UK specialists say strict early access rules for the weight-loss drug tirzepatide (Mounjaro) risk creating a “two-tier” obesity treatment system, with people who can pay privately getting faster access than those relying on the National Health Service.
The rollout of tirzepatide, sold as Mounjaro, is being welcomed by clinicians as a new option for treating obesity, a condition widely associated with serious disease including heart disease and type 2 diabetes.
But specialists from King’s College London and the Obesity Management Collaborative (OMC-UK) argue that the National Health Service’s initial approach to providing the drug could create a two-tier system in which wealth plays a growing role in who gets timely treatment.
In an editorial published in the British Journal of General Practice, the researchers said early NHS access will be limited compared with private prescribing. Citing recent figures, they said more than 1.5 million people in the UK are already obtaining newer weight-loss medications through private providers, while NHS access to tirzepatide is expected to reach about 200,000 patients in the first three years.
Under current NHS rollout criteria described by the researchers, patients generally need a body mass index (BMI) of 40 or higher and multiple related health conditions—such as diabetes, high blood pressure or heart disease—to qualify. The researchers warned that this design could exclude many people at high risk who do not meet every requirement.
Dr. Laurence Dobbie, an NIHR Academic Clinical Fellow in General Practice at King’s College London and the editorial’s lead author, said the planned rollout “risks creating a two-tier system in obesity treatment,” arguing that the qualifying conditions used to determine eligibility are often under-diagnosed in women, people from minority ethnic communities, people on low incomes and people with severe mental illness. He also pointed to regional variation in NHS commissioning as a driver of uneven access.
Professor Barbara McGowan, Professor in Endocrinology and Diabetes at King’s College London, said obesity should be treated as a chronic disease and that access to effective treatment should be based on medical need rather than ability to pay.
Professor Mariam Molokhia, Professor in Epidemiology and Primary Care at King’s College London, said obesity care “should not depend on postcode or the ability to self-fund,” and called for pathways that better account for under-diagnosis and barriers to diagnosis.
The researchers urged policymakers to revise eligibility criteria to explicitly account for under-diagnosis and clinical need, speed up access where possible, and expand culturally adapted behavioural and wrap-around support alongside medication.
They added that drug treatment alone will not solve obesity-related harms and should be paired with broader public-health measures, including improving diet quality, reducing food insecurity and creating healthier local environments.
