Public Health chief warns weight loss jabs may fuel unhealthy diet cycles

By Gabriella Ramagge

With weight loss jabs prevalent globally, the GHA’s Public Health Director has highlighted concerns over the need for behavioural lifestyle support to avoid ‘yo-yo’ diet culture.

Last summer, Public Health Director Dr Helen Carter researched GHA statistics and found that just 20% of Gibraltar’s population was at a healthy weight as she worked on a Covenant of Health to improve local lifestyles and health.

With weight loss jabs such as Ozempic, Wegovy and Mounjaro becoming increasingly prevalent and easily accessible via pharmacies, Dr Carter said she expects to see changes in Gibraltar’s fluctuating waistline.

“I think we're going to see some fascinating patterns happening with our weight, because there has been a massive explosion in [people taking] Ozempic and Mounjaro, and we're seeing that globally,” she said.

“I think we're seeing a lot of people [taking the weight loss drugs], and that concerns me for other reasons, because, yes, undoubtedly, these are amazing drugs that we are still learning a lot about, and people lose a lot of weight on them, but what concerns me is that, without behavioural lifestyle support around them, all the studies are saying that, within a year, people have regained two thirds of the weight they've lost.”

She explained that those on weight loss jabs could be losing muscle mass, stressing the importance this has for core stability and strong bones.

Dr Carter said this could result in risks of osteoporosis and falls.

“That really worries me, from a nutritional minerals and vitamins perspective, because yes, people will lose loads of weight, but they'll be unhealthy,” she said.

This creates a yo-yo effect where people lose and gain weight as they come on and off the medication, which she said could create a cycle of potential mineral deficiencies.

Although the GHA has strict criteria for providing weight loss medication, Dr Carter recognised that the private sector may not necessarily follow the guidance.

“In the private sector, doctors can prescribe if somebody asks for it,” she said.

COVENANT FOR HEALTH

As part of the Covenant for Health, Dr Carter restarted the Childhood Measurement Programme, where children are measured in reception and Year 6.

The aim is to assess the health of children in Gibraltar, and map trends. So far, the results have been unexpected, with more children underweight in comparison to the UK.

“Everybody was thinking, well, we're going to have lots more overweight children. Actually, what we're seeing is underweight children are overrepresented here. So what does that mean?”

She said more research needs to be done locally to understand what is happening in Gibraltar.

“It's probably one of the most common questions I get asked about school lunchboxes, after screen time. School lunchboxes and how healthy they are,” Dr Carter said.

“Would we consider going back to cooking school meals?”

For Dr Carter, the foundations for a healthy eating pattern are laid in childhood, meaning that healthy meals are a must.

She described how “food taster days” have been held in schools and some of the children have never had some of the fruit on offer.

“I absolutely get there are some fussy eaters who just don't like the textured taste, and it's about helping parents, supporting them to keep on trying with the textures and the tastes, because you are setting behaviour for life,” she said.

But a healthy life is more than just a ‘Fruity Friday’, she said. It has to be systematic and buying healthy food needs to be made easy for families.

The GHA is also researching maternal health and is digitising its records.

Currently the maternity data is on paper records, which means it is difficult for the GHA to understand trends in smoking and weight during pregnancy.

She said nicotine is a highly addictive substance, with previous GHA research finding that around 20% of pregnant women locally are smokers, with around 10% quitting during pregnancy.

“We've got emergency smoking cessation clinics put aside,” she said.

“We've done some extra training with midwives, which is great to hear that it's coming through, because it's about supporting women to quit, not just during their pregnancy, but to maintain that, especially when you've got a baby in the house, because there are dangers of passive smoking there for the baby.”

She said the GHA would like to look at maternal well-being as part of a Joint Strategic Needs Assessment.

“Looking at healthy weight, smoking, drinking, because the other aspect that does concern us as well is linking to the drugs and alcohol agenda, that normalisation of usage of, particularly, marijuana here, when you say ‘do you smoke?’ They say ‘no’.”

“We ask do you take marijuana? ‘Oh yeah, I take’.”

“It's almost normalised, and again we need to do some more awareness around that, specifically when you're pregnant.”

She said weight is also a risk factor for premature babies and complications for the mother.

“When we talk about sort of the acuity of risk during pregnancy, it's why we sort of encourage women, before they're even thinking about getting pregnant, people think about folic acid, but think about achieving a healthy weight, going into your pregnancy, because it does get harder and harder with successive pregnancies to then lose the weight,” she said.

“You're stacking up risk factors of not just gestational diabetes, but of type two diabetes post-pregnancy.”