This information leaflet was written in response to a significant number of “Weight Loss Injections” enquiries. The purpose of this is to give patients some information about these drugs and to explain the practice position on prescribing these drugs purely for weight loss.
Practice position on GLP-1 drugs for weight loss alone
As NHS GPs and Nurses, we cannot prescribe these drugs or endorse you buying these drugs privately as many people are currently doing for weight loss. Neither can we support you in the dosing and management on privately purchased drugs.
We understand how desperate some people must feel to turn to these drugs because most of them feel they have tried absolutely everything. If you meet the criteria to be referred to the Specialised Weight Management Services at the Gloucestershire Hospitals Trust, you can be referred there to discuss all your options. At present, these drugs are not yet an option for the Specialised Weight Management Services but it may be an option in the future. We will otherwise be happy to continue to support you with trying to lose weight with available resources.
If you would like to explore lifestyle changes, please visit our lifestyle website at https://www.eatrealfood.uk/
Even if you are not prediabetic or diabetic, you would be welcome to attend practice group sessions which focuses on lifestyle management as well as health coaching.
What are these drugs?
You may have heard of Ozempic, Wegovy and Mounjaro. Ozempic and Wegovy are brand names for the drug Semaglutide. Mounjaro is the brand name for the drug Tirzepatide. This class of drugs are referred to as GLP-1 (Glucagon Like Peptide 1) agonists. Tirzepatide/Mounjaro is both a GLP-1 agonist as well as a GIP (Glucose Dependent Insulinotropic polypeptide) agonist.
Are these drugs new?
We have been actually using a similar class of drugs for over 15 years now for diabetes management (to help lower blood glucose) which was what they were initially developed for. It was found that weight loss appeared to be a significant side-effect and since then higher doses were developed, researched, approved and now marketed as weight loss drugs. For example, the maximum dose of Semaglutide we would use to treat Diabetes is 1mg but Semaglutide in Wegovy for weight loss goes up to 2.4mg.
Who should not take these drugs?
These drugs are not safe for everyone. Those who should not take these drugs include patients with a history of pancreatitis, kidney disease, type 1 diabetes, diabetic retinopathy (which can worsen with these drugs in some cases), pregnancy, breastfeeding, under age 18 years, personal or family history of medullary thyroid cancer or other thyroid issues, personal and family history of multiple endocrine neoplasia or other endocrine issues.
How do these drugs work for weight loss?
GLP-1 agonist drugs work by mimicking natural hormones in your body called Incretins. It sends signals to your brain to tell you that you feel full so it suppresses appetite and appears to curb food cravings. It also slows down digestion which also helps you feel fuller for longer.
Are these drugs effective for weight loss?
In short, for most people the answer is yes – some people can lose several stones of weight taking these drugs. This is why the whole world seems to want these drugs and the demand has led to significant shortages worldwide which have affected many diabetic patients who relied on these drugs for blood glucose control. The main issue is sustaining the weight loss when you discontinue the drug.
Are there downsides to taking these drugs?
As with all drugs, there are risks as well as benefits. The common side-effects include gastrointestinal disturbances like nausea, diarrhoea, abdominal cramps and even vomiting. Rare but serious side-effect is pancreatitis which can present as severe abdominal pain and be life-threatening. Gastroparesis which is delayed gastric emptying is also another uncommon but important side-effect.
Weight loss with GLP-1 drugs is not just loss of fat mass
Mostly we think of weight loss as just losing fat off our bodies. However, we also lose lean mass including muscle with any weight loss regime which does not incorporate strength training and optimal protein intake. With the GLP-1 drugs, patients can lose sometimes 3-4 stone in weight over a few months – 50% of which is estimated to be muscle mass.
Why is muscle mass important?
Muscle is the forgotten largest organ in the body and is critical for metabolic health. Strong and active muscles not only burn more calories at rest but muscle is also the largest sink to take up glucose in the body. Loss of muscle mass – a condition also known as sarcopenia is the biggest killer of older people – we become frailer as we lose muscle mass. Losing muscle mass has huge consequences for your metabolic health and ability to age well.
You regain the weight when you stop the GLP-1 drugs
The vast majority of people cannot afford to continue these drugs long-term as they are very expensive. For many people, especially at the higher doses, they develop significant side-effects which forces them to stop the drug. When the GLP-1 drugs are stopped, people regain all the weight (sometimes even more than they lost). But the biggest concern is that the weight regained is all fat mass (having lost a significant amount of muscle mass already). This means that these people are even worse off now as they have regained all the lost weight and they have less muscle mass.
Can I take these drugs but do anything to minimise the loss of muscle mass?
Yes, this is possible. However, this will require dedication and hard work to change your lifestyle and more importantly to sustain these lifestyle changes – in particular eating a real foods diet with optimal protein intake and strength training to maintain/build muscle. These changes to lifestyle have to be maintained for life. It remains critical also to address sleep issues (many important things happen when we sleep including building muscle) and also addressing chronic stress (stress piles on visceral fat which is central fat around our organs which is inflammatory and drives disease processes).
Whether you take these drugs or not, any sustained weight loss/maintenance efforts have to include optimising your 4 pillars of health – Food, Movement, Sleep and Stress management.
