The advent of medications for weight loss has created huge expectations, with the 10 Year Health Plan for England referring to them as “game-changing medicines” that will “launch a moonshot to end the obesity epidemic.”

This optimism isn’t universally shared. For example, Professor Kamila Hawthorne MBE, Chair of the Royal College of GPs, warned GLP-1 receptor agonists “should not be seen as a silver bullet for weight loss… There is no one-size-fits-all approach to tackling obesity.”

Research about their effectiveness in reducing strokes, heart attacks, kidney failure, liver disease and preventing diabetes appears in the media regularly, as do stories about side effects.

An estimated 1.5 million people in the UK are using these drugs, available under brand names Mounjaro and Wegovy. More than nine in 10 of them are thought to be paying privately.

Eligibility criteria for NHS access are strict – people with obesity need to have a BMI of 40 or more (adjusted for ethnicity) and to have been diagnosed with four out of five weight-related conditions to qualify.  

Under NICE TA1026, integrated care boards (ICBs) were required to make tirzepatide (Mounjaro) available in specialist weight management services to those who met the criteria by March 2025 and in primary care by June 2025.

Rollout has been slow, and the drug is still not available in many parts of the country. In many cases, funding for tirzepatide allocated to ICBs by NHS England doesn’t match the estimated number of people eligible, local population health data show. Source: BMJ

This is creating a two-tier system which risks significantly exacerbating health inequalities. Source: BBC

Anecdotally, we hear that GPs are under significant pressure from patients to give them access to the drugs, and ICBs are swamped by associated complaints and FOI requests at a time when their staffing is being cut significantly.

It doesn’t help that systems are starting from very different places, with historic commissioning arrangements for weight management services often patchy and inconsistent.

There is also the question of long-term sustainability, with evidence suggesting that many people will simply regain any weight lost once they stop taking the medication. Is it really feasible for the NHS to fund these medicines long-term, when 64% of adults in the UK are overweight or living with obesity? Source: Office for Health Improvements and Disparities

So how do systems make sense of this complex, even chaotic, picture and harness the opportunities this revolutionary new treatment can offer to improve health equity and population health outcomes?

ICBs across the country are grappling with that question. We have been providing structured, evidence-informed support to the North Central London Integrated Care Board (ICB) to implement an effective weight management pathway.

While local innovation risks creating fragmentation and inequity, it can also contribute to the emerging real-world evidence base and inform commissioning decisions, which could benefit millions of people. We’ve just heard that GPs will be incentivised through QOF to provide obesity care (including weight-loss medication) – an opportunity to increase access, but one that may be challenging to realise with increasing GP workloads.

There’s unlikely to be one approach that works for all – systems need a delivery partner that can help them to navigate the uncertainty and develop bespoke pathways which harness this new opportunity for the benefit of patients.

That is where we can help – to find out how we can work in partnership with you, offering strategic support and programme delivery tailored to your needs, please contact us using our contact form.