Category: Analysis

• Over 50% of GLP-1 users discontinue use due to side effects, with two-thirds regaining the weight loss – yet the socioeconomic impact of this cycle is rarely analysed or considered in policy decisions.
• Approx. 95% of access is through private pathways beyond NHS structured frameworks; whilst people in least deprived areas are most likely to access these drugs, the highest obesity burden remains in the most deprived areas of the UK.
• The cost of side effects is disproportionately divided between the individual and the NHS – emergency care, follow up costs and lost work fall on systems which lack systemic tracking of who really bears the burden.

GLP-1 receptor agonists have been widely accepted as a phenomena in metabolic health; a “miracle drug”. Originally developed and prescribed for Type 2 Diabetes (T2D), usage has expanded to now cover obesity and weight-related conditions, with the expectation of long-term or lifelong usage. In a relatively short space of time, these medications have entered routine care settings and into public and private health policy considerations.

Whilst “Ozempic” and “Mounjaro” have become household names, our understanding of their real-world impact is only now coming into light, some years after their global adoption. This matters because when therapies are rapidly adopted at scale, the side-effects they come with can have consequences that extend far beyond individual patients but also have growing socioeconomic implications.

What do we know about GLP-1 side effects?

Clinical trials and emerging post-marketing data consistently demonstrate a range of side effects associated with GLP-1 medications, most common being gastrointestinal by nature. More specifically, persistent nausea, vomiting, diarrhoea, constipation and a feeling of sudden fullness due to delayed gastric emptying. Fatigue and general weakness are also frequently reported in response to dosage changes.

In clinical trial settings, where participants were closely monitored, received structured dose adjustments and further clinical support when needed, these observations were classed as “mild to moderate” or “transient”. Real-world use however, where close-up monitoring is not possible, paints a very different picture.

Beyond controlled settings, there is a spectrum of how long side effects persist, the severity of their presentations and how much clinical support they need. Real world studies have also identified less common but clinically relevant complications ranging from nutritional and body-composition changes (such as hair loss and muscle atrophy) to gallstones and in rare occasions, pancreatitis. Whilst some of these symptoms may not be considered medically serious, they are function-limiting and reduce everyday quality of life. As a result, a substantial proportion of users either reduce their dosage or discontinue use altogether due to tolerability issues.

When side effects become an issue

Side effects do not need to be life threatening to be disruptive, they just need to impact daily life.

These effects compound to prompt repeated GP or emergency visits, unscheduled care, nutritional complications, dehydration and mental health strain. Additionally, many of those who discontinue usage altogether, then re-enter the healthcare system to manage weight regain, nutrition challenges, muscle atrophy or to access alternative (possibly more invasive) weight loss therapies such as bariatric surgery.

This repeated cycle translates biological effects into socioeconomic impact.

The emerging socioeconomic costs of GLP-1 agonist-associated side effects

There are few studies formally evaluating or capturing the costs of side effects associated with GLP-1 medications. They are however real and must be considered.

At the individual level, persistent symptoms that are challenging to manage publicly can lead to reduced productivity or absenteeism at work. Patients in hourly-paid working conditions or on lower incomes may struggle to access timely follow-up care or alternative treatments. Even when patients remain at work, prolonged side effects can slowly impact income and professional growth. Further, repeated GP or private clinic appointments, unscheduled care for dependents and nutritional support can lead to out-of-pocket costs which are often associated with mental health challenges. Women are more likely to be prescribed GLP-1 medications for weight management, and more likely to have gastrointestinal or fatigue-related symptoms misdiagnosed, minimised or normalised in the clinic. Starting and re-starting the medication only exacerbates these issues.

At the healthcare system level, there are more emergency presentations linked to persistent gastrointestinal complications, particularly in the early stages of taking the medication. Repeated primary care consultations for continued nutritional advice, alternative weight management support and regular follow-up appointments also lead to more secondary care referrals following discontinuation of GLP-1 medications and weight regain. This results in GP time and resources being diverted and waiting times being longer for patients with unrelated conditions, stretching an already overburdened healthcare system.

These high costs are usually accounted for by the patients or healthcare systems, impeding the budgets available for primary and secondary care within the NHS. This pattern is not unique to GLP-1 injectables, but is a common tendency in healthcare to scale interventions before fully comprehending how their downsides are experienced and the socioeconomic impacts they have. Now, people are starting to raise questions, because when adoption moves faster than evidence generation, uncertainty grows.

Access has consequences…

An estimated 95% of GLP-1 users in the UK access it privately rather than through the NHS. Whilst NHS pathways for GLP-1 medication are tightly restricted (NHS eligibility criteria can be found here) and have long waiting times, they remain low cost to the individual. Meanwhile, private clinics offer easier and quicker access, albeit at a much higher cost. This pricing structure creates a system where those who can afford private care, access GLP-1s, while those who cannot are effectively priced out and left with a choice: stretch their finances for private access, or continue without treatment.

Data shows that those in the least deprived areas in the UK, are most likely to access GLP-1 medications, despite the most deprived areas carrying the highest burden of obesity. For people who have struggled with obesity for many years, a £150-£200 a month private prescription provides a resolution outside of a system that has offered little effective support – especially if they can afford it. But this affordability barrier means the population with the greatest clinical need have the least access, with multi-layered consequences to the individual, the healthcare system and the economy. For some, affordability is a barrier they are willing to break at any cost.

Regardless, GLP-1 side effects do not distinguish between private and NHS patients. When complications do arise, costs are split between the private user who can manage acute symptoms like dehydration or nausea, and NHS services who experience the spillover when symptoms are more extreme. Further, the 95% operating outside of NHS pathways receive none of the structured lifestyle and dietary support that NICE guidelines set with NHS prescriptions. As a result the burden of side effects, like the burden of access, falls disproportionately, based on income and geography or on a system that was not prepared – further compounding health inequalities rather than actually resolving them.

Why does this matter for policy decisions?

GLP-1 medications may well transform metabolic health, but only when matched with the necessary scientific evidence, infrastructure and equity. Right now, side effects are treated like an individual’s problem, rather than a systemic economic one and access adds further complications; the impacts of which we are now observing, with acute complications, lost days at work and private expenditure by those who can and cannot afford it. And the NHS is largely absorbing the consequences.

Stricter prescribing protocols, mandatory support regardless of the funding source and real-world safety monitoring are necessary for responsible use. Without these, we risk preventable healthcare (and associated costs), growing inequality and the loss of public trust in interventions that matter.

Prevention is the policy we keep ignoring…

• Preventative care is allocated only 5.2% of the national healthcare budget (ONS, 2022) despite years of research showing the greater impacts of prevention on healthcare and society.
• Preventable diseases have a multi-billion pound impact on our national health services, with further detriments on our society and economy through indirect costs including absenteeism, presenteeism and out of pocket costs.
• A policy shift towards preventative care could unlock substantial long-term savings upwards of £42 billion in 10 years.

Modern healthcare systems excel in intervening once people are already unwell – clinicians diagnose, treat, and manage complications whilst we absorb the rise in costs. What these systems are far less structured to do, is prevent the disease from occurring in the first place. An estimated 40% of ill health in the UK is preventable, yet the health system is overwhelmingly focused on treating diseases rather than preventing them.

This imbalance is not limited to the clinic, but also poses major moral and socioeconomic risks. Whilst the NHS is continuously overburdened outside of budgets and resources being unrealistically overstretched, preventable diseases continues to drive avoidable suffering, widening health inequalities and pushing public spending. Yet, despite prevention-focused initiatives such as the NHS Prevention Programme, measures remain significantly under-prioritised in policy and funding frameworks. If prevention is evidently beneficial, why is it not at the core of healthcare system policies and frameworks?

What do we mean by prevention?

Prevention is multi-tiered:

• Primary prevention – stopping the disease before it develops, for example vaccination, obesity prevention and smoking cessation.
• Secondary prevention – detecting the disease early, when outcomes are better and costs are manageable, for example early screening and diagnosis.
• Tertiary diagnosis – reducing complications when the disease is established, for example glucose monitoring and physiotherapy. This is synonymous with disease intervention.

In the UK, a substantial budget is spent on tertiary prevention where the disease is most advanced, complicated and costs are highest. By contrast, primary prevention receives a lower proportion of healthcare spending despite its long – term advantages, with only 5.2% of total healthcare expenditure focused on primary prevention initiatives in 2023 (close to pre-COVID-19 figures).

The true cost of preventable disease in the UK – real world examples

Many of the major health conditions placing the greatest strain on the UK’s national healthcare service are not inevitable – they are highly preventable through modifiable risk factors, social structures and policy changes. They’ve also been a part of the prevention conversation for many years. Below are 3 key examples:

Cardiovascular disease (CVD)

CVD remains the leading cause of death and disability in the UK; it is also one of the most preventable through limiting risk factors. Key drivers include smoking, high blood pressure, poor diet and lack of physical activity. A substantial proportion of CVD cases could be delayed or prevented entirely through population-level prevention measures such as tobacco tax, active commuting initiatives and restricting access to unhealthy foods. Yet, treatment (intervention) of CVD takes priority and dominates spending through emergency hospital admissions, long-term medication prescriptions and invasive surgical procedures. Currently, CVD intervention costs the UK health service over £18 million.

CVD burden is not evenly distributed, with rates of CVD being higher in more deprived communities, thus further contributing to health inequalities. As such, prevention is not the sole responsibility of the individual but a combined effort to change food and lifestyle systems, health education and access to support.

Cancer

Cancer care is one of the fasted growing areas of NHS expenditure. Whilst not all cancers are preventable, over one third are linked to modifiable risk factors including smoking (lung cancer), infection (HPV, cervical cancer), alcohol consumption (liver cancer) and obesity (bowel cancer).

Here, primary and secondary prevention with early screening and detection not only improve survival rates but also drastically reduce treatment complexity, quality of life and cost (both direct and indirect). Late stage cancer care is physiologically, emotionally, logistically and financially taxing and often less effective than early stage disease. At late stage, productivity loss, absenteeism and out-of-pocket expenses compound adding to the pressure felt by a cancer diagnosis. Important to note here, is that late stage diagnosis and a lower standard of care are most common in deprived populations, widening the inequality gap (another growing health issue we will discuss in the future).

Whilst we have considered the cost of these diseases on the NHS, it is also important to consider the indirect socioeconomic costs – absenteeism alone costs millions annually due to impacts on productivity, team functionality and financial losses. Of the 9.4 million working age adults who are not in work, 2.8 million are unable to work due to long-term sickness – many cases would be avoidable disease.

Equally detrimental is presenteeism (attending the workplace whilst unwell) which results in reduced working capacity and the same issues we mentioned previously. Again, costing the economy millions every year.

So why has prevention remained a low priority?

We know that prevention is effective, so why has it remained under-prioritised and under-funded? Well, this is due to several barriers not limited to:

• Measurement and data collection challenges – it is easier to count the number of treatments delivered than it is to model the number of diseases avoided and attributing that to specific prevention factors. Although QALYs and DALYs model avoided disease burden, prevention is measured by events that don’t occur and aren’t accurately recorded, such as admissions avoided or complications prevented.
• Budget pressure – as costs are constantly fluctuating, prevention budgets are usually amongst the first to be reduced often due to delayed returns. In contrast, spending on treatments provides immediate, visible outputs so is prioritised.
• Political priorities – prevention-associated benefits are often beyond the scope of electoral campaigns, with focus and funding redirected to alternative initiatives.

From a political and financial perspective, prevention sits in an uncomfortable policy space at the intersection of health, education, housing, transport and employment. As a result, prevention is frequently discussed but rarely implemented.

The socioeconomic case for shifting focus

Healthcare economic analyses increasingly reinforce what evidence has long shown: prevention delivers strong returns that extend beyond healthcare budgets into productivity, social care and consistent workforce participation.

The more people we have in good health, the more they can contribute to our society and economy.

If government policies redirected funding to prevention, it could unlock substantial long-term savings and increase returns; every £1 invested in prevention can generate multiple pounds in return, with wider social and economic value. Lowering preventable mortality even marginally, would save thousand of lives annually whilst also relieving pressure from public health services – a critical consideration given the current climate of the NHS.

Shifting focus does not require drastic policy changes; it only requires consistent prioritisation. Key changes could include:

• Scaling up intervention measures that have proven effectiveness e.g. smoking cessation through tobacco tax , and exercise through community-wide initiatives.
• Ring-fenced funding for evidence-based programmes and studies e.g. provide councils with budgets to maintain park runs to promote social exercise regimes. This also supports mental health and the loneliness epidemic.
• Targeting investments towards communities with the highest preventable disease burden to close the inequality gap, as seen with CVD.
• Strengthening data collection infrastructure to link prevention, outcomes and cost to help guide future investment strategies.

Conclusion: Prevention can no longer be an afterthought

The lack of focus on prevention reflects a systems failure; one that is currently optimised for illness rather than for health.

Health experts understand disease – the evidence is robust and the economic case is unavoidable. What is missing is not knowledge, it is commitment. Every year that prevention remains under-prioritised, the system pays more for late-stage disease interventions applying pressure to health services, whilst individuals pay with avoidable disease and reduced quality of life. Combined, these factors are generating a system set up to fail.

Without strong leadership and advocates for change, how long can we continue to prioritise intervention over prevention?