Wegovy is "not a magic bullet" - 3 doctors reveal what you need to know as the drug is set to be prescribed in the UK

If you've been keeping tabs on the news around Wegovy in the UK, you may have heard that the weight loss injectable will soon be available on prescription from the doctor and high-street chemists, such as Boots, in a £40 million NHS pilot scheme. 

The news landed earlier this month, triggering reactions from experts and politicians alike. Prime Minister Rishi Sunak called the program - which is set to initially allow up to 35,000 people to access the medication for up to two years - "game changing". However, others raised concerns over additional pressures on the already-overstretched health service. 

We've heard so much about the US drug Ozempic for weight loss over the past year, with doctors prescribing the medication - which has only been approved for those with type 2 diabetes - off-label for weight loss in the US. Celebrities like Chelsea Handler, Elon Musk, and Rosie O'Donnell have come forward to say they've taken it and videos about #Ozempic have reached an incredible 1.5 billion views on social media. Despite no endorsement from the manufacturer, Novo Nordisk, the surge in awareness and demand for the drug has continued to grow. 

Practicalities of prescribing a hotly-anticipated specialist drug like Wegovy on the NHS aside, what do the experts think about the wider introduction of quick weight loss injectables like these? 

Here, woman&home speaks to three certified experts to reveal what you need to know about the introduction of Wegovy and similar drugs - from how they work to help people lose weight without dieting excessively, to the side effects people on the program can expect to see. 

How does Wegovy work? 

Firstly, let's start with the basics. Wegovy is a brand name of semaglutide, which by proper definition is a glucagon-like peptide 1 receptor agonist (GLP1a). This is a type of drug that mimics the hormone glucagon, which is produced in the gut and regulates blood sugar levels and insulin, another hormone. 

It helps with weight loss, obesity specialist and Harvard University faculty member Dr Richard Josef explains, "by increasing feelings of fullness and acting on appetite centers in the brain and gut to reduce cravings." This, in combination with a reduced-calorie diet and more physical activity, is the prescribed way forward for those eligible. 

Wegovy was approved by the US Food and Drug Administration (FDA) in 2021 and by The National Institute for Clinical Excellence (NICE) for use in 2022 to treat obesity in the UK. While its use is widespread in the States, with recent reported shortages limiting the supply of the drug's starter doses, it's not yet available in the UK. There's also no word from the manufacturer on when exactly this will be. 

Regardless, it's clear that the interest in weight loss injectables is here to stay. High-street pharmacist chain Boots are already reporting a shortage of Saxenda, the brand name for liraglutide - another medication already approved for diabetes and chronic obesity that works in the same way as semaglutide medications Ozempic and Wegovy. Superdrug, another large pharmacy chain in the UK, told Reuters in April that its remote prescriptions service was anticipating significant demand with "five-times anticipated levels of registration".

The UK's decision to offer Wegovy via the NHS is only likely to heat up the already-controversial debate around whether Wegovy and similar medications are a solution to weight-related health problems or whether there are still better options out there. 

Is Wegovy approved for weight loss? 

Yes, both the FDA and NICE have approved Wegovy for weight loss. On issuing the guidelines, Novo Nordisk recommended it be prescribed to adults who have a particular body mass index (BMI), which is a measurement that aims to work out if your weight is healthy using the ratio of your height to your weight.

Those with a BMI score of 30 and over, which is classified as 'obese' by the metric, or those with a BMI of 27 and over, which includes those who are classified as overweight, and at least one weight-related health condition will be eligible for Wegovy.

This is where some of the controversies around Wegovy and its future prescription in the UK lie. As Dr Josef, who is also the chief medical officer at Restore Hyper Wellness, explains, "BMI is a useful metric to monitor the prevalence of overweight and obesity across large populations, but it's a limited and crude metric when applied to one person. It does not distinguish between excess fat, muscle, or bone mass, nor does it provide any indication of the distribution of fat among people." 

It's a problem, he continues, as prescription based on this method "can lead to inappropriate treatment of patients who may not actually benefit from the medication or may be at risk of adverse side effects." 

For example, as a study by the University of California of over 40,000 adults revealed, nearly one in three "normal weight" individuals as classified by their BMI have other markers of poor metabolic health, such as high blood pressure and cholesterol. While nearly half of those classified as overweight and one in three of those classified as obese were healthy by the same metrics. 

It's a stunning finding. "The authors conclude that using BMI alone as a measure of health would misclassify almost 75 million adults in the US," says Dr Josef. Looking at the prescription of weight loss medications, this means millions could miss out on the benefits - or receive the medication without an actual need. 

Not only is this potentially troubling for those prescribing Wegovy but as body weight is under-reported and height often over-reported in healthcare settings, the doctor says, the link between obesity and chronic health conditions is often missed and the given data can be "easily gamed" in telehealth settings, for instance, by those wanting access to the drug without medical cause. 

"It's important for healthcare providers to consider a patient's individual medical history and other factors in determining whether Ozempic [and other semaglutide medication] is an appropriate treatment option," he says. 

What are the side effects of Wegovy?

Like all medications, there are side effects of Wegovy. According to the prescriber's information, some of the most commonly reported side effects of Wegovy include:

• Nausea and/or vomiting
• Diarrhea and/or constipation 
• Stomach pain 
• Headaches
• Fatigue 
• Upset stomach and/or stomach flu
• Belching
• Gas 
• Bloating
• Dizinness 
• Heartburn
• Runny nose or a sore throat 

Studies by Our Lady of Lourdes Memorial Hospital and the Mayo Clinic also confirm that patients on Wegovy can lose up to 15% of their body weight using semaglutide, the active ingredient in Wegovy and Ozempic, in as little as six months. And where there is substantial fat loss, there are also a whole other host of side effects. 

Dr Molly Maloof, a physician and metabolic health coach specializing in personalized medicine says the link between semaglutide, the active ingredient in Wegovy and Ozempic, and muscle loss is an alarming one. "A study consisting of 18 randomized controlled trials concluded that although antidiabetic drugs have a large weight loss effect, it is important to pay attention to muscle loss because a decrease in fat-free mass was observed." For anyone this can be a problem, however, if you are also experiencing perimenopause symptoms then it could become a serious issue since the changes in hormone levels during menopause also naturally lead to muscle loss without intervention. 

Along with concerns that Ozempic causes hair loss, after reports of shedding by users, some have spoken up about changes to the skin around their faces. Dubbed 'Ozempic face' by those on social media, it's another side-effect of rapid weight loss. 

"Losing up to 15% of your weight can have a dramatic effect on your face and body, which many people don't realize," explains plastic surgeon Miss Sujatha Tadiparthi. "[Those who take the drug] may have achieved their desired body weight, but the resulting loose skin can lead to psychological issues, lack of self-esteem and self-confidence."

These side effects aren't just confined to studies and social media videos though. It's something that Dr Maloof, who works with Lumen, can attest to herself: "After having Covid, I noticed some worsened insulin sensitivity," she tells woman&home. "I decided to experiment with the peptide but after taking it for two weeks, I noticed mood swings and major anxiety. 

"I discovered it was dropping my blood sugar too low and making me totally lose my cool. Suffice to say, I soon returned to the things I know work: low-intensity cardio, balanced eating, stress management, and more time off for human connection."

As well, the unfortunate fact here is there's no sign that these side effects go away with continued use. Instead, surgery is suggested as the main option to help those with 'Ozempic face' and other similar issues. "Surgery to fix the loose skin can be much more expensive than the weight loss injections and result in permanent scarring," warns Miss Tadiparthi, which in combination with the possibility of weight regain can be "disappointing". 

How long do the side effects of Wegovy last? 

Wegovy (and Ozempic when prescribed off-label for weight loss) are relatively new, so the long-term impact of taking the drugs is still being studied. However, when it comes to weight loss in the short-term, the evidence is promising. "The available evidence suggests that semaglutide can have positive effects on metabolic health over the long term," explains Dr Maloofs. "For example, a recent study [in connection with the University of Alabama] found that individuals who received the drug for 68 weeks experienced sustained weight loss, improved blood sugar control, and a decrease in blood pressure and cholesterol levels."

One of the major sticking points around Wegovy is the viability of its use in the long term. While both experts and the prescribing information for the drug confirm it's to be used in conjunction with changes to diet and exercise regimes, the pilot scheme being launched by the NHS is only set to offer the drug for two years. 

Are Wegovy and other injections a long-term weight loss solution? 

While practitioners have stayed positive about the potential of such drugs for weight loss, they are far from being the weight loss "magic bullet" many people think they are. "Obesity medicine practitioners like myself have long been optimistic about the potential of GLP1a therapy to safely and effectively promote sustainable weight loss and clinical trials have demonstrated that semaglutide combined with intensive behavioral therapy results in a significant reduction in body weight," Dr Josef, who is also the chief medical officer at Restore Hyper Wellness, says. 

However, he notes, all of the clinical trials for semaglutide were conducted over a span of 3 years, and practitioners don't have safety or clinical data on the long-term (i.e. 10-15+ years) of semaglutide use. 

Importantly, it's also been well-recorded that patients often regain their lost weight after they stop taking the medication. "Weight loss is a complex and multifactorial issue, influenced by genetics, hormones, environment, and lifestyle factors such as diet, exercise, sleep, and stress," the doctor says. "Obesity is a chronic, relapsing, multifactorial, neurobehavioral disease in which our brain becomes desensitized to normal appetite signals, making it more difficult to sense how much we've eaten and how much fat we have stored."

While medications like semaglutide may be helpful, he confirms: "They are not a long-term solution to obesity and its comorbid conditions. It's not a magic bullet and should be used in conjunction with other lifestyle modifications and behavioral therapies."

Wegovy vs Ozempic: What's the difference? 

• Ozempic is prescribed for those with type 2 diabetes: Despite the popularity around its off-label use as a weight loss drug, Ozempic has only been approved for those with type 2 diabetes. 
• Wegovy is prescribed for weight loss: Wegovy, on the other hand, might contain the same active ingredient as Ozempic, but unlike Ozempic, it has actually been approved for weight loss in those with a BMI of 30 or 27 with another weight-related health condition. 
• The Wegovy dose of semaglutide is higher than Ozempic: Those taking Ozempic for type 2 diabetes may slowly work up to 2mg of semaglutide per week, while those on Wegovy may slowly work up to 2.4mg of the drug per week depending on personal health circumstances. The differing purposes of the drug is linked to their different dosages. 
• Both drugs are administered via injection: Ozempic and Wegovy come complete as pre-filled pens, administered once a week. 
• Both drugs have side effects: Those taking Ozempic or Wegovy can expect some side effects, like any medication, and unpleasant gastrointestinal problems seem to be top of the list.