NHS weight-loss jab access tightened across much of England, analysis finds

Access to NHS weight-loss injections is being restricted in large parts of England, with more than half of local health commissioners tightening eligibility criteria beyond national recommendations.

This prompts warnings that poorer patients are being locked out of treatment.

New analysis from the digital weight-management provider Oviva suggests that 23 of England’s 42 integrated care boards (ICBs) are not following guidance from the National Institute for Health and Care Excellence (NICE) on who should qualify for drugs such as Mounjaro and Wegovy.

Under NICE guidance, adults are eligible for these treatments if they have a body mass index (BMI) of at least 35 and at least one weight-related health condition, such as type 2 diabetes or high blood pressure. NHS England has acknowledged that, despite their high upfront cost, the drugs are cost-effective because they can reduce the risk of expensive long-term complications linked to obesity.

However, many ICBs, which are responsible for planning and commissioning NHS services locally, are setting higher thresholds. In some areas, patients must have a BMI above 40 as well as multiple obesity-related conditions. Others require people to meet four out of five specified clinical criteria before they can access the drugs on the NHS.

The postcode variation highlights growing tension between ministers in Westminster, who have spoken about expanding access, and local NHS leaders facing severe financial pressures. Critics say the result is a two-tier system, where wealthier patients can pay privately for weight-loss jabs while those on lower incomes are left without treatment.

The pharmaceutical industry argues that NHS England guidance has contributed to the problem. While it allows ICBs to prioritise patients according to clinical need, companies warn that language around the “appropriate prioritisation of resources” is being interpreted as permission to restrict access more broadly.

Martin Fidock, UK managing director of Oviva, said the NHS was “pulling up the drawbridge” just as effective new treatments become available. “Investing in effective obesity treatment could save the health service billions of pounds and help people stay in work,” he said. “Access to obesity services should be based on clinical need, but instead the gap between national policy and local delivery is widening.”

Obesity remains a major public health challenge in the UK. The NHS estimates that just under 30 per cent of adults in Britain are living with obesity. Around 1.5 million people are thought to be using weight-loss drugs, either privately or through specialist NHS services.

Health secretary Wes Streeting has repeatedly warned against a future in which “health is determined by wealth” and has said he wants more people to access weight-loss injections through the NHS. NICE has recommended that Mounjaro could eventually be prescribed to up to 3.4 million people in England.

However, the rollout has been deliberately slowed. NICE later agreed to a phased introduction, beginning with around 250,000 people with the highest clinical needs in the first three years, to limit the immediate financial impact on the NHS.

An NHS spokesperson said demand for the new treatments had been high and that work was under way to establish new community-based services to expand access safely. The Department of Health and Social Care declined to comment.