Weight-Loss Drug Access Skews Toward Affluent Areas Despite Higher Obesity in Deprived Regions

Private prescriptions for GLP-1 weight-loss drugs in England are being dispensed predominantly to middle-aged women in affluent areas, despite obesity rates being nearly double in more deprived regions. An analysis found that access in affluent areas far outpaced NHS prescribing in more deprived regions, exacerbating existing inequalities in both the prevalence and treatment of obesity.

The analysis examined 113,630 adults aged 18 years or older who received a private prescription for a GLP-1 weight-loss drug between November 2024 and October 2025 from the online weight management provider Voy. Monthly subscription costs ranged from £144 to £324, depending on the medication and dose, and included support services.

Obesity prevalence was 37.4% in the most deprived areas compared with 19.8% in the least deprived, yet per-person prescribing rates were around 32% lower in deprived areas. People with obesity living in the least deprived areas were more than twice as likely to access GLP-1 treatment as those in the most deprived areas.

Almost 80% of prescriptions were issued to women, with the highest uptake among those aged 30-49 years. Prescribing fell sharply after age 60. After adjusting for higher obesity prevalence in deprived areas, inequalities in uptake became more pronounced. People in more deprived areas were more likely to have a higher BMI at the start of treatment.

In the most deprived areas, around 45% of users aged 30-49 had a starting BMI of 35 or higher, compared with around 30% in the least deprived, suggesting later intervention and greater accumulated health risk.

A study published in BMC Medicine found that approximately 1.6 million adults used such medications to support weight loss in the past year, and a further 3.3 million expressed interest in doing so in the next year. In total, this represents nearly one in 10 British adults. An estimated 2.4 million people in the UK are currently accessing these medications, with NHS prescriptions accounting for less than 10% of the total.

Two online pharmacies are bringing in enhanced measures after it was found they were selling weight-loss injections without proper safeguarding checks. Journalists were able to order so-called skinny jabs to Northern Ireland from Voy and MedExpress using false data and out-of-date images, with no further verification required.

Only obese patients, whose weight, height or body-mass index (BMI) are verified independently by the prescriber, are allowed access to the drugs. Voy has said it has updated its online checks while MedExpress said enhanced checks will be in place by April.

The General Pharmaceutical Council (GPhC), which investigated both firms, said it was "very concerned" at the findings. The GPhC had already issued MedExpress with an improvement action plan after an inspection. In the improvement action plan, it's stated MedExpress will build functionality for live photos, making them more difficult to fake.

When journalists ordered the drugs from Voy and MedExpress, they told the pharmacies the person weighed three stone heavier than they did. A four-year-old photograph, stripped of metadata which could indicate when it was taken, was uploaded to support the submission. Both MedExpress and Voy accepted the photograph and submission without further checks, and the medication arrived the next day.

GPhC guidelines state that an online pharmacy could independently verify the person's weight, height and BMI through a video consultation, in person or by contacting another healthcare provider such as the person's GP.

One company, MedExpress, has declared a 339% increase in orders from Northern Ireland between 2024 and 2025. In Northern Ireland, only those with type 2 diabetes who meet certain criteria can access the drugs on the NHS.

Drugs including semaglutide, liraglutide, and tirzepatide are licensed by the Medicines and Healthcare products Regulatory Agency for weight loss in the UK for patients with obesity (BMI ≥ 30) or overweight (BMI ≥ 27) with weight-related comorbidities, such as cardiovascular disease, hypertension, or sleep apnoea.

National Institute for Health and Care Excellence (NICE) guidance sets a higher threshold than the licensed indications for NHS use in England. NICE recommends tirzepatide or semaglutide for patients with a BMI ≥ 35 and at least one weight-related comorbidity. For semaglutide, a BMI ≥ 30 applies to those who meet criteria for referral to specialist weight management services. For liraglutide, eligibility requires a BMI ≥ 35 with nondiabetic hyperglycaemia and a high risk of cardiovascular disease.

Under NICE criteria, an estimated 3.4 million people in England would be eligible for weight-loss medication on the NHS. However, because of cost and capacity constraints, NHS England opted for a phased roll out, beginning in June 2025. During the first phase, treatment is prioritised for those at highest clinical risk, with around 220,000 people expected to receive the drugs between 2025 and 2028.

Initial eligibility is restricted to adults with a BMI of at least 40, or 37.5 for people from ethnic minority backgrounds, and at least four qualifying comorbidities: hypertension, dyslipidaemia, obstructive sleep apnoea, cardiovascular disease, and type 2 diabetes. This equates to about 6% of those who would qualify under NICE recommendations.

Almost 65% of adults in England were estimated to have overweight or obesity in 2023-2024. Successive government strategies have failed to address the scale of the challenge, with no sustained reduction in prevalence over the past decade.