Thousands struggling with obesity could be prescribed Wegovy, or semaglutide, which scientists have described as a “game changer”, after the National Institute for Health and Care Excellence (NICE) approved its use.
However, eating disorder experts have warned the NHS to proceed with caution in prescribing the drug, with one GP accusing NICE of being “absolutely reckless” in approving it.
The drug was approved on Wednesday for use in adults who have at least one weight-related condition, such as type 2 diabetes, high blood pressure, high cholesterol sleep apnoea and heart disease, and a body mass index score of at least 35. It can only be prescribed to those undergoing weight management treatment.
Some scientists and clinicians have praised the decision, however, Edward Emond, deputy director services for eating disorders charity BEAT, said it was simply a short-term fix.
“Even with it being through prescription this is presenting a drug as a ‘quick fix’ and is not really looking at the bigger picture on why somebody might be struggling with [weight]… Generally, this approach is like a restrictive diet, and we know [that going] on a restrictive diet for a significant period is one of the biggest risk factors for developing an eating disorder.
“Also, like with many restrictive eating-based approaches, it might have a temporary change in someone’s weight, and some of the initial evidence on Semaglutide is showing that people will regain the weight and regain more weight than they’ve lost … It reinforces the idea that the number on the scale is the only factor in somebody’s worth and wellbeing.”
He said there needed to be training for doctors and nurses before they prescribed the drug so they understand the factors involved in someone’s relationship with food, such as whether they are “binge eating” as a coping mechanism.
Semaglutide was approved for use in the USA in July 2021 by the Food and Drug Administration for weight management. One brand of the drug Ozempic, designed to treat diabetes, has been touted by various Hollywood celebrities as a “miracle” drug.
Mr Emond warned publicising the drug that way was dangerous due to the impact it could have on those with eating disorders.
GP Dr Asher Larmie, who describes themselves as a weight-inclusive doctor, claimed NICE had been “reckless” in its approach to approving the drug as it had only considered data from an earlier trial, and called for more data to be considered.
Dr Larmie said: “My concern is not only that we do not have enough data about the long-term impacts of this drug ... if you’re using this drug for two years, you start to regain weight at the end of year one, if you stay on it or not; if you stop it at any time, you regain weight at an alarmingly high rate ... then after two years, when you stop this drug, you regain weight at a tremendous rate.”
They said that was a concern because rapid weight gain has negative effects on the body, and there is a risk that restrictive dieting could lead to people developing an eating disorder.
Dr Agnes Ayton, chair of the eating disorder faculty at the Royal College of Psychiatrists, said: “We are aware that some messaging framing semaglutide as a quick-fix weight loss aid may act as a potential trigger for those living with an eating disorder, and poses a real danger for abuse of the medication by those for whom there is no clinical need to use it.
“With this in mind, we would like to see measures put in place for safeguards regarding high-street availability of this medication, to ensure appropriate prescribing. Quick-fix weight loss messaging has been linked to high demand for this product in the US, amid reports of shortages.”
Alex Miras, a professor of endocrinology at Ulster University, said the decision by NICE was a “pivotal moment” and a “positive change” for people living with obesity, and was based on “solid data”.
He said the weight loss that can be achieved with the “safe” medication is “substantial and likely to lead to the improvement of obesity-related complications in a large number of patients”.
However, he warned that there are not enough services to offer the medication, and that those that do exist are “under-resourced”.
Prof Miras and a number of other scientists also raised concerns that the guidance limits the use of the drug to two years.
He said: “Whilst this is understandable based on cost-effectiveness, it makes no clinical sense, as we would not stop treatment for any other chronic disease.”
Currently, semaglutide is not approved for over-the-counter use in the UK, however major pharmacies, such as Boots and Lloyds Pharmacy, have adverts on their websites for patients to sign up for future use. NICE does not regulate the approval of drugs in terms of private or commercial use, as this falls outside of its remit.
NICE was approached for comment.
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