Drugs Used in the Treatment of Obesity

NHSL Medicines Guidance
NHS Lanarkshire

General Notes

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health.

A multicomponent approach should be adopted to reduce weight. Pharmacological treatment should only be considered after dietary, exercise and behavioural approaches have been started and evaluated.

Medicines should never be used as the sole element of treatment. They should be used in conjunction with a mildly hypocaloric diet rich in fruit and vegetables, exercise and behaviour management.

Weigh to Go is a free weekly adult weight management group with groups running in venues across Lanarkshire. For more information see https://www.nhslanarkshire.scot.nhs.uk/weigh-to-go/

NORTH LANARKSHIRE: https://www.nhslanarkshire.scot.nhs.uk/services/weight-management-service/weigh-to-go/

SOUTH LANARKSHIRE: https://www.slleisureandculture.co.uk/info/506/sllc_gyms/848/weigh_to_go

Information on healthy eating and lifestyle, nutrients in food and weight loss can be found at www.bda.uk.com/foodfacts/home

Anti-Obesity Drugs Acting on the Gastro-Intestinal Tract

Total list (T)

ORLISTAT

  • Orlistat should only be used where diet, physical activity and behavioural changes are supported.
  • Orlistat should be considered as an adjunct to lifestyle interventions in the management of weight loss.
  • Patients with BMI ≥28 kg/m2 (with comorbidities) or BMI ≥30 kg/m2 should be considered on an individual case basis following assessment of risk and benefit. 
  • Therapy with orlistat should be continued beyond 12 weeks only if the patient has lost at least 5% of their initial body weight since starting drug treatment. Therapy should then be continued for as long as there are clinical benefits (e.g. prevention of significant weight re-gain).

 

Specialist initiation (S1)

TIRZEPATIDE (Mounjaro®)

  • Initiation of Mounjaro® for weight loss should be by the NHS Lanarkshire Weight Management Service and will involve a 6-month titration phase. For patients responding to Mounjaro®, a request will be made to primary care for the ongoing supply. Please refer to the NHS Lanarkshire guideline 'Tirzepatide (Mounjaro®) as an Adjunct to Lifestyle Measures in Weight Management'.
  • Prescribe by brand name.
  • Tirzepatide (Mounjaro®) should only be considered for use in adult patients for weight management, including weight loss and weight maintenance, as an adjunct to lifestyle interventions, and is restricted to use in those with BMI ≥30 kg/m2 and at least one weight-related comorbidity, in line with SMC Advice SMC2653. A lower BMI cut-off may be more appropriate for members of minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population. Additional criteria for the use of this medicine for weight management in NHS Lanarkshire can be found in the Prescribing Notes section below.
  • Each pre-filled disposable device contains four doses, which is a four week supply.

SEMAGLUTIDE (Wegovy®)

  • Second-line option, reserved for patients who are unable to use Tirzepatide (Mounjaro®), such as those with pre-existing cardiovascular disease.
  • Initiation of Wegovy® for weight loss should be by the NHS Lanarkshire Weight Management Service and will involve a titration phase. For patients responding to Wegovy®, a request will be made to primary care for the ongoing supply. Please refer to the NHS Lanarkshire guideline 'Semaglutide (Wegovy®) as an Adjunct to Lifestyle Measures in Weight Management'.
  • Prescribe by brand name.
  • Semaglutide (Wegovy®) should only be considered  for use in adult patients as an adjunct to lifestyle interventions for weight management, including weight loss and weight maintenance, and is restricted to use in those with a BMI ≥30 kg/m2 and at least one weight-related comorbidity, in line with SMC Advice SMC2497. A lower BMI cut-off may be more appropriate for members of minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population. Additional criteria for the use of this medicine for weight management in NHS Lanarkshire can be found in the Prescribing Notes section below.
  • Each pre-filled disposable device contains four doses, which is a four week supply. 

Prescribing notes:

  • In NHS Lanarkshire, Glucagon-Like Peptide-1 Receptor Agonists for weight management are available only for patients who are under the care of the NHS Lanarkshire Weight Management Service, as detailed in the clinical guidelines for each drug, which can be found within the NHSL Guidelines toolkit.
  • When the Lanarkshire Weight Management Service (LWMS) makes a decision to commence injectable treatment, the LWMS clinician will contact the patient's primary care provider to request a prescription for the appropriate formulary-choice needles. Throughout the initiation and titration phase, medication supply will be via the hospital dispensary, however prescriptions for needle supply will be requested via primary care from initiation. Formulary-choice needles can be found here. The LWMS clinician will correspond with the patient to provide advice regarding needle disposal.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 01/04/2025

Next review date: 30/06/2026

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.