In Scotland, the use of prescription weight loss medications remains highly restricted, with only a small number of patients currently eligible to receive these treatments through the National Health Service (NHS). Medications such as Mounjaro and Wegovy have been heralded as breakthroughs in the fight against obesity, yet their availability is tightly controlled due to cost and safety concerns.
Strict Prescription Criteria
Obesity is a significant health issue in Scotland, where nearly two-thirds of the population is classified as overweight and one-third—approximately one million adults—are considered obese. Obesity is defined as having a Body Mass Index (BMI) over 30, which qualifies individuals for certain weight loss medications. However, despite the effectiveness and cost-effectiveness of drugs like Mounjaro and Wegovy, these treatments are currently available to only a limited group.
The Scottish Medicines Consortium (SMC) has approved several weight loss drugs for NHS use. Among them, semaglutide—marketed under the brand name Wegovy—is approved for treating obesity, and tirzepatide, branded as Mounjaro, has also been specifically approved for weight loss. A third option, liraglutide (Saxenda), has been available since 2022. Despite their approval, these medications are only accessible under strict criteria in the first phase of their introduction.
Phased Rollout and Eligibility
Under the initial phase, prescriptions are restricted to patients with a BMI over 38 who also suffer from at least one weight-related health condition, such as hypertension. The phased approach is intended to manage access to these drugs while evidence of their effectiveness is collected. The Scottish government has emphasized that this strategy aims to ensure that patients who need these medications most are able to access them sustainably.
While NHS prescriptions are limited, private access to these drugs is available. However, doctors and pharmacists have warned about the risks of purchasing these medications online, leading to tighter regulations requiring in-person or video consultations with a GP and a review of medical records.
Limited Prescriptions and Long Waits
Despite the approval of these medications, data gathered by BBC Scotland reveals that the number of people receiving Mounjaro or Wegovy for weight loss on the NHS is extremely low. Freedom of Information requests indicated that approximately 5,866 individuals are currently being treated by specialist weight management services in Scotland, with an additional 8,756 on waiting lists. However, health boards have been unable to determine how many patients have been prescribed these medications exclusively for weight loss, as they are also approved for the treatment of Type 2 diabetes.
The lack of adequate weight management services and ongoing supply issues have raised concerns about the feasibility of meeting demand. For patients to receive these drugs on the NHS, they must first be seen by a specialist, but there are significant delays in accessing these services.
The Cost of Treatment
Angela and Paul Chesworth, a couple from Dumfries, both take Mounjaro to manage their weight. Angela, 51, has struggled with obesity for most of her life and, after experiencing several failed attempts at weight management, turned to a private prescription of Mounjaro. The drug alleviated some of her health issues, but she and her husband continue to pay £150 a month for the treatment, which they say is necessary for managing their lifelong struggle with obesity. Angela was eventually able to access Mounjaro through the NHS after meeting certain medical criteria.
While Angela and Paul acknowledge the risks associated with the drug, including potential side effects such as nausea and pancreatitis, they argue that the benefits far outweigh the dangers, as it helps them maintain a healthier weight and reduces the risks of other serious conditions like heart disease.
Concerns Over Accessibility and Sustainability
Dr. John Montgomery, a GP working in deprived areas of Glasgow, warned that the widespread distribution of weight loss medications could overwhelm the NHS and deplete resources. He emphasized that while the drugs have a role in combating obesity, addressing the root causes of the condition—such as poor diet and lack of access to exercise facilities—should be prioritized.
Dr. Montgomery expressed frustration with the current situation, where patients who need the drugs due to conditions like Type 2 diabetes are struggling to access them, while others who do not meet the eligibility criteria are obtaining the medication privately. He pointed out that the NHS is already under strain, and distributing weight loss medications to everyone who qualifies could result in a financial burden that the system cannot sustain.
Similarly, Dr. Iain Morrison, chair of the BMA Scottish general practitioners committee, argued that focusing solely on medications as a solution to obesity is short-sighted. He called for a more comprehensive approach that includes addressing the social determinants of health, such as the availability of unhealthy food and the lack of community sports resources.
Conclusion
In conclusion, while weight loss drugs like Mounjaro and Wegovy offer potential benefits for managing obesity, their availability on the NHS in Scotland is currently limited due to cost and supply issues. Strict prescription criteria, long waiting times for specialist services, and the need for a more sustainable strategy to address the underlying causes of obesity all contribute to the current situation. Until these challenges are addressed, many patients may continue to seek private alternatives, despite the financial and health risks involved.
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