I prescribe these sorts of agents- though not for weight loss, as it’s single goal- for other medical conditions.
The concerns I have are that patients are wanting it solely for modest weight loss is that it does not address a fundamental problem that do many have- unhealthy lifestyles. Not everyone, obviously, but why fix that when you can just use a drug? I think it is different for morbid obesity and obesity because the risks are so clearly outweighed by the benefits. But even in these cases, patients should really get support as so many of the patients I work with who are morbidly obese (and not largely due to medication or a specific medical condition) do have other factors at play that led them down that path. Most people who are overweight do have an unhealthy relationship with food, many have disordered eating and some have a full blown eating disorder. Medication works, but we would be doing a much more holistic job if we addressed these factors as well.
Part if the problem is lifestyle- and before I get jumped on, that is not a criticism but a statement of fact. It isn’t as simple as calories in vs calories out, especially once someone is obese, but can we please stop suggesting that all obese people eat healthily and exercise regularly etc. The majority of my patients in this category don’t, they may not not eat as badly or do more exercise than some thin/thinner people they know, but few have “ideal” or even “good” diet and exercise habits. I know because it’s one of the things I have to go over with patients.
I think our perception of a “normal” diet and activity levels is so very distorted from what our bodies are actually physiologically adapted to. And, because of the ease and relative (to the past) low cost, of processed and higher calorie foods (even if you cook from scratch) the majority of us have fallen victim to that distorted perception. Unfortunately, some people are more prone to gaining weight for psychological reasons or physiological/genetic ones. Once overweight, there are additional physiological factors which can influence further weight gain/weight loss- but that is genuinely rarely the sole reason someone continues to have further weight gain/struggle with weight loss.
There have always been overweight people. But they were far lower in number in previous generations. So it cannot all be genetic. There is a reason there is an obesity epidemic now and not 100 years ago. There is a reason that it primarily affects westernised/developed countries, and to a lesser extent, countries who are on that route.
I guess what I’m saying is that my concern is that if all we do to anyone who is has a weight problem, or even just at all heavier than they’d like to be, that they just use a drug and that’s it sorted. But we don’t actually look at the damage the underlying causes of the obesity epidemic, we only change one part of the problem and people’s health will still suffer.
Finally, if you are going to make this available on the NHS to anyone who wants it, no weight/health criteria, you’d better be prepared for the cost of that. The costs would be vast, especially if you are also going to suggest use as maintenance for anyone who wants it for as long as they do. And find manufacturers able to provide it at sufficient scale, currently you’d end up cutting off people who use these agents for diabetes, renal disease, cardiovascular disease inc heart failure, and liver disease, for example.