Weight-loss medications such as Ozempic are contentious, and polarised opinions on them have created a lot of confusion for patients. While some see them as miracle cures, others view them with significant scepticism. Sometimes, they are even seen as reflecting a moral failing for not having the discipline to lose weight by using lifestyle measures alone.
Like all problems in life, the answer is never at the extremes, but somewhere in the middle.
As a cardiologist, here is what I tell my patients. These are medications. They are best used when excess fat risks a person’s health, and the risks of not taking them are greater than the risks of taking them. Both sides of the equation come with risks, just like every decision in life. They are not, however, “lifestyle injections” to get beach-bod ready. They are not a substitute for close attention to good nutrition and exercise. And they should be used in combination with such appropriate lifestyle factors.
Using these medications to lose excess fat that risks your health is no more of a moral failing than using a blood pressure medication to lower high blood pressure that increases your risk of stroke. The primary criticism of those who use medications for weight loss is that they need to focus more on diet and exercise. But how effective are diet and exercise for losing weight? The answer is very effective over short periods of time and under ideal and controlled circumstances. If you were locked in a room with limited access to food, you would lose weight. A better question is what happens to people in the real world because that’s where we live, not in locked rooms.
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Most people who use diet and exercise will lose weight within six months. At two years, however, 50 per cent of people will have regained all the weight they had lost. At five years, 80 per cent of people will have regained all the weight they had lost. This means that 20 per cent of people will successfully lose and maintain that weight loss. It is possible, it’s just not probable.
Unfortunately, diet and exercise are frequently not enough for most people who are aiming to lose weight and sustain weight loss. Multiple studies show that the average weight loss using lifestyle measures at three years is only 2.45kg. While this is a useful change directionally, if you weigh 110kg, this just won’t be enough to reduce the added health risks excess weight presents. And so, for most people who struggle with significant excess weight, they “yo-yo” up and down. Year after year. Making progress and then losing it – an endless cycle of frustration.
Weight loss medications, including Ozempic (semaglutide) and other newer therapies, are an option for patients looking to lose excess weight that presents a risk to their health. In clinical trials, Ozempic showed a 15 per cent reduction in body weight compared with lifestyle measures. Newer therapies such as tirzepatide (Mounjaro) have shown even greater reductions with up to 25 per cent reductions in body weight. Therapies still in clinical trials have shown up to 30 per cent reductions in body weight, which meant a 27kg reduction in weight for many patients.
After two years of treatment, most patients will have maintained that weight loss, compared with the 50 per cent who will have done so using lifestyle measures alone.
What happens when you stop these medications? The answer is that for most people, the weight loss largely disappears in much the same way as would happen if you stopped someone’s blood pressure-lowering medication after six months. Their blood pressure would go back up to where it was initially. So why would we expect anything different from weight-loss medications? Remember, these are medications for managing a medical condition, not a crash diet.
This also means that treatment with one of these medications will probably be a lifelong therapy in some form or another – again, just like a blood pressure lowering medication.
All medications have the potential for side effects, even over-the-counter medications such as paracetamol, and weight-loss medications are no different. Most people will have no side effects on these medications, but about one in five people will have some nausea for the first few months. Less frequently, people also experience side effects such as vomiting, constipation and diarrhoea. Very rarely do serious side effects, such as severe inflammation of the pancreas, occur.
But what about the long-term side effects? Medications such as Ozempic are new, and our long-term experience with them is therefore limited.
Our long-term experience with obesity, however, is not limited. We know that exposure to obesity over long time frames leads to higher rates of diabetes, stroke, heart attack, dementia and even many cancers. We will learn more about the long-term implications of weight-loss medications over time, but we are very clear about the long-term impacts of obesity. Ozempic is part of the first generation of these weight-loss therapies. Others in development have shown even greater promise. Currently, these medications are delivered as an injection, but oral versions will soon be available.
Obesity is one of the biggest public health challenges the world faces. There is no doubt that the environment we live in has changed dramatically over the years and is closely linked to the rise in obesity. Every effort must be made to address the environmental factors that promote obesity, and we should also pay attention to lifestyle factors to prevent obesity in the first place. But for now, weight-loss therapies such as Ozempic and others offer an effective and sustainable solution for many. This does not mean there are no challenges with using these therapies.
In Ireland, Ozempic is currently only approved for the treatment of diabetes. Any prescription for Ozempic solely for the treatment of excess weight will incur a cost of about €160 per month. In the US, the cost is often more than $1000 (€898) per month. These challenges will be resolved with time. But there is no doubt that for those who have struggled with obesity, we now have an additional tool in our toolkit that will dramatically change the landscape in the future.
Dr Paddy Barrett is a preventive cardiologist at the Blackrock clinic and author of Heart An Owner’s Guide
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