Obese people who want to take a new generation of weight-loss jabs should be prepared to stay on them for life, researchers have suggested.
Studies show that people who stop the jabs – such as semaglutide – can regain much of the weight they have lost.
Earlier this year, the National Institute for Health and Care Excellence (Nice) recommended the use of semaglutide (brand name Wegovy) for adults with a body mass index (BMI) of at least 35 and one weight-related health condition – such as diabetes or high blood pressure.
Nice said the jabs should not be taken for more than two years.
However, a team of obesity experts argue this guidance is largely based on the cost of the drugs and that people who take them should be prepared to take them long-term for treating their disease.
We do know that obesity is a chronic disease and we would never think of just giving somebody a diabetes drug or blood pressure drug for two years and then stopping it because, of course, at that point the disease will recur— Professor John Wilding
Carel Le Roux, professor of metabolic medicine at Ulster University, told a briefing: “These are treatments for the disease of obesity and what happens is, when you treat people effectively, the disease comes under control, and the minute you stop the drug, the disease relapses.”
He suggested the medical profession was comfortable prescribing for conditions such as rheumatoid arthritis or high blood pressure, and the same should be the case of managing obesity.
He added: “The minute we stop the drug, the disease (obesity) relapses, so one of the most important questions we ask our patients now is, ‘are you prepared to take this treatment for the rest of your life?’
“Because if you’re not able to do that, you should stop because then we are probably at risk of doing more harm than we are doing good.
“So it’s important to reframe this as a disease that we are treating and that these are disease-modifying drugs, not weight loss drugs.”
We know from the clinical trials that when medications are stopped, the weight is regained...(and) there are psychological issues around weight regained— Barbara McGowen, professor of endocrinology
John Wilding, a professor of medicine who leads clinical research into obesity, diabetes and endocrinology at the University of Liverpool, said: “We do have to think about these medicines as long-term medications despite the fact that, for Nice at the moment, it’s only two years of treatment.
“We do know that obesity is a chronic disease and we would never think of just giving somebody a diabetes drug or blood pressure drug for two years and then stopping it because, of course, at that point the disease will recur.
“We know that happens with obesity. So, I do think we have to think about this as long-term treatment and that’s something that is yet to be addressed from a policy perspective.”
Research results published last year in the journal Diabetes, Obesity and Metabolism on people who stopped semaglutide showed they regained two-thirds of their lost weight over the course of the next year.
Barbara McGowen, professor of endocrinology at King’s College London, said current NHS services were not set up to give the jabs to all those who may benefit from them.
She added: “With regards to the two-year rule… It is just a cost measure rather than a clinical measure. We all agree that obesity is a chronic disease.
“We feel that these medicines should not be stopped after two years – you wouldn’t stop a statin, you wouldn’t stop a blood pressure tablet.
“We know from the clinical trials that when medications are stopped, the weight is regained…(and) there are psychological issues around weight regained.”
It should definitely not be for cosmetic reasons, there's no doubt about that, it should be for health reasons— Prof Barbara McGowan
She said the two-year rule on stopping Wegovy by Nice “is just probably not based on science.”
Prof Le Roux said the two-year rule from Nice was “100% built on health economics”.
He said the drugs are cost-effective but this cost-effectiveness “stops after two years because the drug price continues to go up.”
He added: “The equation is 100% driven by the price of the medication. And as we all know, all drugs become cheaper as time goes on….With more competition in the market, we hope that the drug prices will come down.
“So I think Nice made the right decision at the time, but we do hope that they will revise that decision, as we get more data…but also as prices come down.”
Semaglutide also comes in a lower dose under the brand name Ozempic for managing type 2 diabetes.
Liraglutide (Saxenda) is a different jab available on the NHS as a possible treatment for managing obesity in adults.
Asked about the use of all these drugs for cosmetic reasons – such as among people who were already a healthy weight – Prof McGowan suggested they should not be used inappropriately.
“It should definitely not be for cosmetic reasons, there’s no doubt about that, it should be for health reasons,” she said.
Helen Knight, director of medicines evaluation at Nice, said: “We are aware of more research looking at use of semaglutide over a longer period of time than we have currently recommended. We look forward to the availability of further data, so we consider the longer-term use of semaglutide and establish whether it remains value for money for the taxpayer.”
