Access remains limited and unequal

GLP-1 and dual GLP-1/GIP receptor agonists work by enhancing insulin secretion, delaying gastric emptying and promoting satiety, resulting in weight loss. In the UK, National Institute for Health and Care Excellence (NICE) recommends them for adults with a BMI ≥35 kg/m² and at least one weight-related comorbidity, or for those with a BMI >30 who meet specific referral criteria (e.g. unsuccessful conventional treatment). However, National Health Service (NHS)-funded access is only available for 2 years within specialist services. ¹ Without broader improvements to the food environment, weight regain after stopping treatment is a likely risk, and long-lasting outcomes will therefore remain poor.

Even for those who qualify, access remains inconsistent. This is not just a challenge unique to the UK. In the USA, high cost and strict insurance criteria make these treatments unaffordable for many, particularly lower-income groups who are already disproportionately affected by obesity, due to systemic issues such as food deserts and aggressive marketing. In Latin America, access is mostly restricted to the private sector and often unaffordable. This has fuelled a black market for counterfeit products, reported in Brazil, Mexico and Argentina, posing serious health risks. These examples highlight major limitations of these medications as a long-term solution, especially when factoring in known side effects and the lack of long-term data. Sustained use is costly, and broader action is still required.

Recent developments underline these access challenges. The announced 170% UK price increase for tirzepatide (Mounjaro) following US pressure to ‘equalise’ drug costs internationally illustrates the fragility and inequity of relying on pharmacological solutions. ^{Reference Bowie4} Although NHS-negotiated discounts may shield some patients, private patients, who currently make up most UK users, are likely to face steep cost rises. This shift not only risks widening inequalities in access, but also highlights how global political pressures can directly affect national affordability of obesity treatments. Such volatility further demonstrates why population-level food system interventions remain indispensable.

The NHS’s new 10-Year Plan expands access to weight-loss drugs through outcome-based models, but without bold public health reforms, such as mandatory reformulation, marketing restrictions and better access to healthy food, these efforts risk being palliative, not preventive.

Rethinking and tackling the root causes

A healthy weight cannot be maintained without a healthier food environment and access to high-quality, timely information that enables informed choices. Clear, consistent front-of-pack food labelling, alongside effective lifestyle advice delivered in primary care, is essential but remain inconsistently implemented in the UK. ^{Reference Cecchini and Warin5,Reference Wang, Tan and Liu6}

Regulation of marketing, product placement and food composition is essential. This is especially true for products high in fat, salt or sugar and ultra-processed foods, which are heavily promoted to children. ^{Reference Boyland, Muc and Coates7} Evidence shows that limiting exposure to these foods can reduce unhealthy food purchases and support healthier diets across the population. ^{Reference Alfraidi, Alafif and Alsukait2,Reference Boyland, McGale and Maden3}

Reformulating processed foods and shifting the balance of food availability towards healthier options in retail environments are key strategies. ^{Reference Pineda, Stockton and Scholes8,Reference Carroll, Turrell and Dale9} While some progress has been made, most notably the UK’s earlier success in reducing population salt intake, progress has now slowed and remains uneven, largely because reformulation efforts are voluntary and limited in scope. Governments must go further; they should mandate or incentivise reductions in salt, sugars, trans-fats and other harmful additives, alongside measures to reduce the dominance of unhealthy products on supermarket shelves. UPF continue to contain ingredients linked to inflammation, gut microbiome disruption and increased risk of chronic disease. ^{Reference Lane, Gamage and Du10–Reference Tristan Asensi, Napoletano and Sofi12}

Marketing and placement of unhealthy foods in stores, schools and at points of sale drive impulse purchases, especially of ultra-processed products. ^{Reference Shaw, Ntani and Baird13} While the UK has begun to restrict such promotions and availability of unhealthy foods in schools has been restricted in the UK, gaps remain, particularly in protecting children. Recent evaluations highlight both the promise and the shortcomings of current policies, reinforcing the need for system-wide regulation. ^{Reference Conway14}

Improving access to sustainable, healthier, minimally processed foods must also be made a priority. Policies that improve the affordability and availability of fresh fruit, vegetables, whole grains, healthy fats and lean proteins, such as pulses, are fundamental. This includes shifting agricultural subsidies away from crops that fuel UPF production such as corn and soya and towards those that support healthier, more nutritious diets. In the UK, this is particularly important given that around 85% of land used to produce UK food is currently devoted to livestock grazing or to growing crops for animal feed rather than direct human consumption, limiting the supply and affordability of foods aligned with healthy dietary patterns. ^{Reference Dimbleby15}

The NHS’s ‘Fit for the Future’ 10-Year Health Plan outlines a ‘moonshot to end the obesity epidemic’, including welcome steps such as banning energy drinks for children, restricting junk food ads and mandating health food sales reporting. ¹⁶ However, it still lacks robust regulation of marketing practices across the wider food environment, including hospitals, the out-of-home sector (such as fast-food outlets and chain restaurants), delivery platforms and pervasive advertising and placement of ultra-processed products in everyday settings.

Without systemic changes to improve access to healthy foods, lower-income households will continue to rely on cheap, energy-dense options, locking them into cycles of poor nutrition and chronic disease. Medications like GLP-1s can help some individuals, but they cannot fix a broken system.