The 'Mounjaro gap': How weight-loss drugs are deepening the class divide
The Unfair Access to Weight-Loss Drugs: A Growing Divide
When Kelly Todd, a 46-year-old woman, sought help for weight management on the National Health Service (NHS) four years ago, she was met with a stark reality. The weight-loss drugs she needed, such as Mounjaro, were not readily available, and she was told it would take years rather than months to access them. Determined to take control of her health, Kelly decided to go private, spending £189-£299 a month to receive the treatment she needed. But this decision highlights a growing divide in healthcare access, where the ability to afford private treatment can significantly impact one's health outcomes.
A Class Divide in Weight-Loss Treatment
New research reveals a concerning trend: 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, in collaboration with Voy, a weight-loss drug provider, analyzed private prescriptions for GLP-1 drugs like Mounjaro and Wegovy. They found that 79% of these prescriptions were for women spending hundreds of pounds each month. This data underscores a stark class divide, with people 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 'Intervention-Generated Inequality'
Kate Pickett, a professor of epidemiology at York University, explains this phenomenon as 'intervention-generated inequality.' When public health interventions are implemented, they are often preferentially taken up by the middle class and the wealthy. This can be due to easier access, better education about the intervention's benefits, or more time and capacity to pursue it. However, this creates a cycle where even when interventions improve the health of the population, they also contribute to larger inequalities.
NHS's Unconventional Rollout Strategy
The NHS's approach to making GLP-1 drugs like Mounjaro available has been unconventional. While NICE stated that these drugs should be accessible to anyone with a BMI over 35 and one weight-related comorbidity, the NHS England decided to adjust the rollout. This adjustment means that only 220,000 people will be able to access the drug in the next three years, with the threshold increasing to a BMI over 40 and four or more comorbidities. This strategy, however, leaves many without access, forcing them to seek private treatment.
The Private Option: A Double-Edged Sword
Private weight-loss jabs can cost £144-£324 a month, and Kelly Todd's experience highlights the financial burden and lifestyle adjustments required. She had to leave her job due to her health, and funding the medication privately has been a significant expense. While it has allowed her to prioritize her long-term health, it has also come with sacrifices. Dr. Charlotte Refsum, Director of Health Policy at the Tony Blair Institute for Global Change, warns that the current Mounjaro rollout risks entrenching health inequality, as those with the deepest pockets can buy better health and life chances.
The 'Mounjaro Gap' and Its Impact
The 'Mounjaro gap' raises concerns about a return to a time when being thin was associated with status and wealth. Kate Pickett, the author of 'The Good Society And How We Make It,' warns that class-related differences in body shape may become entrenched again. Private providers are even offering micro-dosing of these drugs to anyone with a BMI of 30 and over, catering to aesthetic desires rather than medical needs.
Addressing the Inequality
Dr. Refsum advocates for population-level interventions, such as restricting the advertising and pricing of health foods, to address health inequalities. Pickett agrees, emphasizing that in our 'obesogenic' world, those most in need cannot be blamed for not taking up interventions like Mounjaro. Both experts call for more research into uptake and patterns with weight-loss drugs to ensure the next rollout reaches those who need it most.
Dr. Refsum suggests an even bolder approach, aiming 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 making these medications accessible to an estimated 14.7 million people, not just the small proportion who can currently access them. By thinking boldly about widening access, from digital-first support to offering treatment at the point of need, we can work towards narrowing health inequalities rather than deepening them.
