Food and nutrition experts call for holistic support for anti-obesity drugs

02 May 2024 --- The British Dietetic Association (BDA) and the British Nutrition Foundation (BNF) recommend that GLP-1 and GIP receptor agonist medication are offered alongside a reduced-calorie diet and increased physical activity for adults with obesity or type 2 diabetes and call for equal access to the medicines. They urge the food environment to change and “make it easier to eat healthier diets,” as drugs are not the solution to growing obesity rates.

In a joint statement, the organizations support using glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP) receptor agonist medications as long as they are prescribed safely and appropriately. 

They note “considerable evidence” supporting their efficacy on clinically significant weight loss, improvement in glycaemic control, cardiorenal protective benefit and improved quality of life. 

“GLP-1/GIP receptor agonists are a brilliant addition to the toolbox for treating obesity when prescribed alongside a reduced-calorie diet and increased physical activity,” comments Caroline Bovey, registered dietitian and chair of the BDA. 

“However, it is entirely unfair if some people can access them while others, who would truly benefit from them, can’t. Budgets and postcodes shouldn’t be a barrier to weight management support.” 

Rewinding the obesity pandemic  
The BNF and BDA highlight that prevention is critical in obesity and type 2 diabetes management. They underscore the need for public health policies and whole systems approaches to improve the food environment, cost and access to healthy foods, mitigate food insecurity and reduce health inequity. 

At the same time, these medications offer an “important treatment option to help reduce the risk of developing related chronic non-communicable diseases and achieve clinically significant weight loss.”

Sara Stanner, science director at the BNF, adds: “For people living with obesity, this will be a valuable and important tool in the toolbox. But alongside treatments, we must continue to focus on prevention and find effective solutions to tackle the underlying factors contributing to obesity, promoting equitable health improvements across all stages of life.”

The BNF and BDA call for food environment changes to make it easier to eat healthier diets to rewind growing obesity rates.Both organizations hope that, where indicated, these medications can be prescribed for the long term. Last year, research showed that two-thirds of GLP-1 consumers stopped the treatment within one year, as costs are too high. 

The statement underscores: “There is a need to stop stigmatizing people living with obesity by only offering them what appears to be time-limited support.” 

At the same time, the BNF and BDA note that a long-term evaluation of the medications’ safety and effectiveness is needed. 

“As our joint statement outlines, while these medications are an important step forward, they will not address the source of the issue,” comments Bovey. “We still need serious investment from the government to ensure everyone has the right to affordable, healthy food and that public health policies and whole system approaches make a real difference.”

Holistic support 
Both organizations underscore the importance of holistic support and management from a multi-disciplinary team — including physicians, psychologists and specialist dietitians — to treat obesity and type 2 diabetes and help patients make and sustain required dietary and other lifestyle changes. 

“Dietary and physical activity advice that promotes maintenance of muscle mass and function is key alongside behavior change support; people should not be prescribed the medication alone,” reads the statement. 

With the medication, patients should also receive behavior change support, and advice on diet and physical activity.The organizations also call for an assessment of potential contraindications to medications, such as eating disorders and mental health risks. Moreover, they ask that the wider family and social context be considered. 

For people who cannot tolerate the medications or who have contraindications, the BNF and BDA ask to provide access to comparable support services. Moreover, they emphasize that “care including dietary and behavior change support should continue as long as indicated and beyond medication cessation.” 

Equal access 
According to the BDA, until everyone can benefit from these medications, irrespective of postcode or budget, “their success will be limited.” 

In the UK, medication access varies substantially, with broader access in Scotland and limited access in England and Wales through the country’s National Health Service (NHS). In some areas of England, people “don’t have any access to these medications unless they can afford to go privately.” 

BDA’s Bovey adds: “We’re encouraged that the Government is looking to expand the use of these important medications into Primary Care. However, it is absolutely essential that this is done fairly, consistently and at pace across the UK.”  

“We need to ensure those desperately in need of support are offered these medications as part of the comprehensive and fully inclusive treatment options available within the NHS,” she concludes. 

By Jolanda van Hal