Magic Pill or Snake Oil?

A year ago this week I embarked on an eating programme which was designed to get rid of the dangerous visceral fat that had wrapped itself round my liver.  Dr. Michael Mosley, a health guru that I really rated and trusted, had promised that rapidly losing at least 10% of my body weight fast on a daily 800 calorie intake was the only sure way to cure my Non Alcoholic Fatty Liver Disease. I was so desperate to alleviate the considerable pain and discomfort I was experiencing in my stomach, that I decided to give his specific regime a try.

Having stuck religiously to the diet for four months, I had shed 10kgs, my pains were gone and I felt better than I had for a very long while. I wrote about this here and was somewhat miffed (understatement) when someone on Facebook said “I bet she’s been on Ozempic”. Why was I so cross? Probably because I felt like I’d just completed the London Marathon, and someone was accusing me of taking the bus!

Which brings me to the late lamented Dr Michael Mosley’s son Jack, also a doctor, who has just published a book all about weight loss medications like Ozempic called ‘Food Noise,’

To be honest it never once occurred to me to go to an online pharmacy to buy either Ozempic, Wegovy, or Mounjaro which would have been necessary because, at the time of writing, these drugs are not available on the NHS. Why did I eschew what looks like a no-brainer easy-option? Because I didn’t know enough about how these new drugs worked, their possible side-effects, nor the longer term implications for either my body or my weight of taking them. And anyway I was fairly confident that I could lose the weight on my own if I was sufficiently motivated, and feeling so unwell was proving to be a very powerful motivator.

Why Are We Fatter than Ever?

Mosley Junior explores the causes of our obesity epidemic in some detail in his book. The statistics are eye watering. In the 1960s only 1% of men and 2% of women in the UK were living with obesity. Now it's 24% of all adults. In the USA the figure is closer to 40%. The impact on health is obvious in increased risk from type 2 diabetes, cardio-vascular disease, high blood pressure, some cancers as well as reproductive issues, osteoarthritis and my fatty liver problem. And the blame for this dramatic increase in obesity in the population should be laid very firmly at the door of the food industry.

You probably know as well as I do that the main culprit is Ultra Processed Foods which have been developed by food manufacturers over the past fifty years to be cheap, snackable, and even addictive in that such foods are designed to make us crave ever more of them. These items owe more to science and psychology than to nutrition. They are also packed with calories from sugar, fats, salt, refined carbohydrates and flavourings whilst supplying very little in the way of nourishment for our bodies. Take Pringles ‘potato crisps’ which are engineered not from actual potatoes but a mixture of ‘dehydrated processed potato’, corn, rice and wheat. The tube that they come in is also designed to make the crisps difficult to get at, so that you have to ‘forage’ for them as if you were a hunter-gatherer out on the prairie (I kid you not). 

Big Food and Big Pharma

So,’ Big Food’ makes eye-watering profits from helping to make more and more people, including children, heavier than they have ever been, and now Big Pharma can make very many more billions from their latest wonder drugs to help us to effortlessly shed the weight and reverse the epidemic of type 2 diabetes. To give you some idea of the potential for profit worldwide, Reuters have forecast that the market for these weight loss drugs will have surpassed $100 billion within the next five years.

Like his dad before him, Jack Mosley is keen to present a balanced appraisal of weight loss medications by exploring how and why the drugs work, some of the benefits of such a speedy and dramatic weight loss, whilst also drawing attention to the commonly experienced side effects and some of the very real drawbacks of altering the relationship between appetite, eating, and pleasure. There are also implications for the longer term that may gradually emerge as very real dangers because of the way that these medications alter the composition of the body. And, personally, I’d be worried about ‘Ozempic Face’ (gaunt) and ‘Ozempic Butt’ (dropped and flat) neither of which sounds particularly attractive.

How Ozempic, Wegovy and Mounjaro Work

Put very simply the drugs work to switch off both hunger and food cravings - which Mosley Jr. calls ‘Food Noise’. To be honest, reading Jack Mosley’s book I was mightily relieved that these drugs were not available fifty years ago when I weighed at least a stone less than I do now and yet was convinced that I was grossly fat and therefore very unattractive. I also obsessed about food continually and when I ‘lost control’ and came off my permanent draconian weight loss regime, it was to binge on foods that were dense in sugar, fat and refined carbohydrate, in the form of golden syrup sandwiches made with white sliced bread thickly spread with ‘proper’ butter (I know, I know.). I would have jumped at the chance to turn down this ‘food noise’ with, I suspect, very dire results for my body.

Reducing Food Noise and other Addictions

The new injectable drugs work by reducing the food noise, blocking the cravings for snacks like crisps, biscuits and chocolates (and alcohol) and preventing hunger pangs. Some people find that their appetite is so reduced that they can go for long periods without eating anything and, as the weight falls, digestion slows and blood sugar spikes are smoothed. The medications may even provide a cure for a range of addictions including drugs, alcoholism and even gambling because of the ‘dampening’ effect on those pathways in the brain that lead to the addictive behaviour.

Weight Loss Health Benefits

The weight loss health benefits are also important and significant, including a reduction in inflammation in the body (responsible for many diseases of ageing), lower risk of heart disease, type 2 diabetes, kidney failure, dementia, Parkinson’s disease and certain cancers and an improvement in sleep apnoea However these outcomes are less to do with the medications and much more to do with the fact that the person is no longer obese.

Side Effects, Risks and Downsides

Common side effects whilst on the drugs may include nausea, vomiting, constipation, diarrhoea and ‘eggy’ burps (yuk). For instance, Stephen Fry loved the effect of Ozempic on his waistline and the loss of his craving for both food and alcohol but could not endure the constant daily vomiting.The other longer term issue concerns the loss of muscle as well as fat. 

Mosley Jr. quotes the case study of a 65 year old obese woman. Dissatisfied with the help offered by her GP,  Susan orders the pre-filled pens from an online pharmacy so that she can inject her stomach with the drug. These online services offer no consultation with a doctor, nutritionist or any healthcare professional or advice on how to make different lifestyle choices (ie diet and exercise). 

Susan loses 15kgs in 4 months and is delighted, however, unbeknown to her she has lost 9kgs of fat and 6kgs of lean body mass. Because the four months on the jab have in no way altered Susan’s understanding of diet and exercise, she is very likely to regain two-thirds of the weight she’s lost, but, worse than that, although she may still be 5kgs lighter, she is now carrying proportionally more fat and less muscle with negative implications for her future health. Why? Because muscles are not only important for movement (and preventing falls) but also support our immune system and metabolism.

My Concerns about Weight Loss Medications

I don’t want to sound like a party pooper but these would be my current concerns for weight loss medications like Ozempic:

1 - The ease with which people can obtain them via online pharmacies. You are required to ‘prove’ that you are suitably overweight but these can be easily gamed with few questions asked.

2 - The lack of guidance, support or screening for people self medicating in this way.

3 - The fact that weight loss is the only objective when what is also needed is education about food choices, understanding nutrition and the importance of exercise to ameliorate the loss of muscle as well as fat.

4 - The danger if you have any kind of eating disorder of the medication leading to becoming  seriously underweight and even anorexic.

In ‘Food Noise’, Mosley Jr. neither over nor underplays the role that these revolutionary new weight loss drugs can play in fighting the problem of obesity. If we accept that we are living through an obesity epidemic that costs our healthcare system billions of pounds, then helping people with an apparently effective and speedy way to reduce their weight is clearly both an important development and one that is here to stay. However the book cautions against seeing drugs like Ozempic as magic bullets whose long term impact on the body cannot be known for several years and can already be seen to have some unfortunate unintended consequences. 

This time last year I was very relieved to discover that my stomach pain and discomfort was not life threatening whilst still wanting to feel better. Once cancer was thankfully ruled out, my only diagnosis was a problem with liver function and Non Alcoholic Fatty Liver Disease. Dr Michael Mosley promised a cure for this on his Fast 800 diet and Dr Jack Mosley presents (but doesn’t necessarily recommend) a solution to NAFLD using weight loss medications to rapidly shed weight in order to get rid of the visceral fat. 

I’m quite glad that this book has been published a year after I embarked on my weight loss marathon. A year in which I have learnt so much about how to eat and stay slim. Having read ‘Food Noise’, I very much doubt that I would have been tempted to self prescribe such powerful medications, however, I would never condemn anyone for choosing a course of Ozempic if they'd tried every diet under the sun and needed to get their weight down quickly in order to improve a health condition or before an operation. 

And please leave a comment below if you have any insights to add about these medications - I’m genuinely interested to know what you think and also about personal experiences - both good and bad.

Tricia x

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