The 'Mounjaro gap': How weight-loss drugs are deepening the class divide
The Unequal Access to Weight-Loss Drugs: A Growing Concern
When Kelly Todd, a 46-year-old woman, sought medical help for weight management four years ago, she never imagined the journey she was about to embark on. The NHS, which is supposed to provide universal healthcare, seemed to be in no rush to offer her the weight-loss drugs she desperately needed. The 'Mounjaro gap'—a term that has emerged to describe the disparity in access to these life-changing medications—has now become a stark reality for many.
Kelly's story is not an isolated incident. Recent research reveals a disturbing 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's collaboration with Voy, a weight-loss drug provider, uncovered a shocking statistic: 79% of private prescriptions for GLP-1 drugs like Mounjaro and Wegovy are for women spending hundreds of pounds each month. This creates a stark class divide, with real health implications.
The Class Divide in Healthcare
Kate Pickett, a professor of epidemiology at York University, explains this phenomenon as 'intervention-generated inequality'. When a public health intervention is introduced, it often benefits the middle class and the wealthy more. This is because they have the resources, education, and time to take advantage of such interventions. However, this creates a cycle where even when healthcare improves for the population, inequalities widen.
NICE initially stated that GLP-1 drugs 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 criterion, NHS England had to adjust the rollout. Only 220,000 people will be able to access the drug in the next three years, and the threshold increases to a BMI over 40 with four or more comorbidities. This leaves many without access, and the only alternative is to go private, where the cost can be a staggering £144-£324 a month.
The Private Option: A Double-Edged Sword
Kelly Todd, who had to leave her job due to health issues, decided to go private. She acknowledges that not everyone can afford this option, and the disparity in access is a significant issue. 'My decision was health-led rather than convenience-led,' she says. 'But it's a sacrifice, and I'm aware that not everyone is in a position to self-fund treatment.'
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'. She believes that those with the deepest pockets can buy better health and life chances, while others are left behind. This goes against the founding principle of the NHS, which should be based on need, not ability to pay.
The 'Mounjaro Gap': A Return to the Past?
The 'Mounjaro gap' also raises concerns about a return to a time when 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 mindset, there are worries that the needle is swinging back, with class-related differences in body shape becoming entrenched.
Pickett points out that private providers are now offering micro-dosing of these drugs to anyone with a BMI of 30 and over, catering to those with aesthetic desires rather than medical needs. This further widens the gap, as weight-loss drugs become more accessible to those who can afford them.
The Way Forward: Addressing Inequalities
Both Pickett and Field call for more research into uptake and patterns with weight-loss drugs, so the next rollout can truly reach those who need it most. Dr. Refsum wants the NHS to aim higher, offering 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 NHS also needs to move faster to keep pace with medical advances, offering treatment at the point patients need additional help. By doing so, these innovations can narrow health inequalities rather than deepen them. The 'Mounjaro gap' is a stark reminder that we must address these inequalities to ensure healthcare is truly based on need, not ability to pay.
