Thursday briefing: Why skinny jabs’ short-term fix comes with long-term concerns
Good morning. If you are as chronically online as I am, you have probably noticed a major shift by some of your favourite celebrities and influencers: many suddenly look much thinner. This phenomenon (one assumes) is due to weight loss drugs, which have transformed how obesity is tackled across much of the western world. Brands including Ozempic, Wegovy and Mounjaro have become household names in a short period of time. These drugs – developed for chronic diseases like diabetes – do more than help people lose weight; they can also significantly improve heart health. But while National Institute for Health and Care Excellence (Nice) guidelines recommend a maximum two-year usage, the scientific consensus suggests that those who stop taking the drug are likely to regain most, if not all, of the weight they lost. A new study shows that once people stop, they not only gain the weight back, but their heart health and metabolism markers, such as high cholesterol and blood pressure, get worse again. So, what are the implications of this for the fight against obesity and the wider public health landscape? To explore this and more, I speak to Tobi Thomas, the Guardian’s health and inequality correspondent. That’s after the headlines. Five big stories Venezuela | Britain’s Ministry of Defence said it had provided military help to the US forces that seized a Russian-flagged oil tanker north-west of Britain and Ireland, initially arguing the operation was legal because the vessel had breached US sanctions on Iran. Ukraine | Keir Starmer has said that MPs would have a debate and vote before any UK troops were deployed on peacekeeping duties in Ukraine. NHS | Patients are collapsing in hospitals unseen by staff because overcrowding means they are stranded out of sight on corridors, the NHS’s safety watchdog has revealed. Greenland | France has said it is working with allies on how to react if the US were to invade Greenland, as the French, German and Polish foreign ministers met. Elon Musk | The influential Commons women and equalities committee will stop using X after the social media site’s AI tool generated thousands of digitally altered undressed images of women and children. In depth: ‘Obesity was often framed as a failure of willpower’ Obesity has evolved into one of the UK’s most challenging public and economic challenges. More than a quarter of adults and almost a quarter of children are affected by obesity, and these figures are predicted to worsen. (It’s worth reading my colleague Martin’s First Edition this week on the government’s attempts to tackle advertising from fast food giants). As is often the case, those living in deprived areas are worse affected. The new use for these drugs offer the promise of low-effort weight loss, tackling an obesity crisis reported to cost the UK economy £126bn a year. “They have already transformed how obesity is treated,” Tobi Thomas tells me. “Being overweight was often framed as a failure of willpower, but diets and exercise plans produced very mixed results. What’s striking about GLP-1 inhibitors [the proper name for drugs like Ozempic] is how consistent the outcomes are across people. If someone takes them as prescribed, weight loss tends to be fairly predictable.” That’s shifted the conversation away from personal blame and towards biology and bodily processes. “But they are not a miracle cure,” Tobi says. For one thing, significant numbers of people report side effects, from the mild (“Ozempic burps” ), to the weird and the worrying. Perhaps most importantly, she says, is that while “people can lose a significant amount of weight while taking the drug, most people who stop will go on to put on most of the weight they had lost”. A new study, which Tobi reported on, is the first to show the rate of weight regained and the estimated time frames for the benefits provided by the drug to reverse. *** How do they work? Before we delve into the latest study on weight loss jabs, I ask Tobi to remind me what they are and how they work. They are GLP-1 medications or glucagon-like peptide-1 receptor agonists. “They’re a class of drugs developed to manage type 2 diabetes, but they’re now widely used for weight loss,” she says, explaining that our bodies produce naturally GLP-1 naturally. “Your gut releases it after you eat, and it helps regulate blood sugar and appetite. These medications mimic that hormone and keep it active in the body for longer.” They work by reducing appetite, which means you feel full for longer, and they help regulate blood sugar by increasing the release of insulin. Tobi also points to recent studies that suggest that GLP-1s may also affect the types of foods people want to eat, reducing cravings for high-sugar or high-fat foods. The benefits are remarkable: patients are able to lose weight more consistently, while also seeing improved benefits on heart and metabolic health markers, such as high cholesterol and high blood pressure. But they come with side effects. Nausea, vomiting, diarrhoea, bloating, and heartburn are common in the first couple of months. “Because appetite is suppressed,” she tells me, “some people forget to eat, which can lead to fatigue, dizziness, dehydration, and low energy.” Rapid weight loss can also contribute to hair loss, low iron, and fatigue, not directly because of the drug but because of reduced food intake, she explains. Tobi has also highlighted concerns around contraception. The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) issued guidance after reports of women on oral contraceptives becoming pregnant while taking GLP-1 drugs. Tirzepatide, in particular, has been shown to reduce the effectiveness of the pill. Weight loss itself can also increase fertility, so pregnancy risk may rise unexpectedly. *** What happens after you stop taking them? People can stop taking weight loss drugs without tapering, Tobi says. But once you stop, the effects can reverse quite quickly. “Appetite returns to baseline, hunger signals resume, portion sizes increase, and cravings may come back,” she adds. The latest study showed that, on average, patients gained 0.4kg a month after they stopped treatment. Weight and risk markers for diabetes and heart disease were also found to return to pre-treatment levels in less than two years. The study was carried out by researchers from the University of Oxford who searched databases for trials and observational studies that compared the effects of weight loss drugs with diet and exercise programmess, as well as with a placebo. They found that the rate of weight regained after stopping the drugs is almost four times faster than after diet and physical activity changes. This was irrespective of the amount of weight lost during treatment. The study also cited estimates that around half of people with obesity stop using weight loss drugs within 12 months. The reasons why are not clear, but costs of the drug, which skyrocketed in recent months, and the side-effects, are likely factors, Tobi tells me. *** How should they be taken? When someone quickly loses a significant amount of weight, the sudden change in their physical appearance gets attention. But the latest study shows that obesity is a complex issue that requires a long-term, holistic approach. “GLP-1s are not something you can just prescribe and walk away from,” Tobi says. “They’re a very physical intervention, and your body goes through quite an extreme change, so there needs to be proper support alongside them.” She continues: “In a lot of NHS and private programmes, people also receive psychological support, group sessions, therapy, and nutritional guidance. That is crucial, because obesity isn’t just a physical condition. It affects how people think about food, their bodies and themselves.” This key point can be lost, she notes, when people exclusively focus on the physical effects of weight loss drugs, and ignore a person’s overall health. “If someone’s diet was poor before, GLP-1s might just mean they eat smaller portions of the same foods. Without support, that doesn’t lead to long-term change. The drug works best as part of a holistic programme that addresses eating habits, movement and psychological wellbeing.” Current Nice guidelines suggest patients should be on these drugs for a maximum of two years, which seems contradictory with the latest research. Tobi explains that the health regulatory always operates with an abundance of caution. “Long-term data is still emerging. The guidance doesn’t mean people must stop after two years, but it reflects uncertainty [about long-term effects].” The study does add to the chorus of evidence that suggests these drugs may require long-term use. “There are links to gallstones, and concerns about muscle and bone-density loss if people lose weight rapidly without strength training. That’s why these drugs are meant to be part of a structured weight-loss programme, not taken in isolation.” For those suffering health problems due to their weight, the benefits are often thought to be worth the risks. But the private market brings additional concerns. While there is a strict criteria on who qualifies for the drug under the NHS, people can access them privately – including through online pharmacies and social media links, and there are serious health risks to people who end up using counterfeit drugs. “You can have someone who is already healthy using them purely for aesthetic reasons – for example, someone who might be a size 14 wanting to be a size 8,” Tobi says. “This shifts the purpose of the drug away from health and towards appearance. When that happens, you’re no longer treating a medical condition, you’re responding to cultural pressure to be thinner.” It’s part of a wider shift in beauty standards, she explains: “After years of body positivity, we’re seeing a move back towards extreme thinness, particularly online. When celebrities and public figures talk openly about using these drugs, it can make thinness feel like the default or even an expectation again.” There is, therefore, a risk that GLP-1s stop being seen as a serious medical intervention and start being treated like a cosmetic shortcut, she adds. “That’s a slippery slope, because women’s bodies in particular end up being treated as trends, rather than something tied to long-term health and well-being.” What else we’ve been reading This feature on cluster headaches by Morgan Ofori (pictured above) is a powerful and affecting read that brings this recurring and debilitating experience with the condition to life. Aamna Miss Rosen has a nostalgic look back for Huck magazine at the 1980s Rockers Reunion Club, a revival of the 1950s motorbike scene, lovingly photographed by Phil Polgaze. Martin A macabre sideshow to the Trump intervention in Venezuela has been the suggestion that gambling markets were manipulated beforehand – one online platform is refusing to pay up. Martin Belam, newsletters team Simon Hattenstone and his partner, Diane Taylor, were the fourth heterosexual couple to enter a civil partnership in Haringey. He writes movingly about why they chose to do so after more than 30 years together, and why the photograph taken at the ceremony is the one he treasures most. Aamna It is 10 years since David Bowie died, and 40 years since he starred in Jim Henson’s Labyrinth. Peter Bradshaw reviews its return to the big screen, calling it “charmingly eccentric”. I’m going on Friday. Martin Sport Football | Darren Fletcher failed to produce what Manchester United’s interim manager, fans and chief executive craved: a cathartic victory to move the club on quickly from the recent turbulence. Cricket | There were a couple of wobbles along the way but at 2.30pm on the final day in Sydney, Australia had knocked off a target of 160 runs to win the fifth Test by five wickets and claim this Ashes series by a 4-1 scoreline. Cycling | Simon Yates, one of Britain’s most storied riders and the winner of last year’s Giro d’Italia, has stunned cycling by announcing his retirement at 33. The front pages “US seizes Russian-flagged tanker in high-stakes Atlantic operation,” is the splash on the Guardian on Thursday. “UK joins in the pursuit of Putin’s shadow fleet,” says the Times, while the FT runs with: “US seizes tanker and aims to control Venezuelan crude sales ‘indefinitely.’” “Splash & grab,” is the lead at the Metro. “UK ready to seize more of Putin’s shadow ships, as ‘grey war’ grows,” says the i paper. “Badenoch blueprint to save our pubs,” is the main story at the Telegraph. At the Mail it’s: “YOU NEED TO BE ON FAT JABS FOR LIFE.” “‘SMA’ heel-prick campaign,” says the Mirror, while the Express has “Don’t run down clock on ‘safe’ right to die law.” Finally the Sun with: “Look who’s Huw.” Today in Focus On the ground in Venezuela after Trump’s ‘operation’ Tom Phillips, the Guardian’s Latin America correspondent, describes the apprehension and mixed feelings among Venezuelans crossing the border with Colombia. He outlines the mistrust and fragility within the new leadership, the disappointment of the opposition movement, and how considerations regarding the country’s oil reserves may have shaped the US’s political calculations. Cartoon of the day | Nicola Jennings The Upside A bit of good news to remind you that the world’s not all bad Tens of thousands of families around the world have long been priced out of modern cystic fibrosis treatments, but after years of campaigning a dramatic breakthrough has been made. A low-cost generic version of the drug Trikafta will be produced in Bangladesh at a fraction of the price charged by Vertex Pharmaceuticals. “We were sitting with our calculator saying ‘we can afford that!’” said one parent. Until recently, most sufferers would die as young adults. Campaigner Gayle Pledger, whose daughter has cystic fibrosis, said families had “watched children suffer and die while a treatment sat on the shelf”, but added: “I’ve come off calls in tears thinking, ‘This is actually going to happen.’” Sign up here for a weekly roundup of The Upside, sent to you every Sunday Bored at work? And finally, the Guardian’s puzzles are here to keep you entertained throughout the day. Until tomorrow. Martin Belam’s Thursday news quiz Quick crossword Cryptic crossword Wordiply







