Are weight-loss treatments contributing to health inequalities?

Two-tiered access to GLP-1 agonists

GLP-1 is a hormone that helps regulate blood sugar levels. Weight-loss treatments based on the hormone have the potential to play a pivotal role in the future management of obesity. Demand for these treatments has soared in recent years, fuelled in part by social media and celebrity influencers.

In the UK, however, National Health Service-funded access is limited. In December 2024, there were 500,000 people taking semaglutide and tirzepatide in the UK – of these, 95% were buying the medications privately at a cost of around £150 a month.

The pace of national roll-out has been slow, and intentionally so, with UK health bodies seeking to ration access over concerns that intense demand could overwhelm the health system in terms of both capacity and cost. In 2024, NHS England requested a phased approach to the roll-out of tirzepatide over a maximum 12-year period, to allow time for service providers to put staffing, training and resource capacity in place. In response, the National Institute for Health and Care Excellence has restricted access to just 220,000 (out of an eligible population of 3.4 million in England) over the first three years of tirzepatide roll-out. According to the Obesity Health Alliance (OHA), the NHS has projected that fewer than 50,000 people per year will receive semaglutide by 2028, despite the eligible population for this treatment being 4.1 million people.

The UK is not alone in its approach to accommodating the surge in demand for GLP-1 weight-loss treatments. In Germany, weight-loss medicines are not reimbursed by the national insurance system – which covers approximately 90% of the population – nor by private insurance companies. This means they can only be accessed by people paying out of pocket. The situation in similar in France, which has opted not to cover the treatments through its national insurance programme.

Health inequalities are being exacerbated

For many people, paying privately for weight-loss treatments is simply not an option. With low-income families already disproportionately at risk of obesity, this raises serious concerns that the two-tiered system of access to GLP-1 agonists will widen the gap in health outcomes between the wealthiest and the poorest people, at least in the short term. This concern has been echoed by a number of professional groups and charities, including the UK Royal College of Physicians and the OHA.

Sarah Le Brocq, the OHA’s Expert Member on Lived Experience, said, ‘It’s essential that these treatments are accessible to everyone who is eligible. We need immediate government support to fund and strengthen NHS infrastructure to meet the demand and ensure equitable access to these treatments.’

Expanding access to GLP-1 agonists could ultimately save the NHS money. In 2024, innovation charity Nesta recommended that the UK government ringfence an extra £500 million a year over the next five years to increase access to the treatments. The charity estimated the annual benefit to the government to be £1 billion in the form of treatment and social care cost savings, as well as a boost in productivity. Similar approaches have been taken in some US states to ensure that these treatments are available to eligible populations.

Prioritising people who need weight-loss treatments most

Providing weight-loss treatments to all those who could benefit from them would help alleviate the mounting pressure on health systems that is caused by obesity and its associated conditions. The economic case is also strong. Expanding access would ultimately lead to long-term cost savings for the health system. This is a persuasive argument for cash-strapped public health services; but, of course, it requires upfront costs that not all governments have.

Policymakers, healthcare providers and pharmaceutical companies must work together to ensure that these treatments are distributed equitably, rather than reinforcing the divide between those who can afford private healthcare and those who rely on the state. Without intervention, the promise of these medications may be overshadowed by their role in exacerbating health disparities in an already unequal system.

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.