It’s not actually that hard to imagine. Have you been on a diet? Have you ever lost weight? If so, the chances are you put that weight right back on again. I’ve done it. Oprah’s done it. Sam Smith have done it. My cat did it (RIP, my boy).
The truth is that the diet isn’t the hard part. It’s what comes after that’s hard: lasting change in an environment set up for us to fail.
And guess what? It’s the same with this new generation of weight loss drugs. Ozempic (not technically a weight loss drug), Wegovy and Zepbound - except the weight regain is worse, because of the extreme way in which these medications suppress your appetite.
And now the NHS – who has just started prescribing these drugs to a cohort of 220,000 patients – has clocked this. Yep, they’ve realised waving a patient goodbye into the sunset with no support whatsoever, after a period of rapid weight loss on very intense drugs is - uh - a bad idea. So they are now recommending check-ups for patients for – drum roll please – over a year post weight loss drug prescription termination. Bravo.
As someone who has reported on weight loss drugs, I can’t say I’m that impressed. It’s not long enough, and it’s not enough support. And it makes me worried for patients who come off Mounjaro, Wegovy, Zepbound or any of the future alternatives.
These drugs are incredibly powerful – when you’re on them. But like the diet, when you stop taking these drugs, the world won’t have changed. You’ll still be invited to Nando’s or Five Guys with a friend, you’ll still be barraged with adverts for chocolate, jaffa cakes and alcohol. You’ll still spent eight hours static in front of a desk. Healthy food will still be more expensive. So no shit, it’s hard to keep the pounds at bay.
Alongside this, the body often adjusts to a new ‘set weight’ once it increases. That means the body genuinely finds it harder to function on a lower daily calorie count.
What’s more, someone may well be genetically predisposed to obesity. The drugs are not going to alter that predisposition for the long term.
With this in mind, it is perhaps unsurprising that research published in May co-authored by Chair of the United Kingdom's Food Standards Agency Susan Jebb showed that almost every patient returns to their previous weight within a year of stopping.
When I spoke to Jebb for The New World back in May, she said she wasn’t so surprised about the weight regain – having worked with people living with obesity for decades – but she was surprised at the speed of it.
That’s where the mental health implications come in. It’s traumatic to lose weight and regain it. Traumatic physically and mentally. The “biology of weight really pushes back against efforts to change our diet,” says Dr Dan Bessessen of the University of Colorado in Denver.
All this said, it’s not a total exaggeration to say weight loss drugs are a miracle cure. There has been no other treatment like them in the decades-long global struggle against obesity. We have had literally decades of failed obesity policies.
We have had literally decades of failed obesity policies
So when Novo Nordisk, the Danish pharmaceutical giant, discovered the weight loss potential of Ozempic (a drug used for diabetes) they were astonished. By 2023, Wegovy was on the market.
Injected once a week, over months it could bring about a 20% drop in weight. For someone living with obesity, that could be a huge and life-saving change, with profound medical implications. The drugs (known as semaglutide-2) work by suppressing appetite. When people are on it, they say sanctimonious things like: “I forgot to eat breakfast, lunch and dinner”. The weight just falls off. They don’t really need to try.
Now in England, one in four of us are obese - so we could certainly do with skipping the odd meal (maybe not all three in a day though). And the NHS has just started prescribing these drugs. Some 220,000 people – with morbid obesity and a range of comorbidities due to their weight – are currently being prescribed the drugs by GPs for a duration of three years. In all, currently more like 1.5 million people in the UK are actually on them - but the vast majority are paying privately. And of those, many are not necessarily obese (though there is no proper data on this).
Prof Jonathan Benger of the National Institute for Health and Care Excellence said on Tuesday: "Successful weight management doesn't end when medication stops or when someone completes a behavioural programme. We know that the transition period after treatment is crucial, and people need structured support to maintain the positive changes they've made."
NICE will advise patients to build long-term behavioural habits, use self-monitoring tools, and draw on wider support "from online communities to family-led interventions and local activities." This is definitely a step in the right direction but really, broader change and more support will have to be introduced if we are to ever get a grip of this crisis.
We imagine it’s normal to be thin - but the body disagrees
Some scientists have suggested patients stay on these drugs for life – a solution that could become more plausible once Novo Nordisk and Eli Lilly’s patents run out in around 2032 and the drugs likely become much cheaper. But existing research suggests many patients – up to 75% – don’t stay on them more than a year anyway. So it seems unlikely to me.
“The staggeringly high discontinuation rates of GLP-1 RA should raise alarms for clinicians, policy makers, and public health experts,” says Sadiya Khan, associate professor of medicine at Northwestern University Feinberg School of Medicine.
One reason is that they come with serious gastrointestinal side effects, which are genuinely unpleasant. They include nausea, gastro pain, constipation and more. It’s also antisocial to skip meals all the time.
More than anything, I think part of the problem is that many of us imagine that it’s normal to be thin, or to be in the parameters of a healthy BMI. When we dream of diets, or a new body shape, we rarely view these remoulded versions of ourselves - trimmer, hencher, toned-er - as temporary. But unless we are willing and able to make very permanent changes to our lives and routines, these new bodies will be fleeting.
That is the problem with this generation of weight loss drugs.
And it’s a problem with humankind in general. We do tend to crave quick fixes, often in pharmaceutical form. That’s why Henry Dimbleby, a food campaigner and founder of Leon, called Ozempic “the obesity version of Prozac”.
What we should be focusing on is using these weight loss drugs for those with complex obesity for sure - for which, by the way, there is very often a genetic reason for the condition. But we must also acknowledge that the way our society is set up is simply not conducive to maintaining a healthy weight. That’s the problem we really need to fix.
Lucy Kenningham is Comment Editor at The Standard
