No one should face obesity treatment alone

Every day, thousands of people begin a course of GLP-1 receptor agonists such as Semaglutide and Tirzepatide, with real hope that these medications will finally unlock lasting weight loss. Yet, without the right support woven around these prescriptions, too many patients find themselves battling unanticipated harms – whether that be fatigue from undetected nutrient deficiencies, muscle wasting away due to rapid weight loss, reduced effectiveness of other medications, rare but serious effects like pancreatitis and ultimately, the disappointment of significant weight regain.

Considering this long list of risks, it is important to ask: what plan is in place to ensure the UK is equipped to fully support and protect those taking the medication? This question was tabled in Parliament recently, with the troubling response from the Government that, “Healthcare professionals should arrange information, support, and counselling on additional diet, physical activity, and behavioural strategies when these drugs are prescribed.” It appears there has been no real assessment of the potential impact of the prescription of weight-loss drugs on the NHS without the associated prescriptions of physical activity on muscle mass.

As a GP, this is deeply concerning. These concerns have also been raised by many other organisations, including The British Society of Lifestyle Medicine. If our ambition is to deliver weight-loss care that is safe, effective and, above all, fair, we cannot place sole ownership on healthcare professionals. We must instead commit to a comprehensive strategy of wraparound support under the NHS, the moment a patient steps through the clinic door. We must also account for patients obtaining GLP-1s privately, ensuring that private providers pair every prescription with genuine physical activity and nutrition guidance, not merely a leaflet or a web link.

Tirzepatide within the NHS is now being extended outside of specialist weight management services and into primary care. This is where we find ourselves with both the opportunity to support a larger proportion of patients but still with the persisting concern around the ability to provide the required holistic support.

If we break down the effects of these medications, it becomes clear that the support needed for those taking the medications is not the responsibility of just one industry.

Strong appetite suppression often leads to significant reduction in calorie intake, and it can make it even more challenging for the patient to consume the required nutrients to maintain good health. Vitamin deficiencies associated with GLP-1 have also been reported. In the absence of close monitoring, these deficiencies can slip under the radar, only to emerge months later with significant worrying symptoms. It is vital that all patients are supported to improve the nutrient quality of their diet as a first point of call.

Then comes the issues of safeguarding the body’s lean body mass. This is all the weight in our body that is not from our fat stores and includes skeletal muscle, bodily fluids, organs and body tissues. When pounds tumble away quickly, loss of muscle can follow and that’s why anyone taking weight-loss drugs should be carefully supported through sustained physical activity.

Obesity management guidelines published by NICE earlier this year indicate that for patients who have lost significant weight following these medications, 60 to 90 minutes of daily physical activity is required to maintain that weight loss. When people embark on weight-loss treatments alongside structured physical activity – specifically, supervised resistance exercises – two things happen: they preserve or even build muscle and bone mass during treatment, and they regain significantly less weight once injections stop. Therefore, it is vital that we provide accessible and varied physical activity support through partnerships with providers in the community, such as gyms, pools and leisure centres.

The reality is clear. The list of complications and side-effects for those taking these medications must be supported by a coordinated and multidisciplinary team. To make this vision real, the Government must ringfence funding so that every weight-loss prescription automatically triggers access to wraparound support. This can help to assess individuals’ needs and target investment in deprived areas to help close the health gap.

If we are to harness the promise of weight-loss therapies without repeating old mistakes, we must move beyond pills and programmes. If the Government is serious about placing the focus on prevention with the NHS 10-Year Plan, then only by surrounding every prescription with the full tapestry of lifestyle support can we deliver weight-loss care that is safe, sustainable and, above all, just.