One of the first effective medication treatments for obesity

24 February 2021

Nearly a third of participants in new study achieved 20% weight loss in 68 weeks.

Prof Barbara McGowan [pictured right] has co-authored a new study that trialled semaglutide medication to treat obesity.

The study has found that one third of its participants achieved 20% weight loss. This is ground-breaking and marks the first double-digit weight loss result for a study trialling the treatment of obesity with medication. Prof Barbara McGowan talks about the study and its results.

Prof Barbara McGowan, please tell us about yourself and role at King’s Health Partners.

I am a consultant in Diabetes and Endocrinology and an Obesity Physician at Guy’s and St Thomas’ NHS Foundation Trust and Honorary Professor of Diabetes and Endocrinology at King’s College London.

I lead the service for complex and severe obesity at Guy’s and St Thomas’ NHS Foundation Trust. This service assesses patients living with obesity and offers them a chance to enter clinical trials offering pharmacotherapy to manage weight, in addition to assessing suitability for metabolic or bariatric surgery.

I am the Research and Development lead for Diabetes and Endocrinology for Guy’s and St Thomas’ NHS Foundation Trust and National Institute for Health Research Clinical Research Network South London, and lead on obesity clinical trials in our Department.

Please could you describe the large-scale international trial and its impacts for improving the health of people with obesity.

The Semaglutide Treatment Effect in People with obesity (STEP-1) trial is a large-scale international trial enrolling nearly 2,000 patients with a BMI of more than 30 or a BMI of more than 27 with co-morbidities. The trial, funded by Novo Nordisk, investigated the effect of giving patients living with obesity and co-morbidities 2.4 mg of semaglutide, a medication that mimics the human gut hormone glucagon-like peptide-1 (GLP-1) which informs the brain when we are full, once a week. The control group was given a placebo, once a week. The medication was administered via a subcutaneous injection. All patients in the trial were also asked to reduce calories by 500 a day and exercise 150 minutes a week.

The results at 68 weeks were impressive, showing in the semaglutide group:

a mean of nearly 15% weight loss
more than 85% of patients achieving more than 5% weight loss
nearly 70% of participants achieving more than 10% weight loss
greater than 50% of people achieving 15% weight loss; and
nearly one third achieving 20% weight loss.

These results are significant and approach mean weight loss values only achievable with bariatric surgery. More than 90% of patients remained in the trial, and the drug was well tolerated.

This is an exciting development as there is currently no effective medication for the treatment of obesity available within the NHS.

What impact do these findings have on improving outcomes for patients in south east London and beyond?

This is the first time that we have an effective and safe drug that achieves double-digit weight loss in patients living with obesity. Currently, with the exception of bariatric surgery, we do not have effective treatments available in the NHS for most patients living with severe and complex obesity. Although the National Institute for Health and Care Excellence (NICE) recently approved the use of daily liraglutide 3.0 mg for a select group of patients, this is half as effective as weekly semaglutide 2.4 mg.

Semaglutide will revolutionise treatment for obesity for large number of patients who are struggling to lose weight with lifestyle changes alone. Its use could help with remission of prediabetes and type 2 diabetes, improving cardiovascular risk factors and management of other obesity-related complications.

What are the next steps for getting this research into practice for patients?

Prescribing patients with obesity 2.4 mg of semaglutide weekly is awaiting U.S. Food and Drug Administration and European Medicines Agency approval and NICE assessment. We need to wait for the drug to be approved so we can start using it to treat our patients. Currently, 1mg dose of semaglutide weekly is available for the treatment of type 2 diabetes and its use has been associated with significant weight loss for this group of patients. Patients with type 2 diabetes and obesity should be considered for GLP-1 agonist therapy to help with management of diabetes and weight.

What do you value most about being part of King’s Health Partners?

King’s Health Partners has an outstanding ability to bring the best healthcare research in the world and translate it into practice for the benefit of patients. King’s Health Partners ethos of always putting the patient at the centre of care delivery is inspirational. It is a privilege to be part of such innovative, cutting-edge and caring clinical academic partnership.

The full publication on these findings is available in the New England Journal of Medicine - Once-Weekly Semaglutide in Adults with Overweight or Obesity.

Our Diabetes, Obesity and Endocrinology Institute is improving health and wellbeing for people living with diabetes and obesity across London and south east England.