The Sunday Telegraph Sunday 11 August 2019 *** 21
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A
ccording to the NHS, 29 per cent of UK
adults are now obese – up three per cent
from 2016. Add in those who are
overweight as well, and it accounts for two-
thirds of the UK adult population. The well-worn
advice to “eat less, move more” is, to be frank,
not cutting it.
But could a new hormone injection for obesity
be the game-changer we need?
The therapy – developed by a team at Imperial
College London and announced last week – is a
combination of three hormones, dispensed for 12
hours a day via an insulin-style infusion pump.
This is attached to the stomach with a patch for
16 weeks. The jab mimics the effects of a gastric
bypass with no need for an operation – and while
it is still in the early stages of testing, the results
are very promising.
“Patients are losing about 4kg [9lb] in a month,
compared to 8kg for someone who has
undergone gastric bypass surgery,” says Prof
Tricia Tan, a consultant in diabetes,
endocrinology and metabolic medicine at
Imperial, who helped develop the therapy.
Most people think that obesity surgery aids
weight loss because it physicallyreduces a person’s stomach in size so
they feel full more quickly, but the reality is far
more complex, she explains.
“Surgery seems to affect the whole gut in a
more profound way. In particular, it has been
observed that it leads to higher levels of the
hormones which affect metabolism, hunger and
insulin production.”
In other words, operations such as the gastric
bypass, or sleeve, act on the brain as much as the
stomach – altering the signals that control our
cravings and feelings of fullness and appetite.
Now, researchers and companies are racing to
develop a drug or jab that reproduces that effect,
avoiding the costs and potential complications of
surgery that mean further revisions are needed
in about 11 per cent of cases.
“When we give the hormones they reduce
appetite naturally and improve the body’s ability
to process sugar, leading to lower blood sugar
levels. This treatment really could be a
breakthrough, an added option for diabetes and
weight loss treatment for everyone,” says Prof
Tan.
One of the first people to try the new therapy
was retired civil servant Alan Palmer, 65, who
lives in Bromley, south London. Palmer joined
Prof Tan’s study in late 2017 after learning about
it at a support group for people with type 2
diabetes. “I’d been overweight since my 30s,” he
says, “and when I started I was just under 18
stone, the heaviest I’ve been. Now I’m 14 stone at
just under six foot tall.”
Palmer is delighted with the results, which
have put his type 2 diabetes into remission. He
has now been settled on to a healthy eating
programme to support his weight loss.
Hormones are being used in other ways to halt
the obesity epidemic. Injections of a compound
called liraglutide (Victoza or Saxenda) and, since
the start of this year, semaglutide (Ozempic)
which mimics the same hormonal action, are
already available to treat type 2 diabetes and
obesity, in conjunction with diet and exercise –
though not yet on the NHS.
Another non-invasive weight loss innovation
now being offered in the UK is the ElipseScientists are developing
non-surgical treatments
in the fight against fat.
Victoria Lambert reports
Could a jab
solve the
obesity
epidemic?
‘Hormone
therapy is
one of the
hopes we
have for the
future.
This is
progress’
Josephine Davies
has lost over a
stone in two
months thanks to a
new procedure that
involves inflating a
balloon in the
patient’s stomachballoon. This works by making users feel
artificially full – thanks to the insertion of a
balloon into their stomachs (swallowed as a
capsule). The balloon is then filled with 550ml of
fluid (mostly water), via a small tube down the
throat in a 20-minute procedure.
The device is thought to retrain the appetite
by reducing space in the stomach and thus
altering the hormones that control hunger and
appetite. The balloon sits in place for four
months before being punctured via a tiny
endoscope which allows the water and deflated
balloon to be excreted naturally.
During that time, users are supported with a
health and wellbeing programme that aims to
re-educate their minds while their stomachs are
retrained by the presence of the balloon.
Josephine Davies, a 52-year-old midwife, who
lives in east London with her black cab driver
husband Tony, is halfway through her Elipse
therapy and has lost one stone and four pounds
in two months.
“I’ve spent my life as a yo-yo dieter,” says
Davies, “and as a nurse on shifts, have always
struggled with hunger. But the balloon fills you
up so you never feel hunger. In fact, if you
overeat at all, you get a stomach ache.”
Davies says the device felt odd to begin with:
“I was very aware of it
sloshing around for the first
couple of days, but now I
never think about it.”
Her husband has also had
the treatment and lost even
more weight. “He had more
to lose in the first place but
is now five stone down,” she
says.
The Elipse balloon –
which costs about £4,000,
and is available to people
over 18 with a body mass
index greater than 27 (for
most adults the healthy
range is 18.5 - 24.9)– cannot
offer the same significant
and rapid weight loss as
bariatric surgery, but its
manufacturers hope it will
be seen as an earlier
intervention. Unlike with
surgery, this and the new
hormone jab can safely be repeated to help users
maintain weight-loss long term.
Because as every dieter knows, losing the fat isonly half the story. For many, the
bigger challenge is addressing the underlying
feelings that led to overeating in the first place.
“Most of my clients over-eat when they are
stressed, sad, bored, tired, have a low mood, feel
lonely or are anxious,” says psychologist Uxshely
Chotai at The Food Psychology Clinic. “A diet or
gastric band surgery can offer quick weight loss
but it does not equip an individual with an
alternative coping mechanism to turn to when
they experience these feelings.
“Establishing a healthy relationship with
food, where you eat for nourishment and
pleasure, is key to achieving long-term weight
loss.”
But for now, those patients who are morbidly
obese find bariatric surgery is still their best
option – as treatments like Imperial’s new
hormone jab just won’t shed the pounds in the
same way, says Prof Francesco Rubino, chairman
of bariatric surgery at King’s College London.
“Hormone therapy is one of the hopes we have
for the future,” he says. “It is not yet possible to
say if it will outperform bariatric surgery but this
is progress.”
He adds: “Obesity and type 2 diabetes are a
spectrum of diseases with different stages. Using
hormones might have an application for some
patients, if not all. Surgery changes the signalling
to the brain to say how full or hungry you are.
But you have to remove or bypass part of the
stomach or gut to get to that point.”
Having previously tried dieting, Alan Palmer
found the real difference that the hormone
infusion made was in terms of appetite. “In the
past,” he says, “I’d never really been aware of my
body being hungry or full. Really basic stuff.”
But while the hormone pump has given him a
jumpstart, he knows the psychological battle will
be with him for life.
“I sometimes feel smug. But other times I
panic because all the reasons I ate badly, the
comfort eating and so on – it’s always a choice
that I’ve still got. Do I keep going or do I go back
to how I was?”
His concerns highlight that there are no easy
solutions for weight loss and major physical and
emotional work are required to maintain a
healthy outlook.
Prof Tan says: “We have approached obesity
wrongly in the past looking for this amazing diet,
or this amazing drug. It’s more complex than
that. It’s important to treat the patient as a whole
person.”For more information about the Elipse Balloon, visit
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