one of the most talked about medication, for both the right and the wrong reasons. what does the evidence say?
What is the problem?
- high levels of obesity
- obesity is multifactorial
- those from the poorest areas of the uk have the double the chance of developing obesity
- newest medication at the moment is the GLP-1 and GIP dual agonist, tirzepatide, which has led to even greater loss than semaglutide the previous generation
- access to this medication is dependent on your ICB
Current NICE guidelines
BMI Thresholds: • BMI ≥35 kg/m² or BMI 30-34.9 kg/m2 and meet criteria for referral to Tier 3 For people from minority ethnic backgrounds at equivalent risk, the threshold is ≥32.5 kg/m².
Health Status: • At least one weight –related comorbidity Service Setting • Treatment should be prescribed in secondary care by a specialist multidisciplinary tier 3 weight management service. • Can only be prescribed for 2 years. Only continued if get 5% weight loss at 12 weeks
well lets zoom into the referral to tier 3
A Tier 3 Weight Management Service will provide specialist assessment and weight management support for adults who have demonstrated that they have maximised primary care and community conservative management which must as a minimum include:
- Receipt of healthy weight and lifestyle advice in primary care AND
- Evidence of active participation in modification to exercise AND diet, which is patient- or GP-led, or delivered by an independent commercial service or Tier 2 service (e.g. Local Authority, NHS Digital Weight Management Programme, Diabetes Prevention Programme (or other weight loss initiatives such a Weight Watchers, Slimming World etc.) for at least 6 months and have failed to achieve or maintain adequate weight loss goal
For saxenda and wegovy, can only be prescribed by Tier 3 clinics of which there are only 42. Referral criteria to these centres are varied. Only 50% have permission from ICB to prescribe drugs. Postcode lottery as to whether we can get it.
Private prescriptoins - As of April > 1 millions people on
NHS End of March 3655 people on