We explore the rising popularity of so-called “skinny jabs” in aesthetic practices, how prescription medications can help with weight management and what the risks are.
One of the latest trends to be sweeping across aesthetic clinics is medical weight loss injections, or the so-called “skinny jab”.
In fact a TikTok-fuelled stampede for a pioneering obesity drug is so high that it has resulted in a global shortage of the medication.
Weight loss injections are different to injection lipolysis, they don’t melt away or destroy fat cells, rather they mimic a naturally occurring hormone known as glucagon-like peptide 1 (GLP-1) that is released in the gut after eating. This hormone acts on receptors in the brain which controls the appetite, giving an individual the sensation of being full and sated. By combining treatment with a reduced calorie diet and increased physical activity, patients can achieve and maintain their weight loss goals, boosting confidence and self-esteem and giving them an opportunity to live a healthier and happier life.
One of the main players in the market is Danish company Novo Nordisk, who launched liraglutide for the treatment of type II diabetes (T2D) under the name Victoza in 2009. Noticing patients were also losing weight, liraglutide was then licensed for the treatment of obesity under the name Saxenda and launched in the UK in January 2017.
In the last couple of years, weight loss injections have become even more popular, particularly since the launch of Novo Nordisks’ longer-acting GLP-1 semaglutide, which is a once-weekly rather than daily injection licensed for the treatment of T2D under the name Ozempic in 2018. This drug is currently being prescribed “off-label” for weight loss whilst we await the much-anticipated launch of Wegovy in Q1 of 2023 – the licensed form of semaglutide to treat patients living with obesity, which was approved by the Medicines and Healthcare products Regulatory Agency (MHRA) earlier this year, when clinical trials found it helped trial participants lose an average of 15% of their body weight.
Endocrinologist and Chief Medical Officer for Learna, Professor Steve Davies explains, “It is a whole new world in terms of weight management. We’ve seen an evolution over the last 10 years of GLP-1 analogs. GLP-1 stands for glucagon-like peptide-1, which is released from the small cells of the intestines. So when food comes through, it causes a degree of stretching in the small intestine, the body releases GLP-1. GLP-1 acts on the arcuate nucleus in the hypothalamus, and as a consequence of that, results in satiety but it usually only lasts a short period of time. By developing analogues of GLP-1 that last longer, people feel full for longer and therefore eat less. Novo Nordisk developed liraglutide, associated in its highest dose, with 8% weight loss. Then came semaglutide a once-a-week injection that, at its highest dose associated with a 15% reduction in weight. So you’re getting almost like bariatric surgery results.
“Interestingly, there’s a new drug produced by Lilly called Tirzepatide. Tirzepatide is a once weekly injection of a GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) analogue where you are looking at a 22% reduction in weight. That’s significant. It is almost a Nirvana in weight management.”
One of the key things with these drugs is medical oversight, and practitioners are concerned about how readily available it is online. Dr Shirin Lakhani comments, “One thing that really worries me is the availability of these drugs through online pharmacies. Patients can lie about their medical history and BMI and get hold of it without any medical oversight.
“It may seem quite easy because you’re not hungry, but without support and lifestyle change, people will end up just bouncing on and off the pens as they did with diets. I do a separate weight loss consultation when we go through their eating habits and the emotions around their eating and things like that. It’s also important to remember there are risks, so the patient should be properly assessed first to ensure they are a suitable candidate.”
Medical oversight is also important due to the side effects patients can experience, such as nausea, vomiting, constipation and diarrhoea.
Sandy Green from the National Medical Weight Loss Programme (NMWLP), which is the UK’s leading training provider for obesity management offering the only weight management training course to be accredited by The Strategic Centre for Obesity Professional Education (SCOPE), comments,
“I am very excited about the future of weight loss medicines and the hope they bring to the many millions living with the daily stigma that obesity brings. Bariatric surgery has long been seen as the gold standard for those hoping to lose weight and reduce cardiovascular risk, but according to many experts, this gap is fast closing with the advent of next generation GLP-1s.”
While Novo Nordisk are the forerunners in the race to cure obesity, other major manufacturers are in fast pursuit. In October of this year, the MHRA approved a new drug for the treatment of T2D; tirzepatide (brand name Mounjaro), manufactured by Eli Lilly. While tirzepatide does not currently hold a licence to treat obesity, in clinical trials it was superior to semaglutide (Wegovy), delivering an average of almost 23% weight loss in patients with obesity.
So what does all of this mean for healthcare professionals (HCPs) working within medical aesthetics? It means there is a growing opportunity to establish safe, effective and evidence-based weight management services to help people living with obesity. The NMWLP welcome HCPs to complete their accredited training and join their community of experts who are sincere in their pursuit of treating this disease.
While medical weight loss injections seem to offer exciting possibilities, like many treatments in aesthetics, it’s not without its controversies, and caution should be taken. Clinics should remember, as these injections are POMs, they are also subject to the same advertising regulations as any other drug.
Furthermore, HCPs based in England should be aware that offering a medical weight loss service using prescription medication is a regulated activity, and as such clinics are required to register with the Care Quality Commission (CQC). Likewise, HCPs in Scotland, Wales and Northern Ireland should contact their appropriate regulatory body to discuss local requirements before setting up this service.
