Who can get weight loss drugs on the NHS in Scotland?

Very few people are currently being prescribed drugs for weight loss on the NHS in Scotland, research by BBC Scotland News has established.

Medications like Mounjaro and Wegovy have been hailed as "game changers" for tackling obesity.

These injections suppress people's appetites, causing them to feel fuller sooner - but they are not suitable for everyone and can have side effects.

Doctors say the cost of prescribing them - and the number of Scots affected by obesity - means they can't currently be given for free to most patients who might benefit.

Two thirds of Scots are classified as overweight, and one third - about one million adults - as obese. That means they have a Body Mass Index (BMI) above 30.

The medicines watchdog has agreed the drugs are safe and cost-effective for NHS use.

Last year, semaglutide was approved for treating obesity under the brand name Wegovy. It has also been licensed under the brand name Ozempic for treating diabetes in some circumstances, but not for weight loss in this country.

At the same time, another drug called tirzepatide was approved specifically for weight loss by the Scottish Medicines Consortium (SMC) under the brand name Mounjaro.

Since 2022, a third drug, liraglutide, has been approved under the name of Saxenda.

But all of these medications currently come with strict criteria for their prescription on the NHS as part of a phased introduction.

In phase one, they may only be prescribed to patients who have a BMI over 38 and at least one pre-existing weight-related health condition, such as high blood pressure.

Further phases will be planned when the evidence of prescribing data and outcomes has been analysed.

The Scottish government said the aim of the phased introduction was "to ensure sustainable access for patients who need it most".

While the use of the drugs is limited on the NHS, they can also be bought privately – but pharmacists and doctors have warned of risks to patient safety through online sales.

Stricter checks were brought in last month to require in-person or video consultations, along with information from GP or medical records.

Most Scottish health boards are not currently prescribing Mounjaro or Wegovy for weight loss, which means that very few people are currently getting the drugs on the NHS.

Freedom of Information requests by BBC News established that 5,866 people are currently being seen by specialist weight services in Scotland.

Another 8,756 people are on waiting lists, and doctors said the number of people eligible for weight loss drugs was far higher.

However, the health boards were unable to say how many people were getting Mounjaro or Wegovy specifically for weight loss on the NHS.

After the SMC granted approval, there was concern that not all health boards had a weight management service model to support the recommendations - and that the potential level of uptake, along with ongoing supply issues, could pose a challenge for budgets.

Any patients to be prescribed the drugs on the NHS would need to see a specialist before starting the injections, and there are long waits for weight management services.

We asked all 14 regional health boards to tell us how many patients were receiving Wegovy or Mounjaro specifically for weight-loss.

The majority told us that because they can also be prescribed for patients with Type 2 diabetes, they were unable to distinguish whether they had been prescribed solely for weight loss purposes.

Addy Mohammed, co-founder of Simple Online Pharmacy, said the latest data from pharmacy wholesalers suggested that more than a million people in the UK were now privately accessing weight loss medications - double the number in October last year.

Angela Chesworth, 51, from Dumfries, says she experienced physical and verbal abuse over her appearance for 30 years.

"I'm petrified of going back to being 24 stone (153 kilos). It's my biggest fear in life," she said.

When she went for her first smear test, she was asked to lie on the floor instead of an examination table because it was not safe.

It took Angela 20 years to go back for her second test because she "couldn't face that humiliation again".

She had bariatric surgery in 2013 and lost 12 stone in 12 months - but during the next decade she regained four stone and started suffering painful spasms in her stomach due to side effects from previous surgeries.

In June last year, before the weight loss drug was available through the NHS, Angela started a private prescription of Mounjaro.

It made a huge difference to her pain.

She has now been prescribed the drug on the NHS under exceptional circumstances because she already had other medical conditions.

She says people used to roll their eyes at her and puff out their cheeks when she was walking down the street - but that the weight loss drugs had now made her "invisible".

"I might be what is deemed a healthy weight, but I'm still living in a body that has obesity, so I'll still need those treatments and support for the rest of my life," Angela said.

Her husband Paul, 60, also takes the same drug for weight loss - but he pays £150 a month for it through a private prescription.

The couple say they have to be careful with their finances, but that the drug is necessary because they will always live with obesity.

Paul has type 2 diabetes, which went into remission before he underwent bariatric surgery.

He started the injections after his diabetes showed signs of relapsing in recent years.

But he was told he could not receive Mounjaro through the NHS unless he became diabetic again.

Paul said the drug reduced his risks of other diseases, such as heart problems and high cholesterol - which means he is likely to cost the NHS less.

The couple acknowledged the serious risks of the drug - including nausea, vomiting or even pancreatitis - but said it was necessary to help them manage their weight.

Dr John Montgomery represents Deep End GPs, a network of doctors who work in the most deprived areas of Scotland.

He warned that if weight loss drugs were prescribed to everyone who needed them, it would bankrupt the NHS overnight.

"We don't have the resources to pay for the drugs and even if we did, we don't have the staff available to administer the drug safely," he said.

Dr Montgomery says areas like Govan in Glasgow, where he works, have higher levels of obesity than more affluent areas.

He says the drugs have a key role to play in tackling obesity, but it has to be accompanied by significant investment in tackling the root causes of obesity.

He has come across patients that do not fit the recommended guidelines who have received private prescriptions.

Dr Montgomery said some of these people were "very vulnerable", including one patient with a long history of eating disorders where he had to intervene because the medication was not safe.

He is also frustrated that his diabetic patients have struggled to get the jabs due to NHS supply issues, while others who do not need the drugs are getting them privately.

Dr Iain Morrison, chair of the BMA Scottish general practitioners committee, said that if the drugs were prescribed to all those in Scotland who qualify it would mean other areas of the health service would lose out.

He said there needed to be "a much better strategy than simply looking toward medication as the answer" to manage obesity.

Dr Morrison added the issues that contributed to the problem included closure of community sport facilities and the easy access to unhealthy foods.

Professor Naveed Sattar, from Glasgow University, is chair of the UK government's Obesity Mission.

He said that when a new innovation came along, like statins did about 30 years ago, they were expensive at first - but then the price started to fall.

While they could only afford to offer weight-loss drugs to those at the very highest risk as the moment, he expected that costs would fall in the coming years and they would then be able to "widen the net" of people who could be prescribed them on the NHS.