Earlier this week, I was contacted by the Irish Independent. I gave a long interview, most of which they didn’t use.  If you’re curious what I had to say, here you are: 

Our goal should always be health gains, not measured in loss on the scale .   “eat less, move more” is not a treatment for obesity which is a chronic, complex, progressive, and recurring disease.  There is a fine-line – but it is critically  important – between talking about how much chronic disease burden  is preventable and not misusing that to patient-blame those who have disease due to things they cannot change  (we call those non-modifiable risk factors). 

Many potential uses for semaglutide have been suggested.  Some clinical trials are ongoing.  But data remains outstanding.  Here are a few things to think about when reading about semaglutide (Ozempic) in the media:

1.  This drug can’t fix the underlying factors that contributed to developing the, including obesity or addiction.   It cannot address trauma, poverty, genetics, mental health.  The drug itself cannot fix problematic relationships with food or alcohol or body image. When it comes to obesity, we have long established researching showing that there is a clear link between adverse childhood events, such as sexual abuse, and later adult obesity.  The drug can’t substitute for whole patient care.

2. The cost of both this drug and accessing qualified care widens the gap that already exists between the health of those who are wealthier  and the health of those who live in poverty.

3. The conversation around this drug means we aren’t talking about the real goal we should all have:  prevention of diseases such as diabetes, complications from obesity, or addiction.  Prevention –  in patients and populations in whom it is possible –  should be seen as more important than the treatment.  While genetics -which can’t be changed – play a factor in chronic disease, things we can change such as diets high in ultra-processed foods, sedentary lifestyles, access to mental health services, healthy low risk alcohol use, education around vaping and smoking, adequate community health education, and primary care supports are important.     25% of children in Ireland are above a healthy weight; 11% have obesity. We should be looking at preventing future complications, from asthma to joint pain to subfertility to liver disease.  While there are genetic factors, we don’t want the conversation to be that they are somehow semaglutide-deficient.

4. We need more studies. Many of the benefits from semaglutide may really be the benefits from the modest weight loss of 10%, however it was achieved. This 10% is important as it is the point at which we usually seem improvement in chronic health conditions. The loss of 10% is associated with reduction in blood pressure, reduction in fasting blood glucose, improvement in joint pain, improved mobility, improvement in urinary stress incontinence, increased menstrual regularity in pcos.  At 10-15%, we often see improvement in MASLD (“fatty liver disease”) and sleep apnoea. Studies will be critical here to show that semaglutide is the best way forward. The suggestion that this drug has potential to reduce risk of dementia is important.  However, the recent study published by Dean Ornish showed intensive lifestyle interventions improved mild Alzheimers.

Lifestyle Interventions are important in the management of chronic disease, but “eat less, move more” is not a treatment for obesity which is a chronic, complex, progressive, and recurring disease.    The goal should not be normalizing weight or always necessarily a major weight loss.

8. The complex case of alcohol:  Not all alcohol misuse is addiction.  Only 1:10 Irish adults can correctly identify 2 most common drink measures. In clinic, it is not uncommon for patient to identify as having 1 glass of wine per night but when we work it out, that “glass” is 250-350mL! (2-3 units). In a recent poll, 50% of adults would like to reduce to low risk guidelines if they had a clear idea of what they were.  One 2% of Irish adults know them. 74% believe that hazardous drinking is normal.   So there is a role for increased engagement – non-judgemental, supportive – for many patients.  In patients with addiction,complex causes and high rates of recurrence mean that semaglutide may have a limited role unless as part of more comprehensive intervention and then likely only for a percentage.

9. Health Economics –The Look Ahead study showed that lifestyle interventions decreased healthcare burdens, such as medications and hospital admisssions. A serious discussion needs to be had in our healthcare services about a long term sustainable mode beyond finding more uses for semaglutide. The combination of four healthy lifestyle factors — maintaining a healthy weight, exercising regularly, following a healthy diet, and not smoking — are associated with as much as an 80% reduction in the risk of developing the most common and deadly chronic diseases.

10. While semaglutide has a promising role, we need to focus on how we gain health – not the loss or scales.

Last thought:  If one were cynical, the data shown in the Look Ahead study would not be something pharmaceutical companies would be interested in. It’s about reducing medication use.  However, there is a potential for significant financial profit for pharmaceutical companies  when a new “clinical indication” is identified for a drug they have already developed before it goes off patent (when a drug goes off patent, other companies can make the drug, called generics.  There is no generic of semaglutide right now).