The UK has experienced a rapid expansion in the use of modern weight-loss medications, such as semaglutide (Wegovy) and tirzepatide (Mounjaro). Although these medicines were initially developed for diabetes management, their effectiveness in promoting significant weight loss has transformed obesity treatment.
Wegovy received UK approval for weight management in 2021, while Mounjaro was authorised for weight loss in 2023. Demand has grown rapidly, driven by strong clinical results, media attention, social media discussions, and limited access through NHS services.
Services offering weight loss drugs in the UK (whether on line or face to face) must be registered with the healthcare regulator, and pharmacies dispensing those drugs also need to be registered with the regulator.
As a result, many people have turned to private online providers to access treatment. ISCAS is beginning to see a number of complaints from people who are unhappy with the prescription, management and outcomes of the use of these weight loss drugs.
One example of concerns is identified in the following case study.
- A patient was prescribed Mounjaro through an online pharmacy (the provider). They used the drug, had the expected weight loss and returned for a repeat prescription.
- They answered the online questionnaire and signed to say they understood the treatment and side effects, and the need to provide accurate and honest information to enable the clinicians to assess the risk.
- They said they understood instructions on how to take the drug.
- They understood that anyone placing a repeat request for any weight loss medication is asked to confirm they are tolerating the treatment, are not concerned by any side effects, and are happy to take the dose requested.
- They had been told if they had any concerns with side effects or their medical situation, they should send a message to the provider or see their GP to discuss it further.
- It was also made clear that medicines could not be returned even if unused (because of the storage safety considerations).
The patient confirmed all the above and the repeat prescription was dispensed.
A few days later the patient spoke to an online doctor from the pharmacy and complained that they had needed to take time off work for nausea, upset stomach and bloating which had upset and inconvenienced them, and asked what they could do. They were concerned that the medication no longer suited them.
The online doctor reviewed the information and history and gave options – to stop treatment, which ‘may be best for the patient’, or to ‘reduce the dose’ to a level where the side effects were manageable, if they had not previously suffered from them.
The patient then complained to the provider that as they had been advised that Mounjaro was no longer suitable for them, they wished to return the medication and requested a full refund on the basis that the order had been ‘supplied incorrectly’ and ‘not been checked thoroughly enough’.
The complaint was not upheld at by the provider; however, they apologised for the patient’s experience and offered a 25% refund as a gesture of goodwill.
The patient responded that ‘the provider should be asking how they are getting on now before prescribing the medication like my local doctor would’. The patient said that the messages they had received about side-effects were generic. They alleged medical negligence and said that the response was poor, and there was a failure of duty of care.
The complaint was escalated to ISCAS for adjudication and the clinical elements of the complaint were not upheld. However, there were lessons to be learned in the complaint handling. No financial gesture of goodwill was awarded.
Lessons Learned:
- The patient was not entirely honest about their symptoms when requesting a repeat prescription.
- The patient’s expectations of the service were unrealistic and not consistent with the contract.
- The patient did not take personal responsibility for their choices.
- The provider was asked to review its patient information to ensure that it gives patients realistic expectations about the support they can seek in connection with weight loss treatment, and in what circumstances the patient should consult their own GP or make an appointment for a detailed consultation with an online private doctor.
- There was no face-to-face complaint meeting (virtually or in person) and all interactions were by email, meaning it was difficult to confirm heads of complaint and understanding.
Suggested Advice For People Considering Taking Weight Loss Drugs:
This checklist has been developed using information from common complaints made by patients.
NB: this list is not exhaustive, and you should research carefully and talk to different providers.
Before You Start: Understanding the Treatment – Can you answer yes to the following statements?
- I understand that weight-loss medications are a tool, not a cure.
- I understand that healthy eating, physical activity and behaviour change remain important.
- I have realistic expectations about the amount and speed of weight loss.
- I understand that treatment may need to continue long term.
- I understand that stopping treatment may lead to weight regain.
- I have been and will always be honest with myself and the provider of the treatment.
Choosing a Provider – what to look for
- Is the provider properly regulated and registered?
- I know how to contact a clinician if I have concerns.
- The provider offers ongoing follow-up and support and is contactable.
- I understand all costs, including future prescription costs.
- I understand the subscription terms and conditions and the cancellation policy.
- I know how repeat prescriptions will be managed.
Medical Assessment – have you?
- I have provided honest, accurate information about my weight and medical history.
- I have disclosed all medications and supplements I take.
- I have discussed previous weight-management attempts.
- I have informed the provider about any medical history.
- I understand why the medication is suitable for me (or not).
Questions to Ask Before Starting
- What results can I realistically expect?
- What side effects are most common? Can I tolerate them, and what happens if I cannot?
- What symptoms require urgent medical advice?
- How often will my progress be reviewed?
- Who should I contact if problems arise?
- How will my GP be informed?
- What happens if the medication is unavailable?
Red Flags: Consider Changing Provider If……
- You cannot easily access clinical advice.
- Follow-up appointments are infrequent or absent.
- The service focuses only on dispensing medication.
- Costs are unclear or continually changing.
- Communication is poor.
- Your concerns are dismissed or ignored.
- The provider cannot explain how your treatment is being monitored.