In October 2021, it was announced that Saxenda weight loss injections would be made available on the NHS and – unsurprisingly – people were extremely interested in the news. The drug, also known as liraglutide, is the first medication to be endorsed for weight management in the UK for almost a decade.
These weight loss injections have been available privately for some time (since 2017) but recently, they've gained even more traction thanks to TikTok, where a number of users are documenting their journeys with the drug. To put it into perspective, the search term 'Saxenda' has a huge 199.4 million views, and 'Saxenda UK' has 166.9 million.
On the NHS, there are some pretty strict rules for prescribing Saxenda – you must have a BMI of over 35 (or 32.5 if you're of south Asian, Chinese, black African or African-Caribbean descent), have non-diabetic hyperglycaemia (or 'pre-diabetes', meaning high blood sugar) and be at a high risk of heart problems. Equally, patients are only allowed to use Saxenda for three months, unless they've lost at least 5% of their body weight.
While the conversations around health indexes such as BMI (or Body Mass Index) are up for debate – with many arguing that it's not a well-rounded marker for health or determination between body fat and muscle – most healthcare professionals maintain that Saxenda is an effective tool for some people with obesity, or health problems deemed to be associated with it.
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But as awareness of Saxenda heightens, so does its availability. While there are a number of hoops to jump through in order to get the drug through a GP, plenty of online pharmacies and stockists are now offering the injections to buy for around £45 per pen, after completing a short questionnaire online.
That's where things start to get a little worrying. The first stockist that pops up on Google only requires a simple online form in order to buy Saxenda – asking for a BMI of over 27 to qualify, and answers to some other health questions – though you can very easily lie about your weight and height (and any other details) to successfully purchase it.
While Saxenda has undoubtedly been a life-changing treatment for some, it has sparked a conversation about whether it's become too readily available to those it is not suitable for – particularly without the guidance of a doctor. It has also raised concerns about its accessibility to those with eating disorders or disordered eating.
As Saxenda weight loss 'before and afters' continue to pop up on TikTok, so do videos documenting side effects such as allergic reactions, gallbladder problems and intense nausea. So is the hype around Saxenda injections becoming dangerous? And when did we start taking prescription advice from social media, rather than our medical professionals?
What is Saxenda?
Dr Chinnadorai Rajeswaran (Raj) is a Consultant Physician specialising in obesity, diabetes and endocrinology and is the clinical lead for obesity at Mid Yorkshire NHS Trust, as well as running private practice The London Obesity Clinic. He tells GLAMOUR exactly what Saxenda is and how it works. "Saxenda is made from the chemical liraglutide. It's a glucagon-like peptide which is a hormone that is normally produced by the body – so it's a naturally-occurring hormone. Whenever we eat food, our body produces this hormone. It only stays in the body for two minutes and gets denatured by another enzyme – and it's why when we eat, we always feel full. It also tells the pancreas to produce insulin."
"The same drug, with a different trade name [Victoza] – we have been using for type 2 diabetes for more than ten years," he adds. "What we found was that those patients started to lose weight. Then the drug company did a trial using a bigger dose of the same medication, liraglutide, and so that's how Saxenda came into being. It's a higher dose of 3 milligrams."
So, Saxenda can also be hugely helpful to those suffering with diabetes, too, as well as helping with appetite control. But though the weight loss treatment has made headlines thanks to its launch on the NHS, Raj warns that it is still incredibly difficult to get hold of free of charge for most patients.
"There's a lot of restrictions. As well as meeting the NHS guidelines, you've often got to be in a system called the Tier 3 Weight Management Service, which is run by a consultant. There's a lot of loopholes," he says. It's no surprise that so many are looking to buy it online.
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"I lost two stone in a month"
GLAMOUR spoke to a number of women who have taken or are taking Saxenda – and the experiences varied widely. 26-year-old photographer Lauren tried Saxenda to aid her on her weight loss journey in January 2022, but stopped within two months due to experiencing skin reactions to the injections. "I was very sick on it. That was one of the main side effects anyway," she says, adding that her skin came out in rashes, too.
"Every needle site had a big ring around it... like a bug bite. Then, over the course of three days, it would just grow, and grow, and grow. And of course, I was injecting every day. They were getting really sore, itchy and hot, like allergic reactions, similar to the reactions I get to insect bites.
"I decided to stop using it, but afterwards I was really, really poorly. For about a week, with sickness and diarrhoea and a temperature of 38."
Lauren adds that aside from the side effects, she was happy with the results from the injections – which she used alongside a fitness routine of personal training and dance classes. "I was so gutted, because it really worked. I lost two stone in a month. It's the first thing that's ever really helped me, and it really did suppress my appetite."
But as for buying the injections online, she did reveal a worrying detail. "I've got a binge-eating disorder, and I have struggled with bulimia and laxative abuse in the past.
"I specifically remember when I was filling it out the first time, it said, 'Do you have an eating disorder? Yes or no.' Initially, I put yes. Then, it came up with big red writing saying, 'you can't have it if you've got an eating disorder.' So, I just clicked 'no.'"
"I lied. Then, obviously, I got it, and I will say, it did start bringing in my bad habits again... because it makes you feel sick. It makes you want to be sick because of the medication. So, if you've already got a predisposition to unhealthy binging and purging, it's not ideal."
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"It's only a tool, rather than a solution"
31-year-old Robyn, who is a nurse, has been using Saxenda for around a year and is hoping to lose four stone.
"I've lost two stone on it so far, so I'm about halfway through," she says. "I find it so helpful, because it really helps control my cravings and things like that. Instead of just eating excessive amounts and then having bits in between, I just have a few normal sized meals a day, so it really helps me stretch that calorie deficit, really.
"I haven't had any bad side effects. The first week I took it, I had a really bad headache. And I sometimes get a bit of acid, especially if I go to the gym and stuff, I get quite bad acid. Apart from that, nothing."
As a nurse, she researched Saxenda in detail before buying it from an online pharmaceutical company, where she had to provide identification to prove herself. And while she's had a positive experience with the injections, she maintains that they're a tool to be used alongside a healthy lifestyle, rather than a quick fix.
"You still have to be determined. You still have to focus on your weight loss. You could still overeat on it," she says. "And it's not for everyone."
"I get loads of messages or Instagram about it all. A lot of them are people that really don't fall into the category for it. Loads of people message me saying, 'I've got six pounds to lose' – well, this isn't for you. A lot of people think, 'Well, I want to just take it, and the weight will fall off me.' That's not going to happen. You have to work towards it, like anything else. It just makes it that little bit easier. It's only a tool, rather than a solution."
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Not a 'skinny jab'
Unfortunately, Saxenda has a worrying recent history. Back in 2020, it became widely known as the 'Skinny Jab' when a number of celebrities such as Gemma Collins and Kerry Katona promoted the injections on social media – they were marketed at the time by a weight loss company named SkinnyJab.
Since then, it seems that the company is no longer visible online, and Saxenda is no longer marketed this way – though a quick search for the term still brings up stockists of the drug. Today, it's the influence of apps like TikTok which have hugely raised awareness of the jabs.
The hype around Saxenda on social media certainly concerns Dr Rajeswaran. "If you look at weight loss medication history, whenever a new treatment comes out, it becomes very popular and gets sold on the internet and even the black market. Saxenda is now being sold in corner shops and even aesthetics clinics not run by medical professionals – and that's worrying," he says.
"It's not a magic drug, and not everyone will benefit from it. All the research shows that even if you're on Saxenda, you need to be supported by a team of experts including dieticians, a psychologist if required, and you need a doctor. People think it's a quick fix, but it's not."
Saxenda is recommended for treating obesity alongside a reduced calorie diet and physical activity – it is not to be used alone as a weight loss tool. "None of these injections or medications can completely cure obesity," says Raj. "We need to use this window of opportunity, while they are on the injections, to deal with the underlying problem. That's the key. The key is to solve underlying issues, change habits, change lifestyles, correct abdominal problems. Otherwise it will not work in the longterm."
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Using Saxenda safely
"If someone is on an injection like this, they need to be monitored," says Raj. "There needs to be someone they can contact who can help if there's a problem. There are some serious problems people can encounter, like pancreatitis, which is inflammation of the pancreas – the patient will experience severe abdominal pain."
While bad complications are pretty rare, Saxenda does have some pretty gnarly side effects such as severe nausea and acid reflux, with others reporting diarrhoea, constipation, gas, fatigue and skin reactions, like Lauren's experience. In more serious incidents, Saxenda has caused gallbladder problems or as Raj says, pancreatitis.
He advises seeking medical help if you experience concerning side effects, which may include severe abdominal pain or even vomiting to the extreme. "If you're experiencing serious nausea and vomiting, it can be so much so that you can become dehydrated. It's always good to seek help immediately, and not wait," he says. "I understand why so many people are buying it online, but you must seek help if you experience severe side effects."
There are potential long-term risks, too. Saxenda may increase the risk of thyroid cancer based on an animal study – though it's unknown whether it can have the same effect in humans. It has also been linked to pancreatic cancer. Dr Rajeswaran will not prescribe Saxenda to anyone with a family history of either condition.
In any case, all experts agree that if you're buying Saxenda online, rather than through a doctor, you should inform your GP so they can support you if needed.
"There are reputable pharmacies who sell Saxenda – I'd recommend buying it from somewhere like that, and then you go into the pharmacy to have your weight taken before you use it," says Raj. "Then, I'd advise that you inform your GP that you're using the injections, and that way if you do experience any side-effects or need some support, at least you can consult with them.
"As well as the jabs, make sure to follow the lifestyle changes. You can join some low cost programmes – we do an online course for £10, that can help. Lots of people can't afford to get private support, or don't qualify for help on the NHS, and it's a real problem."
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Reframing obesity
For Dr Rajeswaran, what's clear here is that the discussion around obesity needs to change.
"The first thing I tell all my patients, is that it's not their fault. They shouldn't feel guilt or shame," he says. "This is the job of the medical profession. Obesity happens because people metabolise differently, they shouldn't think that it's a lifestyle problem.
"We need a cumulative response from the government, media, doctors, all healthcare professionals – everybody needs to understand. There's lots of discrimination of people with weight problems, and that has to stop. The key is support. There's other issues to deal with there, too. Many people also suffer with mental health issues. Obesity and depression are bi-directional, so one can cause the other. You can't just go and tell people to eat less and exercise more – they know all that stuff."
He adds that the online narrative around body size is incredibly problematic, too. "Online, all these before pictures and after pictures, this 'hyping up' of slimmer bodies – that's not nice.
"Healthcare professionals need to change and accept that this is something we need to support our patients with. We also need patients to accept the problem, and while they're not at fault, know that they can seek help. Then we need the media and social media to reinforce the narrative that obesity is a health condition, it is not because anyone is greedy or lazy. That's the starting point."
Many others believe that the term ‘obesity’ has no place in healthcare, and that it incites harmful fatphobia and weight bias. Clinical psychologist Dr Alexis Conason tells GLAMOUR: “The term ‘obesity’ is seen as a slur in many fat activist communities. It’s a way that medicine has been weaponised against fat folks where they are unable to get competent medical care. Often people in larger bodies are given a prescription to lose weight while other significant health issues are ignored or doctors even refuse treatment.”
Of weight loss treatments, she adds: "I do think that the promotion of weight loss medications on social media pathologises higher weight bodies and promotes the message that if you are fat you must be unhealthy and the path to health is to reduce your weight. The problem is, research suggests that health is determined by a multitude of factors and when we account for variables such as genetics, fitness, nutrition, stress levels (including the chronic stress of marginalization and discrimination, including weight bias), these factors wind up being far more impactful for health than BMI. People can be healthy (and unhealthy) across a wide range of different shapes and sizes and focusing on increasing health-promoting behaviours tends to be a lot more helpful in improving health than focusing on body weight, which is not a behaviour.
“Weight loss medications are not without side effects and often lead to the additions of more medications to treat the side effects and often additional weight loss medications to “boost” weight loss once it has plateaued from the original medication. When the focus is on weight loss at all costs, people can end up doing some pretty unhealthy things to achieve that goal.
“Some of these medications are also used to treat diabetes and obviously that is an important use for them. However, I think that the idea that people’s weight is a medical issue that needs to be treated with risky medications that have side effects is fundamentally problematic. Why prescribe otherwise healthy people medications and surgeries that can have potentially harmful effects just because someone is in a larger body?”
What Saxenda say
GLAMOUR reached out to the makers of Saxenda – healthcare company Novo Nordisk – for comment on the medication and its possible side effects.
A representative said: “Novo Nordisk is a leading global healthcare company, our purpose is to drive change to defeat diabetes, obesity and other serious chronic diseases.
“Saxenda® (liraglutide 3 mg) is a once-daily glucagon-like peptide-1 (GLP-1) analogue with 97% similarity to naturally occurring human GLP-1, a hormone that is released in response to food intake. Like human GLP-1, Saxenda® regulates appetite by increasing feelings of fullness and satiety, while lowering feelings of hunger and prospective food consumption, thereby leading to reduced food intake.
“Saxenda® is indicated alongside a reduced-calorie diet and increased physical activity for weight management in adults with an initial BMI of 30 kg/m2 or more (clinically considered to be obese) or from 27 kg/m2 to less than 30 kg/m2 (clinically considered to be overweight) in the presence of at least one weight-related comorbidity such as dysglycaemia (pre-diabetes or type 2 diabetes mellitus), hypertension, dyslipidaemia or obstructive sleep apnoea.”
“The long-term safety profile of Saxenda® has been established through the SCALE clinical trial programme in more than 5,000 patients for up to three years. Across the SCALE clinical trials, the most common adverse events for Saxenda® were transient and mild to moderate gastrointestinal (GI) including nausea, vomiting, diarrhoea and constipation. A 4-week dose-escalation schedule was designed to minimise GI symptoms.
“In clinical trials for weight management, a higher rate of gall stones and inflammation of gall bladder was observed in patients treated with Saxenda than in patients on placebo. The fact that substantial weight loss can increase the risk of gall stones and thereby inflammation of gall bladder only partially explained the higher rate with Saxenda. Patients should be informed of the characteristic symptoms of gall bladder stones and inflammation. This is a common side effect and was experienced by 0.8% of patients in our SCALE prediabetes trial.
“Injection site reactions have been reported in patients treated with Saxenda. These reactions are usually mild and transitory and the majority disappear during continued treatment. This is also a common side effect seen in our clinical trials seen at a rate between 1 in 10 to 1 in 100 patients.
“Gastritis and reflex are common side effects recorded in our trials with Saxenda. All GI side effects generally are mild to moderate and settle down over time.
“Acute pancreatitis has been observed with the use of GLP-1 receptor agonists. Our recommendation is that patients should be informed of the characteristic symptoms of acute pancreatitis. If pancreatitis is suspected, treatment with Saxenda should be discontinued. If pancreatitis diagnosis is confirmed then we do not recommend restarting the treatment.
“There are no reported association between Saxenda and pancreatic cancer.
“Non-lethal thyroid C-cell tumours were seen in two-year carcinogenicity studies in rats and mice. The relevance for humans is likely to be low but cannot be completely excluded. We do not report any incidence of thyroid cancer in the clinical trials run by Novo Nordisk. This is also not listed in SMPC.
“Patients who have been prescribed Saxenda should see the Patient Information Leaflet that comes with their medicine to view a complete list of side effects. Any questions regarding side effects should be discussed with their healthcare professional.”
There's no doubt that Saxenda has sparked a lot of interest to many – but taking advice from your doctor – rather than TikTok – is always paramount. If you're considering using weight loss injections, be sure to keep yourself informed and aware of possible side effects, and always tell your GP.