Obesity is a supersized global challenge. Being overweight links to serious health conditions including hypertension (high blood pressure), diabetes and a range of potentially life-threatening cardiovascular diseases. More people than ever are overweight and with new options on the market, many of them are turning to weight loss medications for controlling weight and lowering blood pressure. So, what are the challenges, considerations and future for weight loss drugs?
A global health crisis
The World Health Organization (WHO) reports a significant global concern with obesity, as the condition has more than doubled since 1990 among adults and quadrupled among adolescents. In 2022, approximately 2.5 billion adults were overweight, of which around 890 million were living with obesity. This means that about 43% of the global adult population is overweight, and one in eight people is considered obese.
These figures highlight the urgent need to address this growing health crisis, which is linked to increased risks of hypertension, diabetes, and heart disease. The rising prevalence of obesity also underscores the importance of healthy lifestyles and proactive public health strategies around food education and physical activity.
On the one hand, where immediate medical intervention is deemed necessary, weight loss drugs are seen as a cost-effective solution by some. There’s also a growing number of patients who have experienced positive results using these medications.
On the other hand, weight loss drugs can have side effects like diarrhoea, nausea, vomiting and constipation and their long-term impact hasn’t been studied yet. Besides, the hype around weight loss injections has fuelled the black market and the production of falsified products. As a result, the WHO has issued a Medical Product Alert in June 2024.
There’s more to come: In a race to crack the lucrative weight loss drug market, pharmaceutical corporations like Roche, Eli Lilly, Novo Nordisk and Pfizer are developing oral medications to help people shed additional pounds. So while long-term outcomes remain uncertain, the spotlight is on weight loss drugs to make an impact on global obesity.
From diabetes to obesity: The rise of Ozempic and Co.
When it comes to weight loss medication, the active ingredient semaglutide has been the key game changer. Semaglutide is to weight loss drugs what an active radar was to microwave: it was initially discovered and developed for a different purpose. And just like radars are still in use, so is Semaglutide to combat type 2 Diabetes.
But since the drug suppresses the appetite by mimicking a hormone called Glucagon-like peptide-1 (GLP-1), it also helps with weight loss. Ozempic has been on the market in the UK since 2019. The NHS only prescribes the drug for type 2 diabetes. But the demand for the drug spiralled in 2022 after celebrities used it to achieve their red carpet figure, actually causing a shortage in supplies for diabetes patients.
Since July 2023 another drug has been available to buy in the UK: Wegovy. It is also available in lower doses of semaglutide and is considered a weight loss and lifestyle drug. However, as Wegovy is new on the market, there are no long-term studies on possible consequences and side effects in the long-run.
Understanding obesity and hypertension: Impacts on heart health
In contrast, the long-term consequences of excess body weight are very well known: It can significantly increase blood pressure by forcing the heart to work harder, as the body requires more blood to supply oxygen and nutrients to the tissues. This increased blood volume puts pressure on the artery walls, raising blood pressure levels.
In some cases, obesity can lead to inflammation and other changes in the heart’s structure and function, increasing the risk of heart attacks and heart failure even further.
Managing weight is critical for both blood pressure control and the prevention of cardiovascular disease. Weight loss can lead to a reduction in blood pressure, which is significant because even a small decrease in blood pressure can lower the risk of heart diseases and stroke. For example, decreasing systolic blood pressure by just 5 mmHg can bring the risk of stroke down by 14% and coronary heart disease by 9%.
For those who have been trying and struggling to shed weight with diet and exercise, weight loss drugs can be a big step towards better health. Using the Aktiia system to monitor blood pressure can additionally motivate you to make healthier lifestyle choices. Observing your weekly averages encourages a balanced diet and regular physical activity.
Weight loss drugs and their impact on blood pressure
Weight loss medications have been studied extensively for their effects on body weight and associated health outcomes, including blood pressure. Medications such as GLP-1 agonists (e.g. liraglutide and semaglutide) have shown to be effective at not only reducing body fat, but also in lowering blood pressure. Studies indicated that these drugs can lead to an average systolic blood pressure drop of 5 to 10 mmHg, which substantially lowers the risk of cardiovascular diseases like heart attacks and strokes.
However, these significant benefits have potential risks and side effects associated with weight loss drugs.
Key considerations when using weight loss drugs
Side effects can vary widely from person to person, which underscores the importance of monitoring and managing these effects with medical supervision. In the United Kingdom, both Wegovy and Ozempic are prescription-only drugs, and therefore not easily accessible. It also means that you would have to be followed by a medical professional when using them.
And while some people might see this as annoying red tape, they should be reminded that these are indeed medications, and not mere supplements. As such, they do come with side effects that can range from nausea, vomiting and diarrhoea all the way to much more serious problems like gastroparesis or pancreatitis, as shown in this study published in JAMA.
It’s also crucial to monitor blood pressure regularly, as changes induced by weight loss drugs can affect cardiovascular health, and have been shown to lower blood pressure, even in people within the normal BP range. This means there is a potential for hypotension, which would be caught by the continual monitoring the Aktiia device offers.
Given the complexities and varied effects of these medications, if you’re considering weight loss drugs, talk to a healthcare professional. They will help to ensure your personal health history, current health status, and potential benefits and risks are thoroughly evaluated. They will also help prevent putting the weight back on once you stop the drug, which could potentially cause a “mental” addiction over obsessing about the number on the scale. Fortunately, no physical one would happen, as these molecules have no addictive property whatsoever. For general information on the efficacy and safety of different weight loss drugs, the Mayo Clinic has a useful guide to weight loss medications and their use.
Weight loss drugs and celebrity endorsements
A few celebrities have revealed their experiences that show the upsides and downsides to weight loss drugs. Sharon Osbourne shared her journey with the weight loss drug Ozempic which helped her lose 42lbs (nearly 20kg). The drug’s potent effects led Sharon to warn of its potential to be addictive, and her story highlights the psychological and physical impacts of rapid weight loss. Sharon also points to a need for public health education about the potential risks of dependency and the importance of setting realistic health goals.
Oprah Winfrey’s weight loss strategy incorporates a more comprehensive approach. Oprah has been open about her use of weight-loss medication as part of her regimen, but she emphasises its role as just one component of a broader lifestyle commitment. This commitment includes rigorous exercise routines and significant dietary adjustments. Following knee surgery in 2021, she adopted new habits like hiking up to ten miles on weekends and maintaining an early dinner schedule. She integrates these activities with a mindful eating plan based on the principles of Weight Watchers.
It’s not all sunshine and rainbows
With celebrities talking more openly about, or even touting those drugs as miracles or “skinny jab”, they have become more mainstream. One of the reasons is, of course, because they have been shown to work. Clinical studies show that drugs containing the active ingredient semaglutide can, depending on the dosage, lead to substantial weight reduction, with a significant proportion achieving an average of 15% weight reduction of their body weight after nearly 16 months of treatment.
However, the success of these drugs is accompanied by significant challenges. Ozempic and Wegovy are the two main drugs known to the public. However, Ozempic is prescribed for type 2 diabetes, whereas Wegovy is prescribed purely for weight loss. The demand for these drugs has since led to shortages, highlighting their popularity, but also the challenges posed by off label prescriptions.
The Ozempic shortage meant that diabetic patients, who were using it for medical reasons, could not access it any more. This situation has led to some patients turning to the black market to obtain these medications, which raises concerns about the safety and efficacy of non-regulated products. Considering the risk of significant side effects, including gastrointestinal issues and potential cardiovascular impacts, weight loss drugs need to go hand in hand with health monitoring and the involvement of healthcare providers.
To the future: Innovations in treatment
The future of obesity treatment looks promising, with ongoing research into new medications that could offer more significant benefits with fewer risks. Innovations in pharmacology continue to push the boundaries of what’s possible in weight management. Weight loss medications can be a valuable tool in managing obesity and its associated health risks, including hypertension. However, they should be viewed as only one part of a broader strategy that includes dietary changes, exercise, and other lifestyle changes.
Disclaimer: If you are struggling with obesity and related health issues like hypertension, consult with your healthcare provider to discuss the best strategies for your health needs. Together, you can decide if weight loss drugs are right for you and how best to integrate them into a comprehensive plan for healthier living.
If you are worried about semaglutide or any other medication’s safety or effectiveness, or suspect it is not a genuine product, please report it on the Yellow Card government website.
Sources:
One in eight people are now living with obesity, WHO, 2024 – https://www.who.int/news-one-in-eight-people-are-now-living-with-obesity
Medical Product Alert N°2/2024: Falsified OZEMPIC (semaglutide), WHO, 19 Jun 2024 – https://www.who.int/news-medical-product-alert-falsified-ozempic-semaglutide
Weight Loss Pills Intensify Obesity Drug Race – But Here’s Why Experts Say Injections Aren’t Going Anywhere, Forbes, 19 Jul 2024 – https://www.forbes.com/sites-weight-loss-pills-intensify-obesity-drug-race-but-heres-why-experts-say-injections-arent-going-anywhere
GLP-1 diabetes and weight-loss drug side effects: “Ozempic face” and more, Harvard Health, 5 Feb 2024 – https://www.health.harvard.edu/staying-healthy-glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more
The Discovery and Development of Liraglutide and Semaglutide, PubMed, Apr 2019 – https://pubmed.ncbi.nlm.nih.gov/31031702
Lowering blood pressure is even more beneficial than previously thought, BHF, 2021 – https://www.bhf.org.uk/news-from-the-bhf-lowering-blood-pressure-is-even-more-beneficial-than-previously-thought
Lowering blood pressure reduces the risk of heart disease, stroke and death, NIHR, 2023 – https://evidence.nihr.ac.uk/lowering-blood-pressure-reduces-the-risk-of-heart-disease-stroke-and-death
Wegovy, European Medicines Agency, 2024 – https://www.ema.europa.eu/en/medicineshuman-wegovy
