The rise in obesity rates has prompted a search for effective weight loss solutions. Weight-loss injections, particularly those containing glucagon-like peptide-1 receptor agonists (GLP-1RAs) like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro), have gained significant attention. These medications mimic the GLP-1 hormone, regulating blood sugar, slowing digestion, and reducing appetite. While these "skinny jabs" have shown promise, it's crucial to understand their benefits and drawbacks before considering them.
How Weight Loss Injections Work
The medications in these "skinny jabs" are glucagon-like peptide-1 receptor agonists (GLP-1RAs) - a group of drugs, usually semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro), that mimic the way the hormone glucagon-like peptide-1 (GLP-1) works in the body to regulate blood-sugar levels, slow digestion and reduce appetite.As blood sugar levels start rising, these medications help the pancreas make more of the hormone insulin. Insulin then helps blood sugar move into the body's cells to be used for energy.
The Allure of Rapid Weight Loss
Pro: Significant Weight Reduction
Clinical trials have demonstrated the effectiveness of GLP-1RA injections in promoting weight loss. A 2021 study involving nearly 2,000 obese participants revealed that those taking Wegovy experienced a 15% reduction in body weight within a year. Mounjaro has shown even more impressive results, with Yale University research indicating losses of up to 20%.
One clinical trial in 2021, involving almost 2,000 obese people, showed those taking Wegovy lost 15% of their bodyweight in a year. And the results for Mounjaro seem even more impressive, with a Yale University study reporting losses of up to 20%.
Pro: Reduced Need for Intense Exercise
Interestingly, some obesity specialists suggest that these drugs work so effectively that rigorous exercise may not be as crucial as previously thought. This is a shift from earlier weight-loss approaches that heavily emphasized both diet and exercise.
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In a bonus for the gym-phobic, obesity specialists now suggest these drugs work so well, you don't even need to exercise too (as was advised with older weight-loss jabs like Saxenda). We no longer "mandate" exercise because "we see that, even without it, people are maintaining their weight loss", David Saxon, medical director of the University of Colorado Anschutz Medical Campus, told The Atlantic.
The Downsides: Side Effects and Long-Term Considerations
Con: Unpleasant Digestive Issues
Weight-loss injections are known to cause digestive problems. Studies confirm side effects like "eructation" (burping), nausea, vomiting, bloating, constipation, and diarrhea. These symptoms tend to be more pronounced at the beginning of treatment or when the dosage is increased. While often not serious, these issues can sometimes lead to complications requiring hospitalization. Weight-loss drugs slow down your gut, and oral contraceptives aren’t going to work the way women are used to them working.
Weight-loss jabs are notorious for producing "fishy burps" and "eggy breath", and studies do confirm "eructation" as a side effect. Other commonly evidenced side effects include "feeling sick, vomiting, bloating, constipation and diarrhoea", said the BBC. These unpleasant gut-related symptoms tend to be at their worst at the start of the treatment, or if you increase the dosage. They are "usually non-serious" but "can sometimes lead to more serious complications, resulting in hospitalisation", said the UK's Medicines and Healthcare Products Regulatory Agency.
Con: Potential Weight Regain
A significant concern is the likelihood of regaining lost weight after discontinuing the injections. A 2022 study in Diabetes, Obesity and Metabolism revealed that individuals regained approximately two-thirds of their lost weight within a year of stopping weekly semaglutide injections, along with a reversal in cardiometabolic health. This suggests that long-term use may be necessary to maintain weight loss, raising concerns about cost and potential long-term effects.
A 2022 study, published in Diabetes, Obesity and Metabolism, found that, within a year of ending weekly semaglutide injections, people regain, on average, two-thirds of the weight they had lost - with a similar reversal in their cardiometabolic health. If you therefore need to keep taking these drugs "in order to ensure that weight doesn't return", then "that's, for me, a big problem", Dr Margaret McCartney, a GP and advocate for evidence in medicine, told the BBC. And, if you're paying upwards of £37 a week for a private "skinny jab" prescription (given that NHS prescriptions are limited), forever fending off that "Ozempic rebound" comes at quite a cost.
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Con: Other Potential Risks
Data also shows an increasing frequency of low blood pressure and fainting, headaches, joint pain and disturbed sleep, and a 15% higher risk of kidney stones.Another risk is how the drugs interact with oral contraceptives.
Health Benefits Beyond Weight Loss
Pro: Cardiovascular and Metabolic Improvements
GLP-1RAs have demonstrated benefits for individuals with type 2 diabetes and have shown promise in reducing the risk of heart attack, stroke, and kidney disease. Research indicates lower levels of stroke and high blood pressure, as well as a reduced risk of pancreatic cancer, liver cancer, muscle pain, and chronic kidney disease.
GLP-1RAs already have a strong track record for treating type 2 diabetes. But the Nature Medicine study highlights a host of other health benefits. It confirms earlier research that the drugs bring a "significant boon to heart health", said the BBC. As well as a 9% reduced risk of heart attack and a 8% reduced risk of deep vein thrombosis, there are "lower levels of stroke and high blood pressure". Other, newly emerged plus points include a lower risk of pancreatic cancer, as well as "less liver cancer, muscle pain and chronic kidney disease".
Pro: Potential Mental Health Benefits
Emerging evidence suggests that GLP-1RAs may positively impact mental health. Studies indicate a potential reduction in the risk of psychotic disorders, suicidal intentions, self-harm, and certain eating disorders. Furthermore, these drugs may curb substance-use disorders by acting on brain regions involved in reward and impulse control, potentially reducing cravings for tobacco, alcohol, cannabis, and opioids.
Perhaps what's got the scientific community most excited in recent weeks is the new evidence about the effects of weight-loss jabs on mental health. GLP-1RAs appear to reduce the risk of psychotic disorders, such as schizophrenia, by 18%, as well as decreasing the risk of suicidal intentions, self-harm and some eating disorders. Fascinatingly, they also seem to curb substance-use disorders: the "drugs act on regions in the brain that are involved in reward and impulse control", Dr Aly told Nature, so this may explain reduced cravings for tobacco, alcohol, cannabis and opioids.
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Pro: Reduced Risk of Cognitive Decline
Weight-loss injections may also decrease the likelihood of cognitive disorders like Alzheimer's and dementia, potentially due to the anti-inflammatory effects of GLP-1RAs in the brain. They are also associated with a lower risk of seizures, bacterial infections, and pneumonia.
People taking weight-loss injections are less likely to have cognitive disorders such as Alzheimer’s and dementia, "which could be because GLP-1RAs reduce inflammation in the brain", said BBC Science Focus. They are also less prone to seizures, bacterial infections and pneumonia. While the reduction in risk for these conditions is fairly small, at 10 to 20%, "the benefits are still significant, especially for conditions like dementia where few effective treatments are available".
Societal and Lifestyle Implications
Con: Altered Relationship with Food and Social Experiences
GLP-1RAs can diminish hunger cues and the desire to eat, which, while helpful for weight loss, may negatively impact one's relationship with food and the social aspects of shared meals. The drugs' effect on reducing the desire to drink alcohol has also raised concerns in the beverage industry.
GLP-1RAs curb hunger cues and remove the desire to eat, which is great for shedding pounds but can shred your relationship with food - and with the social buzz of shared eating. The way the jabs also dampen the desire to drink alcohol has already alarmed investors, with "stock picker" Terry Smith at Fundsmith recently offloading his firm's stake in drinks firm Diageo because the sector is "being impacted negatively by weight-loss drugs", said The Guardian. Could you face getting no pleasure from eating and drinking with friends? Even the "pioneer of Ozempic" thinks not: "once you've been on this for a time, life is so miserably boring that you can't stand it any longer and you have to go back to your old life", Jens Juul Holst, the Danish professor who discovered the hormone GLP-1's effects on satiety, told Wired.
Determining Suitability and Access
Considerations for Prescription
Weight-loss drugs are not a universal solution. Healthcare providers typically consider factors such as BMI, the presence of serious health problems related to weight, and previous attempts at weight loss through diet and exercise. These drugs are often prescribed for individuals with a BMI greater than 30, or greater than 27 with co-existing health conditions.
Cost and Insurance Coverage
The expense of weight-loss drugs can be a significant barrier. Out-of-pocket costs can be substantial, and insurance coverage varies. Government plans like Medicare and Medicaid may not cover weight-loss medications, although this is under consideration. Many individuals with insurance may still face high deductibles, making these drugs unaffordable.
The Importance of Lifestyle Changes
While weight loss injections can be effective, they are most successful when combined with a comprehensive weight loss plan that includes a balanced diet, regular exercise, and lifestyle modifications.
Other Weight Management Options
Bariatric surgery, including gastric bypass and sleeve gastrectomy, achieves weight loss by 20% to 30%. Endoscopic intragastric balloons are less invasive and have lower upfront costs with a 10% to 15% weight loss.