The reporting in The Guardian is usually not bad, but I think this article missed the mark a bit. Semaglutide is a once-a-week injectable medication used in Type 2 diabetes, and is now also as a treatment for obesity.**

Their headline “I miss eating” is catchy.  But we do #FactsNotFears here so…

What did they get wrong?

1. Semaglutide isn’t a weight loss injection for the sake of weight loss. It is a drug for complex, chronic, and recurring disease. Semaglutide improves blood sugars, cholesterol, and reduces the risk of complications from obesity, including those of heart disease and stroke.

2. They did not explore the multiple issues (safety, ethics) raised that this drug being widely used by aesthetic and cosmetic industry his drug is licensed for two serious medical conditions, and in trials and in best practice, is best used with an expert medical team that often includes psychology, endocrinology, lifestyle medicine, exercise physiotherapy, and specialist dietitians.

What really missed the mark? 

1. In clickbait fashion, the article starts off talking about TikTok, celebrity secret, quick weight loss, and even Elon Musk. By the time any real journalism starts, it is so far down the article that, statistically, most readers have stopped. When they get to how the the drug works, it follows on a fitness influencer who wanted to lose 20 lbs – and they managed to tie in menopause for maximum traction on the social media algorithm

2. The article interviewed aesthetic/cosmetic doctors and celebrity “nutritionists” — but not patients with lived experience of obesity, patient advocacy groups, endocrinologist (doctors who specialise in diabetes), obesity medicine doctors, expert dietitians, pharmacists with expert knowledge of how the drug works and side effects, or experienced clinical researchers.

3. It is focuses on the weight for the sake of weight — not framing obesity as a chronic, complex, and recurring disease.

4. Poor research.  It cited a single paper from 2012 —  instead of the multiple published STEP trials, including from 2021, looking at semaglutide that have been published in Lancet, Nature, JAMA, and New England Journal of Medicine.

I’m a doctor who supports patients who are on semaglutide***.  What are some facts you should know?

1. It’s most often a really positive experience for the patient.

2. Patients go on semaglutide for 1) Type 2 Diabetes or 2) Obesity with complications.  It’s used as part of a holistic approach.

3. We follow patients to see improvements in measurements such blood pressure, blood sugar, cholesterol, sleep, fatty liver disease, joint pain, and general well-being/overall energy,  Outcome is not measured simply by scale.

4. Semaglutide, prescribed correctly and with correct expert support, is usually well-tolerated with minimal and short term side effects.

5. Before patients go on semaglutide, they almost always need some health checks. Depending on your health and risks, this can include things like checking for high blood pressure or diabetes, checking your liver, making sure you don’t have sleep apnoea. (This critical patient care and safety may be skipped in aesthetic, cosmetic, or pill-mill online services).

6. A change of lifestyle is needed with semaglutide.  And it’s not about eating less and moving more. A change in what and how you eat is often needed.  Would it surprise you that many of my patients need to eat more, not less – and that’s before starting semaglutide!  Some of them need to cut back on hours of exercise.  This is not about going on a diet.  It’s long term changes to eat healthy.  You should never be hungry or malnourished. You may also need other specialists.  Patients may need a psychologist if they have an unhealthy relationship with food.

7. The involvement of a qualified (in Ireland INDI and CORU registered) dietitian is essential.

8. Not all GPs prescribe semaglutide – mostly because of the above team supports that patients need that GPs aren’t resourced for. Some GPs will get patients started while they are on the waiting list to see a specialist.

9. Cost is a problem. Semaglutide in Ireland is only covered for diabetes.  It is self-pay if a patient has obesity but not diabetes.  (Yes, this is a problem!)

10. Semaglutide in Ireland is available from cosmetic practitioners. It was disturbingly highlighted and even promoted  in FutureBeauty last year in a session that was called “Skinny Jabs” [oh, yes, it was as cringe as it sounds.  I attended!] — something I’m desperately hoping they will not repeat this year. (Weight is not beauty; this is a hill I will die on!)

What should patients know if they want help with weight loss?

1. Start with your GP.  Your GP can start the basic health assessment that might be needed if they haven’t been done already like checking your blood pressure, your blood sugar, and your cholesterol.

2. Not all patients who are above a healthy weight need medication.  Many do well with just lifestyle changes.  Your GP may refer you to a registered dietitian, exercise physiotherapist, psychologist, and/or lifestyle medicine doc (like me!) to start. You may referred to more than one of us.  We tend to work together to support patients. This can be really effective for many – but not all – patients.  You can self-refer to many of these services privately and some are covered by your insurance.  Always choose proper qualifications:  INDI/CORU registered dietitians and Chartered and CORU registered physiotherapists.

3. Worried about your hormones? Touch base with your GP first.  Online hormone tests are more expensive and less helpful than the standard ones already available at your local GP. If you need more hormone tests beyond that, you probably also need referral to an endocrinologist (hormone expert) – not a telephone consultation from overseas.

4. If you have obesity with complications, your GP can refer you to HSE weight management programmes.  There are long waiting lists.  Your GP can also refer you to private endocrinology or bariatric programmes.  You can ask if you are not offered a referral.  Statistically, men especially are less likely to be referred [I highlight this in my article published this month on page 52]

5. Be safe:  Do not book yourself in for foreign bariatric surgery in Turkey. Do not request drugs from online pill-mills. 

6. The weight loss industry is worth millions.  From food intolerance testing to shakes to clubs to hypnosis to magic earrings to patches you put on your foot….  getting expert advice early can save you wasted time and money.

**In Ireland, semaglutide is available currently only as Ozempic and only for diabetes.  The update to include obesity and the preparation Wegovy is expected in 2023.

***The author, Dr. Kate McCann, is SCOPE and Lifestyle Medicine certified.  She also works one day a week in a private hospital multi-disciplinary weight management clinic in Dublin centered on expert endocrinology input.