Weight management for adults

The National Institute of Health and Care Excellence (NICE) has recommended a treatment called tirzepatide (Mounjaro®) to help manage obesity. This treatment is to be used alongside healthy eating and physical activity advice.

This medication can be offered to people who are eligible in both specialist weight management services and primary care settings. Previously, similar medications like semaglutide (Wegovy®) and liraglutide (Saxenda®) were only recommended by NICE for prescription in specialist weight management services (which are usually hospital based services). The inclusion of tirzepatide (Mounjaro®) as a treatment option in primary care marks an opportunity to expand access and offer new treatments for people living with obesity.

Introducing this new treatment to an estimated 3.4 million eligible patients requires the NHS in England to develop a completely new service for weight management and train the varied healthcare professional workforce needed to deliver tirzepatide (Mounjaro®) in primary care.

A staged approach will help manage the impact on existing healthcare services, ensuring tirzepatide (Mounjaro®) is prescribed safely and that patients receive appropriate support.

In the staged roll out, tirzepatide (Mounjaro®) will initially be offered to individuals facing the most significant health risks related to their weight.

Weight loss medicine tirzepatide also known as Mounjaro ® is a GLP-1/GIP agonist. Other medications such as semaglutide (Wegovy ®), liraglutide (Saxenda ®), are known as GLP-1 agonists. They mimic gut hormones released by the body after eating, telling the brain you are full, they also slow down the time it takes the stomach to empty and help control blood sugar levels.

Until now most of these medicines have been used in the NHS to treat diabetes, to help control blood sugar levels helping improve diabetes and other health conditions.

Tirzepatide (Mounjaro®) can only be prescribed by a healthcare professional alongside programmes that support people to lose weight and live healthier lives, by making changes to their diet and physical activity. Tirzepatide (Mounjaro®) is an injection, that you inject yourself once a week.

Tirzepatide (Mounjaro®) will not be suitable for everyone and not everyone who meets the eligibility criteria will want to use it to support their weight loss. There are other options available including weight loss programmes that use tried and tested methods such as lifestyle changes and nutrition and physical activity advice. Please speak to a healthcare professional about what the best option is that is offered locally to you.

There are other options and services available, depending on the health-related conditions you have and your BMI. Weight management services are commissioned by Local Authority, Public health and NHS England.  Below are a few examples services commissioned by NHS England to support weight management .

The NHS Digital Weight Management Programme is available for those with diabetes, high blood pressure or both, with a BMI greater than 30. The BMI threshold is lowered to 27.5 for those from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds.

NHS staff do not need high blood pressure or type 2 diabetes to access the programme. – https://www.england.nhs.uk/digital-weight-management/

The NHS Type 2 Diabetes Path to Remission Programme is available if you are aged 18-65, have a diagnosis of type 2 diabetes within the last 6 years and have a BMI over 27 kg/m2 (where individuals are from White ethnic groups) or over 25 kg/m2 (where individuals are from Black, Asian and other ethnic groups). – https://www.england.nhs.uk/diabetes/treatment-care/diabetes-remission/

Adults are eligible to access the NHS Diabetes Prevention Programme if they have had a blood test in the last year that shows they are at risk of diabetes or if you were diagnosed with diabetes in pregnancy (gestational diabetes). – https://www.england.nhs.uk/diabetes/diabetes-prevention/

The conditions prioritised by NHS England carry a high, immediate risk of life-threatening complications. For example:

• Established cardiovascular disease has a well-established risk of recurrent myocardial infarction, stroke and cardiovascular death.
• Obstructive sleep apnoea is associated with increased cardiovascular mortality, road traffic accidents and resistant hypertension.
• Hypertension is a major modifiable risk factor for stroke, heart failure and chronic kidney disease.
• Type 2 diabetes substantially increases the risk of renal failure, blindness, cardiovascular disease and premature mortality.

These conditions have robust evidence demonstrating that weight reduction and modern obesity pharmacotherapy reduce major adverse health outcomes in those at highest risk.

We acknowledge that there is good evidence that clinically meaningful weight loss would improve many conditions. However, based on current national guidance and the available evidence access to Tirzepatide outside the existing NHS England eligibility criteria is only possible in very exceptional circumstances.