Weight loss medication is no magic wand

GPN Jane Coomber considers the role of the nurse in weight loss. Are patients asking for the latest injectables from the NHS as a ‘magic wand’ to lose weight, without having to pay for it or making any lifestyle or dietary changes? 

More and more these days, I’m struggling to complete an annual diabetic review or monitoring check-up without having the same question from my patients: ‘Why can’t you just give me the fat loss injection?’

They might say: ‘I’ve been to WeightWatchers or Slimming World, and I know I can lose the weight if I stick to that, but if I stop going, the weight just goes back on.’

I try to explain to my patients that losing weight is a lifestyle change. It’s about changing your mindset as much as monitoring your dietary intake and having a less sedentary lifestyle, where that’s physically possible. I tell them that using the weight loss injection is a temporary fix, not a cure-all, and taking it has some risks.

But on the whole, people do want a quick fix, and I understand that. It’s a struggle to stay focused, to maintain the loss and keep to your diet and exercise regimes. FOMO hits hard: everyone knows someone who is on a weight loss jab, and a lot of people have bought it to try at a pharmacy or from online companies. Morrisons sell it!

Depending on the demographic you work in, do you find that your patients asking for weight loss medication eat a high level of carbs or hardly any vegetables and lots of ultra-processed foods? Do younger people or those from socioeconomically poor backgrounds seem to eat nutritionally poor quality and junk food? Ultra-processed foods were developed to be addictive, and they should be avoided.

Many of my patients are from BAME and ethnic cultural/religious backgrounds and eat traditional diets, so along with the lifestyle and religious aspects to food there is fasting and then eating late with high carbohydrates, which has a poor effect. Their QRisk is higher for developing type 2 diabetes and some other obesity related conditions, so it’s important to address this.

Do people have the information they need?

Hardly anyone I speak with about weight loss jabs has looked into the side effects of GLP-1s, the long-term health issues and complications, or understand that after being on this for a couple of years you need to stop taking it, hopefully then having learned how to curb cravings and eat more sensibly. In my short experience as a general practice nurse (GPN) and discussing this with patients recently, this doesn’t seem to be the case.

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Generally, the information they have on this medication is inadequate. They’ve either done no research or ignored the health implications, and that’s a big concern for me.

I tell them that the weight loss jab isn’t a magic wand, and that they will still need to make changes in how they eat and need to start taking some exercise to maintain their weight loss once they come off it.

I’m not a nurse prescriber or a diabetes specialist, so I have spoken to nurses in practice who are to find out more. Here’s what they had to say about it.

In the PCN/district where I’m working, all patients should be referred for diabetes education via Diabetes Book  & Learn, allowing them to receive X-PERT Health education, as well as the Live Well, DESMOND, HEAL-D, or Second Nature and low carb dietary information/plans.

This is much of what I do in practice as a GPN: education and support. This isn’t tier 2/3 referral: it’s about healthy lifestyle changes and local specific support.

My diabetic nursing colleagues tell me that these ‘tried everything to lose weight’ patients become desperate; seem to genuinely need further support, and are at risk of becoming demoralised and even depressed, which is when it’s time to seriously think about weight loss medication.

With the private weight loss injection prescriptions that some people decide to buy, nurses tell me that some patients have been given as much as 12.5mg or even 15mg, while for diabetic control most people will do well on 7.5mg-10mg.

Patients on the lower dose can become frustrated because their weight loss reaches a plateau. They may want the dose increased, but if their HbA1c is in a good place there is no need to, and again, good education and support is vital in keeping the weight loss stable and prevent regression and yo-yoing.

The stigma of being overweight

There’s still a stigma of being overweight. The judgment, even in healthcare, is that it’s always the patient’s fault and I’ve heard my own patients say this about themselves, but this isn’t a positive step forward to help or support anyone in difficulty, is it? As healthcare professionals we must always keep this in mind. We are in the role as health promoters.

There is no doubt that food noise plays a big role in our psychology as humans. There are tribal, social and family gatherings around food; to say no to food offered is a huge dismissal of another person’s kindness love and generosity. Think about being asked to clear your plate as a child: being guilt tripped into eating when you were no longer hungry. We all need to understand the psychological impact of how we feel around food; treats as food; gifts as food – we’re surrounded by it.

Ultra-processed foods are our enemy today. The loss of nutritional value in our foods should be addressed for everyone, not just those of us who have high BMI. Take B12 deficiency, for example, that the soil has been over farmed, and the rise in the vegan diet. Our food choices are limited and controlled by big supermarket chains and by our income. It’s expensive to eat a good diet.

While healthy lifestyle change and our continued support should remain at the forefront of what we do as GPNs, using more medication to solve a problem, possibly temporarily, often caused by poverty and lack of education, is simply keeping us sick and the obesity crisis rages onwards and upwards. One in eight toddlers and primary school aged children in England are obese, according to last year’s Health Survey for England.

While we need to deal with day-to-day care, intrinsically this isn’t our goal, our purpose as the GPN should be to educate and support our patients to be self-caring; and to make better decisions about their bodies and their health needs.

Related Article: Children born to women with obesity have higher risk of infection

Most people with type 2 diabetes or very high BMI are adults, with responsibilities to themselves and their families, and should be treated with respect. ‘Fat shaming’ is rife in social media.

We are also in danger as a country, as a society, of following the lead of the US, where nutritional standards are poor. Food marketing is in itself a health scandal. Sugary breakfast cereals being sold as healthy for example since the 60s. Huge changes in our diets took place reduction of healthy fat due to fear of cholesterol and the damage it was supposed to be doing to us. So much more research has happened since that shows how much over processed foods have contributed to our poor health, gut issues and obesity in our children.

Managing the demand for weight loss medication

Weight loss jabs are expensive, but so is the continued healthcare of patients with type 2 diabetes, kidney failure, heart disease and hypertension caused by obesity. We need to weigh up (no pun intended) how we’re using these funds and the risks.

GPs are now able to give our patients the weight loss injection as part of a weight loss for health/diabetes care programmes. The criteria are online for all to access. More people will be demanding this medication and may feel this is a solution to their health problems, without first acknowledging their dietary and alcohol intake, or other lifestyle issues.

Guidelines tell us that people with a BMI of 35/40 plus will benefit from the weight loss jab. Eligibility includes people in certain ethnicities with higher QRisk factors and who have a 27.5 BMI. Having high blood pressure of high cholesterol is also in the eligibility criteria.

My diabetic nurse colleagues tell me that the weight loss jab is really effective, but most people can’t afford to pay so they ask for it to be prescribed. It doesn’t suit everyone, and people should understand that the eligibility criteria are there for a reason or it can make you very unwell.

Lifestyle changes are also essential

Put simply, weight loss injections are not a magic wand, and won’t help everyone. Our patients need to understand that once they have to stop taking it, unless they have made fundamental changes to their mindset, diet and lifestyle, the weight is likely to go back on.

As with any diet they may have tried or have considered, weight loss medication may not be the cure-all some people hope it will be. What it is, is a means to an end.

GLP-1 medications need to be used with careful monitoring by healthcare professionals; people need to manage their expectations, and the outcome is different for everyone – all of which is true of any other weight loss programme.

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Is this just the latest diet trend? Will people’s appetite for the injections wear off soon? I guess that only time will tell.

Jane Coomber is an RN, GPN working in a small SE London general practice

Diary of a General Practice Nurse is a regular series. Jane welcomes your feedback and responses. If you would like to comment on the above topic or want to write your own Diary article, please send this to the editor at [email protected]