In recent years, weight loss medications such as semaglutide — known under brand names like Ozempic and Wegovy — and tirzepatide (Mounjaro) have surged in popularity, marking a significant shift in approaches to managing obesity. Dr Jack Mosley, a general practitioner registrar, has spoken out about the emerging challenges and misconceptions surrounding these drugs. Notably, Dr Mosley’s observations are influenced by personal experience; his father, the BBC presenter Dr Michael Mosley, who passed away in June last year on the Greek island of Symi, had expressed concerns about the rapid rise of these medications and the way they are managed.
Reflecting on his father’s views, Dr Jack Mosley said, “He could see they were a groundbreaking treatment because there’s such a long history of all these slightly dodgy pills and potions that they used in the past. But he was still concerned about how they were currently being managed, and the fact that there is a wild west of online pharmacies.” His father’s caution related partly to the way these drugs are increasingly accessed via various online platforms, where regulation and dosage recommendations can vary widely.
Dr Mosley emphasises that these weight loss medications were originally designed for people with a body mass index (BMI) over 30, or for women over 27 with an obesity-related disease, and are not intended as a quick fix for shedding a few kilos. He warns, “People are being ramped up really high doses, and some of them are getting more significant – or even intolerable – side effects. Unfortunately, the way a lot of these online pharmacies work is they make more money the higher the dose, so the incentive is quite clear.”
In his recently published book, Food Noise: How Weight Loss Medications and Smart Nutrition Can Silence Your Cravings, Dr Mosley explores the appropriate use of these drugs and how to incorporate healthy lifestyle changes alongside their use. “My dad was a massive inspiration to me, and his mission was empowering people to make healthy choices and change their habits in a way that could improve their life, and I’ve tried to do the same,” Dr Mosley said.
He outlined key points that people should understand about weight loss medications. While these drugs can effectively reduce appetite and cravings, facilitating weight loss, they are not a magic solution. Dr Mosley explained, “I think people just see these drugs as a magic fix. So they take the injection, and they kind of just go along with their lives, and they don’t make the lifestyle changes. They don’t appreciate them as these powerful drugs they are.”
Regarding side effects, users may experience nausea, vomiting, diarrhoea, and constipation, due to these drugs' effects on slowing bowel movement. “If people continue to eat how they did before, they’ll actually get much more significant side effects, which could lead to poor compliance,” Dr Mosley said.
Another important risk associated with weight loss medication is malnutrition. Dr Mosley cited a study from The Lancet indicating that about 50% of people living with obesity in America have some form of micronutrient deficiency. “We’re overfed and undernourished,” he said. He stressed the need to consume nutritious meals while on these medications, warning against the dangers of losing weight on a diet composed of processed junk food. “You may even lose weight on a processed junk food diet [on the drugs] but the problem is, if you’re just eating a smaller bowl of chips, you may end up with downstream consequences – some degree of malnutrition.”
Muscle loss is an additional concern. Weight reduction often includes the loss of lean body mass, particularly muscle, which can constitute 25% to 40% of the lost weight. Muscle is critical for long-term health, mobility, and managing blood sugar levels in conditions like diabetes. Dr Mosley notes, “Muscle is so important. It’s a major predictor of a long lifespan, but also health span... it reduces your risk of falls.”
Exercise, particularly resistance training, is recommended to preserve muscle mass during weight loss treatment. Dr Mosley suggested simple home exercises such as press-ups and squats, or the use of resistance bands, to protect muscle.
When it comes to diet, Dr Mosley encourages a Mediterranean-style diet rich in olive oil, nuts, seeds, oily fish, fruits, vegetables, and pulses like chickpeas and lentils. “It’s got plenty of protein, healthy fats, fibre and micronutrients,” he said. This approach not only supports better health and potentially greater weight loss during treatment, but also aims to make weight management sustainable after stopping medication. He added, “Avoid processed junk food. Some people actually say they have significant side effects when they do overeat these foods [while on weight-loss medication].”
Addressing emotional eating, Dr Mosley highlighted that these drugs do not necessarily curb non-hunger-related food consumption. “There’s multiple reasons we eat,” he said. “One of the big drivers is simply appetite... But our cravings – that internal food monologue... can be turned up if you are hungry, but plenty of people eat even when they’re not hungry.” He pointed to stress as a major factor in such eating patterns and recommended stress-reducing activities including exercise, meditation, mindfulness, yoga, and bouldering.
A further challenge is maintaining weight loss after ceasing medication. Dr Mosley explained, “We know from some of the studies that people can put on two thirds of the weight they lost within the first year.” He likened the drugs to “noise-cancelling headphones” that reduce cravings while in use, but with the potential for cravings to return strongly once the medication is stopped. To mitigate this, he emphasises the importance of making lifestyle and dietary changes during treatment, such as removing processed junk food from the home and planning meals ahead to avoid reverting to previous habits.
Dr Jack Mosley’s book, Food Noise: How Weight Loss Medications And Smart Nutrition Can Silence Your Cravings, is published by Short Books, priced £16.99, and is available now.
Source: Noah Wire Services