A little over two years ago, a whisper of a new drug was abundant. Ozempic was quickly deemed a “miracle” medication, though few could predict how quickly and vastly it would revolutionise the weight loss industry. In Hollywood, it became a coveted accessory, for everyone else an injectable tool for mastering the coveted “before and after” in record time.
Since then the “Ozempic age” has already been through countless iterations – wariness, celebrity denial (quickly followed by countless celebrity admissions, Oprah among them), the apparent baby boom, concerns about side effects (which aren’t for the faint-hearted: nausea, headaches, vomiting and diarrhoea among others) and the “boomerang” weight gain effect once users come off the drug.
The latter has made little difference: the popularity of Ozempic and other GLP-1 receptor agonists like Wegovy and Mounjaro continues to skyrocket. In fact, we’re in the middle of a global shortage; those prescribed semaglutide to treat type 2 diabetes – as it was originally intended – are now facing supply issues due to a surge in “off-label” prescriptions for weight loss.
An “Ozempic crackdown” on those lying about their BMI to access it is now underway, and already eye-watering prices – around £200 per month in the UK; in the US that rises to around $1000 (£824) – are on the rise.
Yet, our obsession is far from over. In fact, a new era is already teetering on the horizon. An oral form of Ozempic – Rybelsus, developed by Novo Nordisk, the company that manufactures both Ozempic and Wegovy – is already available in the US and UK, though it’s currently a prescription-only medicine for adults with type 2 diabetes.
In a statement, they confirmed that they have “completed clinical trials for oral semaglutide in weight management, but we are unable to share regulatory approval timelines at this stage”. In 2023, Pfizer ran trials on a different oral compound, orforglipron, which belongs to the same class of medications as semaglutide, as did Eli Lilly, the maker of Mounjaro.
As those developments continue to bubble away in the background, a new market is rapidly expanding. Late last year saw an onslaught of “natural” alternatives from countless wellness brands that claim supplements or patches can increase the hunger-regulating hormone that GLP-1 agonists target without the need for injectables.
Kind Patches’ “GLP-1 Patches”, which cost £12 for a 30-day supply, supposedly “help you feel full longer, stabilize blood sugar levels and curb cravings”, are sold out; in September Kourtney Kardashian Barker’s wellness brand Lemme launched a similar product. A year before that, Halle Berry took on a role as chief communications officer (as well as being an equity owner) at biotech company Pendulum Therapeutics, which sells a GLP-1 boosting probiotic.
But another startup is doing things slightly differently. US-based Metabolize claims its metabolite-driven product could “redefine the weight loss landscape”. The supplement is taken orally and, essentially, mimics the proven benefits of the keto diet. Based on animal studies already conducted, the company believe their product can provide a 10-20 per cent weight loss with regular use.
“A couple of years ago there was an article published in Nature about an exercise pill that was based on a molecule called lactate phenylalanine,” Dr Morris Laster, a physician by trade who founded the company, tells me over Zoom. The paper was written by Dr Jonathan Long, an associate professor of pathology at Stanford University, and showed that when the molecule is targeted and increased, it suppresses appetite, decreases obesity and improves glucose regulation.
“I called him up,” Laster continues, “and he said, ‘Look, this molecule is great. But there’s one big problem with it – you can’t take it by mouth, you have to inject it.’ Six months later he showed me the results of what we now call ketone phenylalanine. What he found was that ketone phenylalanine and lactate phenylalanine are created by the same enzyme, BHB-phenylalanine – these are all increased by strenuous exercise, intermittent fasting and a ketogenic diet. Their mechanism of action is very similar, so we hit the same receptors in the brain that are involved in long-term appetite suppression. We know that there’s a direct correlation between lactate phenylalanine in the blood and weight loss. And the benefit of ketone phenylalanine is that it’s orally available.”
Essentially, they claim that their product regulates appetite through distinct brain-based neural pathways – and their method is a first-of-its-kind metabolite-driven therapeutic which is safe, cheap and, crucially, side-effect free.
“Ozempic, GLP-1s, all of them do an amazing job for weight loss, but they have a number of side effects beyond the sheer cost of it,” Laster explains. “More than 80 per cent of people who are on them stop taking it within a year, 30 per cent within the first month. There are issues of panic with its potential for thyroid cancer, you feel nauseous often, you can have vomiting and diarrhoea.
“In addition to that, I think one of the big issues is that people don’t realise that the GLP-1 molecule itself, it’s in the pleasure centre of the brain. To use a colloquialism, it inhibits that dopamine squirt you get in the brain, which is essential for pleasure. And, unless you really modify your diet and lifestyle, once you stop taking the drug you will regain the weight.”
Metabolize, he claims, can act as an alternative to “bio-hack” your metabolic system, or as a “ramp” for people worrying about coming off GLP-1 agonists. The effects won’t be so immediate, or drastic – but it could provide a softer, effective way to manage weight long term.
The company is now in the process of getting Metabolize approved as a food ingredient – but hopes to license the product out to food companies to include in “protein bars, snacks” and as a food supplement by next year.
Perhaps it sounds too good to be true – only time will tell. But you can see why the race to find Ozempic alternatives or accompaniments like Metabolize is on: just recently, a new report said that an estimated 3.4 million Brits meet the criteria to receive a prescription for Wegovy and Mounjaro, which would cost £10bn a year. It could potentially bankrupt the NHS.
This is a market that is rapidly evolving. Novo Nordisk is anticipating that the next developments across the industry are likely to “narrow the gap” between weight loss fuelled by medicine, rather than risky surgical procedures. Elsewhere there’s potential in obesity treatment that targets entero-pancreatic hormones that are released while we actually eat. The science is bamboozling, but the effects could be monumental for healthcare. It looks as though the weight loss revolution is only just beginning.