The first of the new wave of weight-loss drugs was approved for treatment in the UK nearly two decades ago, offering hope to type-2 diabetes patients who needed to lose weight.
“I’ve been prescribing these drugs since 2007,” says Dr Stephen Lawrence, a GP and associate clinical professor in diabetes at the University of Warwick. Initially, clinicians thought that patients would be reluctant to inject themselves. “But what we found was that people said: ‘You had me at weight loss’.”
Glucagon-like peptide-1 (GLP-1) receptor agonists are now household names through their brands Ozempic, Wegovy, and Mounjaro, and are being used by more than 1.5 million people in the UK, not just to treat diabetes but also for general weight loss.
They entered public consciousness in 2022, when Variety magazine revealed that actors had been taking Ozempic to lose weight. Wegovy and Mounjaro were licensed for weight loss the following year, and what had been a hidden Hollywood secret became global news and Instagram fodder. Oprah Winfrey, a former WeightWatchers ambassador, Meghan Trainor, who celebrated curvy women with her song “All About That Bass”, Robbie Williams, Rebel Wilson, and Serena Williams are among those who have praised the drugs’ transformative effects.
They would change the world, people predicted: they would save airlines fuel because planes would be lighter, save the NHS the millions of pounds it spends on treating diseases caused by obesity, save us from ourselves.
Approximately 10 million adults in England are classed as obese. Mounjaro has been available on the NHS since June, but only for those who meet strict conditions. Patients must have a BMI of 40 or more, with at least four of five other conditions: type 2 diabetes, abnormal blood fats, sleep apnoea, cardiovascular disease and hypertension.
For everyone else, there are private prescriptions: costing about £1,500 a year. And hundreds of thousands of people have chosen to pay.
So when Eli Lilly announced that the price of Mounjaro would rise by up to 170% from tomorrow to nearly £4,000 a year for the highest dose, people panicked.
The price hike may be less severe than first feared – the wholesale price for a monthly supply will double, from £122 to £247.50, after Eli Lilly said it would give a rebate to pharmacies – but it could still push the drug out of reach for many.
“It’s great if you can afford it, but obesity tends to affect more people from deprived regions than those that tend to be more affluent,” said Nerys Astbury, associate professor at the Nuffield Department of Primary Health Care Sciences at the University of Oxford.
Obesity rates are nearly double among the poorest in society, affecting 39% of women in the most deprived groups in England compared with 22% for the least deprived, according to the Obesity Health Alliance. Black children and adults and Asian children also have higher than average rates of obesity, as do those with learning disabilities.
Before tomorrow’s rise comes into effect, some patients have tried to stockpile, prompting online pharmacies to announce they were out of stock or reserving Mounjaro pens for existing patients, and Eli Lilly to pause its supply last week. Others have been looking for alternatives, including illegal and counterfeit drugs, in the internet’s darker corners.
But some will have to go without. What happens to them? Researchers at Oxford found last year that coming off GLP-1s can lead to rapid weight regain, one reason why some people continue to take so-called microdoses.
A pill is still the holy grail for Eli Lilly and Ozempic’s creator, Novo Nordisk. Both have GLP-1 pills in late-stage clinical trials.
The hope of banishing not just diabetes and obesity but other conditions is tantalising. Scientific papers on GLP-1s appear almost daily – in the past week, research has been published on links between the drugs and a reduced risk of endometrial, meningioma and ovarian cancers, chronic liver disease and peptic ulcer disease. Is this due to the benefits of weight loss or because the drugs are doing something else? We don’t yet know.
“I’m typically unsurprised by the findings of these, which tend to be observational or secondary analysis studies, because we’ve known the benefits of weight loss for so many years,” Astbury said. Still, peptides have multiple effects in the body and Eli Lilly has trials under way looking at GLP-1 effects on Crohn’s disease, ulcerative colitis and arthritis. Other studies are examining the impacts on addiction to alcohol and smoking, Parkinson’s, kidney disease, heart conditions and strokes.
Stories of “Ozempic babies” have also prompted studies into whether GLP-1s may make women more likely to conceive.
But GLP-1s have also been linked to acute pancreatitis. They have side effects such as nausea and diarrhoea that don’t affect everyone but are intolerable for some, and there are risks of gallbladder disease and severe dehydration, which can lead to other complications.
Some small-scale studies have also indicated a potentially increased risk of depression and suicidal ideation.
In the short time since GLP-1s moved from GP treatment rooms to the cover of glossy magazines, they have prompted as many questions as they have provided answers. This week, one that many will be asking is: can you afford them?
Photograph by Michael Buckner/Variety/Getty Images
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