MILLIONS more Brits could be offered weight loss jabs for free on the NHS under proposals to overhaul the BMI system.
Currently, the “miracle” fat loss treatments – which work by making you feel fuller and less hungry – are offered to people with a BMI of 30 or above.
But experts have said those who aren’t technically classified as obese might still need drugs like Wegovy or Mounjaro.
They argued that factors such as the accumulation of tummy fat should also be a component for identifying obesity and prescribing fat loss jabs.
Abdominal or visceral fat, as it’s known, is different to the soft layer of blubber that lies just a layer beneath your skin.
Instead, it sits beneath the abdominal wall and wraps around the liver, intestines, and other organs.
Although visceral fat makes up only a small proportion of body fat, it’s a key player in a variety of health problems – linked to a higher risk of heart disease, dementia and even certain cancers.
But as a result of current BMI index guidelines, people with excess tummy fat might still not be deemed obese – thus missing out on treatments they could benefit from.
Writing in the journal Nature Medicine, a coalition of experts from the European Association for the Study of Obesity (EASO) said: “In many settings, the diagnosis of obesity is still based solely on body mass index (BMI) cut-off values, and does not reflect the role of adipose tissue distribution and function in the severity of the disease.
“Moreover, the indications for using the different therapeutic approaches now available for obesity management remain mostly based on anthropometric measurements, rather than on a more complete clinical evaluation of the individual.”
Anthropometrics is the practice of taking measurements of the human body.
The study authors called for the way we diagnose obesity – and thus the requirement of reaching a BMI of 30 or more to be given obesity drugs – to be overhauled.
“In current practice, the strict application of these evidence-based criteria precludes the use of obesity medications or metabolic and bariatric procedures in patients with a substantial burden of obesity disease, but low BMI values,” they explained.
Experts proposed that people should be offered weight loss medications if they have a BMI of over 25 and a waist-to-height ratio (WHtR) of above 0.5, as well as a weight-related health complication like high blood pressure or diabetes.
Abdominal fat is most accurately measured with an MRI, but WHtR is often used. This is your waist measurement divided by your height.
The larger your waist, the higher your waist to height ratio, and a ratio above 0.5 suggests that you have excess fat around your belly and are at an increased risk of health problems.
“The basis for this change is the recognition that BMI alone is insufficient as a diagnostic criterion, and that body fat distribution has a substantial effect on health,” the obesity experts wrote.
“More specifically, the accumulation of abdominal fat is associated with an increased risk of developing cardiometabolic complications and is a stronger determinant of disease development than BMI, even in individuals with a BMI level below the standard cut-off values for obesity diagnosis (BMI of 30).”
Were this criteria to be implemented in the UK for diagnosing obesity, it would mean that millions more Brits would be eligible for weight loss injections.
The 29 EASO experts behind the new obesity framework included specialists in endocrinology, nutrition, internal medicine, bariatric surgery and primary care.
In total, 79 per cent of the experts agreed that obesity medications should be considered in patients with a BMI of over 25, a WHtR of 0.5 or more.
Authors also called on pharmaceutical companies to use their new BMI diagnostic framework in clinical trials of obesity treatments.
“This statement may also be seen as a call to pharmacological companies and regulatory authorities to use inclusion criteria that are more adherent to the clinical staging of obesity and less to traditional BMI cut-offs when designing future clinical trials with obesity medications,” they wrote.
Weight loss jabs are a hot media topic at the moment, with hundreds of success stories from people who shed the pounds.
In March 2023, the NHS announced it would make Wegovy, a drug made by Danish firm Novo Nordisk, available on prescription to thousands of obese Brits.
It contains the drug semaglutide, which is said to have helped reality star Kim Kardashian and Twitter boss Elon Musk lose weight.
Wegovy, which helped a third of people reduce their weight by 20 per cent in trials, is now available from pharmacies like Boots.
How do they work?
The jabs work by suppressing your appetite, making you eat less and therefore lose weight.
To do this, semaglutide mimics the role of a natural hormone, called GLP-1.
GLP-1 is part of the signalling pathway that tells your body you have eaten, and prepares it to use the energy that comes from your food.
London GP and founder of wellgoodwellbeing.com, Dr Zoe Watson, said: “Your body naturally produces an appetite regulating hormone called glucagon-like peptide-1.
“These jabs work by regulating your appetite, which can lead to eating fewer calories and losing weight.”
Aren’t they diabetes drugs?
Semaglutide, the active drug in Wegovy, was originally sold under the name Ozempic specifically for diabetes patients.
But people started noticing it helped suppress their appetites, stopping them eating as much and helping them shed the pounds.
Novo Nordisk then developed Wegovy, which contains the same chemical but at higher doses specifically to aid weight loss.
Wegovy is not prescribed for diabetes patients.
Can I get them?
Wegovy is offered on prescription to obese adults given specialist weight loss treatment.
The NHS currently also offers a similar drug called Saxenda, or liraglutide.
Both are only available on Tier 3 and Tier 4 weight management services, which means you have to be referred to weight management clinics led by experts.
GPs can’t prescribe them on their own either, Dr Watson said.
The jabs have to be taken as part of an overall programme to help with lifestyle changes and psychological support to get the best effect from the medication prescribed.
Despite being approved for use, supply of Wegovy on the NHS has been postponed indefinitely because of a surge in worldwide demand.
Supply was also halved in the US because of the skyrocketing demand.
Are there any risks?
Like all medicines, the jabs do not come without side effects.
Around half of people taking the drug experience gut issues, including sickness, bloating, acid reflux, constipation and diarrhoea.
Dr Sarah Jarvis, GP and clinical consultant at patient.info, said: “One of the more uncommon side effects is severe acute pancreatitis, which is extremely painful and happens to one in 500 people.”
Other uncommon side effects include altered taste, kidney problems, allergic reactions, thyroid tumours, gallbladder problems and hypoglycemia.
What other options are there?
Mounjaro (brand name for tirzepatide) also came onto the market in early 2024.
Like Wegovy, tirzepatide stems from a drug originally designed to treat diabetes.
The weekly injection helped overweight people drop more than two stone in 18 months.
It is available with to order with a prescription online from pharmacies including Superdrug and LloydsPharmacy Online Doctor.
It works in a similar way to Wegovy and Saxenda, but is more effective.
Dr Mitra Dutt from LloydsPharmacy says: “Based on clinical trials, 96 per cent of people were able to lose more than five per cent of their body fat using Mounjaro. In similar trials, 84 per cent of people lost more than five per cent of their body weight on Wegovy, and 60 per cent on Saxenda.
“Mounjaro works by activating two hormonal receptors (GIP and GLP-1), which enhance insulin production, improve insulin sensitivity, and work to decrease food intake.”
It’s not the first time the BMI system for diagnosing obesity has been called into question.
Italian scientists have found scaling back the BMI threshold for obesity to 27 could paint a more accurate picture of who is affected.
Meanwhile, researchers found that a simple ‘string test’ was more accurate in detecting excess fat in kids and teens than BMI.
In other skinny jab news, drugs like Wegovy may reduce a person’s risk of 10 types of cancer, a new study suggested.
