This week we have Dr Catherine Frankum , discussing the weight loss medications, Wegovy and Mounjaro. These burst on to the scene in September 2023 and December 2024 respectively and promised much from their trial data- but would they match up to expectations in the real world? Read on for her 'no holds barred' insights and observations from the first c.18 months.
WGP: The overall efficacy figures for weight loss medications are undoubtedly impressive- but have you seen these results broadly replicated in the actual results your patients have achieved?
Dr Catherine: The original Lilly studies show an additional 21% weight loss in those participants taking Tirzeparetide (Mounjaro) over placebo over an 84 month period. This trial was started with all participants undertaking a 12 week intensive exercise, nutrition and counselling programme and the mean starting weight was 109.5kg. In my experience, so far, 21% weight loss is a difficult target to reach. Mounjaro helps people eliminate the hunger and cravings which go alongside dieting but it should always be prescribed with sound nutritional support and a plan to increase activity levels as much as possible. Other factors to consider would be that for patients with a lower starting BMI, a 21% reduction in weight would always be harder to achieve. It's also important to note that the trial was fully funded, so none of the participants had to contend with changes in financial circumstances.
WGP: Obviously results vary from patient to patient, and in some cases it does not work out. When the medication has not worked for any of your patients, what has been the reason?
Dr Catherine:There have been a small number of patients who find the side effects difficult, but often this appears transient, and easier with each subsequent injection and dose increase. One of the biggest barriers I feel patients face may be eating for reasons other than hunger. Mounjaro and Wegovy will not ‘stop you putting food in your mouth’ (as one individual described it!) So being mindful of eating for comfort, loneliness or boredom is key. At the highest doses it is rare for a patient to describe hunger pangs, but for some the weight fails to reduce further. This is again where increasing activity levels and mindful/ healthy eating practices really need to be engrained alongside using the medications. Another pitfall may be to assume that weight is the only value that matters. I have had quite a few patients whose weight-loss plateaus, but they have gained some muscle tone - actually making them leaner, fitter and metabolically healthier than ever!
WGP: Is there anything about your practice of prescribing weightloss medications that has changed or evolved since they initially hit the market?
Dr Catherine:Wegovy was improved by NICE in Sept 2023 and Mounjaro in December 2024. The majority of patients now tend to start on Mounjaro for obesity, as it has been proven to have slightly greater efficacy by working against 2 receptors (GLP-1 and GIP) to promote weight loss. Over time we have learnt more about these medications, for example the rare but serious side effect or NAION (non-arthritic ischaemic optic neuropathy) and making sure that we ensure all women of child bearing age have adequate contraception. We have also learnt more about the medications’ positive benefits outside of weight loss such as blood sugar control and possibly reducing the risk of cardiovascular and kidney diseases. They may even offer potential neuroprotective benefits and improvements in cognitive function - research is ongoing.
WGP: What has surprised you about the patient experience of taking weightloss medications
Dr Catherine: One thing that often surprises me is how much more energy patients say they have when using weight loss medications. This could be for many different reasons - reduced energy spikes throughout the day, increased activity levels or improved sleep with weight loss. Another is how many people forget to take the injection weekly! Just as a heads-up, if your injections have been 6 weeks or more apart then we may have to reduce your medication down by a dose to prevent side effects. Set a weekly reminder in the calendar!
WGP: Injecting yourself is something that is new to most patients – what feedback do you get from patients about this part of the regime and are there any tips that you have learned along the way to make auto-injecting easier?
Dr Catherine: Since Wegovy and Mounjaro have been around for some time there are plenty of video tutorials specific to the pen you are using. My top tip would be to examine your needles and make sure to remove both covers if present. Dialling up the dose with a cover still present may waste the injection.
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