@CeruleanDive i not debating what happens to people whilst ON the drug, the issue is that the drug is not a long term solution (NHS currently only prescribing it for 2 years max) and its what happens to people AFTER they stop taking weight loss drugs thats the crux...this bbc article explains the potential issues very well https://www.bbc.com/future/article/20240521-what-happens-when-you-stop-taking-ozempic "Various studies have attempted to examine this particular question, and all seem to point to the same answer – the pounds swiftly pile back on. In one trial, around 800 people received weekly semaglutide injections accompanied by dietary adjustments, a prescribed exercise regime and psychological counselling, all of which helped them to lose nearly 11% of their starting weight over four months. But when a third of the participants were subsequently switched to a placebo injection for another year, they regained 7% of the lost weight.
The same trend was seen after the 2021 trial, known as Step 1. After 68 weeks of semaglutide injections, the average patient lost more than 15% of their body weight, but within 12 months of treatment ending, patients regained two thirds of their prior weight loss on average. This was associated with a similar level of reversion to the patients' original baselines in some markers of their cardiometabolic health – a category which includes conditions such as diabetes and heart attacks.
Both Rubino and other experts around the world have seen similar patterns when administering GLP-1 drugs in their clinics. "There will be a small proportion of people, 10% maximum, that are able to maintain [all] the weight they've lost," says Alex Miras, a clinical professor of medicine at Ulster University.
The trajectory of weight regain is typically faster than the time it takes people to lose the weight in the first place, according to Miras. "People put most of it back on in the first three to six months," he says."
with regards to the satiety aspect you mentioned -"Martin Whyte, an associate professor of metabolic medicine at the University of Surrey, explains one possible theory as to why people tend to regain weight after they stop these medications. The doses of GLP-1 provided by semaglutide and tirzepatide are far greater than the body would naturally expect to receive, he says, which may suppress the body's ability to secrete GLP-1 on its own. As a result, people's hunger may return even more voraciously when they cease their doses, he explains.
"What may be happening, and we don't know for sure, is that when you stop them, your body's left in a GLP-1 deficit which has a major impact on the satiety signal going to the brain," says Whyte.
The potential physiological consequences of this weight regain is currently one of the biggest health concerns for practitioners in the field. In one trial, those switched to placebo injections not only began to reaccumulate body fat, but their waist circumference
also began to revert back to its original size. Excess fat in this area is linked to numerous problems ranging from heart disease to insulin resistance and fatty liver disease.
Miras says that many people who regain weight after medication or dieting experience a change in their body composition which could potentially be even worse for their long-term health than if they had simply maintained their existing weight.
"Weight regain is usually accompanied by accumulation of fat and less muscle," says Miras. "So you end up going back to a higher fat mass and a lower muscle mass. That's not good from a metabolic perspective because having more muscle is good for reducing risk of diabetes and heart disease," he says."
i have no doubt that the NHS are prescribing it because for certain ill or likely to become very ill individuals, the pros of injections to aid weight loss outweigh the cons...i have never been comfortable how the NHS rations certain procedures (fertility services, certain surgeries for eg.) for some obese people without giving them any help to loose weight - but ,like the promotion of vaping to help smokers quit, there are many downsides as people for whom it is not appropriate jump on the opportunity to get it privately. I do hope they continue to develop drugs that don't have the downsides that have come to light so far but I would highlight this is a massive income stream for the drug companies involved (who are often very keen to expand their markets) and its going to take a while yet for good quality research to come through about long-term implications.