Hal Swerissen

Two thirds of us are now overweight or obese. A veritable pandemic of its own! But apart from the social consequences of being ‘fat’ does this matter for your health?

The short answer is yes. In particular, dramatically increasing levels of obesity have led to a rapid increase in the number people with type 2 diabetes. Nearly two million Australians now have the disease.

Type 2 diabetes is associated with a number of health problems. At first blood sugar levels go up, then symptoms like thirst, fatigue, increased urinary frequency, increased hunger and slow healing emerge. Later there can be more serious problems including heart and kidney disease, poor circulation and gangrene, blindness and gum disease.

Type 2 diabetes is one of the nastier consequences of a very overweight population.

It’s caused by insulin resistance. You need the hormone insulin to process sugar for energy. Unfortunately as you become more overweight you produce more insulin and over time cells become resistant to the increase and sugar builds up in your blood stream – and too much sugar leads to nerve damage and a range of serious consequences.

You are more prone to Type 2 diabetes if you have a family history, you’re overweight, have low levels of physical activity and you’re older.

So getting to a healthy weight is a good idea. Ideally your body mass index (your weight in kilograms divided by your height in metres squared) should be between 20 and 25, but the important thing is to take responsibility for your weight and manage it.

But that is often easier said than done. Most of us steadily gain a little weight each year as we get older. At any one point in time more than half of us are trying to lose weight.  Not surprisingly, the temptation of a quick fix is high and some of the new drugs for diabetes look like just the trick. But are they?

Metformin was introduced to treat diabetes about 30 years ago. It reduces the amount of glucose (sugar) in your blood and helps insulin work more effectively, but it doesn’t lead to weight loss. The newer semaglutide drugs do.

Over the last 5 years semaglutide drugs (Ozempic, Wegovy, Rybelsus) have increasingly been used to treat diabetes. These drugs work to counteract the effects of type 2 diabetes by prompting your body to produce more insulin. They can also affect brain centres to reduce appetite leading to significant weight loss.

Not surprisingly, demand for semaglutide has gone viral. Huge numbers of people without diabetes are being prescribed drugs like Ozempic ‘off label’ to lose weight. Instagram is full of testimonials on how effective it is. Elon Musk credits semaglutide for his ‘ripped’ body!

In response, demand has increased so much that Novo Nordisk, the Ozempic manufacturer ran out of stock last year and stocks are still limited in Australia. Currently, priority is being given to people with diabetes rather than others who want to lose weight.

But as is so often the case with new ‘wonder drugs’ semaglutide is being oversold. True, many people lose weight while they are taking the drug, but there are a number of problems. First you have to inject the drug weekly and not everyone likes injections. Next there are a range of common side effects including tiredness, dizziness, headache and stomach problems. About 10 percent of people stop taking it because of these problems.

Most importantly, the weight loss doesn’t last when you stop taking semaglutide. Without ongoing change to your diet and exercise, you are likely to rapidly regain the weight once you stop. You could keep taking it, but the long term negative effects of the drug are unclear and may include gall bladder disease, kidney failure pancreatitis and cancer.  Long term use risks may be worth it if you have a nasty disease like diabetes, but may not be if you don’t.

If we want to stop the obesity epidemic we are going to have to regulate the food industry to reduce the availability of processed food high in salt, fat and sugar and make healthier food choices much easier.  But in the meantime, people who are already over weight and obese still need help to manage their weight particularly when they have type 2 diabetes.

The good news is that it is possible to lose weight and get and stay healthier. At the very least it’s a good idea to put a stop to the gradual weight gain that many of us experience as we get older. Getting some regular physical activity is a good idea too.

Although it’s not easy, many people manage to get their weight under control and get a bit more exercise. But beware of fads. They don’t work and often make things worse. Successful change to diet and exercise has to become part of your ongoing everyday life.

If you’re interested, good online advice is available from the Diabetes Australia and LiveLighter websites.

Apart from checking good quality online information, it’s often useful to get some professional support from a GP, a diabetes educator or a dietician. They can help you set up a plan and provide you with support and advice. It’s even better if you can join a group of people tackling the same problem together who can provide support for one another.

Hal Swerissen is Emeritus Professor of Public Health at La Trobe University