The ‘30-120 rule’ to diet trap…4 Wegovy pill mistakes slimmers must know & the dangers of switching from jabs to tablets

SO long fat jabs – there’s a new weight loss ‘game changer’ in town. The excitement has been difficult to miss. Last month, the world’s first weight-loss tablet, the Wegovy pill, became available in the UK – the first country in Europe to do so. The Wegovy pill was released on sale privately in pharmacies last month Credit: Alamy Female feet standing on electronic scales for weight control on wooden background. The concept of slimming and weight loss Credit: Getty It contains semaglutide, the same appetite‑suppressing ingredient used in the injection, marking the first of a new generation of GLP-1 medication, offering a tantalising route to a slimmer figure. The response was monumental. Online pharmacies reported waiting lists of more than 100,000 patients who wanted to start taking the daily tablet, which is currently only available privately and not on the NHS. In the US, where the Wegovy pill has been available since January, patients have reported remarkable improvements. At first glance, this excitement seems reasonable. At present, weight-loss drugs such as Wegovy and Mounjaro have to be self-injected, a task that many people find off-putting. The tablets are also roughly £30 per week, a fraction of the price of the injections. But, doctors have now warned that many patients are unaware that the pill is not the easy alternative that it might appear to be. Switching immediately could even undo months of hard work after losing weight on the jabs, experts say. So what are the biggest pitfalls you must know before making the leap to the pill? Does the pill have similar side effects to the jab? And how can you avoid them? Here Sun Health explains everything you need to know… The Wegovy pill contains semaglutide, the same ingedient as the Wegovy injection Credit: PA Dose slip-up By far one of the most common misconceptions about the tablet is the dose, experts say. Many patients may assume they’ll move straight from their current injection dose onto an equivalent tablet strength. The highest-strength oral Wegovy tablet contains 25mg of semaglutide, while the maximum weekly injection contains 2.4mg. On paper, this makes the tablet appear much stronger, but the numbers cannot be compared directly. That’s because taking semaglutide orally means only a very small proportion of the dose is absorbed into the blood stream, so a much higher milligram dosage is needed to have the same effect as the jab. “With the injection, you know exactly how much is going into the person and how much semaglutide is being distributed around the body,” says Dr David Strain, an expert in cardiometabolic health at the University of Exeter. “There is a much bigger range with the pill. There are some people on 25mg tablet daily that are actually getting more absorbed in their blood than somebody on a 2.4mg injection. “But there are also patients on 25mg daily getting less than people on just a 1mg injection.” In reality, the most appropriate starting dose will depend on the patient, their medical history and their prescriber’s clinical judgement, experts say. Some patients may need to begin on a lower tablet dose before gradually increasing it to help reduce the risk of gastrointestinal side effects such as nausea, vomiting and diarrhoea. Side effects of the pill are similar to the jab – roughly one in 10 experience mild effects including constipation, nausea, stomach pain, fatigue, diarrhoea, acid reflux and bloating. Rare but potentially deadly side effects can include changes in vision, pancreatitis – inflammation of the pancreas – and kidney, gall or bladder stones. Anyone experiencing such effects should stop taking the pill immediately and speak to a doctor. Abbas Kanani, superintendent pharmacist and weight loss specialist at online pharmacy Chemist Click, adds: “We’ve already seen people assume that because the tablet says 25mg, it must be much stronger than the 2.4mg injection. “Patients shouldn’t try to work out an equivalent dose themselves. Any switch between formulations should always be guided by the clinician prescribing the medication.” The 4 red flag signs your Wegovy pill is fake With demand for the newly approved Wegovy Pill incredibly high, experts have shared key red flag signs to spot which may indicate if you’re buying a knock-off treatment. 1. Spell check Have a good look at the packaging, experts say. Dr Leyla Hannbeck, chief executive of the Independent Pharmacies Association, said: “These fake products may look real but on closer look, many lack the information on their packaging that are required by a regulated product.” Dr Donald Grant, GP and senior clinical advisor at The Independent Pharmacy, added: “Packaging with spelling mistakes, poor-quality printing or missing patient leaflet information are all common indications that the medication may be fake.” 2. Cheap thrills The pill has gone on sale privately at high street and online pharmacies in the UK, but is not yet available on the NHS. Privately, the pill works out at roughly £2.50 a day through some multi-month treatment plans, according to online pharmacies. Prices range between £69 for a month’s supply as part of a three-month bundle for the 1.5mg starting dose, to £189 for the highest dose of 25mg. They are cheaper than the jabs, which are sold for up to £250 for a month’s supply, depending on the dose. But bargains or heavy discounts should still ring alarm bells. “Patients should be wary of prices for GLP-1 medications that are too good to be true,” Olivier Picard, Chair of the National Pharmacy Association (NPA), said. And don’t fall for suppliers that “accept payment in currencies such as bitcoin“, he added. Make sure you check the market value of your pills by looking at what other providers are selling them for. 3. Checked out “Any sales that are made without a prescription and two way consultation with a clinician” can also indicate that your pills are dodgy Mr Picard adds. A thorough consultation process is “required by law to ensure only those who genuinely need the medication can access it”, according to Dr Grant. Legit providers will ask about your medical history, current medications and suitability — even if the process is online. When taking weight loss treatments, it’s important to get ongoing clinical support from a qualified healthcare professional. This is to ensure you’re making the most of your treatment and that you get access to vital information and support when you need it. 4. Social sales “Patients should be wary of sellers on social media or marketplaces, as prescription-only medications should never be sold via these routes,” Dr Grant said. “If a patient is concerned about any medication they have bought online, they should speak to their local pharmacy,” Olivier noted. You can also speak to your GP – but whatever you do, don’t take them. The Wegovy Pill has been pitched as a convenient and easy-to-use alternative to injections. However, it is far from that simple. It cannot just be swallowed with your morning coffee or alongside other medication. Unlike the weekly jab, the pill comes with strict instructions to ensure the medicine is absorbed properly. It must be taken on a completely empty stomach, after fasting for at least eight hours. It can only be taken with a small, specific amount of water – up to 120ml to be precise (half a cup according to manufacturer Novo Nordisk). And then, after swallowing it, patients cannot eat or drink anything at all for 30 minutes. Failure to follow these steps to the letter will affect how much of the drug is absorbed into the bloodstream – and therefore weaken its effect, limiting weight loss. Mr Kanani says: “These instructions aren’t simply recommendations, they’re essential for the medicine to work as intended.” Dr Strain adds: “If you’ve normally got a morning selection of tablets and medication, you need to make sure that these drugs are appropriate alongside the Wegovy pill. “There’s one quite important medication, thyroxine, for people with an underactive thyroid gland, which is very common. It also needs to be taken on an empty stomach. “So when you’ve got two tablets that need to be on an empty stomach, you need to get the timing right. “I’m not saying that you can’t mix and match tablets, but there has to be a strategy in place to make sure that you get the optimum dose of both medications.” Equally, “there’s a lot of people on the injections that might miss a day, take it a day early, or if they’re going on holiday, they might decide to miss it,” he says. “Although not ideal, your body can get away with that. A two or three day gap from taking the tablet or taking it wrong means it might not be as effective.” Diet trap The Wegovy pill, like the injection, reduces appetite – but it doesn’t automatically change food choices Credit: FG Trade Latin One of the most common misconceptions around weight loss drugs is that you can eat what you want, because the injections do the hard work for you. The Wegovy pill, like the injection, reduces appetite – but it doesn’t automatically change food choices. Some users have reported experiencing a shift in appetite after starting the pill. But if your diet is high in junk food after switching to the pill, your weight loss may stall or even worse, you pile it back on once you stop taking the tablets. “Some people notice a temporary increase in appetite or a brief return of food noise during the transition,” Aaron Arman, superintendent pharmacist at online pharmacy CheqUp, says. “This is a physiological response, not a sign that the treatment is not working. It usually settles within a few weeks as the oral dose reaches its effective level.” Dr Strain adds: “Healthy diet is key. It’s all about getting protein, making sure you’re focused on micronutrients, like the zinc, magnesium, both often found in vegetables. “It’s even more important when you’re on these drugs and eating smaller portions that you focus on eating those micronutrients first, then protein, the things that we know are going to fill you up.” Giving up at a plateau The science behind the formulation of the pill is ingenious – but it also has its limits. Research shows it is less effective than the most powerful injections. The Mounjaro jab typically triggers around 20 per cent weight-loss for obese patients. By comparison, studies show the strongest dose of the Wegovy Pill leads to, at most, 17 per cent weight-loss, a meaningful result but one that falls short of Mounjaro. It’s common for patients on the jabs to reach a weight plateau – where they seem to stop having an effect. And, with the pills, this plateau may occur even earlier. “We know with the pill, the average weight lost is slightly less than those on the jabs. But don’t give up when you’ve hit a plateau, do continue,” Dr Strain says. “If you look at those big clinical trials, the amount of difference we’re looking at is one and a half kilos, or up to two kilos difference in weight loss. That’s a small difference,” he adds. Patients must give it time to assess how well the pill is working for them, progress can be uneven early on. “What’s really important is that you’re getting the health benefits of the medication, you’re reducing your cardiovascular risk, lowering the risk of heart attacks and strokes down the line,” Dr Strain adds. “Your bones, as you’re exercising, are less likely to develop the arthritis and all of these diseases associated with obesity. “You’re becoming healthier in yourself, meaning you’re able to do more and enjoy more of the things that you want to do.”