We are at the start of a new era in the treatment of the disease of obesity and Professor Donal O'Shea is excited about it, as he told Brendan O'Connor. The HSE Clinical Lead for weight loss spoke to Brendan about new developments in hormone-based treatments, which have come on stream years earlier than he expected. The top endocrinologist predicts that drugs like Ozempic will eventually be as common as tablets for lowering blood pressure or cholesterol. Professor O’Shea underlined the importance of good food and exercise; even though these are now known to have little influence on long-term weight loss.

Ozempic is a hormone-based treatment for diabetes that has been prescribed in Ireland for over 13 years. Recently, it’s being prescribed for the treatment of the disease of obesity, as it slows down the process of digestion and makes the person feel fuller for longer. Ozempic contains semaglutide and Dr O'Shea explains how it works:

"The companies have gradually turned a hormone that has a half-life of two minutes in your body into a treatment that will last a week in the form of injection."

Prof. Donal O’Shea first became aware of research and testing of Ozempic when he was working in the UK, long before it was approved for use. He says Ozempic and Wegovy (this contains the same active ingedient as Ozempic, only stronger) represent a huge step forward in the treatment of obesity:

"It’s incredible progress. It’s the first, I’m gonna say safe, effective medical treatment we’ve had for obesity."

Professor O’Shea says that some of the media hype about the drug in recent years - particularly in regard to celebrity use - is not helpful. Instead, he says this revolutionary treatment actually helps us to understand the nature of obesity, as it underlines the biological nature of the disease. Now that a cure is in sight, public attitudes will catch up, in the same way as they did with epilepsy; once a treatment was available:

"What’s amazing about this point in the history of obesity, is that we have arrived at a point where there are treatments. The minute you can treat a disease, it truly underlines that it’s a disease. So, epilepsy was 'demons’ and 'possession’ until somebody said ‘it’s brain activity and this treatment improves it and then people stopped seizing. And the exorcisms stopped."

Myths about weight loss are easily spread but difficult to quash, and Dr O’Shea presented the evidence-based statistics about weight which will come as a surprise to many. He says the research shows that once the weight has been gained, weight loss is hard, if not impossible for most people:

"We now know how the body controls weight and it's 90% irreversible for 90% of people."

The ‘set point’ theory is real he says, in that the body will always try to return to the highest weight it has achieved and stay there. The set point is very difficult to adjust without the help of medication or surgery, and Ozempic is one of the medications which can achieve it:

"What this medication does for people with obesity is it allows a re-set in their set point. Your body weight has a set point and your body always wants to get back, to where it was, its peak weight."

The ability to hold on to weight is not a bad thing, Prof. O'Shea says. In fact, it has helped us evolve as a species and is as integral to our survival as breathing. He explains that the tendency to obesity is largely genetic and once the weight is on, the body will fight to keep it. These new hormone-based medications have the power to gently tweak that process into long term weight loss and that is what makes them so exciting for doctors and patients alike:

"I just never thought I would be sitting having this conversation. I didn’t think we’d get to this point during my career, so I am delighted and excited with where we are."

Ozempic is in short supply at the moment as it is in demand from people living with both diabetes and obesity. It’s currently not possible to prescribe Ozempic to every patient, Donal says, but even if you don’t have access to a weight loss drug, there is still a point to good food and exercise. It may only shift the number on the scales by 5%, but doctors no longer take that number as the most important measure of health:

"We are less and less looking at weight as the metric, because, we know; what’s the point in looking at weight as the metric? Get fitter, eat healthier, be healthier."

Conditions like hypertension are now so easily managed with medication, compared to days gone by, and this is the direction we are going in now with the treatment of obesity, Dr O’Shea says:

"We are looking at a 20-30 year timeline where obesity will become like blood pressure - it will be treatable. If you treat it and you treat it early, you will prevent the diabetes, you will prevent the heart disease, you will prevent the cancer. "

As a peek into the future, Donal revealed that tablet versions of medications like Ozempic are currently being tested as well as treatments that combine up to three hormones, which Donal says will make an even greater impact on obesity:

"Ozempic and Wegovy will look weak when we see the treatments that are further down the pipeline."

There is more about how Ozempic works as well as surprising statistics and myth-busting about weight loss in Prof. O’Shea’s full interview with Brendan O’Connor: listen back here.