NICE calls for better care after weight-loss therapy ends

People completing a course of obesity medication, or completing a weight-management programme, need better support to help them stay healthy, according to UK health technology assessor NICE.

A new quality standard published by the agency this morning concludes that healthcare services need to offer structured advice and follow-up support to help people maintain their weight loss. Otherwise, they tend to regain weight, with damaging effects to both their physical and mental health.

The guidance has been updated to accommodate the increase in the use of 'skinny jabs' like Novo Nordisk's Wegovy (semaglutide) and Eli Lilly's Mounjaro (tirzepatide), which are being used by many people in the UK – perhaps as many as 1.5 million – even though most are having to pay for them privately.

The rollout of the injectables through the NHS has been deliberately slow – with use restricted to a narrower population than their approved labelling – to allow time for trusts to put the necessary staffing, training, and delivery capacity in place and to avoid placing too much stress on the health service. Given the costs of the treatments, ensuring their benefits are durable is viewed as a priority.

To help achieve that, NICE is recommending ongoing advice and tailored action plans, covering "everything from regular check-ins and practical strategies to support with sustainable routines, social support, and accessing community help."

Suggestions include online access to patient support through the NHS Better Health platform, action plans with help from healthcare professionals for those struggling to maintain lifestyle changes, and encouraging participation in keep-fit or walking groups.

Around 240,000 people are expected to be offered Mounjaro over the next three years, according to NICE, which has recommended the drug only for adults who have a body mass index (BMI) of at least 35 kg/m2 and at least one weight-related health problem like high blood pressure, elevated cholesterol, cardiovascular disease, and/or diabetes.

Under the new guidance, healthcare teams should monitor individuals for a minimum of a year after they complete treatment and provide additional support as needed.

"Weight management is a long-term journey, not a short-term fix. The evidence is clear that advice and support for maintaining weight after stopping medicines or completing behavioural interventions can help prevent weight regain and enable people to experience lasting benefits," said Dr Rebecca Payne, chair of NICE's Quality Standards Advisory Committee.

"We've seen excellent examples of services that already provide comprehensive discharge planning and ongoing support," she added. "This quality standard will help ensure all healthcare providers adopt these best practices, giving every person the best chance of maintaining their weight management success over the long term."

In England, 29% of adults are living with obesity, and 64% are classified as overweight or obese. It is estimated that obesity costs the NHS £11.4 billion ($15.2 billion) a year, with a wider economic impact of £74.3 billion due to lost productivity, unemployment, and increased demand for social services.

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