Sarah’s Health Notes: Thinking about weight loss injections? Read this first….
No one doubts that obesity has reached crisis levels in this country contributing to diseases including diabetes, heart disease and some cancers. There’s no dispute that people falling into the overweight and obese categories would be more healthy if they lost weight. At the other end of the spectrum, however, are people of healthy weight – and some, sadly, with eating disorders - who become obsessed with being thinner to look better, as they see it. Now doctors are warning that getting ‘beach body ready’ by injecting weight loss drugs can become potentially harmful, with some people ending up in A&E.
The slew of hopeful – or perhaps hype-full - headlines about the first weight loss drugs, marketed as Ozempic for diabetes (the original indication) and Wegovy for obesity, took another turn recently, when doctors revealed that some patients have fibbed about their weight to get the drugs privately from online pharmacies or beauty clinics — leading to complications including inflammation of the pancreas.
Websites ask patients to fill in details of their weight, but most do not require an in-person examination, meaning patients who are a healthy weight - or have an eating disorder - can lie. Taking these drugs inappropriately can lead to deadly complications, warns NHS Medical Director Sir Stephen Powis.
Dr. Vicky Price, a consultant in acute medicine and president-elect of the Society for Acute Medicine, said: ‘I and many other colleagues in acute medicine across the UK are very concerned about the increasing numbers of patients we are seeing with complications from new weight loss drugs they have purchased online. Sadly we are seeing serious, life-threatening complications including inflammation of the pancreas gland and alterations in blood salt levels in these patients, who were not aware of the risk they were taking.’
Recent research found that over 4,000 US adults taking semaglutide or liraglutide, both glucagon-like peptide-1 (GLP-1) agonists marketed as Ozempic and Wegovy, for weight loss, had higher incidence of stomach paralysis (gastroparesis), pancreatitis, and bowel obstruction. Researchers at the University of British Columbia said that, although the events are rare, it could still lead to hundreds of thousands of people worldwide experiencing these problems, especially as the drugs may be ordered online. Warning labels should be updated, they say.
If you’re worried about your own or someone else’s health, you can contact Beat, the UK’s eating disorder charity, 365 days a year on 0808-801 0677 or beateatingdisorders.org.uk.
Dr. David Unwin, a supporter of the College of Medicine Beyond Pills Campaign (which I co-founded) and longtime researcher into dietary shifts for diabetes, has prescribed these drugs a number of times but worries about it for various reasons. ‘My first concern is that we are “medicalising” obesity with a risk that people instead of looking at the true cause of their weight problem (almost certainly poor diet) could come to feel it’s okay to eat whatever they like as long as they get their weekly injection.’
He has also been concerned about the potential side-effects reported in clinical trials by manufacturers Novo Nordisk and now in this epidemiological review. ‘My biggest concern though is what happens when you stop the drug? A double-blind randomised, controlled trial studied the effect of switching people from semaglutide to placebo after 20 weeks. Those who continued to take semaglutide continued to lose weight. They had an average (mean) body weight loss from week 20 to week 68 of 7.9%. Those who were switched to a placebo regained 6.9% body weight on average. This suggests that to keep the weight off you need to inject the drug for life.’
Dr. Unwin’s NHS practice near Liverpool has been offering a low carb approach for over ten years, with audited and published results. ‘For those patients advised on a low carb diet the average weight loss was 10kg over an average of 33 months without a single serious side effect, saving £68,000 per year from our diabetes drug budget into the bargain and improving all cardiovascular risk markers as well as renal function.’
As other weight loss drugs come on the market, all hailed as pharma blockbusters, I talked to a patient of Dr. Unwin on his successful experience of following a low carb diet for three years.
Business analysis manager Daniel Hayes, 42, says he feels ‘a bit of a fraud’. That’s nothing to do with his work for a finance company; it’s because his medical records list him as ‘diabetic’ since 2020. ‘In practical terms, I was only diabetic for two months because following a low carb diet, suggested by my doctor, meant that my blood sugar levels fell so significantly I went into remission and have stayed that way ever since.’
Daniel’s story started 15 years ago when a routine check-up revealed he had high blood pressure. He was prescribed antihypertensives; ‘the dose increased over the years to keep my blood pressure under control; it ended up pretty heavy’. As part of monitoring for repeat prescriptions, Daniel had six-monthly check-ups at Norwood Surgery, his primary care practice in Southport, Merseyside. ‘About three years ago, I was told my blood sugar levels were high but to wait for the next check-up as the spike could be a one-off.’
The second reading showed the father of two’s blood sugar levels were ‘sky high. They’d rocketed in six months to nearly double. The doctor told me I had diabetes.’ At that point, many patients in Daniel’s position would have automatically been prescribed drugs but the Norwood Surgery, led by GP Dr. David Unwin, had been pioneering an alternative option in the form of a low carb diet for ten years. ‘I was told I could either take medication, which would likely be insulin, or trying “turning off the sugar tap” for a couple of months and see if it made a difference.’
The prospect of taking drugs, particularly insulin, shocked Daniel: ‘I felt it was a last resort; I wanted to see what I could do myself first.’ He learnt that sugar wasn’t the only problem but also starchy carbs like potato, rice, bread and pasta, which turn to sugar in the body. Because everyone reacts differently to foods, ‘the most useful thing was being given a continuous glucose monitor,’ he says. The device, which he wore on his arm for a month, alerted Daniel to which foods caused a blood sugar spike - in his case, bread, rice and potatoes.
Cutting out those starchy carbs for three months caused his blood sugar levels to fall so dramatically that Daniel’s diabetes was virtually reversed at that point. Today, after consistently following a low carb diet (with the very occasional lapse, he admits), he has technically been in remission from diabetes for two and a half years. ‘I know it would come back if I went back to eating the way I did before and most of the time it’s fine. Having bacon, eggs and sausages for breakfast makes up for missing out on the Mars bars – and cauliflower rice with curry and chili is a great substitute.’ Although most puds are out, he enjoys his own ice cream made using frozen berries mixed with cream or thick yogurt.
There were unexpected and very positive consequences of following a low carb diet: Daniel’s weight dropped two stone to 12 stone seven pounds, his waist size shrank from a ‘snug’ 36 inches to 32, with a BMI of 23.8, which all meant he had to buy a new wardrobe. But there was another bonus: Daniel’s blood pressure began to fall and today he no longer needs to take pills for that. [Dr Unwin has published various studies; the latest is here.]
Daniel is very appreciative of the ongoing support from the practice. ‘Dr. Unwin doesn’t let patients go; he keeps in touch every six months or so. He even produces a graph to show how you’ve improved. There’s a monthly support group at the practice too.’ It was from another patient that Daniel learnt he could access his medical records via the NHS app. ‘As a data analyst, it really helps me to chart my progress. That was what helped so much wearing the glucose monitor over that first month. Nowadays, I can see the results of my blood tests, for instance, within a couple of days. Seeing the data is very motivating.’
Would Daniel have wanted to try semaglutide? ‘I don't like the sound of this,’ he says. ‘Unless you change your habits, you're not really solving the problem.’
