GPs will soon be able to refer patients for weight-loss treatment with semaglutide, which NICE says can help people to reduce their weight by over 10 per cent.
NICE has today recommended the drug for use as part of a patient’s treatment in an NHS specialist weight management service and with the support of a multi-disciplinary team.
The drug, marketed as Wegovy, should be prescribed to adults who have at least one weight-related comorbidity and a BMI of at least 35kg/m2, alongside a reduced-calorie diet and increased physical activity.
Multi-disciplinary teams will be able to prescribe the drug when the NHS implements the recommendations in NICE’s guidance, published today, which must be done within three months of its commercial availability.
Semaglutide, manufactured by Novo Nordisk, is administered by a weekly injection with pre-filled pens, and it suppresses appetite by mimicking the hormone glucagon-like peptide-1 (GLP-1), which is released after eating.
Helen Knight, director of medicines evaluation at NICE, said: ‘For some people losing weight is a real challenge which is why a medicine like semaglutide is a welcome option.
‘It won’t be available to everyone. Our committee has made specific recommendations to ensure it remains value for money for the taxpayer, and it can only be used for a maximum of two years.’
Professor Nick Finer, honorary clinical professor at the National Centre for Cardiovascular Prevention and Outcomes at UCL, said the drug’s efficacy is a ‘true game changer’ for treating obesity, but criticised the two-year limitation on usage.
He said: ‘The limitation of two years’ treatment is, of course, completely illogical since obesity is a chronic disease and is not cured by this treatment.
‘In common with other diseases, such as hypertension and diabetes, withdrawal of a drug that is working means the benefits are likely to be lost (as has been shown in several trials by partial weight regain after semaglutide withdrawal).’
Professor Alex Miras, professor of endocrinology at Ulster University, also highlighted this issue, and identified the lack of available services as another potential limiting factor.
He said: ‘There are not enough services to offer the medication and the ones that exist are under resourced. This could lead to worsening of health inequalities across the country.
‘It is therefore vital that the appropriate investment in such services becomes available, otherwise the guidance may end up becoming irrelevant to daily care.’
Around 28% of adults in England are obese and a further 36% are overweight, according to the 2019 Health Survey for England, and the Government has estimated obesity in the UK costs the NHS £6.1bn.
The professionals involved in the multi-disciplinary team are experts in coaching people on lifestyle interventions for weight loss, and they will also monitor semaglutide’s potential side-effects, which can include nausea, diarrhoea, constipation and vomiting.
NICE has given examples of weight-related comorbidities, including dysglycaemia, hypertension, dyslipidaemia, obstructive sleep apnoea or cardiovascular disease.
A randomised double-blind clinical trial showed that participants taking semaglutide lost on average 12% more of their body weight compared with placebo.
The drug could also be prescribed to people with a BMI of between 30-34.9kg/m2 with one weight-related comorbidity if they are eligible for referral to a specialist weight management service.
The drug was initially recommended by NICE’s independent committee in June 2022, however publication of the final guidance was pushed to today as the product had not yet been scheduled to launch in England.
Two years ago, NICE approved the use of a similar drug, liraglutide, as an obesity treatment on the NHS for patients with pre-diabetes under the care of specialist weight loss clinics. Also manufactured by Novo Nordisk, liraglutide increases insulin secretion and was recommended in conjunction with lifestyle measures.
In November 2022 the Government announced £20m of funding to trial how best to deliver new medicines and technologies for people living with obesity, particularly in deprived communities across the UK.
Note: This article was updated to reflect that specialist weight management services will start patients on semaglutide, following a GP referral.
READERS' COMMENTS [11]
Please note, only GPs are permitted to add comments to articles
GPs can, legally, but shouldn’t.
It is not core and really needs to be part of an overall weight loss programme at tier 2 or tier 3.
If your ICB wants you to prescribe it, make sure they fund a proper service under a LCS.
Not a helpful headline unfortunately.
We wil NOT be prescribing it for this indication until local enhanced services have been negotiated, as we are not commissioned weight management services.
We are also struggling with supplies of semaglutide for our existing diabetic patients, who will take priority if semaglutide is available.
Are you kidding me ?
This in unlocking the portals of hell
I thought Pulse was a publication for GP’s – surely the headline should read “GP’s furious about media rising expectations of an undeliverable service with no funding at a time they are being imposed on another enforced unworkable contract “
In my practice 22000 we have nearly a half time GP a weeks worth of appointments used for HRT. This is an important service which we are happy to provide.
I would estimate that twice as many appointments would be needed to initiate and monitor this drug.
When will NICE consider “clinician resource needed to provide” in their announcements.
I accept that both of these treatment may save money in the long term and improve QOL but given the pressures in the system this could not come at a worse time.
10 patients so far this morning – two have asked for Semaglutide. A sign of the times I’m afraid
“The committee concluded that, as in the marketing authorisation and clinical trial evidence, these services are the only appropriate setting that can provide the necessary multidisciplinary specialist weight management interventions for a sustained period alongside semaglutide treatment. Therefore, the committee agreed that semaglutide should only be available within a specialist weight management service.”
An indicator of how dysfunctional the NHS is; a major advance in treatment for a major cause of ill health, and the NHS response is to try to find ways of treating as few people as possible.
I must disagree with above comments. Many people are already buying it and the most needy cant afford it. tier 2 and tier 3 services have not exactly been earth shattering in there e effectiveness unless I have missed something and bariatric surgery is also not in essence available. For once a treatment the works and will make a real difference to people as part of a funded holistic service.
Instead of asking people to eat less (unless they can photosynthesise), more work for us. Just what the snowed under GP needs!
Semaglutide= eat less-do more
why so much extra work/cost for NHS ?
if this does not work , what next?
“medicalisation is all the fault of ‘the medical profession'”
or is it …?