14 May 2024

‘If NHS can afford it, people with obesity should have Semaglutide,’ says weight loss expert

Data Correspondent and Presenter

Injections of a weight loss drug could be a ‘game changer’ for cardiovascular patients by cutting the risk of heart attacks or strokes.

A study led by researchers at University College London found that participants who took the drug – sold under brand names including Ozempic and Wegovy – had a 20% lower risk of cardiovascular disease, regardless of how much weight they lost.

We were joined by Professor Frank Joseph, a weight loss expert who was one of the investigators in the study.

Ciaran Jenkins: The study described it as a game changer because because of its impact on potentially reducing heart attacks. Do you concur?

Professor Frank Joseph: I do actually, because the fascinating thing about these drugs is that it was developed originally for diabetes. And as the stories evolved, what we found is not only does it help people with type two diabetes and reduce their risk of heart attacks and strokes and death, but you then can impact people who don’t have diabetes. And the first thing you do and you know what we’ve known about Semaglutide or Wegovy is that it’s a great drug to help people lose weight and get healthier. But what this new data suggests is that it goes beyond just the weight loss, and that actually what it does is reduce your risk of heart attacks, strokes, and cardiovascular death – if you’ve had a previous heart attack or stroke.

Ciaran Jenkins: But it’s not been peer reviewed, this study has not appeared in a scientific journal yet, and it was funded by the drug manufacturers. So are people getting a bit overexcited?

Professor Frank Joseph: I don’t think so. We’ve got to stay optimistic about this stuff because, as a physician, I’m constantly looking for the next thing that I can offer my patients to try and reduce their risk. Because once you’ve had a heart attack or a stroke, the anxiety of possibly having another one is something that we don’t want to live with. And if you can find something that will reduce that further and further, it’s absolutely worth thinking about.

Ciaran Jenkins: And some of your patients in the northwest of England were the patients in this trial. So what did you see?

Professor Frank Joseph: Yeah. So a lot of the patients that we enrolled had previous heart attacks and strokes and got into the trial. Now, the interesting thing about the study wasn’t about weight loss. It was about trying to see what the medication would do to modifying their risk of having another event – what we call nonfatal myocardial infarction or a heart attack that you don’t die from or a stroke that you don’t die from. And what you find is that some people did lose weight, and that’s part of the effect of medication. But in the wider scheme, when you start to look at the larger numbers, you see that people aren’t having as many heart attacks and strokes.

Ciaran Jenkins: And the hype about Semaglutide is that it is been found to improve people’s weight. Would you therefore put the one in four people or the one in three of obese men over 50, whatever it is, on this drug routinely?

Professor Frank Joseph: So if you are by definition living with obesity, so if your BMI is over 30, you’re allowed to have it because actually it will reduce your risk of developing conditions in the future. Because we know that the moment your BMI goes over 30, you are at risk of high blood pressure, cholesterol, diabetes, heart disease.

  • Ciaran Jenkins: A quarter of the population are obese – you would have them all on this drug?

Professor Frank Joseph: If you could afford it, then there is no reason why you wouldn’t want to try and treat them. Now that goes with caveats.

Ciaran Jenkins: Can we afford it? Because a lot of people stand to make a lot of money from this, not least the drug company.

Professor Frank Joseph: And I think the challenge there is and we have great checks and balances in the NHS for that. You know, you have NICE that will look at the cost effectiveness of these treatments and will tell you what the right amount, right treatment, right person is going to be like. And in terms of treating every person with a BMI over 30, they’ve got to have tried to have done it themselves to start with. And actually for a lot of people, diet, exercise the right support will give you the right answer. But this is for people who’ve tried and failed and tried and have failed over and over again.

Ciaran Jenkins: Have you any concerns about it?

Professor Frank Joseph: I mean, with any medication that I give people, I’m always cautious about side effects. You know, even with Semaglutide and with some of the newer agents like Mounjaro or Tirzepatide, we do talk about gastrointestinal side-effects – nausea, diarrhoea, vomiting, and constipation and also gallstone formation.

Ciaran Jenkins: They’re all physical side-effects. Just one question about mental health impacts. This reduces, suppresses people’s appetite. Do we know how that would affect people at a population level?

Professor Frank Joseph: Yeah. So in my personal practice when people are are struggling with their weight, often their mood is affected by the weight that they’re carrying. And sometimes they find that just having a treatment that allows them to get healthier and feel better in themselves actually makes them feel better, their mood’s uplifted. Because a lot of the times for a lot of these people, they’re fighting that constant noise in their head saying, I’m giving into temptation, but actually it’s biology that’s driving their need and it helps them to overcome that.