Table of contents
- 1. What weight management drugs are available on the NHS? skip to link
- 2. What are the benefits of diets with adequate fat content? skip to link
- 3. What has the government said about weight management? skip to link
- 4. What have health professionals and others said? skip to link
- 5. Read more skip to link
Approximate read time: 10 minutes
On 31 October 2024, the House of Lords will consider the following question for short debate:
Lord McColl of Dulwich (Conservative) to ask His Majesty’s Government what assessment they have made of the benefits of diets with adequate fat content for reducing appetite, as an alternative to the use of drugs such as Ozempic.
1. What weight management drugs are available on the NHS?
At present, only three “anti-obesity medicines” have proved to be safe and effective for use on the NHS for weight management, to be taken alongside low-calorie diets and exercise.[1] They are orlistat, liraglutide and semaglutide:
- Orlistat is used specifically to treat obesity by reducing fat absorption in the intestines. It is prescribed to individuals with a body mass index (BMI) of 28 or higher and other weight-related conditions, such as type 2 diabetes, or those with a BMI of 30 or higher.
- Liraglutide is used to treat type 2 diabetes and obesity. It does this by mimicking a hormone that regulates blood sugar levels by increasing insulin production and decreasing glucagon production. It is prescribed to individuals with a BMI of 35 or higher, or those with a BMI of 32.5 or more from certain ethnic backgrounds. It is also prescribed to those at high risk of heart problems.
- Semaglutide (also known as Wegovy) is primarily used to treat type 2 diabetes and works similarly to liraglutide by helping to regulate blood sugar levels. It is prescribed to individuals with a BMI of 35 or higher, or those with a BMI of 32.5 or more from certain ethnic backgrounds. It is also prescribed to those with a BMI of 30 to 34.9, or 27.5 to 32.4, if they meet other criteria to be treated by a specialist weight management service.
The NHS website warns that the drugs can have side effects. This includes diarrhoea, nausea, vomiting and, in some cases, issues affecting other organs.
In October 2024, research by the Obesity Health Alliance (OHA)—an organisation representing 60 health charities, medical royal colleges and campaign groups—found that 4.1 million people in England were eligible for Wegovy.[2] However, the OHA claimed that NHS estimates suggested fewer than 50,000 people would receive the drugs by 2028.
2. What are the benefits of diets with adequate fat content?
Whilst excessive saturated fat intake has led to obesity and other health conditions, dietary fats can provide various nutritional benefits. On its website, the British Dietetic Association (BDA) noted that fats “play an important part in our daily diet” and that people need a small amount “as part of a healthy balanced diet”.[3] It noted that fats are “important” due to several factors:
- Source of energy: They provide nine calories per gram and are an “energy-dense nutrient”. They also provide more calories and energy than carbohydrates and proteins (four calories per gram).
- Vitamin absorption: Fats help absorb vitamins A, D, E and K, which are “essential for our health”.
- Provide fatty acids: These are known as omega-3 and omega-6 and are “essential for keeping our nervous system and brain healthy”.
However, the BDA has warned against a high intake of saturated fats, often found in processed foods, which is associated with weight gain.[4] This can increase the likelihood of developing health conditions such as type 2 diabetes, joint problems, and some cancers.
The ‘Eatwell guide’, which is the government’s dietary recommendation, advises that people eat less red and processed meat, and lower fat and sugar dairy products to help reduce their intake of saturated fat.[5] This advice reflects a recommendation to reduce saturated fatty acids to no more than 10 percent of total dietary energy by the independent Committee on Medical Aspects of Food Policy in 1994.[6] The recommendation remained unchanged following a review of the scientific evidence by the Scientific Advisory Committee on Nutrition in 2019.[7]
Some people argue that the intake of fat helps to reduce appetite. In an interview on the health science company ZOE’s podcast in January 2024, Sarah Berry, an associate professor in the Department of Nutritional Sciences at King’s College London and chief scientist at ZOE, explained why fat can suppress appetite.[8] She stated:
Fat makes us feel full for longer. It delays the rate at which our stomach empties food, which again helps us create that feeling of fullness. So, it also controls our blood sugar levels as well, so that we tend to consume less calories potentially later in the day.
However, the NHS does not advise eating fats to reduce overall calorie consumption.[9]
3. What has the government said about weight management?
3.1 Unhealthy diets
The government has sought to tackle the consumption of unhealthy foods, particularly by children. In the King’s Speech, which took place in July 2024, the government committed to introducing legislation to ban junk food advertising to children and the sale of high-caffeine energy drinks to children.[10]
Several organisations welcomed the government’s commitments. The Royal Society for Public Health stated that the commitments were a “big step towards a coherent strategy to tackle obesity and related harms” and were “serious changes which will make a tangible difference”.[11] Similarly, Hannah Brinsden, the head of policy and advocacy at the Food Foundation, described the commitments as “positive first steps on health, reiterating the government’s commitment for the NHS to focus more on prevention”. However, she called on the government to “go much further than this […] to improve our food system”.[12]
3.2 Weight-loss drugs
The government has also welcomed the rollout of weight-loss drugs in the NHS, alongside diet and exercise, and has suggested that they could potentially be offered to unemployed people suffering from obesity. However, it has also warned about the drugs replacing diet and exercise.
On 14 October 2024, the government announced a collaboration with the world’s largest pharmaceutical company, Lilly.[13] The collaboration would see the UK’s life-sciences sector receive £279mn to tackle “significant health challenges”. In the announcement, the Department of Health and Social Care stated that the collaboration would “set the stage for government to work with industry to trial innovative approaches to treating obesity as part of a rounded package of care”.
In an article for the Telegraph published on the same day, the health secretary, Wes Streeting, said that obesity was placing a “significant burden” on the NHS and was costing the service £11bn annually.[14] He further noted that obesity was “holding back” the economy, with illness caused by obesity causing people to take an extra four sick days a year on average, “whilst many others are forced out of work altogether”. Therefore, he suggested that the long-term benefits of such drugs in tackling obesity could be “monumental” and would be “life-changing” for many people. He argued that this would “help them get back to work and ease the demands on our NHS”. However, he warned that “along with the rights to access these drugs, there must remain a responsibility on us all to take healthy living more seriously”.
4. What have health professionals and others said?
4.1 Unhealthy diets
Some food organisations and stakeholders have called on the government to address the causes of obesity by tackling the provision of unhealthy foods.
In a report published on 24 October 2024, the House of Lords Food, Diet and Obesity Committee examined the role of foods as part of a healthy diet and in tackling obesity.[15] The committee stated that “our food system is broken” and that unhealthy diets were the “primary driver of obesity and preventable diet-related disease”. It attributed this to all income groups failing to meet dietary recommendations because “in recent decades, unhealthy, often highly processed foods have become widely accessible, heavily marketed and often cheaper than healthy alternatives”.[16] It was also critical of government policy to tackle obesity, arguing that successive governments had proposed around 700 policies “over the last 30 years”. Despite this, the committee noted that the obesity crisis had “intensified during that period”.[17]
Therefore, the committee made several recommendations, including calling on the government to introduce a “new overarching legislative framework for a healthier food system”. This would require the government to publish a “new, comprehensive and integrated long-term food strategy”, which would outline targets for the food system and detail the government’s plans to introduce policies to “achieve those targets”.[18] As part of this legislative framework, the Food Standards Agency would be given oversight of the food system and the secretary of state for health and social care would be accountable to Parliament for the government’s progress against the strategy.
In its latest annual report on food insecurity in the UK, published in June 2023, the charity The Food Foundation warned that the current food system was “not serving us well” and “traps us into eating in a way that is harmful to our health”.[19] Examining the affordability of a healthy diet, the organisation reported that the most deprived fifth of the population would need to spend 50 percent of their disposable income to meet the cost of the government’s recommended diet. Additionally, the report noted that healthier foods were more than twice as expensive per calorie as less healthy foods.[20] Therefore, it called on the government to “actively track the cost of a healthy and sustainable diet” to “inform benefits levels and ensure that a healthy and sustainable diet is affordable for everyone regardless of income”.[21]
4.2 Weight-loss drugs
Health professionals and organisations have welcomed the weight loss drugs for individuals with severe obesity or type 2 diabetes. However, the drugs’ popularity has led to concerns regarding their impact on existing weight management services and potential misuse by individuals accessing the drugs without medical reason.
In October 2024, the chief executive of the NHS, Amanda Pritchard, stated that the drugs could be a “game-changer”, alongside earlier prevention strategies, but warned that “without transforming pathways, they could overwhelm already-stretched services”.[22] Similarly, Alfie Slade, the government affairs lead at the Obesity Health Alliance, said that the weight loss medicines “represent a breakthrough in treatment, giving hope to the millions of people struggling to manage their weight”. However, he also expressed concern that “without urgent government intervention, we will fail to meet the needs of millions of patients, leading to greater health inequalities”.[23]
Discussing the potential misuse of those using the drugs outside of NHS services, Barbara McGowan, a consultant endocrinologist who co-authored a study which trialled semaglutide to treat obesity, warned that buyers using the drugs outside the legal supply chain “could be injecting anything” into their bodies.[24] She further said that “we don’t know what the excipients [other ingredients] are” and they “could be potentially toxic and harmful, [or] cause an anaphylactic reaction, allergies and I guess at worse, significant health problems and perhaps even death”. Additionally, the chief safety officer at the Medicines and Healthcare products Regulatory Agency, Alison Cave, stated that buying semaglutide from illegal suppliers “means there are no safeguards to ensure products meet our quality and safety standards, and taking such medicines may put your health at risk”.[25]
5. Read more
5.1 Parliamentary questions
- House of Commons, ‘Written question: Chronic illnesses: Unemployment (9630)’, 22 October 2024
- House of Lords, ‘Written question: Fats (HL1493)’, 21 October 2024
- House of Lords, ‘Written question: Processed food (HL200)’, 30 July 2024
- House of Lords, ‘Written question: Fats (HL4521)’, 17 May 2024
- House of Commons, ‘Written question: Obesity: Health services (20056)’, 28 March 2024
5.2 Press articles and commentary
- Nicola Davis, ‘Weight loss jabs not ‘quick fix’ for UK worklessness, health experts warn’, Guardian, 18 October 2024
- BBC News, ‘Why weight-loss drugs may be no obesity silver bullet’, 15 October 2024
- Sky News, ‘Don’t use Ozempic or Wegovy for ‘Instagram perfect body’, says health secretary’, 14 October 2024
- Lisa Salmon, ‘Doctor explains everything you need to know about weight-loss injections on the NHS’, Independent, 19 March 2024
- Nesta, ‘Can weight loss drugs ‘solve’ obesity?’, 7 December 2023
Cover image by Siora Photography on Unsplash
References
- NHS, ‘Obesity: Treatment’, accessed 18 October 2024. Return to text
- Obesity Health Alliance, ‘New position statement: A way forward for the treatment of obesity’, 16 October 2024. Return to text
- British Dietetic Association, ‘Fat facts’, accessed 23 October 2024. Return to text
- As above. Return to text
- Public Health England, ‘The Eatwell guide’, updated 2 January 2024, p 1. Return to text
- Committee on Medical Aspects of Food Policy, ‘Nutritional aspects of cardiovascular disease’, 1994, p 1. Return to text
- Scientific Advisory Committee on Nutrition, ‘Saturated fats and health’, 5 July 2019, page xxii. Return to text
- ZOE, ‘How to eat well in 2024: Seven essential strategies’, updated 2 January 2024. Return to text
- NHS, ‘Fat: The facts’, accessed 25 October 2024. Return to text
- Prime Minister’s Office, ‘The King’s Speech 2024: Background briefing notes’, 17 July 2024, p 9. Return to text
- Royal Society for Public Health, ‘A new government and the King’s Speech: What does it mean for public health?’, 23 July 2024. Return to text
- Food Foundation, ‘Our reaction to the King’s Speech’, 17 July 2024. Return to text
- Department of Health and Social Care, ‘Landmark collaboration with largest pharmaceutical company’, 14 October 2024. Return to text
- Wes Streeting, ‘Widening waistbands are a burden on Britain’, Telegraph (£), 14 October 2024. Return to text
- House of Lords Food, Diet and Obesity Committee, ‘Recipe for health: A plan to fix our broken food system’, 24 October 2024, HL Paper 19 of session 2024–25. Return to text
- As above, p 5. Return to text
- As above, p 8. Return to text
- As above, p 9. Return to text
- Food Foundation, ‘The broken plate 2023: The state of the nation’s food system’, 27 June 2023, p 3. Return to text
- As above, p 4. Return to text
- As above, p 9. Return to text
- Rebecca Thomas, ‘Weight-loss jabs could ‘overwhelm already stretched’ services, NHS chief warns’, Independent, 16 October 2024. Return to text
- Rebecca Thomas, ‘Doctors’ warning over weight-loss jabs on NHS’, Independent, 16 October 2024. Return to text
- BBC News, ‘Weight loss injection hype fuels online black market’, 15 November 2023. Return to text
- As above. Return to text