The 'Mounjaro Gap': How Wealth Widens the Weight Loss Divide in Britain
New research has exposed a troubling class divide in access to revolutionary weight loss medications, revealing that affluent women are significantly more likely to use drugs like Mounjaro than those in deprived areas who need them most. This disparity is creating what experts term the "Mounjaro gap" – a widening chasm in health outcomes between Britain's wealthy and poor.
Four-Year Wait for NHS Access
Kelly Todd, 46, represents thousands caught in this healthcare divide. After entering NHS secondary care for weight management four years ago, she discovered it would take years rather than months to access weight-loss drugs through the public system. Faced with indefinite waiting, Todd turned to private healthcare, spending £189-£299 monthly while remaining within the NHS framework.
"I still don't have clarity on when I'll be seen," Todd explains. "From first approaching my GP to enquire about GLP-1 access on the NHS to now, I've effectively been waiting over four years. Given the length of time I've already spent within the NHS pathway, it did not feel realistic to wait indefinitely without support."
When the NHS finally made GLP-1 drugs like Mounjaro available last year to those with a BMI over 40 and four weight-related comorbidities, Todd received a referral. Yet nine months later, she continues waiting for medication access.
Stark Class Divide in Medication Uptake
The Health Foundation, collaborating with weight-loss drug provider Voy, analysed private prescriptions for GLP-1 medications including Mounjaro and Wegovy. Their findings reveal 79 percent of prescriptions are for women spending hundreds of pounds monthly, predominantly middle-class women in their thirties and forties.
More alarmingly, people in the most deprived areas were one-third less likely to be taking these jabs and tended to be significantly heavier when beginning treatment. This creates what Professor Kate Pickett of York University calls "intervention-generated inequality" – where public health improvements inadvertently widen existing disparities.
"Quite often, when a public health intervention is implemented, it's preferentially taken up by those who are middle-class and wealthy," explains Professor Pickett. "Sometimes that's because it's easier for them, they have more education to understand why it's needed, or more capacity or time. The problem is that even when you're improving the health of the population, you're also creating bigger inequalities."
NHS Restrictions and Private Alternatives
Despite NICE guidelines stating GLP-1 drugs should be available to anyone with a BMI over 35 and one weight-related comorbidity – potentially covering 3.4 million people – NHS England adjusted the rollout dramatically. Only 220,000 people will access the drug over the next three years under stricter criteria requiring a BMI over 40 and four or more comorbidities.
This leaves many with just one alternative: private healthcare where weight-loss jabs cost £144-£324 monthly. "My decision to do that was health-led rather than convenience-led, and I am very aware that not everyone is in a position to self-fund treatment," says Todd, who left her job due to health issues. "That disparity is a significant part of the wider access issue. That is why it can feel like a lottery. Eligibility does not automatically mean access."
Return to 'Thin as Status' Culture
Beyond health inequality, experts worry the Mounjaro gap signals a return to associating thinness with wealth and status. Professor Pickett notes, "We'd moved on from that with the body positivity movement. But people are worried the needle is swinging back again, that class-related differences in body shape will become entrenched."
Private providers have lowered thresholds to include those with a BMI of 30 and above, meaning medications originally intended for clinically obese patients are now purchased by people with aesthetic rather than medical needs. "They're no longer being used by those who are clinically obese but are being purchased by people who don't have a medical need for them, but an aesthetic desire," Pickett observes.
Deepening Life Expectancy Gaps
The implications extend beyond body image to fundamental health outcomes. With a 20-year gap already existing in healthy life expectancy between Britain's richest and poorest, weight-loss medications risk widening this chasm further. Only 21 percent of private prescriptions are for men, reflecting established patterns where women demonstrate more health-seeking behaviour – one reason women live four years longer on average than men.
Dr Charlotte Refsum, Director of Health Policy at the Tony Blair Institute for Global Change, warns the current rollout "risks entrenching health inequality." She states, "At the moment, those with the deepest pockets can buy better health and better life chances, while others are left behind. That runs directly counter to the founding principle of the NHS – that care should be based on need, not ability to pay."
Calls for Systemic Change
Experts argue the NHS is attempting to medicate a preventable condition while neglecting population-level interventions. Professor Pickett emphasizes that in our "obesogenic" world, those most in need cannot be blamed for not accessing interventions like Mounjaro. "If you live in areas of food desert or you're reliant on food aid, you're not getting the kind of nutritious diets or access to food and gyms you need," she explains.
Both researchers call for more investigation into uptake patterns so future rollouts genuinely reach those needing them most. Dr Refsum advocates more ambitious access expansion: "If we're serious about prevention, we should be aiming to offer anti-obesity medications to adults with a BMI of 27 and over, with no major contraindications, over the next two years. That would mean rolling them out to an estimated 14.7 million people."
The NHS faces mounting pressure to accelerate its response to medical advances that could dramatically improve outcomes and prevent long-term illness. As Todd summarizes her four-year struggle: "Funding the medication privately has not been a small or easy expense. It has required considerable lifestyle adjustments and prioritising long-term health over other areas of spending. If the NHS were able to prescribe it, it would make a meaningful financial difference."
Without systemic changes, the Mounjaro gap threatens to become a permanent fixture in Britain's healthcare landscape – where wealth determines not just lifestyle but life expectancy itself.
