The 'Mounjaro gap': How weight-loss drugs are deepening the class divide
The Unfair Access to Weight-Loss Drugs: A Growing Class Divide
When Kelly Todd, a 46-year-old woman, sought medical help for weight management four years ago, she was met with a stark reality. The weight-loss drugs she needed were not readily available through the NHS, and the wait times for private prescriptions were equally daunting. This is a story that highlights the growing class divide in access to healthcare, particularly when it comes to weight-loss drugs like Mounjaro and Wegovy.
A Tale of Two Worlds: Private vs. NHS
Kelly's experience is not unique. Research shows that weight-loss jabs are more likely to be used by middle-class women in their thirties and forties than those in deprived areas. The Health Foundation's analysis of private prescriptions for GLP-1 drugs like Mounjaro and Wegovy revealed that 79% are for women spending hundreds of pounds each month. This creates a stark class divide, with those in the most deprived areas being a third less likely to receive the jabs and often starting the medication at a much heavier weight.
The Controversy: Intervention-Generated Inequality
This phenomenon is not new in public health. Kate Pickett, a professor of epidemiology at York University, calls it 'intervention-generated inequality'. When a public health intervention is implemented, it is often preferentially taken up by those who are middle-class and wealthy. This can be due to easier access, more education, or more capacity or time. However, even when improving the health of the population, this creates bigger inequalities.
NHS's Unconventional Rollout
NICE stated last year that GLP-1 drugs like Mounjaro would be available to anyone with a BMI over 35 and one weight-related comorbidity. But with 3.4 million people in the country meeting this threshold, NHS England made the unusual step of adjusting the rollout. Only 220,000 people will be able to access the drug in the next three years, rising to the threshold of a BMI over 40 and four or more comorbidities. This leaves many without access, and the only other option is to go private, where weight-loss jabs can cost £144-£324 a month.
The Private Option: A Health-Led Decision
Kelly Todd's decision to go private was health-led rather than convenience-led. She is aware that not everyone can afford private treatment, and this disparity is a significant part of the wider access issue. Funding the medication privately has required considerable lifestyle adjustments and prioritizing long-term health over other areas of spending. If the NHS were able to prescribe it, it would make a meaningful financial difference.
The 'Mounjaro Gap': A Return to Status and Wealth?
The 'Mounjaro gap' raises concerns about a return to a time where being thin was associated with status and wealth. Kate Moss famously said, 'nothing tastes as good as skinny feels'. While the body positivity movement has moved us away from this, there are worries that class-related differences in body shape will become entrenched again, where 'you can never be too rich or too thin'.
Private Providers and Micro-Dosing
Private providers are now offering micro-dosing these drugs to anyone with a BMI of 30 and over, catering to those with an aesthetic desire rather than a medical need. This further widens the gap, as these drugs have a significant impact on health outcomes.
Life Expectancy Gaps: Class and Gender
Dr. Charlotte Refsum, Director of Health Policy at the Tony Blair Institute for Global Change, believes the current Mounjaro rollout 'risks entrenching health inequality'. She points out that only 21% of private prescriptions are for men, which is not surprising given women's greater health-seeking behavior. The biggest issue, in her view, is the NHS trying to medicate a condition that is completely preventable.
Addressing Health Inequalities
Both Dr. Refsum and Kate Pickett call for more research into uptake and patterns with weight-loss drugs, so the next rollout can reach those who need it most. Dr. Refsum wants the NHS to offer anti-obesity medications to adults with a BMI of 27 and over, with no major contraindications, over the next two years. This would mean rolling them out to an estimated 14.7 million people, not just the small proportion who can currently access them.
The Way Forward: Widening Access
The answer, according to Dr. Refsum, is to think boldly about widening access, from digital-first support to offering treatment at the point patients need additional help. This would help narrow health inequalities rather than deepen them. In our 'obesogenic' world, those most in need cannot be blamed for not taking up interventions like Mounjaro. It's a complex issue that requires a nuanced approach.
