Despite the promise of new weight loss medications such as Mounjaro and Wegovy, very few individuals in Scotland currently receive these drugs through the NHS. While these medications help suppress appetite and promote weight loss, their accessibility remains highly restricted due to cost concerns and limited NHS resources.
Eligibility Criteria for Prescription
Approximately two-thirds of Scots are classified as overweight, with one-third—equivalent to about one million adults—categorized as obese (BMI over 30). Although the Scottish Medicines Consortium (SMC) has approved medications like Wegovy (semaglutide), Mounjaro (tirzepatide), and Saxenda (liraglutide) for NHS use, strict criteria govern their prescription.
Initially, these drugs are available only to individuals with a BMI over 38 who also have at least one weight-related health condition, such as hypertension. The phased rollout ensures that those in greatest need receive treatment first, with future access expansions depending on outcome evaluations and prescribing data.
While these drugs remain limited on the NHS, they are available for private purchase. However, concerns over patient safety have led to stricter regulations, requiring in-person or video consultations and verification through medical records before prescriptions are issued.
Current NHS Provision and Demand
Most Scottish health boards have yet to introduce Mounjaro or Wegovy for weight loss, leading to extremely limited NHS availability. According to Freedom of Information requests submitted by BBC Scotland News, only 5,866 people are currently receiving care through specialist weight management services, while 8,756 remain on waiting lists—far fewer than those who could potentially benefit.
Further complicating access, many health boards lack the infrastructure to support widespread prescription of these drugs, citing concerns over supply constraints and budgetary challenges. Additionally, patients seeking NHS prescriptions must first consult specialists, but lengthy waiting lists impede access.
The Reality of Private Prescriptions
Given these restrictions, many individuals turn to private prescriptions despite the financial burden. Angela Chesworth, 51, from Dumfries, shared her personal struggles with obesity, recalling years of discrimination and health complications. She initially accessed Mounjaro privately but later secured an NHS prescription under exceptional circumstances due to pre-existing conditions.
Her husband, Paul Chesworth, 60, also takes Mounjaro for weight management but must pay £150 per month through a private prescription. Although his Type 2 diabetes is currently in remission, he does not qualify for NHS access unless his condition worsens. Paul argues that his use of the medication prevents more severe health issues, ultimately reducing NHS costs in the long run.
Challenges and Ethical Considerations
Medical professionals caution that universal NHS access to weight loss drugs is financially unfeasible. Dr. John Montgomery, a GP in Glasgow’s Govan area and representative of Deep End GPs, warns that providing these medications to all eligible individuals would overwhelm the NHS budget and strain healthcare resources.
Dr. Montgomery also highlights inequalities in access, noting that private prescriptions enable some individuals to bypass NHS restrictions, even in cases where the medication may not be appropriate—such as patients with a history of eating disorders. Meanwhile, some diabetic patients struggle to obtain necessary medications due to NHS supply limitations.
The Future of Weight Loss Medications in Scotland
Experts, including Professor Naveed Sattar from Glasgow University and chair of the UK government’s Obesity Mission, predict that as the cost of these drugs decreases over time—similar to the trajectory of statins—their availability on the NHS will expand. However, for now, the focus remains on prioritizing those at the highest risk.
Ultimately, healthcare leaders emphasize that medication alone cannot solve the obesity crisis. Dr. Iain Morrison, chair of the BMA Scottish general practitioners committee, underscores the need for broader public health strategies, such as improved access to community sports facilities and healthier food options, to address the root causes of obesity.
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