An estimated 2.6million people in the UK already use fat jabs to tackle their weight problems.
But that could be eclipsed by demand for new versions of the drugs in pill form.
The first of these, an oral variant of the Wegovy jab, was approved earlier this month by the Medicines and Healthcare products Regulatory Agency (MHRA) and is available privately at around £100 a month. In the US, where the Wegovy pill was given the green light earlier this year, there were three million prescriptions in the first five months alone.
Meanwhile, Foundayo, another weight-loss pill version of the fat jabs (made by the company that produces Mounjaro), is expected to be available in the UK later this year.
While 2.6 million people in the UK use fat jabs already, that number could be eclipsed by demand for new versions of the drugs in pill form
Wegovy Pill
What is in it?
Contains semaglutide – the same drug used in the Wegovy jab. It is made by Novo Nordisk.
How do you take it?
Once a day on an empty stomach with a little water and at least 30 minutes before eating. You start on a dose of just 1.5mg but, depending on how you respond and only on doctor’s orders, this can be gradually increased every 30 days to a maximum of 25mg.
How does it work?
Like the jab, it contains semaglutide, a drug which mimics the action of our GLP-1 gut hormones – telling receptors in the brain to reduce appetite and slow gastric emptying, making you feel fuller for longer.
However, it also has a special ‘carrier’ molecule – called salcaprozate sodium (SNAC), which protects the drug against the harsh acidic environment of the stomach so it can be fully absorbed into the bloodstream (the jab version goes into subcutaneous fat and passes directly into the bloodstream).
How much weight can you lose?
It can vary, but an average 16.6 per cent of bodyweight. For example, if you weigh 16st 7lb (106kg), you could expect to lose around 2st 7lb (17.7kg) over 64 weeks on the highest dose of 25mg a day, according to trial data in the New England Journal of Medicine last September.
This is slightly less than the overall average reported for Wegovy jabs (19 per cent on a once weekly 7.2mg jab). However, a third of the obese volunteers in the pill trial managed to lose 20 per cent or more.
Any other health benefits?
As with GLP-1 jabs, patients on the Wegovy pill experienced significantly improved HbA1c (a three-month average of the sugariness of their blood), lower blood pressure and a slimmer waist.
Blood pressure, for example, dropped by an average of 6.8mm/Hg for systolic (the top number, which measures the maximum pressure your blood exerts against artery walls when your heart beats) and 2.7mm/Hg for diastolic (pressure between beats).
Average waist circumference declined by 12.2cm (or almost 5ins), and fasting plasma glucose – or the amount of sugar in your blood after not eating or drinking for eight hours – dropped by 6.6mg/decilitre.
Meanwhile, total cholesterol scores came down by an average of just over one per cent, and levels of triglyceride blood fats – known to raise the risk of heart disease – dropped by just under one per cent.
Like the jab, the Wegovy pill contains semaglutide, a drug which mimics the action of our GLP-1 gut hormones
Side-effects
Trial data found 74 per cent of those on the Wegovy pill had gastrointestinal side-effects compared with 42 per cent in a placebo group.In most cases these were mild and this is comparable to jabs, including Wegovy. Seven per cent quit Wegovy pills due to side-effects such as nausea, sleep disorders, vomiting, abdominal pain and indigestion. But the drop-out rate was almost the same – six per cent – in the placebo group.
When will it be available?
Private online pharmacies are now supplying the Wegovy pill. Availability on the NHS would depend on approval by NICE, so the earliest it could be prescribed would be 2027.
Cost
Asda’s online pharmacy, for example, charges £98.97 a month for 1.5mg doses and £118.97 for 4mg. Higher doses are coming soon – these will cost £128.97 a month for 9mg and £188.97 for 25mg.
Pros
Greater weight loss than Foundayo (up to 20 per cent over 64 weeks, compared with 12.4 per cent for Foundayo over 72 weeks).
Cheaper than Wegovy injections.
Lowers blood pressure and glucose levels.
Cons
Has to be taken at least 30 minutes before eating. ‘Otherwise less of it will be absorbed as food dilutes the SNAC protective layer,’ says Professor Yeo.
Must be taken daily (the jab’s once a week).
Likely to be more expensive than Foundayo because of its manufacture – it’s a modified peptide hormone which is more difficult to make; Foundayo is a white powder drug made by chemical reaction, therefore cheaper.
It can affect other medications that need to pass through the stomach quickly because it slows down stomach emptying.
Patients on GLP-1 jabs experience improved HbA1c (a three-month average of the sugariness of their blood), lower blood pressure and a slimmer waist
Foundayo, another weight-loss pill version of the fat jabs (made by the company that produces Mounjaro), is expected to be available in the UK later this year
Foundayo Pill
What’s in it?
Contains orforglipron. Made by Mounjaro manufacturer Eli Lilly.
How do you take it?
Once a day and at any time of day. The starting dose is 0.8mg but this can be increased every 30 days up to a maximum dose of 17.2 mg.
How does it work?
Like the Wegovy pill, orforglipron (the active drug in Foundayo), mimics GLP-1 but, unlike Wegovy, it is a small molecule drug that’s chemically stable. This means stomach acid doesn’t destroy it, so it doesn’t need a protective coating.
How much weight can you lose?
An average 12.4 per cent of bodyweight (27.3lbs) over 18 months, so less than the Wegovy pill, according to trial data. However, those who had previously lost weight on jabs but then plateaued managed to maintain 75 to 80 per cent of their weight loss up to 52 weeks by then taking Foundayo instead.
Any other health benefits?
It reduced volunteers’ waistlines by an average 4.4ins (11.1cm) and lowered systolic blood pressure by an average 6.7mmHg (comparable to the Wegovy pill).
Levels of harmful blood fats called
triglycerides fell 21.6 per cent and non-HDL cholesterol (which includes ‘bad’ LDL cholesterol) readings dropped by 8.5 per cent.
Side-effects
Between five and 10 per cent of patients – depending on the dose – quit the drug due to nausea, constipation, diarrhoea, vomiting, indigestion and stomach pain, though most said the effects were mild to moderate.
Others included headache, tiredness, belching, heartburn, wind and hair loss (these are similar to those reports for Wegovy).
Professor Yeo says it’s not fully clear if one pill has more adverse effects than the other – as there are currently so few Foundayo users.
‘I’m not concerned for now, and time will tell if there are actually more side-effects.’
When will it be available?
it is expected to become available privately in the UK in later this year and is currently being reviewed by the medicines watchdog, the MHRA.
The drug will have to be appraised by the National Institute for Health and Care Excellence (NICE) before it can be made available on the NHS.
Cost
Currently only available in the US for around $147 (£111) a month for the lowest dose of 0.8mg. In the UK it’s expected to be cheaper than injectable GLP-1s.
Pros
Can be taken at any time of day and ‘without food restrictions, which is more convenient than the Wegovy pill’, says Professor Yeo.
It’s a simple powder that means it will be cheaper to make, ‘so, when it eventually goes off patent [potentially around 2039) it will cost pennies,’ says Professor Yeo.
May help those who have plateaued on fat jabs to maintain most of their weight loss, ‘so I suspect the better-off will use it as a cheaper follow-on to injections’, says Professor Yeo.
Cons
Less weight loss on average than with the Wegovy pill
Has to be taken daily (unlike the weekly jabs)
Slightly higher drop-out rate on higher doses due to unwanted side-effects than with Wegovy pill.
