Doctors see positives in obesity drugs but question the long-term plan

The long-term use of weight-loss injections, which the government intends to supply to tackle the country’s obesity problem, remains a question mark for doctors specialised in the field.

While they believe in the positive effects of these drugs in the short term, it is the lack of studies ‒ leaving many unknowns ‒ that concerns them, as well as the fact that the drugs are not “standalone solutions” to this modern-day plague.

Health Minister Joe Etienne Abela recently announced a plan to offer, within the next year, weight-loss prescription injections – which have taken the world by storm – to high body mass index (BMI) patients with obesity-linked conditions. These include type 2 diabetes, cardiovascular disease, hypertension, severe arthritis and sleep apnoea.

The Ozempic and Wegovy injections, now household names, would be prescribed in specific cases, targeting patients with a BMI of over 35 and a related health condition, Abela had said, acknowledging that obesity was complex and that past efforts to manage it had fallen short.

While describing the injections as a “quick fix”, Abela did stress the need for a multifaceted approach to address the issue, adding they were only part of the solution. And specialised doctors were in accordance with this.

They have underscored the point that these medications are complementary to – rather than a substitute for – a healthy lifestyle, and they should be taken on medical advice and under supervision.

Ozempic and Wegovy – both semaglutides that were originally developed to treat diabetes – work by reducing appetite and supporting weight management. Meant to be used along with a healthy diet and exercise to improve blood sugar in adults with type 2 diabetes and to reduce the risk of heart attack and stroke, their popularity for weight loss has shot up.

Short-term benefits

The ability of this injectable prescription medicine to promote sustained weight loss and improve cardiovascular and metabolic outcomes is well-supported by clinical evidence, doctors speaking to Times of Malta noted, adding they also helped in reducing the risk of kidney disease in patients both with and without diabetes.

Asked whether he thought the government’s plan to offer this medication to patients to treat obesity was a good idea, UK-based longevity medicine specialist Philip Borg acknowledged there was an abundance of “good evidence” on the effects of GLP-1 agonists, as they are known, in obese and diabetic patients in the short term.

The resulting reduced healthcare costs, due to a decreased incidence of diseases, less need for other medication and bringing patients with comorbidities back into the workforce, would be beneficial from an economic perspective too, Borg highlighted.

Obesity cost the public health service €19.5 million in 2008, and this was estimated to grow to €27 million a year by 2020, due to more and longer patient stays in hospital and more frequent consultations.

The health ministry was asked to confirm and update the figure but did not do so by the time of writing.

No data on long-term outcomes

“One question to ask,” Borg continued, “is whether governments are prepared to fund these drugs long term. If patients with a BMI above a certain threshold lose weight, will they continue to fund the maintenance?”

Borg underlined that two-thirds of weight is put back on when GLP-1 agonists are stopped – “and most of this is fat as muscle is very difficult to regain,” he pointed out.

A consultant cancer interventional radiologist at Manchester’s Christie Hospital, he also mentioned that, to date, most studies on these medications were under three years long, meaning the longer term remained an “unknown”.

One question to ask is whether governments are prepared to fund these drugs long term

Borg’s reservations revolved around no data on long-term outcomes in terms of rebound weight in people who stopped taking the drug for various reasons, including side effects. He also had concerns about muscle loss and long-term health outcomes such as frailty.

The long-term neurological or psychological effects from the chronic prescription of these medications was also unknown, he noted.

‘Not a standalone solution’

Godfrey Grech, health innovator and lifestyle medicine specialist, also maintained that semaglutide-based medications were “a powerful tool – but not a standalone solution”.

For the best and safest outcomes, its use had to be part of a comprehensive, long-term obesity management plan, centred on sustainable lifestyle change, said the oncology researcher, with a special focus on gut health.

“What we lack here is the plan for long-term use, the monitoring required and the integration of lifestyle changes,” Grech said.

While Wegovy and Ozempic marked a major advancement in obesity treatment, their benefits were not a replacement for foundational lifestyle changes.

“Long-term health improvement depends on pairing semaglutide with meaningful changes in diet, physical activity and behavioural habits. Patients who rely solely on the medication risk regaining lost weight and missing out on broader health improvements,” Grech concurred.

While most side effects are manageable, clinicians must closely monitor for rare but serious risks, such as gastrointestinal issues, kidney problems and thyroid-related complications, he said, singling out medullary thyroid carcinoma (MTC) – a rare form of thyroid cancer.

‘No quick fix’ for obesity

Welcoming the minister’s announcement to introduce anti-obesity medication, Stephen Fava, consultant diabetologist and endocrinologist, also insisted these were “complementary to, rather than a substitute for, a healthy lifestyle”.

His colleague Rachel Agius, also a consultant diabetologist and endocrinologist with a special interest in bariatric medicine, stressed that obesity, being a chronic, relapsing, progressive disease, needed to be managed long-term.

On the current obesity management plan proposed by the government, her message to the public was that there were “no quick fixes” for this condition, like any other chronic disease, and that anti-obesity medications were not “magic”.

Several environmental, socioeconomic, psychological and ethnic factors contributed to the condition, in conjunction with the individual’s biological factors, Agius said.

“Management of obesity would entail a multifactorial approach: identifying these various contributors and modifying them through lifestyle changes in conjunction with use of medication.”

If prescribed in the right way to the right patient by the right prescriber, they are safe effective and, overall, well tolerated, she said.

Ozempic has been in the spotlight for its beneficial life-changing effects on users, but others have also expressed how the new drug was “no miracle shortcut” to weight loss.

The Times of London recently reported how Ozempic, Wegovy and Mounjaro, which have changed how obesity and type 2 diabetes are treated, have also led to claims of extreme side effects, including suicidal ideation.

Abela, a surgeon by profession, has also floated the idea of introducing a tax on sugar – something that has been periodically raised over the past 15 years. He also said he wanted to “go big” on weight-loss surgery to tackle the epidemic.