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The Obesity Epidemic

Weight loss infographic

At a time in which the obesity epidemic continues to explode across the world, many pharmaceutical companies and health care professionals have been working diligently to discover the most effective medical treatments to help patients manage their weight.

Excess weight increases the risk of a number of medical conditions, such as high blood pressure, high cholesterol, heart disease and some cancers. Obesity is also associated with reduced fertility, an increase in mental health problems and number joint and mobility problems.

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Manufactured by Novo Nordisk, Saxenda was the first new weight loss treatment to be endorsed by NICE in the UK (National Institute for Health and Care Excellence) in over five years. Saxenda has been available in the UK since 2017 and has quickly become established as one of the leading weight loss treatments across the world.

The medical component of Saxenda is called Liraglutide and has been available across Europe for another medical purpose since 2015. The medication’s original purpose was for the management of Type 2 Diabetes, and the medication brand is Victoza. It helps diabetic patients manage their blood sugars. During the course of studying Victoza, it became noted that certain doses over a certain period of time caused patients to experience a reduction in their appetite and as a result, experienced weight loss.

There are two main approved treatments for obesity via the NHS. Saxenda and an older treatment called Xenical(Orlistat). Orlistat has been available on prescription for many years and was made available over the counter in 2010. There is good evidence of its effectiveness, but many patients report significant side effects. It works by reducing the amount of fat absorbed from food in the gut. This reduces the total calories absorbed from food. The difficulty with the way it works is that in some patients it can increase the chance of diarrhoea. Consuming fatty food is the main thing to avoid. In a minority group of patients, the side effects are significant enough that they have to stop treatment. These patients can suffer with incontinence and oily stools and understandably choose to cease the medication.

The newer treatment, Saxenda, has been approved by NICE for the treatment of obesity, but its availability through the NHS is unfortunately limited by funding restrictions across different areas of the country. Often only available in specialist weight loss clinics (sometimes known as Tier 3 weight management services), patients need to be affected by more than one weight related medical condition to qualify for treatment.

Mysimba is an effective tablet medication but has not been approved by NICE. It is available only with a private prescription in the UK but it is the most popular weight loss drug in some other countries including the United States of America.

Bariatric (weight loss) surgery has been available for many years and techniques have improved over time. It is a very effective treatment for many patients, but it has significant financial costs and also carries the typical risks of surgery (which can sometimes be heightened due to obesity itself). It is usually reserved for morbidly obese patients in whom all other treatments have failed. NHS criteria for surgery are very strict but surgery is also available privately for suitable patients. Due of the costs and risks related to surgery, many patients opt for treatment with medication.

Urgent action is required to combat obesity

The number of patients with obesity in the UK has doubled over the past 20 years and studies are increasingly demonstrating the increased health risks that obesity brings.

It raises the risk of multiple types of cancer and various cardiovascular diseases including heart attacks and strokes. It is also a significant factor in the development of Type 2 Diabetes in patients. With the recent Covid-19 pandemic, obesity was one of the major factors that affected survival rates, with patients who had a higher BMI (body mass index) being at increased risk of mortality from the infection. Though comprehensive data is not yet available, it is clear that rates of obesity worsened during the Covid-19 pandemic because of reduced activity levels with successive lockdown and general movement restrictions.

What is clear however, is that obesity is a multifactorial condition with diet and exercise being only part of the equation.

Doctors across the country were consulted by the government after the pandemic when they unveiled the national obesity strategy with Dr. Nitin Shori, one of our team at PrivateDoc, providing his input. Some of the government strategies have included changes in food advertising and an increased emphasis on providing calorie details in restaurants.

What is the best way to lose weight?

Ultimately, weight loss comes down to being in a calorie deficit. This means using more calories each day than you are taking in and it is an inescapable equation.

One of the difficulties here is that the number of calories each person gets from the same food can vary depending on absorption and their own metabolism. It is difficult to be completely accurate when calculating the number of calories used by someone – for example, if two people were to run at a steady pace for ten minutes, the amount of calories those two people would burn would be different and would depend on their weight, their metabolism, their level of fitness etc.

Online calculators are available to calculate something called the ‘Basal Metabolic Rate’ (BMR) and whilst these are not specific to each individual, they can be useful as a starting point to work out how many calories you need to maintain your current weight. The BMR is the number of calories your body needs to maintain itself as it is right now.

Once you know what your approximate calorie intake should be (using a BMR calculation or another method), you can start to see how many calories you need to be deficient in every day to start to see weight loss on the scales.

One strategy that is used by many is to set yourself a calorie target for a period of two weeks and weigh yourself at the start of the fortnight, after one week and then at the end of the fortnight. If you have stuck to your calorie target well, this method will help you get a more individualised calorie target for weight loss. For example, if you set your target as being a daily intake of 2000 calories, but at the end of the fortnight you have gained 2kg, you know that 2000 calories is sitting above what your body needs to lose weight. So for the next two weeks you might choose to stick to 1800 calories and see again if your weight increases, stays the same or decreases.

Medications can further help patients by altering the way patients use the calories they take in and by reducing the total number of calories consumed. Saxenda works to reduce a patients appetite, which helps to decrease the overall number of calories taken in. It can also help someone to feel fuller for longer. The time food takes to pass through the digestive system is also slightly quicker when someone takes Saxenda, which can reduce the amount of time available for calories and nutrients to be absorbed from the food, helping to reduce the overall number of calories taken in.

In Primary Care, we see time and time again the measurable benefits of losing weight. We see patients ‘cure’ themselves of Type 2 Diabetes and bring their blood pressures back to more normal levels. This can lead to some patients no longer needing any medication for these conditions which can be life changing and liberating for many patients.

Just as obesity can be caused by a number of factors, so can conditions such as high blood pressure and Diabetes. Therefore it is important to understand that with these conditions, the benefits may be delayed. It can take time for the body to adjust to a lower body weight. It is also important to be aware that not everybody will see improvements in these conditions despite weight loss; sometimes the conditions have gone too far to be reversible, or that there are other factors/reasons leading to these conditions.

Obesity is a very difficult issue with both physical and emotional factors involved. Medications are rarely the sole solution and changes to diet and lifestyle are also required. With Saxenda, we generally see that with treatment, a third of patients will lose more than 10% of their bodyweight, and one in seven will lose 15% of their bodyweight.

Saxenda - medication to help with weight loss

Saxenda is daily pen injection that is one of the most effective medications at reducing appetite that we have seen. It mimics one of the body’s own hormones to make you feel full and reduce hunger symptoms. The hormone it mimics is called GLP-1 which the body naturally releases after food to make you feel full. The difference between your body’s own version of the hormone and the injected form (Saxenda) is that Saxenda works for 24 hours whereas the body’s version may only last for a few minutes.

In practical terms, Saxenda helps to promote feelings of fullness and something called early satiety (or feeling fuller quicker with smaller meals than usual) by mimicking the bodies own natural response to food, and in doing so, mimics this action for far longer. Where someone may have a meal and feel hungry again a few hours later, a patient with Saxenda will find that those hunger feelings take much longer to return. Ultimately this means that a patient taking Saxenda will consume less food when they are eating a meal, and will often find they are not snacking or picking during meal times due to those feelings of fullness.

It has to be injected under the skin in a simple process which involves a pre-loaded pen like device containing the medication and a tiny needle. This is generally injected into the skin of the abdomen, upper thigh or upper arm with a simple click.

A common question is how long does a Saxenda pan last? When starting Saxenda, patients will begin on a low dosage of 0.6mg per day, and gradually increase this dose by increments of 0.6mg every seven days until they reach a treatment dose of 3mg per day. It takes six weeks to reach the treatment dose. When starting treatment, the first pen of Saxenda will last 17 days whereas a pack of five pens will last 44 days. Once on a treatment dose of 3mg, a pack of five pens will last 30 days.

Sometimes patients see results almost straight away, but it is important to remember that it can take time to start to see results with any weight loss medication and that these results are entirely dependent on the other changes made – such as diet, activity levels, alcohol intake etc.

As with all treatments, there are side effects from treatment and some are more common than others. The most commonly experienced side effects include nausea, vomiting, acid indigestion/reflux, bloating and either constipation or diarrhoea. These side effects are most prominent when first starting treatment and also at times of dose increase. Simple remedies such as opting for blander food choices (such as toast or crackers) and keeping well hydrated can help to counteract these. It has also been reported that switching to administering the medication at night time rather than in the daytime can reduce impact these side effects might have.

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