?

I could do with dropping 10kg to get to my racing weight. If I do that, and beat some people in races, am I cheating?

scruff9252
Free Member
I could do with losing a few stubborn kgs which having a newborn at home is proving troublesome to shed.

I could definitely do with some of that; what’s its name and where can I buy privately & legitimately

Try Asda. (No idea if this is a competitive price though.)

https://onlinedoctor.asda.com/uk/weight-loss-treatment.html

Sign me up too! £70 odd quid a month privately though. I'm not overweight but I might get on the pies for a bit then waddle along to my GP for a prescription. Could top up the carbs saved with extra booze!

Moly, can’t you just take PEDs and SARMS like all the rest?

Genuinely curious as to its effectiveness.

It reduces appetite but I was under the impression that there's an element of habitual eating in some or many obese cases.
Will it change that habit.
What's the NHS load comparing say the effects of bad diet (high BP etc) with the overall effect of obesity?
I suppose the question is will reducing obesity remove the other related issues.

.

My brother in law is on it for his diabetes, and has lost 20kg over the last 15 months - noticeably changed his appearance, he feels better.

Bloke on the radio talking about it this morning. Basically said it's great but pretty much universal reversal of weight loss once you stop taking it. Said it should effectively be viewed similar to statins as something you need to be on for life.

Also to note - only going to be available on NHS through specialist weight loss centres - only a relatively small proportion of the uk are served by these and obviously only the most significant cases get referred to one.

To me it sounds (for the moment at least) as basically only relevant to extreme cases - and geographically lucky ones at that. An irrelevance to most of the 25% of UK adults who are obese currently.

How long before the criteria gets relaxed?

Well I'm obese with a BMI of 35. 105kgs. Could do with losing about 20kgs. I don't do enough exercise, but find it difficult sometimes as I'm too heavy, so end up with injuries. I do park runs, ride to work, can ride a decent pace on a road bike for 40/50 miles, used to ride 70/80 miles regularly.

I've been a bit shit for the past year or so, but even when I was doing lots, running 10k's, or doing sprint tri's I still only got down 95kgs or so.

Not sure what my point is really, but some people are just big and heavy. I probably wouldn't get the drug on NHS and I'm not gonna pay for it privately, but I'd probably give it a go. I'd love to be 80kgs again like I was when I was 19.

I know I need more exercise and less food, but a helping hand would be nice.

Surely some of that 70 quid a month will be offset by not spending money on sausage rolls, pies, crips, chocolate, fizzy pop etc?

I'm similar to ads678 I think, 78kg in my 20's, 80kg+ in my 30's, now I've had kids and creeping up to 100kg! Started to come down recently though, cut out snacks and booze.

I'm basically carrying around an ebike all the time.

It reduces appetite but I was under the impression that there’s an element of habitual eating in some or many obese cases.

Well - reducing appetite might well be an effective tool in breaking habitual behaviour. Two years having your appetite suppressed is really quite a long time and could well have quite a significant psychological effect. Where weight is a result of addictive behaviour then thats a very difficult addiction to address. Most other additions you treat by through abstinence. Alcoholics don't drink a bit less, the yhave to not drink at all ever. If someone's addiction issues are around food the problem is - you still actually have to eat.

But there are other cases where an intervention like this can help. Often weight issues are as much about inactivity as eating and people can get into a sort of trap where injury results in immobility, immobility results in weight gain, weight gain exacerbates the injury but the weight gain also makes surgery to address the injury too dangerous. So being able to bring people's weight down so you can safely resolve mobility issue can help people get an active lifestyle back and get into better health.

I’ve been a bit shit for the past year or so, but even when I was doing lots, running 10k’s, or doing sprint tri’s I still only got down 95kgs or so.

We use the words 'health' and 'fitness' interchangeably but they don't mean the same thing. Running, sprint triathlons - thats fitness related activity - as in building up competitive fitness for sport. They're not necessarily beneficial for health. Health exercise is about gentle, sustained effort - just, you know,  going for a walk. The trouble with energetic exercise is its over before you've done very much of it. So if the aim is to, for instance lose weight,  if you running, racing, exerting then the 'exercise' is over before you've done very much of it

Good exercise for health is too mundane for the fitness industry to monetise so it gets overlooked. Healthy excercise is a level of exertion where you can easily converse - a purposeful walking pace for instance, but with duration. Ride your bike, don't 'train' - just ride places.

Typical response to an issue these days.

Problem: How do we stop people from eating copious amounts high calorie, low nutrition foods?

Answer: We don't change anything except give them a drug that artificially alters their body's chemistry.

I was chatting with a 58 year old colleague the other day who didn't realise that bread was so calorific 🤦🏻‍♂️

My local gym (in a small town) had to extend it carpark, I've seen people do laps of the carpark to find a space closer to the entrance.

But if this drug does save lives and also helps people regain their health and fitness then I'd be mad to be against. Just we should really be looking at the causes of obesity rather than treating the symptoms.

Agree with the above. There is a difference between sporting performance, health, strength, fitness and physical aesthetics. Just because you have a good looking body it doesn't mean you are healthy or fit or strong. Same with sporting performance, just because you are a world class athlete, it does not mean that you are healthy or have a good looking body (Mícheál Rasmussen always comes to mind on this one). Etc, etc

We use the words ‘health’ and ‘fitness’ interchangeably but they don’t mean the same thing. Running, sprint triathlons – thats fitness related activity – as in building up competitive fitness for sport. They’re not necessarily beneficial for health.

Exactly. Plenty of examples of top athletes dying of heart problems at a young age. Also, things like distance runners starving themselves until they develop health issues.

Obesiity and diabetes cost the NHS 30 billion a year. Then there is the cost to employers, employees, the bigger chance of many diseases outside of the obesity classification.
Hence its a great idea.
Evn for the people who cannot be bother to get off their sofas to often - unless the Doritos have run out.

Listening to the rushed in R4 programme about it yesterday it was apparently originally being used as a treatment option for T2 diabetes they said, and weight loss was observed as a side effect. Tweak the dosage and it can be sold as an effective appetite suppressant. There are potential side effects still, like any drug.

The media frenzy is of course focussed on the 'debate' around how deserving/undeserving obese people are (without actually saying it) and I found some of the vox-pops used rather telling about our national attitudes.

It's not going to be an "easy" treatment to get though as it can only be prescribed via specialist services not your GP and so to get put on it you'll probably already have gone through a fair bit of faff with the NHS. Lots of things are "available on the NHS" that doesn't mean you can just wander in to your local GP clinic and get whatever you fancy...

My worry is the aftercare bit, what happens after 24 months with an artificially suppressed appetite?

The woman who'd been on the trial and was cheerleading for it did state that after finishing she started to gain weight and ultimately went for a gastric band (a whole other medical procedure)... If it just becomes a Yo-yo treatment where people shed several stone over 2 years but another 3 years on they're back in the same position (imagined example) can it truly be said to offer VFM and effective treatment? It's got to be part of a suit of treatment not used as a magic bullet...

Is it available on Deliveroo?

But there are other cases where an intervention like this can help. Often weight issues are as much about inactivity as eating and people can get into a sort of trap where injury results in immobility, immobility results in weight gain, weight gain exacerbates the injury but the weight gain also makes surgery to address the injury too dangerous. So being able to bring people’s weight down so you can safely resolve mobility issue can help people get an active lifestyle back and get into better health.

Kind of applies to me. A history of being very active with hiking, biking, gym, whilst having essentially bulimia (binge and over-exercise to manage that rather than puke). When I was younger it was fine as I could out exercise it, but now I have a knee replacement (the other going), expecting wrist fusions before long, microvascular heart disease and suffer with stress related CFS.

To put it bluntly I feel like if I was a dog I'd have me out down. I've had some therapy on my ED, but it's a constant struggle with depression from pain, tiredness and inability to do the things I love and the desire to eat a shit load of tasty stuff and an appetite built up over 52 years of abuse.

I still exercise loads compared to most 52yo, but I really suffer from doing it, I'm always in somemlevel.of pain and fatigue. I'm in a bit of a hole. Not having the appetite for a lengthy period of time might help me break the cycle of eating and exercise, but I'm not diabetic (may be just because of the exercise?) and my BMI is just short of the minimum.

If I could manage my eating/appetite (and lose weight) I wonder if I could manage the exercise drive better and reduce it to the healthy minimum'. But it's a catch 22. Currently I fail on both accounts, I'm just not quite as bad as I was , so I'm not AS bad at eating, and not AS bad at over-exercising, so I'm yo-yoing around the same weight (120kg, 6', size 13 feet, large rugby player frame).

Oh well didn't expect that blurt! Obviously needed to get it out 🙄 Probably the start to the day I needed to remind me what I need to do, or more accurately, not do.

Obesiity and diabetes cost the NHS 30 billion a year. Then there is the cost to employers, employees, the bigger chance of many diseases outside of the obesity classification.
Hence its a great idea.

If you reduce this treatment to purely economic benefits you'll also need to include the increased costs to pensions of all these people living longer.

If you reduce this treatment to purely economic benefits you’ll also need to include the increased costs to pensions of all these people living longer.

Which will hopefully be offset by those same people being able to return to work and contribute more to the economy.

It's an absolute no brainer to try and find any way possible to reduce obesity. Why people would be against it because it's a pill not "HaRd GrAfT" is dumb.

If it keeps people in work longer then pension pot will be bigger.

Should be a gateway drug for people to get skinner to start leading healthier lives. Their current state makes it harder to get active in the first place.

I used to work with someone who had had Gastric Band surgery

They had lost loads of weight. For some reason though they still thought it was ok to keep eating take away meals and crap every single day.

So yes it will save the NHS some money, but unless you change behaviour then I assume it will save the NHS money on bariatric chairs and beds but the underlying health issues will be there still to some extent.

Great if it helps reduce obesity but one thing it can't do is to improve the food choices people do make. Lets say your appetite is dramatically reduced, are you going to lose the highly processed salt, fat and sugar laced food from your diet or the less "addictive" but more beneficial foods?

Hopefully the healthy eating message won't get lost because everyone thinks as long as they aren't overweight what they eat doesn't matter.

Is it available on Deliveroo?

Genuine LOL for that one!

I worked on a GLP-1 agonist some years ago (albiglutide). The Glucagon-like peptides and mimetics are an interesting class. Originally for T2DM, the original ones were short-acting (exenatide was isolated from saliva of a the Gila monster) as they are small peptides. Longer acting ones like semiglutide and albiglutide need much less frequent dosing (we were hoping for every two weeks or even less). Semiglutide is effectively a modified natural GLP-1 that is a bit sticky to albumin, so it hangs around for longer. It's a nice idea and was just a follow-on to the short-acting liraglutide.

The weight loss is a come lately feature and demonstrated in randomised clinical trials https://www.nejm.org/doi/full/10.1056/NEJMoa2032183 - hence the approval. Magnitude of effect in these trials is impressive (12 kg over placebo), but then nothing much has worked in obesity trials. The real revolution is the realisation that gut hormone signalling plays a role in satiety, and that different people have different sensitivity to this signalling. The class also has a dose limiting toxicity in that you basically dose them until you are sick (they are an effective emetic at high enough doses). Everyone is now looking at the role of other gut hormones, PYY being one.

Yes semaglutide has been used for diabetes for a few years. In fact another drug for the same class has also been available on NHS for weight loss (very strict criteria and supplied by hospitals only, not in primary care) semaglutide just seems more efficacious and has been approved now too for weight loss but I guess will have similar restrictions.

In any case it seems those in the clinical trials were on a strictly monitored diet too.

Interestingly we've had serious problems in the last 6 months or so with semaglutide availability for diabetic patients. We can't start diabetes pt on this drug at the moment...because global production has shifted to the "weight loss" form which is much more lucrative for the manufacturer (it's been used in the USA for this for a while).

Had to google Gila monster. Who else did?

I’ve been working on GLP1s and GLP1 dual agonists for the past decade. Semiglutide is good but Lilly’s GLP1-GIPP agonist phase 3 results were spectacular.

The interesting thing about these treatments are they all influencing hormonal pathways. Similarly gastric bands don’t work because they shrink your stomach they work because they change hormone levels.

Poor diet especially excessive sugar and carbs screws up folks hormones whether its insulin or hunger and sesiaty homromes which drives further obesity.

Even as a short-term fix for people with, for instance, a knackered knee I could see it's value in increasing mobility during recovery post-op. It could be the difference between someone having an op, recovering effectively, and returning to work, rather than continuing to be in pain, suffering knock-on problems such as back pain, and being signed off sick long term.

As said above, as a Type 2 diabetic with Type 1 daughter, the issue being is that the availability and price now is being driven up for the NHS and diabetic clinics because it has become a "fashion drug".

I personally think, and i am lucky in that i seemed to have developed T2 after COVID, and placed it into remission within a few months via a higher protein, less simple carbs diet and exercise, but I think that people should be given a nutritionist and access to apps similar to Noom, that are looking at breaking bad habits and establishing good habits and education on nutrition, with these drugs as the very last resort.

If you give someone an easy crutch to lean on, without educating them properly, then 9 times out of 10 they'll take the easier option.

You only have to look how when it comes to diets and nutrition how companies follow trends and what makes them money, there are far more diabetics than there are people who are truly gluten intolerant, but every supermarket has a gluten free section, but no diabetic friendly section, again, go into any restaurant and say you are gluten intolerant and they will bend over backwards, i tell them my daughter is T1, and you will never find any info on the amount of carbs in the food (weirdly McDonalds are one of the best although we avoid it)

...I think that people should be given a nutritionist...

When it comes to NHS use, that'll be what's happening...

Also to note – only going to be available on NHS through specialist weight loss centres

The effect of people buying for themselves causing problems fulfilling on prescription, that's a worry for sure, but production will be ramped up.

you will never find any info on the amount of carbs in the food

Been carb counting for our youngest who's type1 for a decade... eating out hasn't got any easier in that time... pretty useless. You get used to worrying less about how far out your own guesstimates are over time... as you have no other choice really. We used to take travel scales, but just do it by eye instead when out now. Everything weighed when eating at home still though.

@kelvin we're the same, we have scales at home at used to carry them everywhere, but can "guesstimate" now..

I found the hardest things are places like Costa or Starbucks, where my daughter wants a "fruit cooler", you take 10 minutes to find the item on their app, only to find it has twice the sugar of a proper Coke

"Can we have the bottle/can to read the carbs please?" ... > confused look <

If you give someone an easy crutch to lean on, without educating them properly, then 9 times out of 10 they’ll take the easier option.

Taking the easy option is human nature.

Yes it would be great if everyone ate healthily, but that's just not going to happen....

If this drug can reduce obesity and help people avoid / put in remission T2, then it will save the NHS and UK PLC billions. That can only be a good thing...

The drug price will plummet once it comes off patent in a few years, so this could be a really cheap long term way of tackling obesity.

 I sincerely hope that this drug won’t be abused by those just wanting to lose a stone or two without the effort and discipline required.

Prejudiced much? Obesity is a disease, it can be incredibly difficult to lose weight, hence the prevalence of obesity.
As a previously reasonably fit, now very fat person I have struggled for the last 20 years.
Telling people to have self discipline implies "eat less" is like asking them to not drink when they are thirsty or not breath when they are out of breath.

Take ozempic (semaglutide) as a type 2 diabetic (not a fatlad i have a damaged pancreas) it does supress appetite and makes you feel full quicker. However its not an easy ride - nauseous a lot of the time and if you don't eat little and often you feel dreadful. Also its a weekly injection and it does "wear off" by day six. Once you stop appetite returns with a vengeance.

@5plusn8
Not prejudiced at all, although I can see how that came across. That's why I used the word "wanting' rather than "needing". I understand clinical obesity and many of the causes and effects and totally empathise.
Actually, I think the more I attempt to elucidate, the messier this will become, so maybe I'll just shut up.