Opinion: We must remember that these drugs are intended to treat chronic illness and not be used as beauty products for the rich and image-conscious
The EU approval of Wegovy marks a new era in obesity treatment. Wegovy is a brand name for semaglutide, a drug which has been used to treat diabetes under the brand name Ozempic since 2017. It is one of a range of drugs known as glucagon-like peptide 1 (GLP-1) receptor agonists. These drugs come in pre-loaded injection pens, similar to the EpiPen for anaphylaxis, and mimic the action of GLP-1, a hormone that occurs naturally in the human body.
Surprisingly, they are based not on human GLP-1 but on a similar substance, Exendin-4, that was discovered in the venom of the Gila monster, a lizard found in the southwestern United States and Mexico. A synthetic version of Exendin-4 was developed to treat diabetes in the early 2000s and other GLP-1 mimicking drugs have been developed since, including liraglutide (Saxenda) and tirzepatide (Mounjaro).
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From RTÉ Radio 1's Today With Claire Byrne, GP and obesity medicine specialist Dr Michael Crotty on the Ozempic drug
GLP-1 is a type of hormone known as an incretin. Hormones are the body's messengers, communicating between different organs and tissues, coordinating everything from whether we get periods to when we sleep. When we finish eating a meal or snack, the body has only begun the complex process of harvesting nutrients and energy from that food. During this process, incretins like GLP-1 tell the pancreas to release insulin. Insulin, in turn, tells our cells to absorb the glucose flowing through the bloodstream, allowing us to use or store energy.
But some people, including those with type 2 diabetes, have insulin resistance, meaning their cells struggle to absorb glucose even as their pancreas releases more and more insulin. GLP-1 drugs work, in part, by helping the pancreas to make more insulin but only when it is needed. This helps keep blood sugar levels within a safe range, avoiding spikes (hyperglycaemia) or dangerous dips (hypoglycaemia).
However, GLP-1 drugs also have other effects. They delay gastric emptying, making you feel fuller for longer. And, crucially, they reduce appetite, though scientists are still not quite sure why. The result is that some people lose quite a lot of weight: people on tirzepatide in one study lost 21% on average of their starting body weight.
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From RTÉ One's Six One News in 2022, Ireland has become the first country in Europe to introduce clinical guidelines to treat obesity as a disease
Given our "cultural drive for thinness", many people get excited when they hear about this kind of weight loss. Terms like "skinny jab" and "wonder drug" make these drugs sound like a dieter’s dream. But GLP-1 drugs are not a magic bullet for weight loss. Even for those who really need them, they are not a quick fix. You must adhere to a healthy diet and lifestyle to get the full benefit, and you have to take the injections indefinitely since the effects stop when you stop taking them. These drugs are very expensive, and they are not reimbursed by governments in the way that other drugs for chronic diseases are.
Like all medications, they also have side effects. Many patients experience nausea, vomiting, diarrhoea or constipation, especially while they are getting used to the medicine. There are reports that semaglutide can make diabetes-related eye damage worse in some patients, and it even carries a warning about the possibility of thyroid cancer.
None of this has stopped those who can afford to from hopping on the bandwagon: Taking off-label Ozempic to lose weight is apparently so common among Hollywood stars that Jimmy Kimmel made a joke about it in his opening monologue at the 2023 Oscars. Some have blamed this off-label use for the recent shortage of Ozempic.
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From RTÉ Radio 1's Drivetime in 2021, Stephen O'Rahilly from Cambridge University on treating obesity with medication
Now, semaglutide patent-holder Novo Nordisk is ramping up production, as medical services get ready to prescribe the drug on a large scale. In the UK, companies like Boots and Superdrug are inviting patients to register for online medical consultations about Wegovy, seemingly flouting a UK ban on advertising prescription drugs directly to consumers. In the US, Weight Watchers purchased telehealth company Sequence to allow it to offer a similar service.
Novo Nordisk has certainly done its part to fuel the hype around its new blockbuster drug, and some have alleged that it has overstepped ethical boundaries in the process. The Observer recently reported on a lack of transparency around the company’s efforts to promote semaglutide for obesity. The company has been given a two-year suspension from the Association of the British Pharmaceutical Industry in the UK for "serious breaches" of its standards and is also under investigation by the UK’s pharma watchdog. This kind of vigilance is especially needed because obesity drugs are big business. It is estimated that the market might be worth as much as $54 billion in the next decade.
We can and should stand in awe of the science that turned lizard saliva into safe, effective medicine. But, amid the hype, it’s important to remember that GLP-1 drugs are exactly that: medicine, not beauty products for the rich and image-conscious. It’s up to governments and medical experts, as well as the drug companies, to make sure this medicine gets to those who need it to treat chronic illness, and not just those who can afford to pay for it.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
