Weight loss drugs are effectively the blockbuster drugs of the modern era.
Much like Valium and Prozac were in the past, and the modern-day statins to reduce cholesterol, and before them, aspirin and ibuprofen and a host of others.
Today, brand names like Ozempic, Mounjaro, Wegovy are almost household names, and next generation versions of these drugs known as GLP-1s are on the way.
Since Ozempic came onto the market, it has made over €57 billion for the makers Novo Nordisk. So, this is also big business medicine.
It is important to be aware that these are prescription-only medicines and should only be taken when prescribed by a doctor.
The first of these drugs, used for diabetes, came on the market in the US around 2005.
The name GLP-1 stands for glucagon-like peptide-1.
This is a natural gut hormone and the drug reduces blood sugar, slows-down digestion and tells the brain that the body is full and so it suppresses appetite.
The trials show that these drugs can reduce weight by around 15%-20% and can help with other health problems too.
Ozempic arrived around 2017 and the surge in the prescribing and widened use of these drugs for weight loss effectively began around six or seven years ago.
Popularity of weight loss drugs spawn black market
These drugs have made the manufacturers very wealthy and have also spawned a black market with some people trying to access them online and illegally.
Yesterday, the British Medical Journal reported that a new generation of the drug for obesity, retatrutide, will now be available to some patients, before it is approved by the US Food and Drug Administration.
The Journal said the announcement from the drug manufacturer Eli Lily, came amid speculation that the then 79-year-old US President Donald Trump was given access to the drug.
It followed a report from the online news website STAT, describing the patient as a man 79 years of age with refractory obesity, obstructive sleep apnoea and pulmonary hypertension.
However, a White House spokesperson firmly denied the speculation that the US president was given this new drug.
Whatever the reality is about that report, there is no doubting that weight loss drugs are a world story.
Weight loss drugs among falsified or illegal medicines seized
Earlier this year, the Health Products Regulatory Authority here (HPRA) said that last year, it detained over three quarters of a million dose units of falsified or illegal medicines.
Illegal GLP-1 drugs obvious health dangers, the HPRA has said (stock image)
A significant proportion of these were presented as GLP-1 drugs.
In 2024, the number of these drugs detained was 1,582 units.
Within a year that had increased to 48,752 units seized.
With online purchase, people do not know what they are buying and there are obvious health dangers.
The cost of the GLP-1 drugs can also drive some people to alternative markets.
The HPRA has been involved in having websites shut and social media pages taken down, if they have been involved in trying to sell these prescription products.
Most of these weight loss drugs have been for injection, but the more recent development is the arrival of pill versions making use much easier.
A separate issue is the environmental danger when the expired injection pens and the needles are not disposed of safely, and in keeping with recommended disposal into puncture-resistant sharps containers.
In reality, these drugs for diabetes and weight loss have only been on the market for a few years.
So there is much we still do not know about their long-term use and effects, including wider possible health benefits.
Over time, it should become much clearer what the broader benefits of these drugs are, including reducing the risk of stroke, heart attack, chronic kidney disease, arthritis and other problems.
The medicines regulator, the Health Products Regulatory Authority, said this week there have been over 1,500 reports of suspected adverse reactions from weight loss medication here.
Nausea, vomiting, diarrhoea among common side effects
The most common side effects reported have been gastrointestinal issues, nausea, vomiting and diarrhoea.
There were also nine reports describing individuals who were known to be taking anti-obesity injections who died.
However, the HPRA said this does not mean the medicines caused side effects or fatalities.
All medicines have side effects and the primary issue with all drugs is whether they have been deemed safe and effective and also that the benefits outweigh the risks.
Consultant endocrinologist at St Vincent’s University Hospital and St Columcille’s Professor Donal O’ Shea said some patients were not sure about what they were getting with weight loss drugs and some were not appropriately counselled about the side effects.
Prof O’Shea told RTÉ News that it is important for patients taking these drugs for obesity to be supervised by their GP or practice nurse.
Prof Donal O’Shea said weight loss drugs have the potential to become a ‘runaway train’
But he also cautioned that we need to take stock of the situation with GLP-1s before the drugs become “a runaway train”.
The advice when taking GLP-1s is to drink lots of water and eat plenty of fibre so as not to get constipated.
People who start vomiting should stop taking the drugs immediately.
Experts say the side effects numbers here are in keeping with what has been seen in the UK.
It is hard to see the popularity of these weight-loss drugs waning, despite the high prices for private patients.
Clinical trials show these weight loss drugs are effective, but can healthcare systems afford them?
The growth in demand is phenomenal, and it will be some years before cheaper generic versions will be available.
The speed of impact in reducing weight makes these drugs very attractive, especially for people who have battled for years with yo-yo diets, extensive gym work or tried other ways to reduce their weight.
Studies do show that when people cease taking GLP-1s, over time, they often return to their original or similar weight.
So, are some people expected to be on them for life?
The expectation is that people will keep purchasing weight loss medications in high numbers and the move away from injection to pill delivery can be expected to drive that growth.
Given that reality, the most important message is that the use of GLP-1s is done under medical supervision.
Read more: 1,500 reports of suspected side effects from weight loss drugs – HPRA