Lilly, the manufacturer of the weight loss drug Mounjaro, recently announced a significant price increase for the UK market, effective September 1. The wholesale price for a month's supply of the highest dose is set to more than double, rising from £122 to £330. Lilly justified this change by stating that the initial UK launch price was 'significantly below the European average to prevent delays in NHS availability' and that the adjustment is necessary 'to ensure fair global contributions to the cost of innovation'. This price hike, however, does not affect the heavily discounted rate negotiated by the NHS for prescription users. Despite this, a substantial portion of the estimated 1.5 million people in the UK using weight loss drugs, particularly Mounjaro, pay privately, with estimates suggesting nine out of ten private users. This announcement has caused widespread panic among these private users, many of whom consider the drug 'life-changing' and are now concerned about being priced out, leading to fears of weight regain.

For those currently paying for Mounjaro privately, obtaining it on the NHS is not a straightforward solution. NHS criteria for weight-loss jabs are strict, typically requiring patients to have a BMI of at least 40 (severely obese) along with four obesity-related conditions such as high blood pressure, high cholesterol, sleep apnoea, heart disease, osteoarthritis, or diabetes. These criteria are set to expand in the coming years, but private clinics offer Mounjaro to patients with a BMI over 30, or 27 with one weight-related condition, making NHS access challenging for many private users. Eligible NHS patients must undergo face-to-face appointments with their GP and a suitably trained healthcare professional for initial assessment, prescription approval, and ongoing monitoring for side effects and overall health.

Given the affordability challenges, experts suggest switching to alternative medications. Thorrun Govind, a TV pharmacist, and Toby Nicol, CEO of CheqUp, both recommend switching to Wegovy as a more affordable and clinically proven effective drug. Patients can ask their provider to facilitate this switch, ensuring a safe transition. Experts strongly caution against 'microdosing' remaining Mounjaro pens or purchasing from unofficial sources due to the risks of serious side effects, potential for life-threatening infections, and reduced effectiveness. Wegovy, containing the ingredient semaglutide, is a popular alternative, though Mounjaro (tirzepatide) has shown higher average weight loss in clinical trials (20% over 72 weeks compared to Wegovy's 14%), primarily because Mounjaro mimics two appetite-regulating hormones while Wegovy mimics one.

When switching, patients should be aware of potential differences in side effects. Dr Suhail Hussain notes that Mounjaro is generally better tolerated gastrointestinally than Wegovy, meaning patients might experience more nausea or vomiting when switching. Common side effects for new GLP-1 medications include nausea, diarrhoea, constipation, and headaches. To manage the transition and avoid a 'hunger rebound', pharmacists advise taking the next semaglutide dose one week after the last Mounjaro injection, effectively replacing it without a long break. However, there is no direct dose conversion between tirzepatide and semaglutide, so patients might start with a low dose of semaglutide and gradually increase it. Experts also warn against completely stopping weight loss jabs suddenly due to fears of side effects and weight regain. Pharmacists advise a period of abstinence, typically seven days between the last tirzepatide and the first semaglutide dose, to prevent massively increased side effects and due to a lack of long-term evidence on concurrent use.

In parallel to the discussions around injectable weight loss drugs, British scientists have developed a new 'natural Mounjaro' pill called Elcella, which aims to slash appetite without the debilitating side effects associated with slimming jabs. This £49-a-week capsule is made from just three natural oils: linseed oil (flaxseed), coconut oil, and MCT oil. In trials, Elcella helped patients lose an average of 1 stone 1 pound in 12 weeks, cutting calorie intake by 18 percent, with no reported side effects. This contrasts with synthetic GLP-1 drugs like Ozempic, which caused an average weight loss of 13 pounds over 40 months in some comparisons. Elcella's mechanism involves triggering the natural release of gut hormones GLP-1 and peptide YY in the colon, which send signals of fullness to the brain. Its strength lies in a special enteric coating that allows its natural ingredients to reach the colon before release, 'hyperactivating' these appetite-reducing hormones.

Developed by Dr Madusha Peiris and Dr Rubina Aktar of Queen Mary University, London, Elcella is taken twice daily and aims to offer a safer, non-injectable alternative to address the global obesity epidemic. Unlike prescription weight-loss drugs which replace natural hormones with synthetic ones, Elcella stimulates the body's own natural hormone release, reportedly leading to no dependency and additional benefits such as less stomach pain, healthier hair and nails, and more regular bowel movements. It is available online without a prescription, costing £535.50 for a three-month supply, approximately £45 per week. With two in three UK adults being overweight or obese, and rising rates of conditions like type 2 diabetes and cancer linked to excess weight, new and accessible solutions like Elcella are emerging amidst the evolving landscape of weight management treatments.