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NICE recommends semaglutide for people with obesity

NICE recommends semaglutide for people with obesity


Draft NICE guidance has recommended semaglutide as a new treatment option for weight loss and management in obese adults with at least one weight-related condition.

The Novo Nordisk drug, known by the brand name Wegovy, is indicated for adults with at least one weight-related condition and a body mass index (BMI) of at least 35 kg/m2, and exceptionally, to those with a BMI of 30.0 kg/m2 to 34.9 kg/m2.

It should only be prescribed as part of a specialist weight management service with multidisciplinary input (such as a tier 3 weight management programme or tier 4 specialist obesity services including surgery service), the draft guidance stated.

Treatment should not continue for more than two years, and patients must be following a reduced-calorie diet and increasing their physical activity while using the drug.

Semaglutide, which is marketed in a different dosage to treat diabetes, binds to and activates the GLP-1 (glucagon-like peptide-1) receptors in the brain to increase insulin secretion, suppress glucagon secretion, and slow gastric emptying.

The NICE guidance explained that through this mechanism the drug makes patients feel full resulting in them eating less and reducing their overall calorie intake.

Evidence from a randomised double-blind trial called STEP 1 showed that participants taking semaglutide lost on average 12% more of their body weight compared with placebo.

‘It is appropriate to use semaglutide alongside intensive lifestyle interventions that are provided in specialist weight management services because this is in keeping with the clinical trial,’ the draft guidance stated.

Helen Knight, programme director in the centre for health technology evaluation at NICE, said management of overweight and obesity was one of the biggest challenges facing the health service with nearly two-thirds of adults either overweight or obese.

‘It is a lifelong condition that needs medical intervention, has psychological and physical effects, and can affect quality of life. But in recent years NICE has been able to recommend a new line of pharmaceutical treatments which have shown that those people using them, alongside changes to their diet and exercise, have been able to reduce their weight,’ she said.

Patients must inject themselves with the drug weekly using pens pre-filled with semaglutide. The draft guidance recommended an induction dose of 0.25 mg, titrated up every 4 weeks to 0.5 mg, 1.0 mg, 1.7 mg and 2.4 mg, with a maintenance dose of 2.4 mg.

The draft guidance also recommended a lower BMI threshold for treatment (usually reduced by 2.5 kg/m2) for people from south Asian, Chinese, and Black African or Caribbean family backgrounds.

Comments can be made on the committee’s recommendations via nice.org.uk until 5pm on Tuesday 1 March 2022.

It comes after the Department of Health and Social Care launched a new Office for Health Promotion in September last year, to try and better tackle obesity and poor mental health.

A version of this story was originally published on Nursing in Practice sister publication The Pharmacist.