The centuries-long search for a miracle weight loss remedy appears to be over. Ozempic, Mounjaro and the other wonder drugs have burst onto the scene and captured the public imagination – especially on social media – by promising an easier route to a slimmer waist than the latest TikTok workout challenge. But widespread awareness and online —misinformation present dangers to patients and public health, which is proving to be a huge challenge for health professionals everywhere.
GLP-1 drugs were designed to help people with type 2 diabetes reduce their blood sugar levels by mimicking the actions of the naturally occurring GLP-1 hormone. The same hormone also slows digestion and triggers the brain to make you feel fuller after eating. Researchers soon realised that GLP-1 drugs were causing diabetic patients to lose weight – and fast. By chance, a blockbuster weight-loss medication was born.
Broadly speaking, in the Gulf, GLP-1s are prescription-only medications restricted to diabetics whose obesity is an aggravating factor for their condition. But there is evidence to suggest that some clinicians in the region are following a global trend in being overly generous with their interpretation of prescribing guidelines. There is also evidence that some pharmacists have not played by the rules at all: in November 2021, Bahrain’s medicines regulator issued a severe rebuke to pharmacists who were dispensing GLP-1s to patients who did not have prescriptions.
GLP-1s can cost between $1,000 and $2,000 per month of treatment, so only the wealthiest among us could seek to secure genuine drugs without a prescription. Unfortunately, those of lesser means might be tempted to turn to the black market in the form of an unregulated online shop, or a social media influencer peddling cheap fakes as the real deal.
Rich or poor, patients who seek to buy genuine GLP-1 drugs without a prescription or a proper treatment plan are taking a huge risk. Emergency rooms in the Gulf are reportedly seeing rising numbers of patients suffering from complications after self-administering genuine GLP-1 drugs. Indeed, this is a problem in many parts of the world. In November last year, a genuine GLP-1 drug was listed as a contributing factor in the death of a 58-year-old nurse in the UK, who had taken only two low-dose injections.
Meanwhile, the World Health Organisation has warned that social media platforms and other unregulated outlets are selling fake GLP-1 drugs that could be toxic. A woman who bought an unlicensed version of Ozempic from an Instagram influencer said she fell seriously ill and vomited blood.
There is also a broader public health concern: unregulated or lax distribution of GLP-1s means that researchers cannot collect the data they need to assess their long-term effects on weight loss patients, nor their affect on Gulf populations specifically. I am not aware of any large-scale research project of this kind in the region; indeed, we have no idea how many people in the Gulf are using GLP-1s for weight loss. In the same way that some people are genetically inclined to become obese, some may be genetically inclined to react badly to a particular medication — even one that has a strong safety record to date.
This is not to say that GLP-1 drugs are “bad”. It is fair to class them as wonder drugs because they are effective at reducing the appetites of overweight patients if used in tandem with diet and exercise programmes. Research supports this, and I have seen it with my own eyes in my own hospital.
Nor is it to say that GLP-1 drugs should not be used for weight-loss purposes. If safety research supports their widespread use in Gulf populations, they could be key to helping us fight the obesity epidemic in the region.
More than half of adults in GCC nations are overweight or obese. Tackling obesity is central to health policy across the region, because less obesity means people live longer and enjoy a better quality of life. It also means that pressure is relieved on health systems struggling under the enormous burden of treating the many complications caused by obesity. Reducing the number of overweight people in the GCC by 5 per cent over the next five years would save 50,000 lives and $100 billion in the subsequent decade, according to one estimate.
In my hospital in Saudi Arabia, we are seeing demand from overweight patients who want to be treated with GLP-1 drugs. Presently, we do prescribe GLP-1s but only for diabetic patients. It is a worry of mine that patients who want to use GLP-1 drugs but are not prescribed them may seek to obtain them from alternative or unregulated sources, including the black market.
Medicines regulators across the Gulf are co-ordinating efforts to regulate the distribution of GLP-1 drugs and prevent illegal sales. The region’s healthcare leaders and insurance companies are introducing guidelines to manage the prescribing and distribution of GLP-1s to ensure exercise and diet management are central to therapy. However, hospitals, primary care physicians and other healthcare providers that prescribe GLP-1s need to collaborate and collect the data that is desperately needed for crucial research.
We need to know who is taking GLP-1s, what effect their treatment has on their weight, and whether they suffer side-effects – and we need to collect this data on a regional scale. If research addresses questions about the long-term safety of GLP-1 drugs and their effects on Gulf populations, healthcare providers across the region would be able to relax prescribing guidelines to treat a wider group of patients. They would also be better positioned to subsidise these expensive medicines, ensuring treatment is available to patients of lesser means but greater need.
As patents expire on GLP-1 drugs in the coming decade, generics manufacturers will release affordable copies, cutting the cost of the drugs to patients, healthcare providers and governments alike. In other words, millions more people in the Gulf will be able to access GLP-1s in the not-too-distant future. And doctors may soon be prescribing GLP-1s for more than just diabetes and obesity: clinical trials suggest GLP-1s are effective at preventing chronic kidney disease and treating sleep apnoea, a breathing disorder. Meanwhile, tests are under way to see if GLP-1s can be used to treat Alzheimer’s disease, addiction, substance abuse, long-term infections and liver disease.
GLP-1 drugs are not just a medical sensation but a cultural phenomenon, and demand for them will only continue to rise – as will the risk to public health if access to them is not adequately restricted and data is not collected for essential research.
