Do I need semaglutide and how can I get it?

Written by | 11 May 2023 | 'In Discussion With'

Semaglutide works well on its own as obesity treatment but it works even better with the support and guidance of a multi-disciplinary weight-management team, according to Alex Miras, Professor of Endocrinology, University of Ulster.

“Since [semaglutide] is going to become available in the National Health Service I can see no reason why [interested people] should not seek a referral from the general practitioner to a specialist Weight Management Centre in order to be assessed and, hopefully, be given the medication”, says Professor Miras. If this option is not available or involves a long delay, then people may wish to seek a supply in the private sector. However, “If they are to do that, I would stress the importance of having a specialist weight management team that looks after them because it’s not about taking the medication for six months and then stopping it and seeing how things go”, he adds. People suffering from the disease of obesity need long-term treatment, ideally with the support of a multidisciplinary weight-management team, he emphasises. “So, again, I stress the importance of not using the DIY model of care”, he says.

Pharmacy supply

Supply of semaglutide at NHS expense, via a community pharmacy, could be possible if the community pharmacist is part of a specialist weight management team. The good thing about the NICE guidance is that it has deliberately left the details of the specialist weight management teams vague. Professor Miras hopes that some GPs will now set up weight management teams in the community in order to increase the access to the medication.

Natural stimulation of GLP-1 secretion

There is not yet a ‘natural’ way to stimulate the release of GLP-1.  Professor Miras explains that the hormone is produced in a group of cells predominantly found in the distal part of the small intestine – the ileum. These are entero-endocrine cells that respond to the presence of food in the lumen of the gut by secreting the hormone (GLP-1). “Now the best way we have at the moment of enhancing the release of GLP-1 is eating protein because what has been shown is that, as opposed to fat or sugar, high protein meals [elicit secretion of] more of this hormone for the same [number] of calories. So, protein is satiating and that’s why protein can cause weight loss and weight loss stability.  But apart from …. having a diet which is high in protein, at the moment we do not have anything else we can naturally do to produce more of that hormone, but I’m sure that that will also come”, he says.

Inevitably, some people will seek to use semaglutide on its own, without lifestyle modification but how well might this work? Professor Miras explains that the reason why the medication works is because it makes people change their diet. “The diet changes because of the drug ……. I mean that the vast majority of people will eat pretty much the same foods that they were eating before taking the medication but they would just eat less.  There is a smaller proportion of people that may also change the type of foods that they eat and this may enhance their weight loss”, he says.  Nevertheless, the support and guidance of a multidisciplinary team can personalise the treatment to optimise and enhance the biological effects of the drug. The combination of the drug with nutritional advice and physical activity has additive, and possibly synergistic effects, he concludes.

Grants/Research Support: Fractyl, Novo Nordisk, Randox.
Other Financial or Material Support/Honoraria: Novo Nordisk, GI Dynamics, AstraZeneca, Boehringer Ingelheim, Currax Pharmaceuticals

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