Obese people on weight-loss jabs ‘should be prepared to stay on them for life’

New weight loss drugs must be prioritised for those who most need it amid widespread shortages, experts warn

Nice currently say the jabs should not be taken for more than two years (Getty Images/iStockphoto)

Obese people taking weight-loss jabs should be prepared to stay on them for life, experts have warned.

Studies show that people who stop injections of drugs like semaglutide – sold as Wegovy and Ozempic – can regain much of the weight they have lost.

Research results published last year in the journal Diabetes, Obesity and Metabolism on people who stopped semaglutide showed they regained two-thirds of their lost weight over the next 12 months.

Earlier this year, the National Institute for Health and Care Excellence (Nice) recommended the use of semaglutide for adults with a body mass index (BMI) of at least 35 and one weight-related health condition, such as diabetes or high blood pressure.

Nice has said that the jabs should not be taken for more than two years. However, a team of obesity experts argue this guidance is largely based on the cost of the drugs and that people who take them should be prepared to take them long-term for treating their disease.

Experts also warned the NHS weight-loss clinics do not yet have the capacity to meet the demand for services, giving an example of a clinic in London now treating 1,250 patients in a year compared to 500 in previous years.

It comes amid wider fears over the availability of the drugs, which are also used for patients with diabetes.

Semaglutide comes in a lower dose under the brand name Ozempic for managing type 2 diabetes. Liraglutide (Saxenda) is a different jab available on the NHS as a possible treatment for managing obesity in adults.

Carel Le Roux, professor of metabolic medicine at Ulster University, told a briefing: “These are treatments for the disease of obesity and what happens is, when you treat people effectively, the disease comes under control, and the minute you stop the drug, the disease relapses.”

He suggested the medical profession was comfortable prescribing for conditions such as rheumatoid arthritis or high blood pressure, and the same should be the case for managing obesity.

He added: “The minute we stop the drug, the disease (obesity) relapses, so one of the most important questions we ask our patients now is, ‘are you prepared to take this treatment for the rest of your life?’

“Because if you’re not able to do that, you should stop because then we are probably at risk of doing more harm than we are doing good.

“So it’s important to reframe this as a disease that we are treating and that these are disease-modifying drugs, not weight loss drugs.”

Professor Barbara McGowan, professor of endocrinology and diabetes at King’s College London and Guy’s and St Thomas’s Hospital, said: “When we initiate treatment for obesity using these medications we do discuss the fact that obesity is a chronic disease and that treatment is therefore life-long, not just a short intervention.  

“I usually use the example of blood pressure medication or statins to make the point – i.e. we would not stop these and we would continue life long.  Similarly with medication, the idea is for life-long treatment, although within the NHS we need to adhere to NICE guidelines and only prescribe for 2 years.”  

She added: “Patients sometimes think that the medication is not working anymore as they are not losing more weight, it is therefore important that they know that it works by maintaining weight. As with any chronic disease, it is likely that they may eventually escape and start gaining weight, at that point we would add another anti-obesity medication, similarly, we do this for blood pressure management.”

Professor McGowan also acknowledged there has been “inappropriate use of these drugs” and said that, amid shortages, tighter prescribing controls are needed to ensure those who need the drugs most are able to get hold of it.

Prof Le Roux said the two-year rule from Nice was “100 per cent built on health economics”.

He said the drugs are cost-effective but this cost-effectiveness “stops after two years because the drug price continues to go up.”

He added: “The equation is 100 per cent driven by the price of the medication. And as we all know, all drugs become cheaper as time goes on….With more competition in the market, we hope that the drug prices will come down.

“So I think Nice made the right decision at the time, but we do hope that they will revise that decision, as we get more data…but also as prices come down.”

John Wilding, a professor of medicine who leads clinical research into obesity, diabetes and endocrinology at the University of Liverpool, said: “We do have to think about these medicines as long-term medications despite the fact that, for Nice at the moment, it’s only two years of treatment.

“We do know that obesity is a chronic disease and we would never think of just giving somebody a diabetes drug or blood pressure drug for two years and then stopping it because, of course, at that point the disease will recur.”