New Weight-Loss Drugs Are Here—But Your Wallet Might Decide If You Get One

Access to breakthrough obesity medications in the UK may soon depend more on your bank account than your medical need. Researchers from King's College London warn that strict National Health Service (NHS) eligibility criteria for new weight-loss drugs like Mounjaro could create a two-tier healthcare system, leaving vulnerable patients without treatment while those who can afford private care get help.

How Many People Are Already Paying Out of Pocket?

The numbers reveal a striking disparity in access. More than 1.5 million people in the UK are already accessing newer weight-loss medications through private providers, while NHS access is expected to reach only about 200,000 patients over the first three years of the program. This means private access currently outpaces NHS availability by more than seven to one.

Mounjaro, also known as tirzepatide, represents a significant advancement in obesity treatment. However, current NHS guidelines require patients to have a body mass index (BMI) of 40 or higher—roughly 280 pounds for someone 5'10"—plus multiple related health conditions like diabetes, high blood pressure, or heart disease to qualify.

Why Are Experts Concerned About Fairness?

The strict eligibility requirements may inadvertently exclude those who need help most. Researchers point out that the very conditions used to determine access are frequently under-diagnosed in specific populations:

• Women: Many qualifying conditions are missed or under-diagnosed in female patients
• Minority ethnic communities: Systematic under-diagnosis affects access to treatment pathways
• Low-income patients: Financial barriers often prevent proper diagnosis of qualifying conditions
• Patients with severe mental illness: Mental health conditions can complicate diagnosis and treatment access

"The planned rollout of Mounjaro risks creating a two-tier system in obesity treatment. Unless we adjust how eligibility is defined and how services are delivered, the planned roll-out of Mounjaro risks worsening health inequalities, where ability to self-fund determines access to treatment and those with the greatest need are less likely to qualify for treatment," said Dr. Laurence Dobbie, an NIHR Academic Clinical Fellow in General Practice at King's College London.

What Changes Do Experts Recommend?

The research team calls for several policy adjustments to ensure fairer access. Professor Barbara McGowan, Professor in Endocrinology and Diabetes at King's College London, emphasized the urgency of reform: "Obesity is a complex, chronic disease that demands equitable access to treatment for all who need it—not just those who can afford it. The current approach risks entrenching a two-tier system where wealth, rather than medical need, determines access to care."

The researchers recommend revising eligibility criteria to account for under-diagnosis, creating clearer pathways to care that consider ethnicity and diagnostic barriers, speeding up the national rollout, and expanding digital health services in areas with limited specialist support. They also stress that medication alone isn't sufficient—effective obesity care must combine with broader public health efforts like improving diet quality, reducing food insecurity, and creating healthier urban environments.

Professor Mariam Molokhia, Professor in Epidemiology and Primary Care at King's College London, added that geographic and economic factors shouldn't determine healthcare access: "Obesity care should not depend on postcode or the ability to self-fund. Current criteria risk excluding high-need patients because qualifying conditions are often under-diagnosed in the very groups who face the greatest barriers to care."

Without prompt policy changes, researchers warn that inequalities in obesity treatment will likely continue and may become even more pronounced for future generations, potentially leaving the most vulnerable patients behind in an era of medical breakthroughs.