The government’s approach to weight loss management needs to be “fundamentally reimagined” and services need “overhauling”, according to a new report by the parliamentary Health and Social Care Select Committee (HSCC).
Published today, the HSCC’s second report from its inquiry into “‘Food and Weight Management” called the “absence of adequate weight management services” an “indefensible failure of people living with obesity”.
And it urged the government to publish a modern services framework (MSF) “recognising [obesity] as a condition and setting clear standards of delivery and accountability”.
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According to the report, obesity costs the UK at least £74.3bn a year, with over two-thirds of the population living with overweight or obesity.
The committee said that current weight loss services are “poorly designed” and highlighted a “lack of uptake of other existing evidence-based interventions”, such as bariatric surgery or behavioral interventions, compared to GLP-1s.
It also identified a “significant postcode lottery” in access to NHS weight loss jabs across the country, noting an “emerging two-tier system” based on patients’ “ability to pay for private access”.
“Learn from the private sector”
The report said current plans to roll out Mounjaro on the NHS are “unambitious given the scale of the challenge of obesity” and “reach a woefully small number of people who could benefit”.
It added that due to the “much larger number of private prescriptions of GLP-1s”, there are “opportunities to learn from the private sector and better use the capacity of digital providers”.
But it warned that issues around data sharing must first “be addressed in a way that did not place additional burden on general practice”, adding that private providers had reported relying on patients to provide medical information “because they did not always have access to GP records”.
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It said Pharmacy2U chief medical officer Dr Kieran Seyan told the committee this was a “known risk [ … ] becoming more prominent because of the demand” for GLP-1s.
The HSCC called on the government to “urgently reassess the pace of rollout of Mounjaro” and said this “should include making better use of the capacity of digital providers”.
“As a first step, the department should hold a summit on GLP-1 access with a range of providers and healthcare professionals to open a dialogue on how best to improve the rollout,” it said.
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And it added that pharmacies and providers should have “secure access to relevant patient information and the ability to update records to show that a patient is receiving a GLP-1”.
The committee also urged the government develop an MSF that defines obesity as a “lifelong, relapsing and remitting condition that requires ongoing management” and treats it similarly to other long-term conditions such as type 2 diabetes.
It recommended that the MSF supports patients in accessing the full range of treatments available for obesity, including Type 2 Diabetes Path to Remission Programme, and said the government should review current behavioral interventions with a view to create “a single national design that a range of providers can offer”.
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Alongside the remission programme and behavioral interventions, the committee pushed for the government to “commit to an increase in the number of bariatric procedures carried out per year”, with an initial target of around 13,000 procedures, double the current figure.
It also stressed that all obesity treatments should be “accompanied by consistent, long-term wraparound support, including nutritional, behavioral and mental health services” for which “uptake data is routinely collected”.
Black market GLP-1s
The report also acknowledged the issue of illegal GLP-1s on the black market, noting that Pharmacy2U told the committee that “the slow national rollout of medications might be driving individuals to unregulated online suppliers selling products at a cheaper price that may contain toxins and harmful ingredients”.
The committee heard from the Medicines and Healthcare products Regulation Agency’s (MHRA) deputy director of criminal enforcement and head of the Criminal Enforcement Unit Andy Morling, who said that “many people did not realise they were buying from the black market” because the public struggle “to tell the difference between genuine providers of GLP-1s online and illegal online sellers”.
He added that “we cannot arrest our way out of this”, and other witnesses suggested to the committee that “public education and awareness was a core component of tackling black market access to weight-loss medications”.
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Following this evidence, the committee called on the government to review the MHRA’s “capacity and capabilities” to address the illegal trade of weight loss drugs.
It also urged the government to launch a public awareness campaign aimed at “members of the public most likely to consider buying from unregulated sources”, and develop a “joined-up action plan” for tackling illegal GLP-1s and access to them via social media.
Other recommendations included a section within the MSF dedicated to support for children, improved guidance for professionals, more standardised referral criteria and expectations for workforce training on obesity.
“Repeatedly failed”
HSCC chair Layla Moran MP said the NHS “should provide effective, structured support to beat obesity for all those who seek it” but “instead, those people are repeatedly failed”.
She added that while weight loss drugs have been “a positive innovation”, the two-tiered system that has emerged due to limited NHS supply has “inadvertently” deepened health inequalities.
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Moran said the report “urges the government to make improvements to obesity care a priority” through “a new, nationally available care pathway modelled on how diabetes is tracked and managed”.
And she called for “a change in attitudes, and in language used in policy making, to properly recognise obesity as the serious health condition that it is”.
“Community pharmacy is ready”
National Pharmacy Association (NPA) chief executive Henry Gregg said the body “agrees with MPs that the NHS rollout remains extremely slow, with many people who could benefit from treatment being unable to access it”.
“Not only does this slow NHS rollout create a postcode lottery for patients, but it also inadvertently helps to fuel a growing black market for unlicensed or counterfeit versions of GLP-1 treatments,” he added.
“Community pharmacy is ready to support a wider rollout, which will help eligible patients access treatment safely and help mitigate the impact of obesity on the NHS.”
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And Company Chemists’ Association chief executive Malcolm Harrison said the committee has “rightly called for the NHS to roll out access to weight loss medicines at pace” and said pharmacies are “ideally placed to the expand the NHS’s reach”.
“The benefits of weight loss services cannot be underestimated. With the advent of independent prescribing pharmacists, a national, pharmacy-led pathway, alongside existing private services, would significantly expand access, and should be commissioned without delay,” he added.
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It comes after Boots superintendent pharmacist Claire Nevinson told the HSCC in March that the NHS and the government have a “real opportunity” to look at how community pharmacy can support expanding NHS weight loss services.
And it follows the HSCC last year launching an inquiry into the government’s approach to tackling the “obesity epidemic”, exploring “what public health interventions have been the most effective” at reducing it so far.
