What’s the buzz?
The UK seems to be going mad about weight loss drugs at the moment. The newspapers publish enthusiastic or shock-and-scare stories about them every week, whilst Minister for Health, Wes Streeting, has even said – one has to admire his optimism – that he’ll use them to get overweight unemployed people back to work.
A weight-loss drug that works, and is safe, has been the holy grail of big pharma for decades. The target audience is huge (pardon the double entendre) and the potential profits are equally vast. From the “sanitised tapeworm eggs” advertised in the Victorian era (which some people claim never really happened) to the amphetamines of the 1970s and illegal thyroid pills of the 1980s, the potential for money-making from weight loss has never waned.
But have we finally got weight-loss drugs without a downside?
Weight Loss Injections and Drugs in the UK: Saxenda, Wegovy and Orlistat
The drug options for weight loss include injections or tablets. Whilst there’s definite evidence that they help people lose more weight, the amount of difference they really make may be disappointing to many people. The fact also remains that they only work if you are also dieting hard and exercising regularly – so they give a weight-loss regime a little boost, rather than being the miracle some people think they are.
Saxenda (Liraglutide)
How do you take it? You need an injection once a day.
How does it work? The drug works in two ways, making your body more inclined to burn up calories as energy, and making your stomach remain full for longer after eating. Saxenda contains liraglutide, a GLP-1 (glucagon-like peptide-1) receptor agonist which was originally invented to treat type 2 diabetes. It helps the body make extra insulin when it’s needed, which encourages you to use up calories by giving you more energy. GLP-1 is a hormone involved in blood glucose regulation and appetite control. By mimicking this hormone, liraglutide can also slow down the time it takes for the stomach to empty, making you feel fuller for longer.
How effective is it? Studies indicate that patients using Saxenda, along with a calorie deficit diet and extra exercise, can lose up to 5-10% of their body weight over 5 months. This is better than the placebo group who were not getting any Saxenda, but it’s hardly miraculous. Someone who started out weighing 15 stone would get down to 14 stone 3 pounds at this rate.
What’s the downside? Common side effects include nausea, vomiting, and constipation. This is to be expected when something slows the movement of your digestive system right down, keeping food in your stomach potentially for hours longer than usual. It’s a particularly severe side-effect in people who already have acid reflux problems or a hiatus hernia. Saxenda has also been found to cause pancreatitis and gallbladder-related issues in some people.
Wegovy (Semaglutide)
How do you take it? You have an injection just once a week rather than every day.
How does it work? Like Saxenda, Wegovy also acts as a GLP-1 receptor agonist, but it’s stronger.
How effective is it? In clinical trials, semaglutide was remarkably effective, with participants losing an average of 15-20% of their body weight over 68 weeks when combined with lifestyle interventions that included diet and exercise.
What’s the downside? Side effects are similar to those of liraglutide, including acid reflux and nausea, tummy pains and constipation, and an increased risk of gallstones. Concerns have also been raised about potential long-term impacts on the pancreas.
Orlistat
How do you take it? Orlistat comes as tablets, and it’s more widely prescribed than the injections.
How does it work? It works by inhibiting pancreatic lipase, a key digestive enzyme for breaking down dietary fats. By blocking this enzyme, Orlistat stops us being able to absorb the fat we eat, which overall reduces the calories we can take in from our food.
How effective is it? Orlistat has been shown to support weight loss of around 5-7% of body weight over a year. The effect is much more modest than the injectable GLP-1 receptor agonists, partly because you will still absorb all the calories from carbohydrates and protein.
What’s the downside? When we don’t absorb fat, it passes through the whole intestine and comes out in our stools, which means Orlistat mimics the symptoms of gallbladder disease. After eating those fatty foods that will miraculously become calorie-free for you thanks to Orlistat, your bowel movements will float, smell foul, and glue themselves to the toilet bowl. You should also brace yourself for griping tummy aches, diarrhoea and periodic attacks of severe flatulence.
Those readers who take an interest in nutrients will also know that vitamins A, D, E and K are obtained from fat only. Research has found that Orlistat significantly reduced the absorption of vitamin E (by 43% to 60%), but not that of vitamin A, at the dose levels studied. Its effect on vitamins D and K have not been measured, so beware of osteoporosis!
Natural Supplements: Berberine and Apple Cider Vinegar
Natural supplements are less well-researched than the prescription drugs – they’re far cheaper, so no surprise there. So far, research suggests they definitely work, but seem to have a milder effect than the alternatives from big pharma. Their attractions to some people include the fact they are very easy to buy, cheaper and generally safer options.
Berberine
How do you take it? Food supplement capsules, readily available online. Berberine is an alkaloid extracted from various plants, including goldenseal and barberry.
How does it work? Berberine works in two ways, which are similar to Saxenda and Wegovy but with a milder effect. It makes your body more inclined to burn up calories as energy, and makes your stomach remain full for longer after eating. It has been shown to activate AMPK (adenosine monophosphate-activated protein kinase), an enzyme that regulates energy balance and metabolism. This activation may improve insulin sensitivity, promote fat breakdown, and reduce inflammation. Berberine can lower blood sugar levels, and must not be taken with drugs to treat diabetes – such as Metformin – as its effects are very similar.
How effective is it? Research on berberine has shown modest weight loss effects. A meta-analysis of studies suggests that berberine can contribute to a reduction in BMI and body weight, but results are not as dramatic as with GLP-1 agonists.
What’s the downside? Berberine has fewer reported side effects than the pharmaceutical weight loss drugs. Since it slows down stomach emptying, however, it can cause acid reflux, nausea and constipation. It does cause diarrhoea in some people, or general abdominal discomfort. It may also interact with certain medications, including those that impact liver enzymes.
Apple Cider Vinegar (ACV)
How do you take it? Bottles of vinegar in supermarkets, or as food supplement capsules, readily available online.
How does it work? ACV contains acetic acid, which may reduce blood sugar spikes after meals and improve insulin sensitivity. Acetic acid may also delay gastric emptying, keeping the stomach full of food for longer after meals and so encouraging you to eat less.
How effective is it? Studies on ACV for weight loss suggest minor benefits. A Japanese study found that participants who took ACV daily lost modest amounts of weight compared to a placebo group, but these results were small in magnitude.
What’s the downside? ACV is generally safe when used in moderate amounts, but the acidity level means it can damage tooth enamel due to its acidity. It can also cause stomach irritation. Excessive use may also lead to low potassium levels and interact with medications like insulin and diuretics.
Weight Loss Drugs vs. Natural Supplements: How do they compare?
Mechanisms and Efficacy
The main advantage of pharmaceutical injections like Saxenda and Wegovy is that they have a greater effect than the herbal alternatives. This is due to the targeted mechanism of GLP-1 receptor agonists. In contrast, berberine’s AMPK activation and ACV’s acetic acid effects offer more indirect metabolic benefits and result in modest weight loss at best. While berberine and ACV can support metabolic health, they lack the powerful appetite suppression and fullness effects provided by GLP-1 agonists.
Safety Profile
GLP-1 agonists like Saxenda and Wegovy present a more complex safety profile, including potential risks for pancreatitis and gallstones. By comparison, berberine and ACV, although causing some digestive side effects, are generally considered safer for broader, long-term use. However, excessive or inappropriate use of ACV can lead to serious dental and metabolic issues.
Cost and Accessibility
In terms of cost, natural supplements like berberine and ACV are affordable and widely available over the counter, making them accessible to almost everyone. In contrast, GLP-1 agonists are prescription-only. Whilst there’s much talk of the NHS providing these drugs, the current criteria for obtaining them are extremely restrictive, and likely to remain so until the cost comes down. Currently, the NHS is providing them to people who have already gone to weight loss groups that prove they’re willing to stick to a diet an exercise regime – otherwise the drugs won’t work – and who also have obesity severe enough that NOT treating it will cost the NHS more in the long-run, in the form of obesity-associated diseases.
Conclusion: Which is best for weight loss, drugs or natural supplements?
It’s clear that the pharmaceutical drugs have a stronger effect, and also a greater risk of side-effects. None of the drugs or supplements we’ve looked at will work unless you are also dieting to a calorie deficit, and also exercising to lose weight.
Given this, our view is that the natural supplements are probably the starting point for everyone, and the drugs may be a second resort to people who find that gentler supplements aren’t have enough of an effect.
This is a personal view. You should always speak to a medical professional before using medications for weight loss and seek expert advice that’s tailored to your personal situation.
