It was intended to serve as a pivotal moment for obesity treatment in the UK. However, the introduction of the new weight loss medication tirzepatide, branded as Mounjaro, is revealing significant flaws within the healthcare system. Researchers from King’s College London caution that the National Health Service’s stringent eligibility criteria could lead to a two-tiered system, neglecting the most vulnerable and ill patients.
An editorial published in the _British Journal of General Practice_ contends that the NHS’s plan to provide treatment to only 220,000 patients within the first three years, while more than 1.5 million individuals in Britain already use GLP-1 receptor agonists privately, equates to care being rationed based on income. This disparity, they argue, poses a risk to exacerbate pre-existing health inequalities related to socioeconomic status, ethnicity, and mental health.
## Stringent Requirements, Restricted Access
During Phase 1 of the rollout, only those adults with a body mass index (BMI) of 40 or greater and at least four out of five designated comorbidities—such as type 2 diabetes, hypertension, or cardiovascular issues—are eligible for NHS-funded tirzepatide. Essentially, this means many at-risk individuals are excluded due to the absence of formal diagnoses necessary to meet the eligibility criteria.
Researchers highlight that the very conditions established to assess eligibility are frequently underdiagnosed in groups most impacted by obesity. Women, ethnic minorities, and individuals suffering from severe mental illness (SMI) are notably subject to higher rates of missed or delayed diagnoses. For instance, findings from the UK’s E-ECHOES study showed that over one-third of South Asian participants and one-fifth of African-Caribbean participants had undiagnosed hypertension.
This diagnostic discrepancy carries repercussions. A patient who hasn’t been officially diagnosed with hypertension or type 2 diabetes does not qualify for the medication, even if they satisfy all other clinical criteria.
> “The intended rollout of Mounjaro poses a risk of establishing a two-tier system for obesity treatment,” stated Dr. Laurence Dobbie, NIHR Academic Clinical Fellow in General Practice at King’s College London. “Unless we reconsider how eligibility is assessed and how services are provided, the intended rollout of Mounjaro risks aggravating health inequalities, wherein the ability to self-fund dictates treatment access, leaving those with the greatest needs less likely to receive care.”
Geographical disparities add another dimension of unfairness. By August 2025, merely eight of England’s 42 Integrated Care Boards permitted tirzepatide for obesity treatment, with some considering limits on first-year patient numbers. Individuals in rural regions encounter even greater obstacles, as referral rates to weight management services are five times lower than those in urban locations.
## Advocacy for a More Equitable System
Lead author Dobbie and his associates advocate that the NHS criteria should adapt to account for real-world discrepancies in diagnosis and access. They suggest gradually lowering BMI thresholds, creating dedicated pathways for individuals with SMI, and enhancing digital health initiatives to bridge regional disparities. They further encourage policymakers to follow recommendations from the Society for Endocrinology and the Obesity Management Collaborative-UK, which acknowledges circumstances like cancer recovery, fertility treatments, and surgical readiness as valid grounds for prioritized access to GLP-1 medications.
> “Obesity is a complex, chronic illness that necessitates fair access to treatment for everyone in need—not solely for those who can afford it,” remarked Professor Barbara McGowan, Professor of Endocrinology and Diabetes at King’s College London. “The existing approach threatens to cement a two-tier framework where wealth, rather than medical necessity, dictates treatment accessibility. There is an urgent requirement for a more inclusive, fair, and scalable model that guarantees effective treatments are available to all communities, especially those already grappling with systemic healthcare barriers.”
In addition to medication eligibility, the authors stress that equity hinges on the quality of supportive care. Programs offering behavioral support, nutritional guidance, and psychological services must be culturally sensitive and attuned to social challenges like food insecurity. Without these modifications, even well-intentioned national initiatives risk perpetuating the very disparities they aim to resolve.
If a patient has not been formally diagnosed with hypertension or type 2 diabetes, they do not qualify for the medication, even if they meet all other clinical indicators. “We should not accept a future in which one’s location or financial status dictates access to lifesaving treatment,” they assert.
Full study available at [British Journal of General Practice: 10.3399/BJGP.2025.0610](https://doi.org/10.3399/BJGP.2025.0610)
**There’s no paywall here**
*If our reporting has informed or inspired you, please consider making a donation. Every contribution, no matter the size, empowers us to continue delivering accurate, engaging, and trustworthy science and medical news. Independent journalism requires time, effort, and resources—your support ensures we can keep uncovering the stories that matter most to you.*
Join us in making knowledge