There is some good news today. The National Institute for Health and Clinical Evidence (NICE) has published guidance supporting the use of semaglutide (Wegovy) for the management of people who are overweight or obese, under the NHS.
As expected, however, the guidance will not help everyone who would like to use it. It will still be hard to get NHS funding for this new drug.
What has NICE recommended?
Semaglutide is recommended for some people living with obesity if prescribed within a specialist weight management service alongside lifestyle interventions. I know from setting up one of these services, which are generally hospital based, that waiting lists are very long.
Within these services, semaglutide can be recommended for adults with at least 1 weight-related comorbidity and a BMI of at least 35 kg/m2. A small number of patients may meet referral criteria at a lower BMI of 30-35 kg/m2 if they have complex health needs too.
However, many patients in these specialist services already have type 2 diabetes for which a similar version of semaglutide (known as Ozempic) is already often prescribed. So, there probably isn’t going to be a huge change in NHS prescribing of a drug that has been shown to reduce weight better than existing non-surgical treatments.
I am pleased to see, however, that NICE recognises that some ethnicities may be prone to obesity-related complications at a lower BMI and so have lowered the referral threshold by 2.5kg/m2 for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family backgrounds.
What does this mean in practice?
If you are struggling with your weight such that your BMI is 35 or over and you have a health problem related to your weight, you can ask your GP for a referral to a weight management service. You may then be assessed for lifestyle interventions +/- medication like Wegovy, or even surgery if appropriate. Unless you have good health reasons requiring weight loss support, it is unlikely that you will be referred for medication with a BMI under 35.
Can you still use Wegovy if your BMI is less than 35?
Wegovy is licensed for weight loss in people with a BMI of 27 and over if they have a weight-related health problem, otherwise 30 and above. It should be used alongside lifestyle changes – reduced calorie intake and increased activity. So people with a BMI less than 35 can still be considered for a Wegovy prescription from a specialist weight loss professional…but they will have to fund it themselves. That is a problem – the drugs are expensive and many people who struggle with their weight will also struggle to pay for the medication they need.
Why won’t the NHS fund Wegovy for more people?
We all know the NHS is over-stretched. So NICE has to consider the health and economic benefits as well as the ability of NHS staff to support the large numbers of people who would potentially benefit from Wegovy.
Can you use Ozempic instead?
Ozempic is not licensed for weight loss alone – it is a drug that is used to treat diabetes. The media-driven demand for this medication has resulted in some services prescribing it off-licence without proper assessment and support, and reports of drug shortages for diabetics.
However, Wegovy is due to be launched within weeks. In the meantime, Saxenda or liraglutide, is a similar medication that is helping weight-loss, though not quite as effectively as Wegovy has proven in clinical trials.
If you are interested in discussing the best weight loss treatment for you and whether NHS referral is an option, please click below and I can get back to you.