Ozempic and weight loss injections
It hasn’t taken long for Ozempic to hit the headlines. Occasionally a medicine comes along that is a real game changer, and it feels at this point like Ozempic, and related medicines in the same class, have real potential to make a big difference beyond the world of diabetes for which they were originally designed.
Ozempic is the trade name for semaglutide, which is a manufactured version of a hormone your gut produces naturally. The hormone comes from the last bit of your small bowel, and is a signal to your brain via the bloodstream that says “this binge has been good fun and really beneficial to store calories for the long, hard winter months ahead, but we’re really at bursting point now and you’re going to have to stop!” Of course that sort of signal was really useful several thousand years ago when food was scarce over the winter, and finding a tree full of ripe fruit was a real opportunity to lay down some fat stores but you had to know your limits. This is no longer quite so useful with supermarkets on every corner.
When this hormone signal was discovered a few years ago it seemed a great target for a group of people who really needed to reduce their calorie intake, namely diabetics. That is the world this medicine started out in, but the observed weight loss led to an expansion of its studied remit. A large study into its effectiveness for weight loss alone had to take the rare step of stopping early because it was so obviously effective that the time taken to continue the study would bave been a disservice to those for whom this medicine could be helpful. And so began the excitement of the weight loss injections…
There are clearly huge benefits of this injection. It alters the way you digest food, but the most noticeable effect for the user is that it reduces your appetite, sometimes so much so that you can go most of a day barely eating without even worrying about it.
Some people are worried about injecting themselves - it’s such a short and fine needle, barely bigger than a mosquito bite, delivered just under the skin and you can’t feel it. The device it comes in is so easy to use: you just wind it up, press a button and hold it against your skin - it takes a few seconds.
Unfortunately there are also several problems with this injection. Firstly it can give you an upset tummy, including nausea and diarrhoea - to varying degrees, and most get used to this, but for a few it is intolerable. Secondly the effect stops as soon as the drug stops, so a rebound in weight from restarting old eating habits is clearly a risk.
However my advice to people considering this intervention is to take it for a few months, initially at a dose to achieve a controlled weight loss (which we monitor closely) and then at a dose to maintain weight at a healthy level whilst supporting sensible lifestyle changes. The drug is not reducing the impact of the calories you eat, it is just making you less inclined to reach for the biscuit tin. The idea is that it should change your habits and give you a real understanding of what you should be buying, cooking and eating. Once you really have that thorough understanding of the quantity of food that leads to weight loss and weight maintenance then you can impose those changes on the rest of your life without needing to continue the injections.
If you think you’d like to explore the use of Ozempic then you are strongly encouraged to speak to a qualified and informed doctor - Lisle Medical is an excellent place to achieve this, face to face and in your own home. We don’t charge extra for this service as some do, and we have the benefit of wider medical expertise to understand whether this is the right treatment for you in the context of your full medical background.
May 2024 update. There are now several options available to those considering these types of treatment, including a more effective version called Mounjaro. However evidence is now also emerging of the disproportionate loss of muscle mass in many while undergoing treatment. We now recommend a baseline body composition scan through My Vital Metrics in London before starting treatment (or at least shortly afterwards). Additionally the longer term data is more convincingly showing a plateau effect of these drugs at some point after 18 months or so, as well as in many cases rebound weight gain of up to two thirds of what had been lost. We are therefore suggesting limiting treatment duration but maximising dose within the limits of tolerance and appropriateness (determined by side effects and follow up investigations) with an acceptance that treatment will not be indefinite.
