Obesity is defined as a Body Mass Index above 30. The condition has become epidemic, with 75% of adults in the UK between 45-74 years being overweight/obese, and 25% of children.
The health implications are significant, with increased all-cause mortality, high blood pressure, cardiovascular disease, diabetes, osteoarthritis, sleep apnoea; as well as low self-esteem.
The main causes are poor diet and inadequate exercise. Genes have a role in a minority of people.
The major problem in management is breaking the cycle. Some people are successful in improving their diet and increasing their exercise, but it is for others an uphill struggle.
GLP-1 analogues (glucagon-like peptide-1 receptor agonists) have been available since 2009. They are used in the management of type 2 diabetes. They stimulate insulin release and suppress appetite by reducing hunger-signalling hormones (making you feel full sooner and reduce the desire for snacking).
The latest iteration is a drug called semaglutide. It is effective in increasing weight loss. It is available in either a weekly injectable form (Ozempic) or daily tablet (Rybelsus). My prescribing experience is that Ozempic is very significantly better tolerated, to the extent that I no longer use Rybelsus.
The starting dose is 0.25mg weekly for 1 month, then 0.5mg weekly for 1 month. 1mg weekly for 1 month for as long as is necessary. When target weight is achieved, gradual reduction of the dose regime commences.
Management includes full history and examination, including height, weight, BMI and body fat %. Blood tests will include general haematology, biochemistry, Vitamin D and, in men, where appropriate, testosterone.
Dietary information will be offered, including improving gut biome and Vitamin D supplementation. Exercise advice will be directed at reducing both BMI and body fat %: you will be encouraged to involve a Personal Trainer to achieve this. I should emphasise that medication alone is unlikely to resolve the problem. Review at 1 month, 2 months, 3 months, 6 months, then every 3 months. Blood tests as indicated.
The importance here is that gradual improvement is encouraged: your body is unlikely to accept sudden changes without the risk of “bounce-back”.