Each morning Danielle Breckenridge wakes up and reaches for the bottle of pills on her bedside table, taking a tablet before getting on with her day.
The tablet is Rybelsus (or semaglutide, to use its non-brand name) and is a ‘protein in a pill’ medication developed for Type 2 diabetes, but is also being prescribed off-label in slimming clinics across the UK for weight loss – one of its happy side effects.
Semaglutide is the drug that made the headlines last week when results of a new clinical trial revealed it caused 15kg weight loss over 15 months in its participants with a weekly injection.
Created from GLP1, a gut hormone that occurs naturally in our body, it is an artificial, longer-lasting version that suppresses the appetite by mimicking the feeling of being full and was reported as a game-changer in the world of obesity.
But semaglutide has, in fact, been offered by private clinics as an aid to weight loss for some time, either as a weekly injection known as Ozempic, which was launched by pharmaceutical company Novo Nordisk in the UK in January 2019 or as a daily tablet like the one Breckenridge has been taking, which came to market in September last year.
Both these drugs are a newer, more convenient version of Saxenda, promoted on Instagram as the ‘SkinnyJab’, by celebrities such as Gemma Collins and Kerry Katona. However, the Advertising Standards Authority (ASA) stepped in after it was found the promotional ads exploited body insecurities.
Breckenridge first went on Saxenda at the private weight loss clinic Slim Transformation in September 2019 for help with her weight. At 5ft and 13 stone, she had a Body Mass Index (BMI) of 35, classifying her as obese.
“I had gestational diabetes during pregnancy, which made me put on four stone and after my daughter was born, the weight just wouldn’t shift,” says Breckenridge, 31, an office administrator from Stevenage, Herts. “I had a diabetes test a year later and it came back borderline, which was a huge shock. The GP offered me a referral to Slimming World but I was in a panic and knew I needed something a bit more effective.”
After doing her research online, she went to the clinic and after an initial consultation and various medical checks, she was prescribed Saxenda for four weeks, at a cost of £180, alongside a diet and exercise plan. The drug, self-administered daily with pre-filled injectable pens, had the desired effect, curbing her appetite and causing her to lose 11lbs in three weeks.
“I had a bit of nausea but I just wasn’t hungry any more and wasn’t even tempted by party food, my usual weak spot,” adds Breckenridge.
She then turned to Ozempic for the next four weeks because, “the weekly injection was easier as I sometimes forgot to do the daily one” and all in all, she lost over two stone.
Ciara Lawless, 40, also lost two stone in May 2020 on the Ozempic weekly jab after seeing it advertised on Instagram and has since returned to it twice to keep her eating in check.
‘’I was over 12 and a half stone and all the diets I went on never seemed to work,’ says Lawless, who works in sales and lives in Dublin. “I feel so much better about myself now and my confidence is so much higher. I did maintain my weight with clean eating and having a weekly treat but it’s nice I can come back for help when I need it.”
With BMIs of 30, neither Breckenridge nor Lawless would have been eligible for weight loss drugs on the NHS.
Saxenda has only recently been recommended by the National Institute for Health and Care Excellence (NICE) for use on the NHS in England for adults, making it the first pharmacotherapy to be endorsed by NICE for weight management in almost a decade. But the drug is only available for those with a BMI of 35 or over (or 32.5 and over in the case of certain minority ethnic groups).
To be eligible for NHS treatment, patients must also have pre-diabetes and a high risk of cardiovascular disease, based on risk factors like high blood pressure and cholesterol. The treatment is prescribed along with a programme of eating fewer calories and upping physical activity and will end if the patient doesn’t lose at least 5 per cent of their body weight within 12 months.
“Since 2009, the only other alternative on the NHS for weight loss is the drug, Orlistat, which is a tablet taken three times daily and works by interfering with the way fat is digested and has helped many people lose weight,” says Giles Yeo, principal research associate at the Metabolic Research Laboratories and MRC Metabolic Diseases Unit, University of Cambridge.
“However, it is known for its unappealing side effects, including oily stools and diarrhoea, so Saxenda is a step in the right direction, although the criteria to receive the drug on the NHS is strict.”
In the meantime, Orlistat – under its brand name Xenical – and Saxenda can be bought fuss-free from numerous online pharmacies if you have a BMI over 27, simply by completing a brief health and history questionnaire which is reviewed by ‘certified prescribers’ and putting in your card details. On expresspharmacy.co.uk for example, it costs £84.95 for a four-week/one pen supply of Saxenda and £51.99 for a two-week supply of Xenical.
While the private clinics also supply weight loss drugs to people with a BMI of 27 or above, there is more overall support – the key, experts believe, to long-term weight loss.
“We are very aware that drugs on their own don’t work and weight is not the problem but the symptom of the problem,” says Dr Chinnadorai Rajeswaran, consultant physician in obesity, diabetes and endocrinology at the London Obesity Clinic. “That’s why we have a multi-discipline team with a fitness trainer, endocrinologist and dietitian because the problem has to be treated holistically. You can lose weight on the drugs but you can just as easily put it back on once you stop taking them if you don’t adopt the lifestyle changes.”
Indeed, Breckenridge maintained her weight for over a year off the medication, but recently returned to the clinic for help as her lockdown eating habits had spiralled out of control and she needed a boost.
Andrew Forsyth, lead clinician at weight loss clinic Slim Transformation, says: “Monitoring wise, we check in with our clients via email on day 10 and 20 after starting the medication and we also follow up with phone calls, texts and messages via social media. We also give each client a named nurse to contact should they need anything, meal plans devised by our nutritionists and a personal trainer who writes them a basic home workout routine.
“On average, our clients lose in the range of 10lbs-18lbs. The majority of our clients manage to either maintain weight loss or only regain a small amount of weight, but we do have repeat patients. The lockdown period especially has made it hard.”
All the obesity experts are expecting to see a roll-out of semaglutide-based drugs at some point in the future, to tackle the growing obesity crisis, made worse by the Covid lockdowns.
“If society accepts it and we know that it’s safe then I expect one day semaglutide will become a pill that you can buy over the counter in Boots,” says Yeo.