Thousands of individuals in the UK are currently missing out on potentially life-saving weight loss treatments, specifically the drug Mounjaro, due to a significant disparity in NHS provision, often referred to as a 'postcode lottery'. Despite health chiefs announcing a phased 12-year rollout in which millions of obese patients would receive Mounjaro—a drug known to help users shed up to a fifth of their bodyweight—analysis by the British Medical Journal (BMJ) reveals a stark reality. Since the rollout commenced in June, less than half of England's commissioning bodies have begun prescribing the drug. Funding shortfalls are a major issue; only nine Integrated Care Boards (ICBs) had sufficient funding to cover at least 70 per cent of their eligible patients, while some, like Coventry and Warwickshire and Suffolk and North East Essex, could fund 25 per cent or less. Five ICBs are even contemplating tightening prescribing criteria further or rationing treatment.

Professor Nicola Heslehurst, president of the Association for the Study of Obesity, expressed concern, stating, 'The deficit in funding compared with need is another blow for people living with obesity, who deserve evidence-based care to manage their health needs,' and criticized the current commissioning model for creating this 'postcode lottery.' Dr. Jonathan Hazlehurst, a consultant endocrinologist, highlighted the lack of clarity and funding for even strict prescribing rules, lamenting that patients needing Mounjaro for urgent conditions, such as to access cancer diagnostics, transplantation, or orthopaedic surgery, are not included in interim commissioning guidance. The BMJ's freedom of information request to 40 of 42 ICBs exposed severe disparities: Coventry and Warwickshire ICB, for instance, received funding for only 376 patients despite identifying 1,795 eligible ones, covering a mere 21 per cent. Humber and North Yorkshire ICB similarly had funding for just 21.38 per cent of its eligible patients. While Northamptonshire ICB appeared to cover 109 per cent of its identified eligible patients, it expects the actual number to be significantly higher, making its dataset inaccurate. A Department of Health and Social Care spokesman affirmed expectations for ICBs to make these drugs available as part of the phased rollout, emphasizing a shift from treatment to prevention and ensuring modern treatments are accessible to all.

Under official guidelines, Mounjaro is prescribed on the NHS only to patients with a Body Mass Index (BMI) over 40 and weight-related health problems like high blood pressure, type 2 diabetes, or obstructive sleep apnoea. However, tens of thousands are believed to be accessing the drug privately. This private market saw significant upheaval when manufacturer Eli Lilly announced that wholesale prices would more than double from September 1, with the highest dose rising from £122 to £330 a month. This sparked 'Covid-like panic buying' among users, with many purchasing months' worth of pens or switching to alternatives like Novo Nordisk's Wegovy. Despite commercial deals allowing pharmacists and private providers to offer lower prices (e.g., the top dose at £247.50), experts warned that the price hike could drive more people towards the black market, where dangerous fake weight loss jabs with toxic ingredients have been found, leading to severe illness and even fatalities in some cases in the UK.

Adding to the concerns surrounding access and cost are dangerous DIY practices emerging among users. One such trend is 'microdosing,' where individuals split their slimming jabs into smaller, more frequent doses, deviating from official guidance. Siobhan Jackson, an NHS receptionist, successfully lost 4st using this method over 11 months, explaining that she experimented with reducing her 7.5mg pen to 6.25mg and injecting twice weekly with 3.125mg. While she found it worked well for her, experts vehemently warn against it. NHS psychiatrist Dr. Max Pemberton stated, 'There are real risks. You could inject too much or too little. You could damage the drug in the process.' Professor Alex Miras, an endocrinologist, cautioned against serious side effects from overdosing and the potential for life-threatening infections, noting that pens can malfunction if used improperly and lose sterility once opened, allowing harmful bacteria to be introduced. The Medicines and Healthcare products Regulatory Agency (MHRA) stresses that patients must follow dosing directions from their healthcare provider and adhere to patient information leaflets, warning that failure to do so could harm health or cause personal injury.

Another prevalent hack is the 'golden dose,' where users extract the small amount of medication remaining in pre-filled Mounjaro pens after the four prescribed weekly doses, using it for an additional jab. This practice could save regular users around £615 a year. In response, Eli Lilly confirmed that a modified KwikPen would be made available globally, designed to reduce the leftover medicine after four doses, effectively preventing the 'golden dose' hack. Users reacted with fury on social media, with many vowing to continue trying to extract any remaining liquid. Health chiefs have repeatedly urged patients against this practice. Dr. Alison Cave, chief safety officer of the MHRA, reiterated warnings against tampering with pre-dosed injection pens. Professor Penny Ward, a pharmaceutical expert, highlighted the grave risks, including serious side effects from overdosing and the high potential for developing life-threatening infections such as an abscess or even sepsis, as the pens are no longer sterile once opened and used. The economic burden of weight-related illness in the UK is estimated at £74 billion annually, with two in three Britons classified as overweight or obese, and average weights having increased by about a stone over the past three decades. The ongoing challenges in Mounjaro access, coupled with the dangers of unapproved usage, underscore a complex public health crisis.