While body positivity is important, clinical obesity is a disease – is weight-loss medication a healthy solution?

Unless you have been living under a rock for the past year, you will be aware of the significant media attention surrounding a group of new medications often referred to in the press as “weight-loss injections” or “skinny jags”. These are known as GLP-1 agonists.

I’ve been getting more and more questions about this topic lately, and I’ve even had the chance to share my thoughts on TV. So, let’s dive in and explore this interesting area of medicine together!

GLP-1 agonists are pretty fascinating. They work by mimicking a natural hormone called glucagon-like peptide 1 (GLP-1), which helps keep our blood sugar levels in check. When your blood sugar rises, GLP-1 signals your pancreas to release more insulin. That’s why these medications were originally created to help people with type 2 diabetes. But there’s more to the story. GLP-1 agonists also slow down how quickly food leaves your stomach, which helps you feel full for longer. Plus, they send signals to your brain to curb your appetite. This is great news if you’re trying to manage your weight. By making you feel satisfied and less hungry, these medications can help you eat less without feeling like you’re missing out. Many people who use them say they think about food less and find it easier to resist cravings.

Possible side effects

This all sounds promising, doesn’t it? But, like any medication, there are some side effects to keep in mind. The most common ones are generally not too serious but can still be uncomfortable. For example, you might experience stomach pain, indigestion, nausea, vomiting, diarrhoea or even constipation as the movement of food through your digestive system slows down. 

There are several serious side effects to consider, including gallbladder disorders, intestinal obstructions, acute pancreatitis (inflammation of the pancreas), kidney problems and heart issues. Fortunately, these serious side effects are quite rare.

Other considerations

Additionally, we need to consider the cost and availability of these medications. They are not widely available on the NHS due to their high cost and are typically reserved for specialist (tier 3) weight-loss services.

If we prescribed GLP-1 agonists to everyone who qualifies, it would blow the NHS budget. That’s why many people turn to sourcing them privately. While some find trustworthy sources, others may turn to less reliable online vendors or even the black market, which can be risky. I’ve seen patients buy these medications from their hairdressers, which doesn’t guarantee their safety. I have also had a patient with anorexia who managed to buy them online by giving false information about her weight. It’s crucial to be careful and informed when it comes to these medications.

So, do they work? 

Yes, they do. In my 20-year medical career, this is the first weight-loss drug I have seen that truly works. Time and again, I hear patients describe the experience as “life-changing”. While people are successfully losing weight, one big question remains: What happens when it’s time to stop using these drugs? The longest licensed use for one of these medications, Mounjaro, is two years. It’s not surprising that pharmaceutical companies are investing heavily in research for longer licensed uses; after all, the longer people stay on these drugs, the more revenue the companies generate. What is clear is that if individuals haven’t made lifestyle changes – such as improving their diet and becoming more active – or addressing the emotional triggers behind their eating habits, they are likely to regain weight once they stop the injections. In some cases, they may even gain back more weight than before. That’s because weight loss from these injections can lead to muscle loss if one does not engage in intentional muscle-building exercises. Since muscle is a calorie-hungry tissue that burns a lot of energy, losing muscle during treatment with GLP-1 agonists can decrease metabolism, making weight gain even more likely once the medications are discontinued.

Personal reflections

Taking everything into account, I’d like to share my thoughts on these medications. 

For many people, GLP-1 agonists can be a helpful tool in making positive lifestyle changes, but they aren’t the complete solution on their own. If you use them without addressing what you eat, how much you move, how you manage stress, your sleep quality and your emotional wellbeing etc, you might find yourself gaining weight back when you stop them.

These medications must be used as a part of a programme that understands the complex nature of obesity. Treatment should support people in recognising what led them to become obese and how to navigate the challenging obesogenic world we live in.

This is the first weight-loss drug I have seen that truly works

As Christians, what should our response be to medications like these? One aspect that has always troubled me about the weight-loss industry is its impact on self-worth. The notion that a person’s value is tied to their appearance and body aesthetic is fundamentally wrong. We are unconditionally loved whatever our shape and size, and we must not lose sight of this nor conform to what the world tells us determines our value. As God tells us in Isaiah 43:4: “You are precious and honoured in my sight, and…I love you.”

While body positivity is important, clinical obesity is a disease, and it now appears we have a family of drugs that can help manage it. We don’t hesitate to use medications to treat high blood pressure or type 2 diabetes, both of which can develop due to unhealthy lifestyle choices. So why should we have a problem with using GLP-1 agonists to treat clinical obesity?

It’s important to remember that there are other ways to lose weight; medication is not the only option. However, making sustained behavioural changes can be challenging and takes time. This is one reason I set up Maldod Life: to help people make whole-person behaviour changes, whatever their goal. 

My final thought on this emotive subject is that God calls us to glorify him while we are on earth. May we be able to say, as Jesus did in John 17:4: “I have brought you glory on earth by finishing the work you gave me to do.” If your health, due to obesity, is hindering that calling, perhaps it is time to address this and start making some changes. 

Key takeaways:

Checking your weight 

As mentioned in January’s issue, BMI (body mass index) is a measure that compares weight and height to try and give an idea of whether someone is of a ‘healthy’ weight. It is somewhat flawed as it does not take into account body composition – ie how much of that weight is fat versus muscle. It also does not take into account where that fat is stored. If it is stored around the middle abdomen area this is more dangerous than if it is around the hips and thighs. Different ethnic groups also have risk factors at different BMI levels. 

Current classification of obesity is based on BMI, although there is discussion around changing this classification due to some limitations with it.

For most adults, if your BMI is:

below 18.5 – you’re in the underweight range

18.5 to 24.9 – you’re in the healthy weight range

25 to 29.9 – you’re in the overweight range

30 to 34.9 – you’re in the obese class 1 range

35 to 39.9 – you’re in the obese class 2 range

40 or more – you’re in the obese class 3 range 

You can calculate your BMI here: nhs.uk/health-assessment-tools/calculate-your-body-mass-index 

Further reading

I would highly recommend Johann Hari’s book Magic Pill (Bloomsbury Publishing). He delves deep into GLP1-agonists and gives a very balanced viewpoint on them.