To weight loss jab or not? Dr Jack Mosley urges caution in new book
Injectable weight-loss drugs have been hailed as a silver bullet in the fight against obesity, but Dr Jack Mosley, the son of the late leading weight loss advocate Dr Michael Mosley, urges caution in his new book.
Weight Loss
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My dad, Michael Mosley, was an inspiration to millions of people worldwide – particularly those living with obesity or type 2 diabetes.
In the afternoon of June 5, 2024 he suddenly disappeared on the beautiful Greek island of Symi.
His disappearance and death came as a huge shock to my mother, my siblings, myself and Dad’s family and friends, but also to many people around the world. He was such a likeable, relatable, familiar face that many felt they had lost a friend.
Dad’s passion was medicine, science and changing people’s lives. He was originally inspired to focus on diet after seeing his own father Bill’s health decline. Bill had a terrible sweet tooth and he suffered from a number of weight-related diseases, including type 2 diabetes, osteoarthritis in his knees, high blood pressure, coronary heart disease and, eventually, mild dementia. Bill made many attempts to improve his diet, including trying The Cabbage Soup Diet and toasting a slice of organic wholegrain bread for breakfast in the misguided hope that it would offset all his many daily indulgences, in particular ice cream.
Sadly, he developed heart failure and passed away at the age of 74.
Naturally, when Dad himself was diagnosed with type 2 diabetes in his 50s he was shocked; but when he managed to reverse that diagnosis by losing 9kg with his now famous 5:2 diet, it was a great relief. Over the 12 years that followed, he and my mum worked together to follow the emerging evidence as the science of weight loss evolved. The books, recipes and the program now known as The Fast 800 are widely used around the world.
Of course, Dad was closely following the new generation of injectable weight loss drugs that had started to appear over the horizon. He was fascinated by the way the jabs were beginning to take over the diet scene, but he had significant reservations.
He would have been extremely wary of the way they are being used at the moment and, had his life not been cut short, I’m pretty sure he would have been writing this book himself.
Like Dad and my mum, Clare Bailey Mosley, I am medically trained. I have long been fascinated by lifestyle medicine and for many years my focus has been on treating obesity – there’s no doubt some of my parents’ passion for the area has rubbed off on me.
While studying medicine at Newcastle University, I was fortunate to complete a Master of Research with Professor Roy Taylor, who was a hero of my dad’s for his pioneering work with type 2 diabetes. Remarkably, Professor Taylor was able to show that type 2 diabetes, a condition that was previously thought to be a chronic and irreversible illness, could be put into remission by following a low-calorie diet. For my dissertation, I interviewed the patients who had been involved in Professor Taylor’s seminal research, exploring the reasons why some were able to keep the weight off and stay out of the diabetic range, and why others struggled.
Since then, I have spent several years working as a doctor in emergency medicine in the UK and Australia, and I now work as a GP registrar. I was working in Australia when the new generation of GLP-1 (Glucagon- Like Peptide-1) weight loss medications began to make a splash on the global stage. Studies showed that semaglutide (the generic drug name for Ozempic and Wegovy) could lead to an astonishing 15 per cent sustained body weight loss in people who were overweight and living with obesity. Results like this, without dangerous side effects, had never previously been seen in a long history of weight loss drugs.
Suddenly everyone was talking about Ozempic and Wegovy, and celebrities, social media influencers and journalists flocked to take the jabs as the word spread. Semaglutide was catapulted into the limelight and quickly became a social media sensation, racking up hundreds of millions of mentions with the #ozempic hashtags on TikTok.
The weight loss jabs looked like they would be a miraculous silver bullet in the fight against obesity. But with demand so high, large parts of the market have become a lawless free-for-all.
People with worrying obesity-related illnesses are self-administering the drug, and increasing their doses to eye-watering levels, without any kind of medical or nutritional advice or support.
Naturally slim people are acquiring pen syringes from black-market suppliers, and using the appetite-suppressant properties to skip meals to get themselves “beach body ready”. Others go “on the pen” to improve their gym-honed physiques, potentially jeopardising their health.
Thousands are joining unsupervised online support groups to chat with glee about how they haven’t eaten anything all day other than a few biscuits in the evening, and are looking to each other for nutritional and dosage advice.
It really has become the “Wild West” out there, with plenty of gun-slinging cowboys selling dangerous or counterfeit products for a quick profit. Although the majority of reputable online pharmacies are selling the correct product – whether that’s semaglutide (Ozempic or Wegovy) or tirzepatide (Mounjaro) – their incentive seems clear: to sell as much of the product as possible and to encourage users to increase their purchase to the highest doses tolerable. These are serious medications and, at the time of writing, we have no long-term studies to show how safe they are to take at higher doses for any protracted period of time.
I’m neither for nor against these medications, but as a doctor I will always urge caution, and I will always back the science. These jabs have arrived on the scene just in the nick of time, though.
Obesity levels worldwide are completely out of control, and we have a major public health issue on our hands.
In parts of Australia, they practise “prescribed burning”, which means setting controlled fires to reduce the flammable bush and grass in a bid to reduce rampant fast-moving bushfires later in the dry season. The focus is on acting early to prevent future disaster. Perhaps this is what the jabs will do.
For many forms of addiction or overconsumption, there are medical treatments to reduce use and so minimise long-term health problems, such as nicotine patches for smoking and methadone for opiate addiction. These weight loss jabs could provide one powerful preventative solution to reduce the numbers of people living with obesity before obesity-related illnesses become an uncontrolled inferno.
The powerful effect of the GLP-1s on reducing appetite has highlighted for many an aspect of their internal monologue they always knew they had, but had rarely acknowledged before – “food noise”. Food noise is the voice in your head telling you to look for your next meal or snack. It is the craving that tells you to eat that chocolate bar, even when you know you shouldn’t. It is a phenomenon that has been brought to prominence by the weight loss drugs – which appear to “silence” them so effectively.
I share my dad’s view that these jabs are likely to be an effective hammer in the toolbox to combat obesity and obesity-related illnesses.
We have never had a pharmaceutical tool in the weight loss management toolbox quite like it. Some of the newest jabs on trial are so powerful, they look more like a sledgehammer!
To continue the metaphor, if you’re doing a bit of DIY, a hammer is a useful tool, but it is not the only tool you need or should use.
It is clear to me that these drugs are best taken to complement positive diet and lifestyle changes. Sadly, that is rarely the case at the moment. The lack of support for people taking the drugs and the shocking scarcity of advice about what to eat to ensure you get the most out of your minimised food intake is the reason I was so keen to write this book.
While the new weight loss drugs may be an excellent way to help prevent the tidal wave of obesity-related health conditions that doctors fear are heading our way, I have concerns that widespread and unsupervised use of these jabs could create a whole new set of societal health problems. Entire populations may inadvertently switch obesity for a state where they are malnourished and frail.
Our junk-food lifestyles mean we have become paradoxically overfed yet undernourished. Yes, the jabs address the fact that we are overfed, but my worry is that they may leave us even more undernourished.
When you lose weight fast, you inevitably lose muscle as well as fat. Unless the millions of people taking these jabs improve the nutritional composition of their diet and take concerted care to protect and build muscle, there could be long-term repercussions for their metabolism and mobility.
The first part of my book unpicks the sinister factors that have contributed to the obesity epidemic and highlights some of the potential downstream consequences of the weight loss drugs. The second part tells you everything you need to know about this fascinating new generation of so-called miracle weight loss drugs: where they came from, how they work, their side effects and shortcomings, as well as surprising, non-weight-related benefits. Finally, in the third part I will set out how to use these medications safely and effectively to lose weight – if that’s your chosen path – and keep the weight off. I unpick the latest research and speak to some of the leading experts in weight loss management, diabetes and nutrition, and look at how to eat healthy, nutritious food, while maintaining your muscle mass. It will show you how to follow a nutritious diet and healthy lifestyle to ensure the best possible long-term weight loss results.
At the back of the book, you’ll find 50 easy-to-follow recipes that have been created by my mum, Dr Clare Bailey Mosley, working with the brilliant food writer Kathryn Bruton. The recipes are both delicious and easy to make, as well as packed with beneficial nutrients.
You’ll also find a week’s worth of meal plans, to help you keep on track and get all the nutrients you need.
Originally published as To weight loss jab or not? Dr Jack Mosley urges caution in new book
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