Statins are advised for nearly everyone past a certain age, to reduce heart attacks
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Hello and welcome back to Everyday Science.
If you’ve been seeing more than the usual number of stories about weight loss jabs lately, it is because there has been a medical conference in Spain on obesity medicine.
I have just returned from there, having contributed to the torrent with a few of articles of my own, listed at the bottom of this email.
Some of the media coverage may have sounded like hyperbole, such as claims that we are entering a “golden age” of obesity treatment. They are also being compared to statins in terms of their potential impact on public health.
The first wonder drug
The role of statins would certainly be very big shoes to fill. These medicines were developed to cut cholesterol for preventing heart attacks, but they turned out to lower risk even in people who don’t have high cholesterol.
As a result, once statins became available in cheap generic versions, doctors began recommending them for most people as they get older, depending on other risk factors. About five million people are taking them in England.
Some doctors have even said the NHS should routinely offer a heart “polypill” containing a statin, aspirin to thin the blood, and two blood pressure medications.
Heart doctors have until recently ignored trying to reduce people’s weight, because it was so hard, said Professor Donna Ryan, an obesity specialist at Pennington Biomedical Research Centre. “It takes a huge amount of effort, and then weight regain is such a big problem,” she said.
Long history of failed diet drugs
But obesity is one of the biggest risk factors for heart disease and a growing one. In common with most western countries, people in the UK have been getting steadily heavier since the 1980s and obesity is now seen as one of the world’s biggest public health problems.
Various diet drugs have been tried over the years, but nearly all have turned out to have dangerous side effects. Wegovy (also known as semaglutide or Ozempic when used for diabetes) is the first weight loss drug to be both highly effective and generally safe.
When Wegovy was approved in the UK, just two years ago, it was immediately controversial.
Critics said we should be trying to fix the unhealthy western diet instead of resorting to injections.
But that is easier said than done. Different governments have been trying to reverse the obesity epidemic through public health campaigns for the past four decades, and no one has yet found a way to do it.
So, the NHS is currently wrestling with how to deliver Wegovy and similar drugs to all those who are eligible, more than a third of the population, without busting its drug budget.
People are generally paying privately for Wegovy in the UK (Photo: Tatsiana Volkava/Getty)
In the meantime, those who can afford it are just paying for the jabs privately through a relatively new set up for the UK, where people buy them through online pharmacies for £100 to £250 per month.
The problem here is that people are most likely to succeed with the jabs when they are used under medical guidance. That’s needed to manage side effects, adjust the complex dosing schedule, and to avoid users getting malnourished, a real risk when someone is on a long-term low-calorie diet.
While some of the online pharmacies offer online guidance, others do little more than require people to take a selfie as proof they are overweight and then send the drugs through the post.
Doctors at the conference this week discussed how one overlooked problem is that many people who start weight loss jabs give up within a few weeks or months because they don’t get enough medical support.
In one real-world study, only half of the people were still taking Wegovy after one year. It can’t be a solution to the obesity crisis if so few people stick with it.
Long-term side effects
Another common criticism of the injections is that, because they are relatively novel, we don’t yet know if they will cause side effects when used for many years.
In fact, concerns about this among doctors are fading, because the more research is done, the better these medicines appear. Larger benefits than we expected are emerging for conditions such as heart attacks, strokes and cancer.
Those three diseases are among the biggest causes of ill health in the UK, so it is hard to imagine how a new side effect could later emerge that outweighs these impacts.
What’s more, the medicines are showing promise for improving so many diverse conditions – from depression to addiction to Alzheimer’s disease – it may be too narrow to think of them as weight loss drugs. New Scientist magazine recently ran a cover story calling Wegovy the “everything drug”.
For now, cost is a barrier, and may be another reason why so many people stop taking the medicines after a few months.
But within the next 10 years, the patent is due to expire for the drug that is in Wegovy and Ozempic injections, and that means the price is likely to plummet.
The National Pharmacy Association said in May that about 1.5 million people are paying for the jabs even at their current price. That is already not so far from the five million taking statins, which, of course, are given out free by the NHS.
It seems quite likely that when the cost of weight loss injections falls further, they will overtake statins, as a way of lowering heart disease risk that brings cosmetic benefits as a bonus.
What I’ve written from the conferenceI’ve been reading
I devoured The Ministry of Time by Kaliane Bradley on my plane journeys to and from Spain. It has something for fans of sci-fi, thrillers, history, romance, and even some steamy sex scenes.