As the UAE becomes only the second country to approve the medication, experts explain why sustainable weight loss involves far more than simply replacing injections with a daily pill
For years, the global narrative surrounding next-generation weight-loss medications has been visually defined by the click of an injection pen. We have watched from afar as Hollywood and social media feeds turned a class of chronic disease medications into the ultimate cultural status symbol. But this week, the UAE entered a new chapter in the rapid weight-loss conversation.
In a decisive move, the Emirates Drug Establishment approved Wegovy (oral semaglutide) as a once-daily pill for long-term weight management in adults. Indicated for individuals with obesity or those classified as overweight with at least one weight-related comorbidity, the pill also carries a milestone regulatory mandate: reducing major cardiovascular events in high-risk patients.
With this approval, the UAE becomes only the second country globally following the United States to greenlight and receive supply of the oral tablet. And as the collective conversation pivots from weekly needles to a morning pill, a critical question re-emerges: Are we treating a complex, multifaceted chronic disease or are we simply looking for a more convenient way to chase a lower number on the weighing scale?
To understand the clinical, cardiac and psychological architecture of this major medical shift, we spoke to three leading UAE-based experts navigating the front lines of metabolic health, cardiology and clinical psychology.
Why obesity treatment is about more than weight loss
To understand why a daily tablet is a structural shift rather than just a cosmetic upgrade, one must look at the sheer scale of metabolic issues surrounding modern life. For Dr Ihsan Almarzooqi, co-founder and managing director of Metabolic (formerly GluCare.Health), the regulatory speed reflects an urgent, data-driven necessity.
“It signals that the conversation has finally caught up with the data,” Dr Almarzooqi says. “In the region, we have one of the highest burdens of metabolic disease in the world. A significant proportion of the population here is living with diabetes or pre-diabetes and close to two-thirds of adults carry excess weight. These are not cosmetic numbers. They are the upstream cause of the heart disease, fatty liver and kidney disease that fill our clinics.”
For the average patient, the immediate appeal of the oral tablet lies in its simple use. However, Dr Almarzooqi is quick to clarify a common misconception that this, by no means, is a diluted version of the injectable format. “This is the same molecule as the well-known weekly injection. It is not a different or weaker drug,” he explains. “The only difference is how it gets into the body… For a lot of patients, that removes a genuine barrier. No needles, nothing to keep in the fridge, nothing to carry when they travel.”
However, that convenience also introduces a strict behavioural trade-off. “The tablet has to be taken first thing in the morning on an empty stomach with water, and you wait before eating or drinking, because the absorption is highly sensitive,” Dr Almarzooqi adds. “In the trials, taken properly, the pill delivered weight loss in the same range as the injection, around 17 per cent over about a year for people who stayed on treatment.”
Crucially, this efficacy means that candidate selection must remain fiercely disciplined. The “right” candidate, according to Dr Almarzooqi, is an adult living with obesity or someone overweight navigating conditions like Type 2 diabetes, hypertension or cardiovascular risk. The “no” list remains never-ending. Beyond pregnant individuals or those with specific histories of medullary thyroid cancer or pancreatitis, Dr Almarzooqi draws a firm line against purely aesthetic consumers.
“The group that is hardest to turn away because they are often the keenest: people who are already at a healthy weight and want the drug to drop a few kilos before a wedding or a holiday,” he says. “If your BMI is in the normal range and the goal is aesthetic, the answer is no. That is not what this medicine is for and prescribing it that way is how people get hurt.”
Can the oral pill reduce risk of heart attack and stroke?
While the public focus remains on physical transformation, cardiologists view the oral medication through a fundamentally different lens. The Emirates Drug Establishment’s approval explicitly highlights the pill’s ability to reduce major adverse cardiovascular events (MACE) such as heart attacks and strokes in high-risk populations.
Dr Ahmed Sharafeldin, consultant interventional cardiologist at RAK Hospital, views this as a vital turning point for a region where cardiovascular disease routinely manifests at unusually young ages.
“What is particularly encouraging is that we are no longer talking about weight loss solely as a cosmetic outcome,” Dr Sharafeldin says. “From a cardiology perspective, that is an important development. Historically, we have advised patients to lose weight because we knew it would improve blood pressure, cholesterol and diabetes control. Increasingly, evidence suggests that effective treatment of obesity can also contribute to reducing cardiovascular risk.”
To demystify how excess weight translates to cardiac danger, Dr Sharafeldin adds, “A useful analogy is to think of the cardiovascular system as a city’s road network. Excess weight places additional strain on every part of that system. It increases blood pressure, promotes insulin resistance, raises the risk of Type 2 diabetes, worsens cholesterol levels and increases inflammation within blood vessels. Over time, these factors damage the arteries, leading to plaque formation and narrowing of blood vessels supplying the heart and brain.”
The pill, therefore, acts as a mechanism to clear the metaphorical traffic. Yet, Dr Sharafeldin issues a stern warning to anyone assuming that a powerful daily tablet grants permission to abandon broader medical regimes or healthy habits.
“I would strongly discourage that way of thinking,” he adds. “The approval itself is based on use alongside a reduced-calorie diet and increased physical activity, not instead of them. Weight-loss medications do not eliminate the need for exercise, smoking cessation or healthy nutrition… Patients who combine these measures with appropriate medical therapy generally achieve the greatest long-term health benefits.”
The mental health side of weight-loss medication
While clinical data may demonstrate its effectiveness, it is the emotional landscape that ultimately determines whether weight loss is sustainable. The simplicity of taking a daily pill can easily mask the profound psychological and emotional shifts that occur when a person’s relationship with food changes dramatically.
Alina Vasilache, clinical psychologist and medical director at Potentia Clinics, emphasises that obesity can never be viewed in isolation from a patient’s internal world, arguing that successful long-term weight management requires addressing the psychological factors that often underpin eating behaviours.
“The approval of an oral medication is an important development and a huge help,” Vasilache says. “But it is very important to recognise that obesity is always intertwined with a person’s emotional wellbeing, self-esteem, body image, relationships, attachments and life experiences. Actually, the psychological intervention and support for these cases is one of the most complex in clinical practice.”
While patients frequently experience a wave of hope, increased social confidence and silencing of those constant food cravings, rapid physical changes can trigger unforeseen emotional challenges.
“Some individuals assume that losing weight will automatically resolve long-standing insecurities and emotional distress,” Vasilache adds. “When these issues persist despite weight loss, patients may feel disappointed or confused. Others may develop heightened anxiety about regaining weight. Some develop a strong dependence on these drugs and a terrifying fear of having to stop them one day.”
Vasilache notes that specific red flags in a patient’s history, such as Binge Eating Disorder (BED), chronic yo-yo dieting, severe body dysmorphic concerns or using emotional eating as a primary coping mechanism, require mandatory psychological support alongside a prescription.
“The medication may reduce appetite, but it does not automatically address the psychological drivers of eating behaviour,” she explains. “If self-criticism or body dissatisfaction remain untreated, patients may continue to struggle… in some situations, they can struggle even worse than before due to the removal of a coping mechanism that was the function of their eating.”
What to ask before you start taking oral Wegovy
“A prescription without a programme is how you manufacture the yo-yo,” warns Dr Almarzooqi, pointing out that real-world evidence shows up to 70 per cent of patients regain weight after discontinuing GLP-1 medications if the drug was treated as the sole intervention. “The drug buys you a window. The behaviour change is what makes the result last.
So if you are in the UAE, reading about Wegovy and feeling both hopeful and scared, what should you do before saying yes?
As a first step, Vasilache urges patients to sit down with a trusted doctor and ask direct questions: What amount of weight loss is realistic for me? What side effects should I anticipate? What happens if I stop taking the medication? How will my progress be monitored? By who? What lifestyle changes should I work on and who can help me with that?
Second, she suggests looking honestly at your relationship with food and your body. If eating is frequently driven by emotions rather than hunger, psychological support can be extremely valuable alongside medical treatment, she says.
Third, she encourages patients to widen their definition of success when it comes to taking the pill. I recommend focusing on broader measures of success rather than weight alone. Improvements in health markers, energy levels, mobility, sleep quality, mood, selection of meals and overall functioning are often more meaningful indicators of progress than the scale.
And through it all, she comes back to self compassion. Maintaining a self compassionate approach helps reduce anxiety, she adds. These medications are a great help and we are lucky to live in an era when we can have access to them.”
However, patients should view these medications as just one part of a broader journey that combines medical treatment, psychological support and sustainable lifestyle changes, she urges. “The end goal is for people to achieve a weight where they can live a healthy and happy life, not just a quick fix of a number on the scale. No person should be reduced to their weight.”
