How to get the ‘Wegovy effect’ when you can’t get Wegovy

The clamour was inevitable: Wegovy’s arrival on private prescription in the UK this week is the golden ticket for those searching for a no-effort way to slim. Since the weight-loss jab circulated in Hollywood last year – and was credited for a raft of stars suddenly looking more svelte – demand has been insatiable; which may well happen here, now that a month’s worth of doses can be bought for £200-£300 (or about the same as a swish gym membership).

Semaglutide, originally designed as a diabetes drug called Ozempic, has been found in trials to trigger a 15 per cent loss in body weight over 68 weeks. Its effect soon became so notable that global shortages ensued, as patients urged their doctors to prescribe it “off-label” (where a drug is given for reasons outside of those it has been created for).

The launch here of Wegovy, explicitly branded as a weight-loss medication, coincides with its creators Novo Nordisk this week becoming the most valuable company in Europe. While its short-term credentials are compelling, those who stopped taking the appetite-inhibiting drug regained two-thirds of the weight they had lost within a year, per a study published in Diabetes, Obesity and Metabolism. Not that those results have dented its popularity, which “makes sense in today’s day and age of worshipping immediacy over hard-earned results”, says Sandy Macaskill, co-owner and master trainer at Barry’s UK. “The nation would be in a much better position if everyone was rushing to do some exercise” – rather than to take an effort-free shot.

Macaskill has a point. In more than a decade of trying to lose weight via fat-free cooking sprays, Rosemary Conley videos and periodic (albeit brief) moratoriums on crisps, I can vouch for the fact that only two things really work long term: a decent diet and exercise. Boring, certainly – and a hell of a lot harder work than injecting yourself once a week. But after a couple of years of (mostly) diligently sticking to that combination, I lost around half my body weight and reached a healthy BMI for the first time in my late twenties. It’s a simple formula, but a lifelong commitment – maintaining weight loss is, as every dieter knows, significantly harder than shedding it in the first place. But that’s true of semaglutide, too: while it may seem like the perfect shortcut, signing up to take medication for a lifetime hardly seems ideal.

For those resolving to lose weight without Wegovy, here’s what the latest studies say can help the old-fashioned way work best...

Most scientists will tell you that losing weight is almost entirely about what you eat, with exercise being a useful, but unnecessary, addition. “The key thing is that what [diet] you choose is something you can stick to” - be that low-carb, 5:2, keto or anything else, says Duane Mellor, lead for evidence-based medicine and nutrition at Aston Medical School.

A study published in Annals of Internal Medicine in June compared intermittent fasting with calorie-controlled diets to measure what proved most effective – and both were evenly matched, leading participants to lose around 4 per cent of their body weight.

“Weight loss is always going to require some dietary change,” says Saira Hameed, consultant endocrinologist at Imperial College London and author of The Full Diet. “Since biologically we gain weight through the action of the fat storage hormone insulin, a neat way to lose weight is to lower levels of insulin in the body.” If you cut out sugar and refined carbohydrates (for eg cereal, rice, pastries, pasta), “insulin levels run low and you are no longer fat storing – instead you are fat burning”.

Hameed advises eating a moderate amount of protein, which “helps generate a strong fullness response in the body”; avoiding processed food is also key, as this “drive[s] overeating through an effect on the brain’s reward centre”. Alcohol is typically high in carbohydrates (which can raise blood-glucose levels) and calories, also landing it on the banned list. (The often touted benefits of resveratrol, found in red wine, have not yet been found to translate to humans.) Intermittent fasting is now among the most popular diet regimes – and while it may not lead to more weight loss, it may be easier for some to work into their schedules, Mellor says. Approaches can include eating around 600 calories two days a week (while the rest of the time maintaining a balanced diet), or fasting for up to 16 hours a day – restriction that should trigger the body to use fat stores for energy.

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While exercise alone won’t help you to lose weight, a paper published in Nature Metabolism this week showed that dieters who worked out doubled their metabolic health benefits, showing twice the rate of improved insulin sensitivity, higher numbers of new blood vessels, and more mitochondria (which powers our cells).

Matt Roberts, a personal trainer, suggests a fairly rigorous workout regime of at least three “heavy” resistance training workouts each week, plus 45 minutes to an hour of “zone 2” cardio – low-to-medium level work at one pace, such as a fast walk or cycle – each day. Adding a further two high-intensity workouts on top “will give you a huge metabolic boost, [and] huge heart and lung capacity growth”, helping the body to better burn fat while working out or at rest.

Research presented at the Endocrine Society’s annual meeting in June suggested that participants who consumed more than 80 per cent of their daily calorie intake by 1pm saw a reduction in blood-sugar levels, and improvement in their metabolic health, making weight gain less likely.

As well as shifting eating earlier, there is some evidence to show that exercising in the first part of the day works best too. Peer-reviewed research published earlier this year by the Karolinska Institutet in Stockholm found that “late-morning exercise could be more effective than late-evening exercise in terms of boosting the metabolism and the burning of fat”.

Roberts agrees that kickstarting the body each day with exercise – such as a relatively fast walk of around 30-45 minutes – makes it “very efficient at asking for fat as a source of energy, and that’s where you get a good basis of burning fat long term”.

He also advises drinking 1.5 litres of water within the first six hours of waking each day, and three two-to-five-minute sessions of cold immersion (even in the shower) weekly, which a review from the Arctic University of Norway last year found “may have a protective effect against cardiovascular, obesity and other metabolic diseases”.

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“Good gut health could help with weight-loss goals,” says Dr Nabeetha Nagalingam, principal translational scientist at OMED Health, which offers digestive analysis via breath testing. A 2022 study published in Gut Microbes concluded that “the gut microbiome may be a mediator between obesity and health outcomes”, with greater bacterial diversity linked to better health. She suggests monitoring each food you eat, and your body’s response to it, as “the key to better gut health and to weight management is control – understanding what goes in, and the impact it has on you. You are unique, and you need a gut health plan and a diet that works for you and your gut.” Probiotics (yogurt, kefir), prebiotics (flaxseeds, legumes) and polyphenols (blueberries, spinach) help to nurture a varied microbiome, and fermented foods - like kimchi and kombucha – often contain all three.

Weight loss “can be very challenging”, Mellor says, “and it is a little easier if you have the support of others”. A recent study from the University of Surrey showed that friends or family members of dieters can have a major impact – for the worse. Changes to an individual’s appearance – and, as a byproduct, the social dynamics of their relationships – may lead them, “consciously or subconsciously, to try to derail a person’s attempts to lose weight in order to keep things the way they are”, researchers said. Another study, published in Biomedical Central Public Health last month, showed that “motivational interviewing and cognitive behavioural therapy” effectively lowered the BMI and waist circumference of teenagers studied, making those psychological interventions “effective and durable” for weight loss.