Weight-loss drugs cannot be seen as short-term solutions by the NHS and GPs will inevitably need to engage with obesity management as the medicines are rolled out, researchers have said.
Researchers from the University of Oxford said that while the medications are highly effective in helping patients lose weight, their recent findings strike a ‘cautionary note’ on how they are best used.
A systematic analysis of trial data of GLP-1RA treatments found that semaglutide and tirzepatide led to an average weight loss of 16kg, but once participants stopped taking them, weight returned to baseline by 1.7 years.
Presenting the research at the European Congress on Obesity, the researchers said it was vital for the NHS to consider how to ‘optimise their use’.
NICE guidance on semaglutide for weight loss suggested it is used for a maximum of two years but recommendations on tirzepatide did not stipulate a treatment length. NICE will be reviewing evidence from real-world use of the drugs on the NHS.
The study concluded: ‘Cessation of GLP-1 RAs leads to return to baseline weight in less than two years with no difference to control groups in less than one year.
‘This rate of regain is greater than observed following behavioural weight management programmes and sounds a cautionary note to the use of these medications without a more comprehensive approach to the treatment of obesity and prevention of weight regain.’
Study lead Professor Susan Jebb, professor of diet and population health in the Nuffield Department of Primary Care Sciences at Oxford University, told Pulse that the results were not surprising given that people tend to regain weight whatever method they have used to lose it.
GPs will inevitably need to get more engaged with obesity management as the medicines are rolled out, Professor Jebb said.
It has been estimated that around 1.5 million people are already using weight-loss medications in the UK mainly through online providers.
Phased roll out plans from NHS England are due to start in June with GPs able to prescribe tirzepatide (Mounjaro) to the first priority cohort who have a BMI of 40 or higher and more than four other comorbidities such as hypertension or diabetes.
Professor Jebb added: ‘I think we will need a specialist weight management hub so you have a team who understand the different pathways and who can help signpost patients to the most appropriate pathway for them.
‘Some will go to Path to Remission, some will go to GLP-1RAs, but that you’ve got to have somebody in your ICB who’s coordinating and organising and thinking about this, you cannot leave that decision making to every individual doctor.’
She said the NHS has to face up to the fact these are likely to be long-term treatments but that people buying weight-loss drugs privately also need to be aware that it will be a long-term commitment.
She added: ‘For the NHS the cost implications are substantial so we have to really think hard about who should be getting these treatments.
‘We need to make sure patients are getting the right treatment for them, but also the most cost-effective treatment.’
She added that the NHS Path to Remission Programme – the Soups and Shakes diet – works well and was very cost-effective, but not every patient wants to take that approach.
For others who have the highest levels of obesity, bariatric surgery could be more cost-effective in the long run, she added.
She said: ‘I think it’s really important that we don’t jump to [medicines] as being first line therapy for everybody all of the time.’
The extent of the weight gain seen after people stop taking the medications is quite ‘astonishing’, she noted, although as yet there isn’t a huge amount of data.
‘We just need to be honest about the situation rather than deluding ourselves that they are an easy solution,’ Professor Jebb added.
One option could be a ‘pulsed’ approach where people go back on the medicines for short periods.
‘In academia, research, clinical practice, we’ve got to work out how we are going to support people in the longer term,’ she added.
Last week, a think tank said that the roll out of weight loss drugs in England could be dramatically sped up to millions of working age adults by making use of existing private providers and a ‘digital first’ approach.
What percentage of people return to baseline blood pressure and cholesterol after their ramipril and atorvastatin are stopped?
Why do these researchers keep saying GP’s should do this and GP’s should do that. None of them appear to insist that there are things that GP’s should not be involved in.
There are only so many hours in the working day.
What are they are going to recommend GP’s stop doing in order to be able to contribute to these obesity management programmes?
What percentage of people must revert to self-pay after 2yrs on NHS treatment and how does that demographic sit with those who need/benefit/can afford it most? Implications of long-term GLP1 treatment for obesity is in the £ tens of thousands.
Sure… I’ll put on that on my to do list, since I’m “best placed”:
1. Check boiler/heating
2. Stop terrorists
3. Fix leaky pipes
4. Mow lawn…
Researchers need to engage their brain cell to the fact that GPs are underfunded and undeerrstaffed as a result, and just plain do not have the time to do their current job AS WELL AS something new, just to please the greedy Pharma companies wanting to profit from giving drugs for a problem that is better dealt with by telling people to stop acting like gluttons and learn some self-discipline instead.
We could maybe do this INSTEAD of seeing ill patients and helping people with their current problems and inability to nevigate the undeerfunded NHS, maybe by going private and sharing in the rampant greed for fees, but would our patients really want that?
Being fat is related to eating too much, and should be tackled by Public Health, by banning adverts for fattening foods, alcoholic or sugary drinks, and other expensive but useless fads for losing weight that do not increase self-discipline, self-respect, and self-control.
“Being fat is related to eating too much”
I suspect you are right David, even if nowadays such a view would be considered heresy
We probably shouldn’t even think it
Employ clinicians to do the job, otherwise where is the time for GP to accommodate this service?
Engagement has a cost.
NO. Researchers need to realise GPs are not best placed to do this work. We are a shrinking group, and you cannot ask a shrinking workforce, to do every public health campaign ! Vaccinations, screening, alcohol, mental health, weight loss, smoking, etc… The country needs to wake up and smell the coffee, there is nothing wrong with people paying privately for this (surely part of the gain is they are spending less on junk food)
Classic example of how the authoritarian and paternalistic attitudes of UK Medicine harms patients, and the failure of the NHS.
Several mllion people in the UK could potentially benefit from these drugs; the NHS might manage to offer them to a fraction of that – thousands.
Meanwhile doctors have tried to restrict public access to the drugs through regulation and non-cooperation with private prescribers.
There is good evidence of reduced morbidity and mortality with these drugs; current foot-dragging will cost lives.