The skinny on the weight loss jab


A new ‘magic’ weight loss injection has been in the news – could it work for you? Nutritional therapist Karen Geary takes a look


The notion of a silver bullet for weight loss is highly appealing. If you have a BMI of at least 30 and likely at least one other health concern such as diabetes or high blood pressure, under NICE guidelines you may soon be eligible to receive Semaglutide, the new ‘weight loss injection’.
However, you need to go beyond the headlines to understand what it is, how it works, the risks and the alternatives from a nutritional therapy standpoint. Here is the low-down.

What is it?
Glucagon-like peptide (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are hormones that are released naturally by the gut; jointly, they have an impact on the hormone insulin. GLP-1 and GIP agonists are drugs that work by mimicking the effects of these hormones. They started out as drugs to treat patients with type 2 diabetes (T2D) and act through simulating insulin release and inhibiting glucagon release.
The net effect is a lowering of blood glucose/improved glycemic control, but in T2D patients, another effect was noted – weight loss.
We still don’t really have a clear explanation as to WHY the hormone is also increasing satiety and reducing appetite, but it is highly effective – hence the excitement.
One of the new drugs, Semaglutide, is pure GLP-1 and is licensed for use as an obesity drug. The newer Tirzepatide is a combination of both GLP-1 and GIP and is currently only licensed for T2D, but is reportedly even more effective than Semaglutide (so expect to hear more about it in the future as a potential option for obesity should it be approved for use).
Semaglutide is administered weekly via an autoinjector pen requiring refrigeration and is known as Ozempic or Wegovy; the difference between the two is purely dose rates and branding. Tirzepatide is branded as Mounjaro and is administered in the same way.

Does it work?
It is extremely effective; BUT it comes with a large caveat.
In both the original trial and its extension, weight loss was significant in all participants and begins to slow, at around 60 weeks.

As soon as treatment stopped at 68 weeks, there was an average two thirds regain in weight in all participants.
The amount of weight regained depended upon how much was lost originally. Those who lost 20 per cent or more of body weight regained some, but not all. However those who lost 15 per cent or less ended up weighing more than their start weight by the 120 week mark; hence its intended use for those who are genuinely obese.

Known side effects
Anything that changes things in the gut is going to have side effects. In trials these are noted as nausea, diarrhoea, vomiting, constipation, headaches and dyspepsia. However, these are all noted as transient and can be managed well under medical supervision if the dose is slowly increased to minimise side effects.
There were reports of thyroid tumours in rodents from a small trial of an earlier product, Liraglutide, which is why GLP-1 agonists are not recommended for any patient with certain thyroid conditions.
Peter Attia MD, based in the US, has been using Semaglutide on patients for more than two years. His clinical observations are not part of trial data but you can read about what he has seen in a longer version of this article here.


What are the alternatives?
A good diet is about eating food which contains nutrients critical to satiety, but without over-eating in calories. If you are not getting enough nutrients, your body will naturally go in search of the vitamins, minerals, essential fatty acids and amino acids you may lack by eating more.
Protein is the cornerstone of feeling full (many people on Semaglutide struggle to get adequate protein intake as they are just not hungry). Proteins are recognised as potent natural stimulators of GLP-1. A palm-sized portion at every meal should be the mainstay of any diet, whether that be animal or plant based. The high amount of amino acids in protein also help to fuel the feel-good ‘happy’ neurotransmitters. So, two eggs at breakfast or three tablespoons of chia seeds or a tub of natural yogurt.
For lunch, why not try canned sardines or some pulses in a soup. For dinner enjoy a portion of meat, fish, lentils or pulses. Whey protein is often used in studies for the stimulatory effect on GLP-1 secretion, but make sure you get a good source.
The second thing that makes you feel full is fibre, so load up on veg and a little fruit – at least half the plate.
There are some natural GLP-1 boosters for blood sugar management and satiety; avocado, cinnamon, curcumin, eggs, green tea and rosemary. There are also certain supplements that have a similar action.


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