University College London finds weight-loss drug semaglutide an alternative to bariatric surgery, yet study shows the inequality of long-term success.
Bariatric surgery, also known as metabolic surgery, has shown its effectiveness in treating patients living with severe weight-based conditions such as Type 2 diabetes or obesity if traditional methods such as diets and exercise fail.
This often takes the form of changing the anatomy of the digestive system and its functions through surgeries including gastric bypass and sleeve gastrectomy. Patients have been shown to lose up to 77% of excess weight, showing clear benefits.
But there is a problem. With a fifth rate of weight regain, there is demand for an alternative. A study displaying the effectiveness of semaglutide on those for whom surgery was ineffective shows promise.
GLP-1 receptor agonist semaglutide, popularised by Ozempic, Wegovy and Mounjaro, targets weight gain by raising insulin levels to decrease appetite, which promotes weight loss. In the University College London BARI-STEP trial, semaglutide at a dose of 2.4mg in patients who had not responded well to bariatric surgery was found to increase weight loss greatly when receiving lifestyle support and a reduced calorie diet when compared to the placebo group.
Among patients taking semaglutide, 62% lost at least 15% of their body weight, compared to 7% in the placebo group. Results were even more striking at higher levels of weight loss, with 47% losing at least 20% of their body weight, compared with just 3% when taking a placebo version.
Improvements in blood sugar and cholesterol levels were also noted, in addition to most of the weight loss coming from body fat rather than muscle.
“These findings strengthen the case for using semaglutide in people who do not respond well to bariatric surgery, offering an alternative to repeat operations,” said trial lead Janine Makaronidis, senior clinical researcher at the UCL Centre for Obesity Research.
Broader problems exist
All good news. But while semaglutide and similar weight-loss drugs have shown promise in shifting how we tackle obesity, a proverbial thorn in the side exists; health inequality.
According to research at UCL and Cambridge, without affordable, healthy food options as well as wider health-based support, the long-term benefits may be more dependent on factors beyond just the medication.
The research team notes that nutrition advice, healthy food, access to exercise and ongoing healthcare support all shape how effective the treatment may be.
“We have highlighted that obesity treatment is not just a medical issue, but a social and structural one,” said senior author Adrian Brown, associate professor in nutrition and dietetics in the Centre of Obesity Research at University College London.
“Without integrated dietary support and attention to food affordability, these medications could deepen existing health inequalities,” he added.
The problem stems from the affordability of a healthy lifestyle. Healthier diets are often more expensive, as well as being more difficult to get in some cases. This creates more hurdles for people already facing food insecurity or financial hardship.
This is not a theoretical problem; an estimated 1.6 million adults across the UK use weight-loss drugs. With food insecurity effecting 12% of UK households, co-author Cara Ruggiero notes this as a “critical context” and one “cannot ignore”.
There is, however, a significant financial barrier-to-entry with many weight-loss drugs.
Eli Lilly and Company’s Mounjaro, a leading weight-loss drug, typically costs £200 a month, making it unaffordable to many. Despite this, lead author Marie Spreckley, principal investigator of the AMPLIFY study, said that that affordability is not the direct issue at hand with the drug. “If access to healthy food, nutrition support and ongoing care is uneven, there is a risk that the benefits of these treatments will also be uneven,” she said.
The associated cost-of-living issue spells danger of bringing about a two tier system, in which treatment effectiveness is based on who has the ability to pay for and has access to comprehensive and continuous support, while others just suffer from widening health inequality.
