When the Scottish Medicines Consortium gave the green light to semaglutide (Wegovy) for weight management in 2022, it was hailed as a breakthrough for tackling obesity. Yet new figures reveal a stark reality: fewer than 800 people in Scotland have actually received these injections through the NHS. That's a tiny fraction of the hundreds of thousands who might meet clinical criteria. The gap between approval and access raises urgent questions about who gets these treatments, and why so many are missing out.
The Approval and Its Promise
Semaglutide, a GLP-1 receptor agonist, was initially developed for type 2 diabetes but later approved for weight loss in people with a BMI of 35 or higher, or a BMI of 30 with at least one weight-related condition such as high blood pressure or sleep apnoea. Clinical trials showed participants lost around 15% of their body weight on average, a result that far surpasses most lifestyle interventions alone. For Scotland, where nearly two-thirds of adults are overweight or obese, the potential impact on public health seemed enormous.
Who Actually Gets the Jabs?
NHS Scotland's eligibility criteria mirror those used in England: patients must have a BMI of at least 35 (or 30 with a related condition) and be referred by a specialist weight management service. But here's the catch: these services are not available everywhere. According to recent data, only a handful of health boards routinely prescribe semaglutide, and even then, supply issues and strict criteria mean very few patients make it through the system.
So who are the lucky few? They tend to be individuals with severe obesity and multiple comorbidities, often already under the care of endocrinologists or bariatric specialists. Many have tried and failed with conventional weight loss programmes. Yet even for them, the path is far from straightforward.
Why Are So Few Getting Them?
The reasons are a tangled web of clinical, logistical, and financial factors. First, NHS Scotland faces the same global supply constraints that have plagued other countries. Novo Nordisk, the manufacturer, has struggled to keep up with soaring demand, prioritising higher-paying private markets. Second, not all health boards have the specialist infrastructure to safely prescribe and monitor these drugs. GPs, who are often the first point of contact, are largely unable to initiate treatment due to lack of training and resources.
Third, there's the question of cost. While the NHS pays a discounted price, the overall budget impact is significant. Treating just 1,000 patients for a year can cost upwards of £1 million. With stretched budgets, health boards must weigh this against other pressing needs. Finally, some clinicians remain cautious, citing unknown long-term effects and the need for lifestyle support alongside medication.
What This Means for Patients
For someone living with obesity, the news that a life-changing treatment exists but is virtually inaccessible is a bitter pill. Many turn to private clinics, where a month's supply can cost £200 or more, putting it out of reach for those on lower incomes. This creates a two-tier system: those who can afford it get the jabs, while others are left to manage their condition with limited support.
The psychological toll is immense. Obesity is often stigmatised as a failure of willpower, yet the science shows it's a complex metabolic disease. Denying effective treatment only deepens that stigma. As one patient put it, 'It feels like being told there's a lifeboat, but you're not allowed on it.'
The Road Ahead
Pressure is mounting on the Scottish Government to act. Advocates are calling for a national rollout strategy, including training for GPs, dedicated weight management clinics, and ring-fenced funding. Some suggest allowing GPs to prescribe semaglutide under supervision, which could dramatically increase access. Others argue for a phased approach, prioritising those at highest risk.
Meanwhile, the pharmaceutical pipeline offers hope. Newer drugs like tirzepatide (Mounjaro) are showing even greater efficacy and may soon be approved. But without systemic changes, they too could remain out of reach for most.
Frequently Asked Questions
Who is eligible for NHS weight loss jabs in Scotland?
You may be eligible if you have a BMI of 35 or higher, or a BMI of 30 with at least one weight-related condition such as type 2 diabetes or high blood pressure. You must also be referred by a specialist weight management service.
Why are so few people receiving them?
Supply shortages, limited specialist services, and budget constraints are the main barriers. Many health boards simply don't have the resources to prescribe and monitor these treatments widely.
Can I get weight loss jabs from my GP?
Currently, most GPs in Scotland cannot initiate these treatments. They can refer you to a specialist service if you meet the criteria, but waiting lists are long and not all areas offer the service.
What can I do if I don't qualify on the NHS?
You could explore private prescriptions, but they are expensive. Alternatively, ask your GP about other weight management options, including dietitian support and behavioural programmes.
Are these jabs safe?
Semaglutide is generally safe and well-tolerated, but like all medicines, it can cause side effects, most commonly nausea and digestive issues. Long-term effects are still being studied.