New weight-loss jabs are helping slim down Scotland

“It has changed my life. I’ve always struggled with my relationship with food and turned to it when I was feeling down. I would always eat everything in front of me and more, snacking in bed,” says Terri, four months after beginning injections of the weight-loss drug Wegovy.  

“I have another three stone I want to lose and for once I’m hopeful it’s actually going to happen,” she writes in a Facebook group set up for users of semaglutide – the active ingredient in Wegovy and other weight-loss medications like Ozempic. 

Semaglutide has historically played a key role in treating type 2 diabetes. It acts as a naturally occurring hormone, GLP 1, which plays a key role in regulating insulin secretion, blood sugar, and appetite. That latter effect has led it to be described as a miracle drug in the battle against overweight and obesity. 

Following recommendation from the National Institute for Health and Care Excellence (Nice), in March last year, NHS England and Wales approved Wegovy, which is manufactured by Danish pharmaceutical company Novo Nordisk. Scotland followed suit seven months later.  
It is part of a new wave of weight-loss drugs such as liraglutide and tirzepatide which have been proven to help people shed 10 per cent of their body weight. Patients receive it via an injection into the skin once a week.  

To receive Wegovy treatment, NHS Scotland requires a patient to have a Body Mass Index (BMI) score of 30 or more (the threshold for determining diabetes) or a score of 27 or higher if they have at least one weight-related comorbidity such as type 2 diabetes, hypertension or cardiovascular disease.  

It is prescribed in combination with a commitment to lifestyle changes such as a reduced-calorie diet and increased physical activity. Patients are expected to demonstrate a willingness to engage in these changes.   

Dr Scott Muir, Scottish Medicines Consortium chairman, said at the time of approval:  “Used alongside a weight management programme including diet and exercise, semaglutide (Wegovy) could assist carefully selected patients in their weight-loss journey.”

The introduction of the new medical intervention follows public health data published in the 2021 Scottish Health Survey, which found across the last 15 years overweight and obesity rates in Scotland have remained relatively similar. Two in three adults are overweight and just under a third are obese, and this is despite consistent public health messaging encouraging better diet and increased physical activity.  

The introduction of semaglutide to the NHS is the first major new intervention in the post-Covid era that will attempt to help tackle the national obesity issue. Professor Lora Heisler, the director of research at the University of Aberdeen’s Rowett Institute, is optimistic about the use of drugs like semaglutide in the fight to treat obesity in Scotland. She says the “idea is not to treat the nation with drugs”, rather, they must be used as part of “a multi-pronged approach”. 

“The best way to tackle obesity is to have different options available. The medicine is meant to be prescribed in association with dietary changes and exercise. You’re not supposed to just take the medicine and do nothing else.  

“This shouldn’t be looked at like a magic pill, there is still work involved and the medicines in the NHS are prescribed for up to two years. The idea is not to have a person on it for the rest of their lives, but rather to find the skills and tools to create change, change in lifestyle patterns, to keep the weight off once the drug has been withdrawn.”

She adds: “These are really exciting drugs, and they can have an impact not only on national health but international health. But they’re not for everybody, they are not for cosmetic purposes, it is for health, like any medicine.” 

Obesity not only causes a huge strain on the health care system in the UK, but it also on the economy. Annually, obesity costs the NHS £6.2bn – a figure expected to rise to close to £10bn each year by 2050, according to UK Government projections. The economic impact on the wider UK economy is estimated to be £27bn per year.  

Earlier this month, UK health secretary Wes Streeting wrote in The Telegraph that weight-loss jabs such as Wegovy could be potentially “life-changing” for people, perhaps helping them to return to work and alleviating the strain on the NHS. He argued that offering these treatments to unemployed individuals could help them return to work. 

Sir Keir Starmer endorsed Streeting’s comments about the drug, saying: “[Weight-loss jabs are] very important for our NHS, because, yes we need more money for the NHS, but we’ve also got to think differently.” 

Some doctors have branded the suggestion “unethical”, saying it would target people for economic reasons “rather than prioritising the person’s interests and health”.

Obesity expert Dr Dolly van Tulleken said, besides the “serious ethical, financial, and efficacy considerations,” the plans were also unrealistic.   

Dr Andrew Fraser, chair of the Obesity Action Scotland, tells Holyrood Streeting’s suggestion is “interesting”.  

“The first reaction from clinicians was we don’t have the infrastructure in place to deal with the service he infers is needed, which is the immediate and very widespread availability of a service offering this drug to people who are out of work. 

“If you are looking at inequalities and tackling them, there are some attractions to look at work and the people who are out of it. But I think that comes with all sorts of potential complications. Questions of who gets access, as well as the stigma that’s attached.  

“We know from evidence presented about a decade ago that people who are obese do their utmost to stay in work. They don’t just sort of wander off because they have problems, they try and stay at work by and large.   

“It’s an interesting, sort of labour market-driven offer but I would suggest only a small glimpse of what we need to do on obesity – and Wes Streeting might say he has a bigger strategy coming out – but it is a very strange way to start one.” 

Another issue that Streeting’s plan would need to contend with, and more importantly the people who qualify for weight-loss jabs through the health service, is the global shortage of semaglutide. At the beginning of the year, the NHS warned the shortage would last until at least 2025.  

Diabetes charities criticised private doctors offering the drugs “off-label” to non-obese dieters, arguing that they are contributing to the shortages. 

This shortage has led some people to seek out semaglutide from other unregulated sources. In October last year, the Medicines and Healthcare products Regulatory Agency (MHRA) issued a public warning “not to buy pre-filled pens claiming to contain Ozempic (semaglutide) or Saxenda (liraglutide)”. 

It says it seized 369 potentially fake Ozempic pens in the ten months leading up to the warning and received reports of fake Saxenda pens that were obtained by members of the public in the UK through non-legitimate routes (not prescribed by a qualified medical professional).  

Heisler also emphasised this and described procuring the jabs through these routes as “super dangerous”.  

“The drugs need to be acquired through the appropriate channels and for the correct reasons – you ultimately have no idea what you are getting from the internet. 

“It is prevalent because there are global shortages. It’s not always what it is said to be, and that is so dangerous.” 

While these drugs offer a new lever to the treatment plans being offered to people living with obesity, they will not help to tackle one of the Scottish Government’s big commitments in its approach to lowering obesity – halving childhood obesity by 2030 and significantly reducing diet-related health inequalities. 

The latest Scottish Government report on childhood obesity in 2022 found a third of children aged two to 15 were at risk of being overweight and obese. That is the joint-highest ever recorded, alongside the 2011 Scottish Health Survey. It also found 18 per cent of children were at risk of obesity.

Fraser points out that weight-loss jab interventions are not part of the plan for tackling childhood obesity. “They won’t do anything for youngsters,” he says.  

“We need to do a whole host of things. This is a complex problem and no one thing will make a dramatic difference. 

“Take the sugar levy. It has done a great deal in decreasing sugar intake and in modelling it has done a bit in reducing the risk of complicated bad health outcomes. But by itself, it’s only touching the edge. It has only decreased modelled likelihood of mortality by less than one per cent. 

“We have lots still to do. We have to develop the retail environment. When I go shopping you get to the low-cost biscuits before the fruit and vegetables. Before you get to can put milk in your basket you get to chocolate, and when you get to the checkout you get to sweeties. You run the gauntlet around enticing offers which are trying to persuade you to buy things high in fat, sugar and salt.”   

Last week, the House of Lords’ Food, Diet and Obesity Committee published a report examining the food system in the UK. The report, titled ‘Recipe for health: a plan to fix our broken food system’, described obesity as a “public health emergency” and demanded the government develop a comprehensive, integrated long-term new strategy to fix the UK’s food system, underpinned by a new legislative framework. 

It noted “there has been an utter failure to tackle this crisis” and said between 1992 and 2020, successive governments proposed nearly 700 wide-ranging policies to tackle obesity in the UK, but obesity has continued to rise. 

The report said there was “no silver bullet” that will solve obesity and placed a heavy emphasis on the food industry making healthier food accessible and affordable for all, and highlighted the role inequalities plays. 

Baroness Walmsley, chair of the committee, said: “Something must be going wrong if almost two in five children are leaving primary school with overweight or obesity and so many people are finding it hard to feed healthy food to their families. That is why we took a root-and-branch look at the food system and analysed what had gone wrong over the past few decades. 

“Over the last 30 years successive governments have failed to reduce obesity rates, despite hundreds of policy initiatives. This failure is largely due to policies that focused on personal choice and responsibility out of misguided fears of the ‘nanny state’. Both the government and the food industry must take responsibility for what has gone wrong and take urgent steps to put it right.”

The socio-economic barriers to a healthier life have long been discussed – and it is a real issue in the context of childhood obesity. Obesity Action Scotland has published data suggesting children from the most deprived areas are more than twice as much at risk of obesity compared to those from the least deprived localities. 

The steering group says growing inequalities in child health outcomes across Scotland indicate a clear correlation between increasing deprivation and unhealthy food consumption. 

It suggests the best way to tackle this problem is by regulating the price and location promotions of food and drinks high in fat, salt, and sugar, while restricting advertising on those types of foods, particularly in outdoor spaces.  

It also called for the implementation of mandatory healthy children’s menus in the out of home sector and the expansion of universal free school meals to all school-age children, while utilising the national and local good food nation plans to ensure the availability of healthy food in communities. 

Fraser adds there is a “very big issue” between ease of access to shops that offer a good balance of healthy food for people living in deprived areas.  

“Some of the outlets that people in deprived areas rely on in their neighbourhoods have very poor offerings. We need to look at some of these outlets in the areas of greater deprivation to tackle this problem.  

“We also have to look at what it means to families so that they don’t have to worry so much about paying the bills. There is definitely a poverty element to this problem as well.”