Patchy access to weight-loss jabs risks widening health inequalities, particularly between people who can and cannot afford private prescriptions for the drugs, medics have warned.
The likes of Mounjaro and Wegovy have been hailed as wonder drugs but there are also concerns that demand for the medications are fuelling a two-tier system.
The strict NHS rules on who is eligible, combined with a “slow” national rollout due to cost, means people are increasingly turning to private doctors – if they can afford it.
A monthly private prescription can cost patients between £100 and £250, and the drugs are most effective when taken long term.
“We already know that there’s a huge gap in healthcare in the UK, and that can range from things as simple as the cost of fresh fruit and vegetables in the supermarket to access to computers and tech to book appointments,” said Dr Alia Fahmy, a GP who herself uses Mounjaro.
“Now access to medications such as Mounjaro… are only further widening that gap.”
The Royal College of Physicians added that current trends in the way obesity is treated risk creating a two‑tier system.
The warnings come amid concerns that uneven access to jabs could force some people to obtain them on the black market.
“This demand for weight-loss medication, coupled with a very slow and cautious NHS rollout, has created the perfect storm for criminals who are running a growing black market selling counterfeit weight-loss medication,” said Henry Gregg, the chief executive of the National Pharmacy Association.
Tears as monthly cost ‘rises to £540’
Obesity increases the risk of numerous health conditions such as type 2 diabetes, coronary heart disease and some cancers.
Dr Lucy Hooper, a GP based in London, said obesity is more common in economically deprived groups. People who cannot afford weight-less injections are “more likely to carry on struggling with obesity”, she added.
Wegovy, Mounjaro and Saxenda, another weight-loss drug, can be accessed privately with clinical screening if patients have a BMI of 30 or more, or at least a BMI of 27 and a weight-related health condition.
Mounjaro is only available on the NHS to people diagnosed with obesity and four of the specified weight-related health problems and a BMI of 40 or more, with adjustments made based on ethnicity. For Wegovy, people are usually eligible with a BMI of 35 or more and health problems due to weight.
“Those in more deprived areas face narrow NHS criteria, long waits and supply constraints,” said Palvinder Deol, the superintendent pharmacist at the online Happy Pharmacy.
One in five local areas in England still do not provide Mounjaro on the NHS six months after the drug was said to be rolled out across the country, according to an investigation by The BMJ.
Healthwatch England, which represents the views of patients, said some people had reported their GP saying they “probably wouldn’t get Mounjaro for two years” while others were struggling to afford it themselves.
One weight-loss jab user with lipoedema, an abnormal build-up of fat in the legs and arms that can be painful, said they spent two days in tears when the price rises were announced last year. They were quoted £540 for a monthly prescription that had previously cost them £200.
Another said: “Friends bought me the first month for Christmas and I agreed to do the second month – but stay on the low dose because I can’t afford the more expensive higher doses.”
Dr Alexander Miras, an obesity specialist at Imperial College London, said: “Any medication that first comes into the market is expensive by default. When they become cheaper the healthcare inequalities will ease.
“In the meantime, yes people will pursue any approach, legitimate or not, in order that they really need and they should be eligible for in the NHS.”
Patients are being priced out of accessing weight-loss injections, fuelling concerns of a two-tier system (Photo: Peter Byrne/PA)The black market for weight-loss jabs
In October, the Medicines and Healthcare products Regulatory Agency raided a major illicit weight-loss jab manufacturing facility in Northampton, with officers seizing tens of thousands of weight-loss pens.
Gregg said: “Not only are unregulated sellers breaking the law, they can cause serious damage to your health, with treatments not meeting UK safety standards and sometimes even being faked or swapped for an alternative medication, such as insulin.”
Dr Lorraine Albon, a member of the Royal College of Physicians advisory group on nutrition, weight and health, said: “The Government’s 10‑Year Health Plan promised to ‘launch a moonshot to end the obesity epidemic’.
“To achieve this, it is essential that people across the country have fair access to weight‑management services and treatments that are proven to work.
“At the same time, there must be clear, joined‑up strategies to prevent overweight and obesity in the first place.”
An NHS England spokesperson said it has been supporting the phased rollout of tirzepatide [Mounjaro], in obesity, for eligible patients through funding to local health systems since March 2025.
“The NHS has worked hard to deal with high demand for these treatments, establish brand-new services in the community, and explore innovative ways to scale this up safely so that people will be able to access weight-loss medicines that have the potential to transform healthcare.”
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