Barely a day goes by it seems without a new revelation in the media about the global phenomenon that is weight loss medication. This degree of media attention reflects the public clamour to access these revolutionary and spectacularly successful new treatments for obesity. Brand names such as Wegovy, Saxenda, Mounjaro and Ozempic have swiftly become household names.
However, the airtime also reflects a growing sense of public and scientific concern. There is a widespread unease about unscrupulous marketing and dispensing of the drugs, and the lengths that some people are prepared to go to gain access to them. Alongside this, an increasingly polarised quasi scientific debate is being played out. On the one hand, there are regular studies and reports extolling the medication’s astonishing wider healing properties. On the other, we see increasingly alarming reports of perceived safety risks and potential side effects.
Why are these treatments so popular?
In short, the treatments are in such massive public demand because there is so much anecdotal evidence that they work – at least in the short to medium term. It seems that wherever we turn, we see celebrities waxing lyrical about how shedding the pounds has given them a new lease of life. And the science supports this. It is now accepted to be beyond reasonable scientific debate that
GLP-1 Receptor Agonists (to give them their technical name) are incredibly effective in helping people lose weight. Clinical studies have shown impressive results: semaglutide, resulted in 12% larger weight loss than placebo after 68 weeks of treatment, while tirzepatide, a dual GLP-1 and glucose-dependent insulinotropic polypeptide co-agonist, led to 18% weight loss compared with placebo after 78 weeks.
GLP-1 Receptor Agonists achieve this by mimicking a natural hormone that helps regulate sugar and appetite, helping the person feel full for longer and slowing digestion. This, in turn, helps reduce hunger and calorie intake.
It is also uncontroversial (and, of course, very welcome) that this degree of weight loss brings numerous associated health benefits, including a reduced risk of type 2 diabetes and improved cardiac health, not to mention boosted self-confidence and a better overall quality of life.
Wonder drug or risk to public safety?
However, despite their obvious efficacy, wider concerns have been circulating for some time about the safety of these treatments and their potential longer-term side effects. Here, the debate becomes much more nuanced and greyer.
On the positive side, the treatments have been held up in some quarters as a miraculous wonder drug whose benefits exceed well beyond mere weight loss. For example, a recent, extensive US study published in January 2025 the journal Nature Medicine, which was based on analysis of the medical records of about 2.5 million patients, concluded that GLP-1 medicines could be protective against as many as forty-two different diseases. The list of conditions for which protective properties were claimed is long and diverse – spanning from Alzheimer’s Disease and dementia to psychotic illnesses, liver cancer, infections, and pneumonia. And the claimed-for benefits do not stop there – the list of mind-boggling wider health ranges from curbing heavy drinking and treating alcoholism to slowing down the clock on biological ageing.
Alongside this, however, a quite different picture is emerging. As well as anecdotal stories emerging of increased hospitalisations, muscle wastage and osteoporosis, a spate of recent studies has raised concerns about some profoundly serious potential side effects. These are said to include severe visual problems - up to and including blindness (allegedly due to non-arteritic anterior ischemic optic neuropathy), gastroparesis (stomach paralysis), a significantly increased risk of pancreatic cancer, and increased anxiety and depression.
A regulatory challenge
It is too early to reach any definitive view about longer term risks and wider benefits, but current MHRSA Guidance is that the evidence shows the benefits of licensed weight loss injections outweigh the risks, provided they are used for their licensed indications. However, it is becoming increasingly clear that, whilst these drugs are highly effective for weight loss, for some people, at least. they can carry significant potential risks. They are clearly not appropriate for everyone.
For their part, UK regulators have long recognised that these are serious, potentially life-changing treatments and all licenced weight loss injections in the UK are prescription only medications (POMs). It is, therefore, illegal to sell weight loss medicines in the UK without a healthcare professional’s prescription (usually a GP). In addition, NHS access is tightly controlled. To be eligible under the NHS, the patient must either have a body mass index (BMI) of 30 or higher, or a BMI of 27+ with weight-related health conditions like diabetes or high blood pressure.
In the context of such sky-high demand, these narrow eligibility criteria have inevitably led to a bottleneck scenario, and regulators have had to be alive to attempts to cut corners, whether by reckless patients or unscrupulous suppliers. This pressure is at its most acute in two respects: first, there has been a sharp rise in the illegal sale of weight loss medicines without a prescription, usually via beauty salons or social media. Secondly, the popularity of weight loss medications has led to an unprecedented demand for online pharmacies. This demand was reported by the Times last week to have soared by 300% for some providers, principally because of the rush to access weight loss treatments.
MHRA & GPhC
The two principal UK regulatory bodies charged with policing this febrile environment are the UK medicines regulator, the Medicines and Healthcare products Regulatory Authority (MHRA) and the General Pharmaceutical Council (GPhC), which regulates the pharmacy sector in the UK.
Criminal activity
The MHRA’s Criminal Enforcement Unit is responsible for identifying and preventing the illegal sale of weight loss medications without a prescription. This body recently issued a public Notice reiterating the message to the public not to buy weight loss medicines without a healthcare professional’s prescription. The Notice urged the public to be aware of fake pharmacy websites and media posts offering weight loss medicines illegally.
The Criminal Enforcement Unit is working closely with social media platforms and technology companies to identify and prevent the illegal sale of weight loss medicines online without a prescription. Sanctions include the removal of social media posts illegally selling medicines and, where necessary, the suspension of accounts and the taking down of websites. The MHRA can also use the full range of its investigative powers to bring offenders to justice in the courts.
Online pharmacies – GPhC Guidance
The demand for online pharmacies, as reported by the Times last week, has soared for some providers, in no small part due to the rush to access weight loss treatments. The Times report refers to a study extrapolating real-time spending data of 150,000 people, which suggested that, in the 12 months to 1 February, spending at online pharmacies increased by £283 million. The data also showed that older millennials were among the biggest customers of online pharmacies, with almost half of patients aged between 35 and 44.
Unsurprisingly perhaps, the GPhC responded earlier this month releasing tightened guidance for all registered pharmacies providing services at a distance, including online. The new guidance aims to strengthen safeguards and prevent the inappropriate supply of medicines, particularly high-risk medications such as weight loss drugs. The guidance – which applies to all prescribers associated with online pharmacy services – introduced stricter best practice precautions for prescribing medications for weight management. These include the requirement for independent verification of patient information—such as weight, height, and BMI—before prescribing weight loss medications. This verification can be achieved either through video consultations, accessing clinical records, or contacting the patient's GP. The guidance also emphasises the necessity for timely two-way communication between the prescriber and the patient.
Striking the balance between availability and safety
In the face of soaring demand and growing safety concerns, regulating weight loss medications remains a complex challenge. While these drugs offer undeniable benefits for many, their potential risks, and the rise of illegal distribution call for robust oversight. UK regulators, including the MHRA and GPhC, have taken steps to tighten controls, but continued vigilance will be essential to ensure that access remains safe and appropriate. Striking the right balance between availability and safety will be crucial in managing this rapidly evolving landscape.
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