Obesity Treatment Becoming “Two-Tier System,” Experts Warn

Researchers warn that strict NHS rules for Mounjaro could deepen health inequalities, leaving vulnerable patients without access while wealthier individuals turn to private treatment.

Access to obesity treatment in the UK could soon be divided into two levels, leaving many of the most vulnerable people without help.

Specialists from King’s College London and the Obesity Management Collaborative (OMC-UK) warn that strict NHS rules mean only a limited number of patients will qualify for the weight-loss medication Mounjaro, while those with financial means are turning to private treatment instead.

In an editorial published in the British Journal of General Practice (BJGP), the researchers explain that this situation is creating a clear divide in care, where financial ability rather than medical need determines who receives treatment.

Obesity remains a major global health concern, closely linked to serious illnesses such as heart disease, type 2 diabetes, and cancer. The NHS rollout of tirzepatide (known by its brand name Mounjaro) has been viewed as a positive development in addressing these challenges.

However, recent figures show a striking difference in access. More than 1.5 million people in the UK are reportedly obtaining these new medications through private channels, while NHS availability is expected to reach only about 200,000 patients within the first three years.

Strict NHS Criteria Leave Many Behind

The current NHS criteria for access to Mounjaro require patients to have a BMI of 40 or above combined with several additional health conditions such as diabetes, high blood pressure, or heart disease. While this approach does provide some access to effective obesity treatment, it excludes many people who are at serious risk but do not meet all of these requirements.

The researchers warn that these rules risk widening existing health inequalities.

Lead author Dr. Laurence Dobbie NIHR Academic Clinical Fellow in General Practice at King’s College London said:

“The planned rollout of Mounjaro risks creating a two-tier system in obesity treatment. Unless we adjust how eligibility is defined and how services are delivered, the planned roll-out of Mounjaro risks worsening health inequalities, where the ability to self-fund determines access to treatment, and those with the greatest need are less likely to qualify for treatment.

“Current eligibility criteria require multiple diagnosed qualifying criteria, yet the very conditions used to gatekeep access to Mounjaro are frequently underdiagnosed in women, people from minority ethnic communities, those from low income, and patients with severe mental illness. The under-diagnosis is well-documented and regional variation in NHS commissioning creates a postcode lottery.

“We should recognize under-diagnosis explicitly in obesity pathways, prioritize our patients at the highest clinical need, and scale culturally adapted wrap-around support so access is based on need, not means or location.”

Calls for Fairer and More Inclusive Policies

Professor Barbara McGowan, Professor in Endocrinology and Diabetes at King’s College London, said:

“Obesity is a complex, chronic disease that demands equitable access to treatment for all who need it — not just those who can afford it. The current approach risks entrenching a two-tier system where wealth, rather than medical need, determines access to care. We urgently need a more inclusive, fair, and scalable model that ensures effective treatments are accessible across all communities, especially those already facing systemic barriers to healthcare.”

Professor Mariam Molokhia, Professor in Epidemiology and Primary Care at King’s College London says:

“Obesity care should not depend on postcode or the ability to self-fund. Current criteria risk excluding high-need patients because qualifying conditions are often underdiagnosed in the very groups who face the greatest barriers to care. For equitable delivery of care, it is important to: recognize under-diagnosis in eligibility criteria, prioritize severe obesity and those with the highest clinical needs, and provide culturally adapted behavioral support.”

The opinion piece calls for changes to improve fairness and equity. These include changing who qualifies for support, setting up clearer routes to accessing care that take ethnicity and under-diagnosis into account, accelerating the national rollout, and expanding digital health services to reach patients in areas where specialist services are limited.

The authors also stress that access to medication must go hand-in-hand with broader public health measures, including policies to improve diets, address food insecurity, and ensure healthier urban environments.

The researchers conclude that without urgent changes to policy, inequalities in obesity care will persist and worsen for future generations.

Reference: “Tirzepatide and the NHS: are we creating a two-tier obesity treatment system?” by Laurence J Dobbie, Mariam Molokhia, John PH Wilding, Tricia M-M Tan and Barbara McGowan, 31 October 2025, British Journal of General Practice.
DOI: 10.3399/BJGP.2025.0610

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