Anti-Obesity Medications – Adult Weight Management and Type 2 Diabetes Prevention Service

Updated June 2024

Anti-Obesity Medications

Thank you for your patience as we work hard to bring new treatments for obesity and weight management to NHS Lothian. The medications we are hoping to provide access to are known as glucagon-like peptide 1 receptor agonists (GLP-1 RA) and a newer ‘dual agent’ medication known as GLP-1 combined with glucose-dependent insulinotropic polypeptide receptor agonists (GIP RA).

semaglutide (Wegovy®)

Semaglutide (Wegovy ®) has been approved for use in NHS Scotland to support weight management for health reasons. The criteria for NHS Scotland has been agreed however this medication has yet to be added to NHS Lothian prescription list so we cannot accept referrals for Wegovy® at this time. Please see proposed criteria below once we are able to prescribe this medication.

tirzepatide (Mounjaro®)

Tirzepatide (Mounjaro®) is currently being assessed by the Scottish Medicines Consortium for use in NHS Scotland. We are expecting a decision to be made in June 2024 and will update the website as soon as we have the updated information available.

liraglutide (Saxenda®)

Unfortunately, due to a global shortage of Liraglutide there is very limited supply of this medication and therefore NHS Lothian are unable to accept referrals for this medication at this time.

From May 2024 we are not accepting further referrals for anti-obesity medications until we have approval to start prescribing in NHS Lothian. We will update our website once we are able to accept referrals into our service for medications. We apologise for this delay however we need this medication approved onto the prescription list before we can prescribe.

Approved criteria below

Guidance criteria for the prioritisation of use of GLP-1 RAs and GLP-1/GIP RAs in the treatment of obesity in NHS Scotland

Treatment with these medications is not intended to be an alternative to evidence based dietary advice and support in the treatment of obesity, but should be used as an adjunct.

SMC advice includes the following restriction that “patients should be treated in a specialist weight management service”. As there are different configurations of weight management services in different Health Boards, the SLWG advises that:

Patients can be treated in any healthcare setting where evidence-based and appropriate lifestyle advice can be delivered. This could be:

A tier 2 or tier 3 weight management service depending on the complexity of the individual’s needs
Primary and community care, consistent with long term condition management of associated condition e.g. hypertension
Secondary care as part of specialist treatment for associated conditions e.g. diabetes

Advice and support for a reduced energy diet (calorie deficit) and to increase physical activity is essential and it is for managing clinicians to ensure this is available to individual patients.

Key points:

Prescribing should be initiated by an appropriately trained healthcare professional who has a full knowledge of the patient’s physical, mental and social health, and of all concurrent treatments and their interactions, with a plan in place to monitor the response to treatment.
Treatment should be withdrawn if weight loss is under 5% at 6 months.
Dose escalation should be stopped at the lowest effective dose.

Priority criteria for Phase 1 are listed below:

Phase 1:

GLP-1 RA and GLP-1/GIP RAs should be used as an adjunct to a reduced-calorie diet and increased physical activity for weight management including weight maintenance, in adults with an initial BMI of:

≥38kg/m² (≥35kg/m²for members of minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population)

AND

One or more obesity-related clinical conditions (see below)

Edmonton Score of 3 or 4 EOSS – Edmonton Obesity Staging System (ottawahospital.on.ca)

Prescribing below this BMI cut-off, or for other diseases mediated by obesity, will only be in clinical scenarios where BMI criteria is a clinical requirement for access to essential treatment, for example, life-saving surgery, in-vitro fertilisation. All Health Boards have Medicines Access routes for patients that fall outwith ‘advice’.

Obesity-related clinical conditions*

Chronic kidney disease (stages 3 or 4)
Pre-existing cardiovascular disease
Type 2 diabetes
Hypertension
Idiopathic intracranial hypertension
Metabolic dysfunction-associated steatotic liver disease (MASLD/NAFLD)
Obstructive sleep apnoea
Polycystic ovary syndrome (PCOS)
Prediabetes
Dyslipidaemia
Significant psychological distress related to obesity

*for the purpose of this consensus statement the expert group preferred the term ‘obesity-related clinical condition’ rather than ‘weight-related comorbidity’ which was the term used by the pharmaceutical company within their application for licence. Within our phased prescribing guidance, we have therefore used our preferred term, however the conditions listed are the same.

These conditions will remain under review as the evidence base evolves and outcomes from implementation of Phase 1 are evaluated.

Phase 2:

GLP-1 RA and GLP-1/GIP RAs used as an adjunct to a reduced-calorie diet and increased physical activity for weight management including weight maintenance, in adults with an initial BMI of:

≥35kg/m² (≥32kg/m²for members of minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population)

AND

One or more obesity-related clinical conditions

Phase 3:

GLP-1 RA and GLP-1/GIP RAs used as an adjunct to a reduced-calorie diet and increased physical activity for weight management including weight maintenance, in adults with an initial BMI of:

≥30kg/m² (≥27kg/m²for members of minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population)

AND

One or more obesity-related clinical conditions

References

For any queries related to this document, please contact Laurie Eyles, Professional Adviser, Scottish Government laurie.eyles@gov.scot

You can find more information about our other programmes and referral forms on our web page

Adult Weight Management and Type 2 Diabetes Prevention Service – NHS Lothian | Our Services

Adult Weight Management and Type 2 Diabetes Prevention Team

Woodlands House, Astley Ainslie Hospital, 74 Canaan Lane, Edinburgh, EH9 2TB

E-mail: weight.management@nhslothian.scot.nhs.uk

Telephone: 0131 537 9169