A drug that can safely aid rapid weight loss and keep it off sounds too good to be true. Yet apparently it exists.
Saxenda (generic name, liraglutide) was originally developed as a drug for diabetes but has been shown to reduce body weight by, on average, 7.5 per cent in under nine months.
And in a trial led by Copenhagen University, Denmark, involving 195 obese adults, those given the drug (administered as a daily injection) lost 16 per cent of their body weight in a year when combined with regular exercise, according to research in the New England Journal of Medicine in May. The drug works by mimicking a hormone that suppresses appetite.
Given that one third of the UK population is now ‘obese’ (it was 5 per cent in the 1970s), the drug looks like it might be a useful way to help tackle the nation’s growing waistline.
Yet under NICE guidelines, Saxenda can be prescribed, with diet and exercise changes, only to those with a body mass index (BMI) of 35 or more (classed as ‘extremely obese’), who have pre-diabetes and a cardiovascular complication such as raised blood pressure or raised cholesterol. Otherwise, it is available only on private prescription — at £260 a month.
Saxenda (generic name, liraglutide) was originally developed as a drug for diabetes but has been shown to reduce body weight by, on average, 7.5 per cent in under nine months [File photo]
Experts believe treatments such as Saxenda should be more widely available.
Among them is John Wass, a professor of endocrinology at Oxford University and a spokesman for Obesity Health Alliance, a coalition of organisations working to reduce obesity. He says: ‘The drug is very effective, safe and has minimal side-effects. People can often lose more than 5 per cent of their body weight within three months.’
Professor Wass believes the narrow criteria for its use is part of a bigger issue.
‘The Royal College of Physicians has recognised that obesity is a disease, but the Department of Health and Public Health England haven’t,’ he says. ‘I think politicians are worried that it will cost too much and GPs will get overwhelmed with demand.
‘But losing weight isn’t as easy as just eating less and moving more. About 70 per cent of weight is determined by your genes, while socio-economic factors also play a role, as does the availability of cheap junk food.
‘People need help to lose weight — and obesity drugs work, particularly alongside diet and exercise changes.’
Saxenda is one of a range of weight-loss prescription drugs now available on the NHS and to buy privately from some pharmacies. These include orlistat, which blocks fat absorption and has been shown to reduce weight by an average 3 per cent over a year, but only 355,000 prescription items of this drug were issued in 2019.
The lack of availability of such pills — and the lack of diet help generally — means people are turning to less regulated options. The demand is huge, with the global diet supplements industry predicted to rise to £29 billion ($40 billion) by 2024.
Overweight people are ‘buying everything under the sun out of desperation because the NHS system is not helping them’, says Dr Abd Tahrani, an honorary consultant endocrinologist at University Hospitals Birmingham NHS Trust, who works with Novo Nordisk, the manufacturer of Saxenda.
Many of them turn to online diet supplements — promoted with vague claims — and occasionally bogus celebrity endorsements.
A recent review of 121 studies of weight-loss supplements, the largest review in ten years and involving more than 10,000 patients, concluded there was ‘insufficient evidence that herbal and dietary supplements produce clinically significant weight loss’
In May, comedian Dawn French noticed her image was being used on an advert claiming, falsely, that she had lost over 6st in five months using a raspberry ketone diet supplement, billed as a fat-burner.
On Twitter, French made it plain to her 500,000 followers that this was not the case.
This is just one example of the many herbal and food supplements touted as slimming pills on the internet — with many claims based on the flimsiest of evidence and backed up by little long-term safety data, says Gunter Kuhnle, a professor of nutrition and food science at Reading University.
Some supplements may even be toxic at high doses. In a case reported last year, in the Anatolian Journal of Cardiology, raspberry ketone supplements, a current popular choice, were thought to have induced cardiac vasospasm — sudden narrowing of the arteries — in one woman who took two tablets for the first time.
An earlier study, published in 2015 in the journal Regulatory Toxicology and Pharmacology, concluded the ‘toxic potential’ of raspberry ketone needs to be clarified with further studies.
Another risk is that such food and herbal supplements can contain added drugs.
‘People need to be aware of this, especially when buying online from websites,’ says Professor Kuhnle. ‘Very little checking by authorities is done.’
Dr Tahrani says people aren’t only being tempted by herbal or food supplements. ‘They will also buy drugs from unregulated online agencies — medications such as sibutramine, an appetite suppressant drug which was withdrawn in the UK in 2010 because of safety reasons, including an increased risk of heart attack and stroke.
‘This is a very dangerous area — people are so desperate to lose weight, either because they’ve tried to get help within the NHS system and failed, or they feel the stigma of being overweight and don’t seek medical help.’
The most effective medical solution for people who are overweight is bariatric surgery — for example, a gastric bypass or gastric band. This type of surgery can help patients lose up to 60 per cent of their excess weight.
However, to qualify for bariatric surgery on the NHS you need to have a BMI of 40 or more, or a BMI of 35-40 and an obesity-related condition such as type 2 diabetes.
Only around 7,000 operations a year are performed on the NHS each year, despite estimates that 3.5 million people could qualify.
To find out what the other options are, Good Health asked experts for an update on the evidence for, and safety of, the latest medicines and supplements.
Food and herbal supplements
Some of the popular ingredients in weight-loss supplements include raspberry ketone (a compound that gives raspberries their distinctive aroma), apple cider vinegar, green tea extract, capsaicin (a component of chilli peppers) and white kidney beans.
These claim to work in two ways — blocking the absorption of fat or starch, or by speeding up metabolism, says Professor Kuhnle.
Yet many of them make claims based on laboratory experiments on animals, not humans, which isn’t clear on the packaging or the website where a product is sold.
For example, some sites hold claims that raspberry ketone speeds up metabolism — but closer inspection of the research reveals this is based on studies on mice, which showed they promote weight loss, says Professor Kuhnle.
‘The only study in humans I could find mentioning raspberry ketone was on a supplement with multiple ingredients, including capsaicin, caffeine and bitter orange.’
Professor Kuhnle is slightly more convinced by supplements with white kidney bean, which block the absorption of starch by inhibiting enzymes. ‘These may have small effects, as the starch will pass out of the body undigested and also make you feel fuller for longer and reduce hunger,’ he says.
Green tea extract is a popular choice, and a study from Taiwan published in 2016 in the journal Clinical Nutrition found that women treated with a high dose (856mg) of the extract for 12 weeks had lost 2.4lb (1.1kg), which the authors said may be associated with a reduction in the hunger hormone ghrelin.
However, the study also showed an increase in liver enzymes — a sign that the liver is struggling.
‘The worry with green tea extract is that if you use excessive amounts, it’s toxic,’ says Professor Kuhnle. ‘Anything above 800mg a day [equivalent to drinking around 1.2 litres, which most people would find difficult to consume] is toxic to the liver.’
Apple cider vinegar supplements are also popular. A study published in the Journal of Functional Foods in 2018, based on 44 people, found dieters who followed a reduced-calorie diet who also consumed 30ml of apple cider vinegar a day lost 3lb more weight over 12 weeks than a control group of dieters.
‘But there doesn’t seem to be much clarity about the mechanism,’ says Professor Kuhnle. ‘It might well be that the vinegar taste has an impact, and the acetic acid in the vinegar could also be used by intestinal cells in some way, but the data is rather weak.’
A recent review of 121 studies of weight-loss supplements, the largest review in ten years and involving more than 10,000 patients, concluded there was ‘insufficient evidence that herbal and dietary supplements produce clinically significant weight loss’.
The study, which was published in two parts, in Diabetes, Obesity and Metabolism in 2020 and in the International Journal of Obesity in 2021, looked at trials of 60 different substances. None had a clinically significant effect, defined as weight loss of 5.5lb (2.5kg).
‘People are just wasting their money on these supplements: in terms of clinically significant results of weight loss, the evidence just isn’t there,’ the study author, Erica Bessell, a PhD student from Sydney University, told Good Health.
Pharmaceutical companies have been working on a new class of diet drugs, glucagon-like peptides (GLP-1) agonists. These were developed as diabetes drugs but were found to lead to weight loss, too
‘Our main concern is that some claims made are misleading, and they are persuading people to buy them when there isn’t the evidence to back them up.’
There is also the more serious risk that some also contain drugs, a number of which are banned.
A U.S. study of food supplements published in 2018 in the journal JAMA Network Open, identified 776 ‘adulterated’ supplements — 40 per cent of them for weight loss — sold between 2007 and 2016. The mst common ingredient added to supplements was sibutramine, the drug withdrawn from the UK market in 2010.
Another commonly added was the laxative phenolphthalein, a potential carcinogen which may also lead to gastric problems. Professor Kuhnle says there is so little enforcement of the food supplement world that it has been described as a ‘Wild West’. The market seems to fall between different regulatory authorities, while internet sites are hard to control.
Meanwhile, another supplement called 2,4-Dinitrophenol (DNP) is sold illegally on the internet, across social media and in gyms as a ‘fat burner’. It contains a chemical used to make munitions in World War I and has caused 32 deaths in the UK since 2007.
In 2020, Bernard Rebelo from Gosport, Hants, was sentenced to seven years in prison for gross negligence manslaughter for supplying DNP to a 21-year-old student, Eloise Parry from Shrewsbury, Shropshire, who died after taking eight capsules. Rebelo sold the drug via two websites.
Prescription drugs have proven weight-loss benefits backed up by large trials.
The drug orlistat, first introduced ten years ago, stops the absorption of roughly one third of fat intake.
However, research shows the drug achieves only modest weight loss — 3 per cent more than those who diet alone — and many patients stop taking it as it may cause fatty stools and diarrhoea. Orlistat is available over-the-counter under the brand name Alli.
Pharmaceutical companies have been working on a new class of diet drugs, glucagon-like peptides (GLP-1) agonists. These were developed as diabetes drugs but were found to lead to weight loss, too.
They mimic the appetite hormone glucagon-like peptide (GLP) that controls hunger.
Saxenda is one of these and has been available privately in the UK since 2017. Last year, LloydsPharmacy began selling it on private prescription (for about £260 a month) for people with a BMI of 27 or more and with certain health conditions. Last October, NICE approved it for use on the NHS for those with a BMI of 35 (32.5 in certain ethnic groups), plus pre-diabetes and a risk factor for heart disease, such as raised blood pressure or cholesterol.
Also available in the UK is Myalept (generic name, metereleptin), a medicine developed to replace leptin, a hormone that tells the brain we are full. In January, NICE approved it for people with the genetic disorder lipodystrophy, who lack leptin.
Diet drugs in the pipeline
There are new weight-loss drugs on the horizon including another effective GLP-1 agonist (like liraglutide) called Rybelsus (generic name, semaglutide). This is already approved here as a diabetes drug in the form of a 1mg pill, and as a weekly injection (brand name Ozempic) to control blood sugar.
Last month, it was approved in the U.S. as a higher dose injection under the brand name Wegovy for weight loss. It is being assessed by the Medicines Healthcare Regulatory Agency here as a weight-loss treatment, with a decision expected in the autumn.
The latest research on semaglutide, published in the New England Journal of Medicine in February, found it could help some obese people lose 20 per cent or more of their body weight.
The average participant in the 68-week trial lost 15.3kg (nearly 3st); this was accompanied by reductions in risk factors for heart disease and type 2 diabetes, such as blood fat and blood sugar levels.
Rachel Batterham, a professor of obesity, diabetes and endocrinology at University College London, one of the principal authors on the paper which involved almost 2,000 trial participants in 16 countries said: ‘Three quarters of people who received semaglutide (at the 2.4mg weekly dose) lost more than 10 per cent of their body weight and more than one third lost more than 20 per cent. No other drug has come close to producing this level of weight loss. This really is a game-changer. For the first time, people can achieve through drugs what was only possible through weight-loss surgery,’ she adds.
However, it works only in around one third of people and possible side-effects include mild to moderate nausea and diarrhoea. Furthermore the benefits stop when the patient stops taking it.
Another drug undergoing clinical trials is tirzepatide, a weekly injection which targets the GLP appetite control hormone and another hormone (called glucose dependent insulino-tropic polypeptide) that slows down emptying of the stomach and makes you feel fuller for longer. Studies found patients lost 12lb over 12 weeks.
Simon Capewell, a professor of public health at Liverpool University, adds a note of caution though.
‘The drugs have a role, but that role should not be overstated,’ he says. ‘They are more effective if used as part of a comprehensive weight loss regimen with a patient . . . getting psychological support as well as advice about diet and exercise.’
You won’t shift the pounds unless you change your mindset
By Dr Alastair Santhouse for the Daily Mail
When I began work at Guy’s Hospital’s bariatric [weight loss] surgery service as a psychiatrist some 18 years ago, the surgery itself was a real innovation.
What’s more, in the UK, having psychiatrists involved in assessing patients’ readiness for the operation was then rare.
Yet attempting weight-loss surgery before someone is psychologically prepared to change their behaviour around food can often lead to weight being regained.
Some patients still managed to keep eating after their newly shrunk stomach felt full by liquidising high-calorie foods such as chocolate or grazing (eating frequent snacks).
The same sort of emotional challenges exist for all those who are trying to lose weight — and the difference between success or failure often lies in people’s heads, rather than just on their plates.
To lose weight successfully and sustainably, we need to adopt effective psychological strategies to help us. This is how changing your mindset can make all the difference.
Keep a mood diary
When I was a medical student, almost nothing was taught about the psychological aspects of eating and obesity. I only remember hearing of a single study that discussed this.
The research showed that overweight people, when stressed, will eat snacks as a means of trying to calm their anxieties.
Other internal triggers that can make people eat impulsively include emotional upset, frustration, boredom and even, surprisingly, happiness.
All of these can become linked with wanting to try to control our emotions through eating.
Other overweight people habitually scroll through online menus and recipes as a form of entertainment. But this only serves to trigger their hunger.
Identifying your individual triggers for eating and keeping consciously aware of them can be very helpful when sticking to healthy eating patterns.
One of the best ways to do this is by recording everything you eat and how you were feeling at the time. This can empower you to resist your triggers.
Keep a food and mood diary for at least several days. Patterns concerning internal triggers and eating usually emerge quite quickly. It’s important to fill in the diary just after eating, as it can be hard to remember emotions and the amount of food you ate, after even only a short while.
I tell patients that changing their eating habits begins with the food that they put into their shopping trolleys.
This might sound obvious, but it’s often not until you draw attention to the problem that they realise they’ve been buying food that undermines their efforts.
Many people are now familiar with the idea of mindful eating — taking time to notice the taste, smell and texture of your food (rather than just eating it mindlessly in front of the TV). Enjoying and appreciating the food means you are less likely to overeat without thinking.
We should also shop mindfully. It can involve making a shopping list based solely on what we need to eat healthily — and sticking to it.
In stores, be aware of tactics shops employ to get you to buy more — particularly calorie-laden treats placed by the checkouts.
It’s tempting to think you’re only buying treats for visitors, but once the food is in your shopping basket, you will end up eating it.
Be kind to yourself
People internalise a lot of negativity about their size and weight. We live in a culture suffused with negative judgment, and it’s a common but mistaken belief that overweight people lack moral fibre and self-control, or are weak.
Overweight people often internalise this and start to think of themselves in the same unhelpful way. This only makes them feel even worse, intensifying any feelings of defeatism and despair. The answer lies in developing self-compassion and realising that you are doing your best.
Be supportive of yourself. Don’t say things to yourself that you would not say to someone you love.
It also helps to understand that making a change should be driven by something that you want to do in a healthy way to improve your wellbeing. If your motivation comes from peer pressure or a punitive internal dialogue, then you are in danger of perpetuating a cycle of shame that leads to low mood, anxious eating and feeling depressed. This, in turn, may make you feel socially isolated and in danger of again turning to food for support.
Trying to control your weight can, in itself, seem a miserable and daunting task. It’s important to begin positively by remembering that every journey starts with a small first step.
Set positive goals
it is important to motivate yourself with positive goals that will genuinely improve your lifestyle and health. Many people who lose weight successfully set themselves the goal of improving their health, such as fending off type 2 diabetes, stopping snoring or giving their knee joints an easier time. It’s all about developing a more positive relationship with your body.
And find support
If food is a way of coping with anxiety, then you have to find another way of dealing with it. You can’t just remove eating as a means of coping without replacing it with something else. The eating is an outward manifestation of inner distress.
While normalising your relationship with food, you need to ensure that the old eating patterns aren’t replaced by an equally unhelpful way of coping with difficult emotions, such as smoking or using alcohol.
Healthier ways of dealing with anxiety that don’t involve food might include taking regular walks or immersing yourself in a hobby — anything you find relaxing, distracting and enjoyable.
Some people will need support and advice from professional services. Consult your GP and use the help that is on offer.
Closer to home, you may find help from friends or relations with whom you can discuss your anxieties. You’ll find many people are only too happy to lend their support when you are making positive changes.
Dr Alastair Santhouse is a consultant psychiatrist in neuropsychiatry and liaison psychiatry at the South London and Maudsley NHS Foundation Trust. His new book, Head First: A Psychiatrist’s Stories Of Mind And Body (£14.99), is published by Atlantic Books on Thursday.