Q&A: Your fat jab questions answered by Dr Zoe

IT’S been astonishing to see the weight-loss results of some people who have used Mounjaro and Wegovy.

But while we have ten-20 years of reassuring safety data for their use in diabetes, GLP-1 weight loss injection medications are relatively new.

We lack decades-long data when it comes to their use specifically for treating obesity.

So, while many people were keen to give them a try immediately, others are cautious – and rightly so, as we don’t yet fully understand the long-term risks.

This week, I’m answering questions about GLP-1s, which work by mimick­ing GLP-1, a hormone which slows digestion and reduces appetite.

My opinion is that these medicines have huge potential, which goes beyond weight loss and blood sugar management.

Studies show improvement in cardiovascular disease, kidney disease, and there’s building evidence that they may treat psoriasis and addictions.

But patients should consider their own individual risk versus benefits.

Here’s a selection of what readers have asked me . . . 

FEARS OVER FAINTING 

Q) MANY people say they will “be on GLP-1s forever” after losing lots of weight.

This is putting me off starting them.

Can I microdose, to avoid getting too reliant on a heavy dose?

Will this be easier to wean off?

A) Originally, guidelines like those from the NHS recommended using weight-loss injections for up to two years, because these were the lengths of the initial studies that showed their effectiveness.

But as these studies have been extended, they have shown that those who stay on them longer-term do better when it comes to weight loss and weight maintenance.

Most obesity-medicine and endocrine specialists now think of them as long-term medicines that are treating an underlying biological condition.

Therefore, stopping them would be equivalent to stopping someone’s medication for high blood pressure or cholesterol.

The decision to stay on them should balance benefits, risks and quality of life. Some people will tolerate side effects for a year or two, but not indefinitely.

More likely, people will shift to a maintenance dose at the lowest amount that is effective. This is not a microdose.

Microdosing means administering a very small dose – smaller than the lowest prescribed amount – with the idea of managing weight without adverse side effects. It costs less, but is not recognised or clinically validated.

All of the clinical benefits in research (on weight, blood sugar or cardiometabolic outcomes) come from standard, approved dosing protocols. This involves increasing the dose gradually to lose weight, and a maintenance dose once a goal weight is reached.

In theory, taking a tiny dose might slightly suppress appetite and help with weight maintenance, but the effectiveness and risks are unknown.
It absolutely needs more research before it can be recommended.

You don’t say how much you weigh. For someone just looking to lose a small amount of weight, the risk-benefit ratio may not justify using the drug at all.

It comes back to getting it from a registered and reliable prescriber, then following an individualised plan that is backed by scientific research.

Don’t buy from unregulated sources, as this carries safety risks.

ARE FAT JABS JUST ANOTHER FAD?

Q) I AM considering starting Mounjaro, but I’m worried that fat jabs will turn out to be another fad that will cause me to put more weight on in the future.

I am 48 years old, female and I’ve lost weight and put it back on a few times since my 30s.

What do doctors really think of weight-loss jabs?

A) There are really mixed views across the medical community.

As a GP with a special interest in obesity and lifestyle medicine, I see both sides.

Doctors who work in obesity treatment tend to be very positive about these drugs.

They understand the realities faced by people with severe obesity, many of whom have tried everything without success. They often suffer from pain, immobility, chronic illness and more.

Before now, bariatric surgery was often the only effective option, but it’s not accessible or suitable for everyone – so, for this group, these weight-loss injections are deemed a game-changer.

Other doctors, though, may be more sceptical.

Many of us in the lifestyle medicine field are personally interested in nutrition and fitness, perhaps because we have managed to maintain a healthy weight – possibly, in part, due to more favourable genetics.

With that comes a drive to help other people look after their health with lifestyle measures.

There’s also concern that these drugs could be misused by people who don’t have a clinical need. And there are equity issues.

NHS access to these drugs often depends on where you live, making the system unfair – a postcode lottery.

But the bottom line is, among specialists working in the field of obesity and those who have experience of working with the patients these drugs are intended for, I’ve yet to meet anyone who thinks they are an entirely bad idea.

CAN I GET GLP-1S WHILE ON HRT?

Q) HAVING gained two stone post-menopause, I now weigh 12 stone.

As well as HRT, I am also on propanol for anxiety, and I’m dealing with a bereavement.

I feel miserable and don’t go out. Can I get GLP-1s?

I am 57 and used to love dancing, but now I stay in all the time.

I avoid all pictures and videos as I hate how I look.

A) To be eligible privately for GLP-1s, you need a BMI over 30 or a BMI over 27 with a weight-related condition – something like diabetes, high blood pressure, high cholesterol, sleep apnoea or cardiovascular disease.

The NHS has an online tool where you can calculate your BMI.

It’s important to note that if you are taking HRT orally, GLP-1s may affect the absorption of some oral medications.

It doesn’t mean that you can’t take both, but if all or part of your HRT is oral, discuss with your prescriber whether an alternative way of administering would be more reliable.

Options include patches, gels and Mirena coils.

I do want to raise the point that losing weight is often not the silver bullet that people hope it is.

You’re dealing with a really hard time at the moment and it has understandably left you feeling low.

While weight-loss injections may help physically in terms of mobility and inflammation, they won’t fix grief.

And the jury is out on whether they improve mood and reduce anxiety, or make them worse.

I wonder whether you may benefit from some talking therapy support, too, to help manage your anxiety, which can feel unmanageable when you are also grieving.

Consider NHS Talking Therapies or other support alongside.