However tough the start to the new year has been, it can’t compare to the awful scenes of fire and destruction in Los Angeles. A friend of mine lives in LA, and I was lucky enough to visit her last year. Looking at google maps her house came very close to being enveloped by fire. Thankfully she and her family are ok, but have been trapped indoors for days, and the air quality is suffocating to the point that despite air purifiers and shut doors and windows they will need to leave temporarily for the sake of their children’s young lungs. Hopefully things there will improve soon, and the almighty clean-up operation that is needed can start.
One thing that struck me about LA was how pervasive the health and wellness industry was there – a sauna, ice-plunge pool and gym on every street corner. People appear to take their health very seriously. However obesity is clearly a huge issue there, even more so than in the UK.
When it comes to weight management and exercise, the sad truth is that simply doing lots of exercise and eating whatever one wants just doesn’t work. It’s all a question of priorities. Don’y get me wrong, I am absolutely in favour of lots of exercise, and there is abundant research data for this, but not necessarily for weight loss reasons. Metabolic health, muscle growth and preservation, mental health, reducing a range of disease risks like cancer, heart disease and dementia, sure.
I expect many people reading this will already either have started on some new year’s resolutions with respect to health priorities, or at least thought about it. Do you want to lose a few pounds? Maybe get a bit fitter?
Over the last two weeks I have written about my favourite research trials and topics that came up during 2024, but left out one which is so big I thought it needed a whole section on its own. There has been so much interest in ‘weight-loss wonder drugs’ called GLP-1 agonists that I thought I would give my take on them. I see pros and cons. Let’s deal with the cons first. Conceptually, I worry about a group of medications that in a few short years are likely to become the most prescribed drugs on the planet, without very long term (as in decades) data on safety. I also worry that human nature is often to take the easy option (which is why as a country two-thirds of us are obese), and a weight loss drug is an easier option than education, careful attention to nutrition, exercise and so forth. These drugs, as any drug, can have side effects, including nausea, vomiting, diarrhoea and muscle loss.
However, I do also see big upsides. The weight loss that some of my patients who have been on the drug have achieved is amazing, in individuals who had tried all manner of ways to lose weight and been unsuccessful beforehand. In the trials, patients have typically lost around 4% of their body weight in 2 months, 8% after 4 months, and a whopping 15% by 17 months.
The UK Medicines and Healthcare products Regulatory Agency (MHRA – the government agency tasked with approving/or not medicines for the UK population) have recently updated their guidance on semaglutide, one of the GLP-1 drugs in question. Previously, its licence was for overweight adults for the treatment of obesity (BMI >30, or 27-30 plus at least one weight related health condition, for example high blood pressure). Based on new trial evidence, they have expanded the indication. In a multi-national, multi-centre, placebo-controlled double-blind trial (ie – a high standard of medical evidence) that randomly assigned over 17,600 participants to receive either Wegovy (semaglutide) or a placebo, Wegovy significantly reduced the risk of major adverse cardiovascular events by 20%, such as cardiovascular death, heart attack and stroke.
The licence now says that adults with a BMI equal to or greater than 27 and cardiovascular disease can now access the drug. There is also huge interest in the heart failure community, where latest research shows enormous benefit for patients with heart failure taking semaglutide. I expect it will take some time for UK guidelines and licencing to catch up, but i’m confident it will in due course.
However, semaglutide is not currently easily available on the NHS. I get a number of enquiries about these medications, and as GPs can’t often prescribe it either, I haven’t had a good answer. Given the benefit in this group of patients, I have decided to work with the manufacturers to access a supply for my patients who meet the MHRA criteria. As you may know, access to these drugs has been a worldwide issue for supply reasons, but I am assured by the manufacturer this would not be an issue for my patients.
This would be a new service for Coastal Cardiology, and I would like to add some important details. As I mention above, I worry about people being on these drugs long term. What I would like to see, is people using the period of weight loss to make lifestyle changes that will benefit them in the long term. This will enable them to come off the drug safely in the future, whilst maintaining the health and wellness benefits. I will therefore be working with patients who I prescribe the drug for to help them with those lifestyle changes. I love this stuff, and am passionate in my own life about all the little things that can be done to maintain good health.
If this is something you think you might be interested in, simply hit reply, let me know your best email and phone number and I will contact you with more details. There’s absolutely no commitment at this stage.
Earlier this week, I was absolutely delighted to finally prescribe a brand new heart drug for 2 patients of mine with an inherited heart condition. It’s taken over a year of meetings and paperwork to get to this point, as the drug in question is incredibly tightly regulated with only a few handfuls of specialist consultants in the UK eligible to prescribe it. In this week’s video, I use a model heart to demonstrate what it is, and why I’ve been so excited by it.