By Holly Giles | Deputy Editor
The Health Suvey for England now estimates that 28% of adults in England are classified as Obese and a further 36.2% are classified as overweight, meaning over half the adult population ahave a BMI over the recommended average for their age and height.
As well as adult obesity, recent years have seen an increase in childhood obesity levels with close to 10% of children aged 4-5 being classified as obese and a further 13.1% are overweight. This figure then increases to 21% and 14.1% by the age of 10.
Obesity is associated with day-to-day problems including breathlessness, joint and back pain, difficulty with movements and feeling tired. However, it is also linked to more serious health conditions where being overweight has been recognised as a serious risk factor for type 2 diabetes, high blood pressure, cancer, gallstones, osteoarthritis, liver, kidney and heart disease and a range of other problems. As a result of this obesity reduces life expectancy by 3-10 years and has a huge effect on quality of life.
The main treatment methods for obesity are encouraging patients to exercise and eat healthily and then eventually to undergo bariatric surgery. This term refers to a collection of procedures which reduce the size of the stomach in order to reduce the amount of food eaten by the individual to try and help them lose weight.
However, a new drug may be able to do this without surgery as seen in the 15-month trial of semaglutide. The study was performed on almost 2,000 people who received either weekly injection of semaglutide alongside advice on diet and fitness, or an empty injection serving as a placebo and just the advice.
They found that those on the injection showed an average 15kg weight loss during the 15-month period compared to 2.6kg without. 32% of those taking the drug lost a fifth of their body weight, compared with fewer than 2% of the placebo group.
The drug works by mimicking Ghrelin, a hormone released after a meal to tell the brain that your stomach is full and that you don’t need any more food. Being able to synthetically increase the feeling of fullness reduces the amount eaten by individuals, helping them to lose weight.
One participant from the trial, Jan, said: “The drug changed my life and completely altered my approach to food”. She said dieting had made her miserable but that this drug was “effortless” as she was less hungry,
A limitation to the treatment is that it only suppresses appetite whilst injections are ongoing, meaning appetite levels return as soon as the treatment stops. Jan told: “It felt effortless losing weight while on the trial, but now it has gone back to feeling like a constant battle with food”. Trials are continuing in a five-year study in order to investigate the long-term effects of the drug and if the weight loss can be sustained in the long-term.
The treatment was also associated with a number of side effects including nausea, diarrhea, vomiting and constipation.
Despite this, experts are calling the drug a sign of a new era for anti-obesity treatment. Professor Sir Stephen O’Rahilly, from the University of Cambridge, said:
“The amount of weight loss achieved is greater than that seen with any licensed anti-obesity drug. This is the start of a new era for obesity drug development with the future direction being to achieve levels of weight loss comparable to semaglutide, while having fewer side-effects.”
This was seconded by Professor Rachel Batterham from UCL:
“This is a game-changer in the amount of weight loss it causes. I have spent the last 20 years doing obesity research, up until now we’ve not had an effective treatment for obesity apart from bariatric surgery.”
Finally, Dr Duane Mellor, a dietitian, said: “”It is useful to have a potential option to help people lose weight, however we need to acknowledge that weight loss will still need lifestyle change, and that any medication or change in lifestyle can bring potential risks and side-effects. So, it is always wise to speak to a health professional before trying to lose weight.”
Semaglutide is now awaiting approval from drug regulators, but is expected to be able to be prescribed in the near future for those unable to lose weight through diet and lifestyle alone.
Adding therapeutic options to this ever growing condition will help stem the curve of increasing obesity across the UK and provide people hope that weight loss is possible. The key question though for clinicians to answer next, is when the treatment stops does the weight loss stop? And, how can they make this answer no?