These days, food makes Jai nauseous. She has to force herself to eat toast for breakfast. Most days she can only manage half a slice. For lunch, she has a cheese sandwich. For dinner, a small plate of enchiladas.
Jai, 36 from London, is one of the growing number of people in the UK prescribed the drug semaglutide. The drug has been available on the NHS since 2018 to treat diabetes and in 2021, was also approved for aiding weight loss.
Since then, it has soared in popularity: within months of its distribution as weight-loss medication, the US reported shortages. One of the more popular semaglutide brands, Wegovy, even received a surprise endorsement from Elon Musk. When asked how he had shed weight so quickly, he told his 121 million Twitter followers that he had been injecting Wegovy. Google searches for the drug spiked after Kim Kardashian shared that she lost 7kg in three weeks in the lead up to the 2021 Met Gala, although she never confirmed use of any weight-loss drug.
Currently in the UK, the drug is only available to people with a BMI of over 30. According to semaglutide manufacturer Novo Nordisk – which recently reported sales of the drug had increased by 59 per cent in the first nine months of 2022 – it slows the movement of food through the stomach, decreasing appetite through the slow absorption of food and therefore reducing body weight. It is available in three different doses: 0.25mg, 0.5mg or 1.0 mg and is administered by a once-weekly injection. The more you take, the less food your body craves.
Thanks to polycystic ovaries, Jai has been struggling with obesity for years. Her diet was never super healthy, but she wouldn’t binge on food. “I’d have a chocolate bar most days and maybe if I made pizzas for my kids I would have three slices for my own dinner,” she says. With a BMI over 30, Jai went to her NHS doctor and asked if there was anything that could be done. “My doctor just told me to go for a run,” she says. But after a year of exercising, Jai had only lost a couple of kilos.
Frustrated, she decided to take matters into her own hands and went to a private doctor: “I showed them how much I had been jogging: I even showed him my running app,” she says. “The new doctor said, listen, there is this new drug out now for weight loss called semaglutide. I said yes. I’m desperate at this point.” He wrote Jai a prescription.
But even with a prescription, getting hold of semaglutide wasn’t easy – or cheap. Eventually, after calling dozens of pharmacies, Jai managed to get hold of three months’ worth of the drug for £350. “The main thing the drug has done is suppress my appetite and my cravings, so my portion sizes have massively reduced. I used to crave crisps or chocolate but not anymore. I’m not even having fizzy drinks,” says Jai.
“Sugary stuff just doesn’t appeal to me now.”
Jai started on the lowest dose, then went up to 0.5mg, then 1mg. “In three months, I’ve lost one stone,” she says. “I’ve never felt better.” But while Jai might feel happier with her weight, the drug isn’t without its side effects.
Jai used to love fried food but now she can’t eat it. “I went for a Chinese the other day and we were having fried vegetables but I just couldn’t eat it. I felt a bit sick afterwards.” Before starting to take the drug, if Jai didn’t eat during the day, she would usually feel light-hearted or shaky. “That’s because my blood sugar was really sensitive. But actually, I’m not feeling like my body is telling me to go eat. It’s not giving me those hunger symptoms. I can go until midday and remember I haven’t eaten anything.”
But this new drug is not a quick fix. “As soon as people come off this drug, they will put the weight back on,” says Paul Gately, Professor of Exercise and Obesity at Leeds Beckett University. “We shouldn’t be surprised that they gain the weight back because, effectively, the semaglutide is influencing energy balance, so what the body takes in and what it takes out, in an artificial way.”
That doesn’t mean the drug isn’t helpful: “Getting weight off people for a period of time is better than not having the weight off them at all,” says Gately. “Plus the drug is pretty cost-effective for the NHS in that way.” The latest government figures estimate that obesity currently costs the NHS £6.1bn each year.
Jai is worried about how long she might have to be on semaglutide. “We don’t know the consequences of being on it for a long time but I also don’t want to put the weight back on as soon as I go off it,” she says. “But I’m trying to incorporate more exercise into my life now so that I can keep it off.”
In animal studies, semaglutide caused has thyroid tumours or thyroid cancer but it is still not known whether these effects would occur in people. Several other studies have concluded that it’s unlikely that the drug will cause damaging health effects. One piece of research led by the Amsterdam Medical Centre concluded that the drug has “low risk for severe adverse events.”
“Guidance recommends users take the drug for two years at the moment,” says Gately. “But people don’t want to take medication for longer than need to, and they shouldn’t either.”
Amy Latham, 35, first heard about semaglutide in October. Her private endocrinologist, a doctor that specialises in hormones, recommended it. She had been on a different weight management drug, metformin, for almost a decade and had barely lost any weight. Semaglutide felt like her last hope.
“I have been on semaglutide now for a month and have already lost 8kg,” she says. “It’s hugely changed my life already.” She has chronic knee pain and walking has become increasingly painful. “Losing weight has already made it easier to walk on my knees. I have PCOS and I’m insulin resistant so I’m unable to lose weight with calorie counting alone,” she says. “I want to eventually lose three stone.”
In just a few weeks, Latham feels different. “My energy has increased tenfold and my depression and anxiety has stablised. It’s not just a physical journey, it’s a mental journey,” she says.
The side effects, on the other hand, have not been what she expected. Alongside the usual nausea most semaglutide users report, she has experienced a repulsion to unhealthy food.
“My body craves a salad over anything greasy or oily,” she says. “My husband fried mushrooms the other day but I boiled mine. The idea of frying them made me feel ill.”
Side effects are varied. Some semaglutide users have reported diarrhoea and constipation as well as vomiting. “I get sulphur burps every couple of weeks. My twins hate it,” says one semaglutide user Katie Crawcombe, 44 who was prescribed the drug by the NHS to manage her weight loss after being diagnosed with type 2 diabetes. “I also have terrible cramps. When I first started I needed to go to the toilet a lot.”
After a few months, Crawcombe’s symptoms subsided but she is surprised that the drug has become so popular. “If you don’t get it on the NHS it’s very expensive,” she says. “I’m not sure why celebrities would want to put themselves through the nausea and shits for the sake of a few pounds.”
But for Jai, the success of semaglutide has had an enormous impact on her happiness. “I’ve always suffered with confidence but losing one stone has made me feel so much better. I am now really progressing in my career.” She adds: “I’m not as quiet as I was. It’s made a huge difference.”