Weight-loss injections in Kenya: Who should take them and who should stay away?

The use of GLP-1 medication for weight loss has sparked debate among Kenyan influencers, with some arguing that exercise and dietary changes could be alternatives. However, medical professionals say that weight management is not simply a matter of discipline and that people have different medical and physiological circumstances. According to Dr Lyudmila Schukina, a weight-loss specialist at Nairobi Bariatric Centre, GLP-1 medications are recommended for adults living with obesity or those who are overweight and have weight-related health complications.

Eligibility for GLP-1 medications is assessed individually, taking into account a person's body mass index (BMI), waist circumference, medical history, general health, and previous attempts at weight management. Patients with a BMI of 30 or above may be considered for treatment, while those with a BMI of 27 or higher may also qualify if they have conditions such as type 2 diabetes, high blood pressure, high cholesterol, or sleep apnea. Dr Schukina emphasizes that these medications are not for people who are already at a healthy weight and just want to lose a few kilos to look slimmer.

Lisabel Nabwile, a clinical nutritionist and dietician, shares Dr Schukina's view that GLP-1 medications are not suitable for people with no underlying health concerns who want to shed a modest amount of weight. Instead, she recommends a meal plan, working on calorie intake, increasing physical activity, and getting enough sleep. Meeting the general eligibility criteria does not automatically mean someone should be prescribed the medication; a qualified professional's assessment is necessary to establish whether it is appropriate, taking into account their health history and any potential risks.

Before prescribing GLP-1 injections, Dr Schukina checks the patient's weight, BMI, blood pressure, medical history, and any medication they are already taking. She also conducts blood tests to check blood sugar, kidney function, and often liver function and cholesterol. The doctor also asks about previous pancreatitis, gallbladder problems, stomach conditions, and pregnancy plans. Certain conditions, such as pregnancy, medullary thyroid cancer, or MEN2 (multiple endocrine neoplasia type 2), are contraindications for GLP-1 medications.

To understand why GLP-1 medications are prescribed for weight management, it helps to understand what GLP-1 does in the body. GLP-1 is a hormone that regulates blood sugar and appetite. Medications that mimic its action were initially developed to treat type 2 diabetes but were found to also promote weight loss. Today, these medications have become an important part of obesity treatment, helping people eat less and creating the conditions for weight loss.

Dr Schukina explains that GLP-1 injections do not burn fat directly but help people feel full faster, eat smaller portions, and not think about food as much. They also slow down how quickly food leaves the stomach, especially at the beginning of treatment. However, hunger is not the only reason people eat; stress, emotions, boredom, and long-established habits can also influence eating behavior. Dr Schukina emphasizes the importance of combining medical treatments with psychotherapy to help patients understand and work on their eating behaviors.

Proper nutrition and physical activity are also crucial considerations in GLP-1 treatment. Lisabel recommends following a nutrition plan that provides enough nutrients, particularly protein, alongside regular physical activity, to help preserve muscle mass. Different GLP-1 medications, such as semaglutide and tirzepatide, have different effects on appetite and weight. Tirzepatide generally produces greater weight loss than semaglutide, according to Dr Schukina, citing the SURMOUNT-5 trial.

Key points

• GLP-1 medications are recommended for adults living with obesity or those who are overweight with weight-related health complications.
• Eligibility for GLP-1 medications is assessed individually, taking into account a person's BMI, waist circumference, medical history, and general health.
• GLP-1 medications should not be used by people who are already at a healthy weight and just want to lose a few kilos to look slimmer.