1. Why are existing policies relating to food and diet seemingly not succeeding in reducing rates of obesity, and what should the Government learn from this, or do differently, when designing and implementing policy in future?

We face an obesity crisis. Around 36% of children in England are living with overweight or obesity by the time they leave primary school [i]. The UK has the third highest rate of adult obesity in Europe, and third in the G7 behind only Canada and the US [ii] with around two thirds of England (64%) now living with overweight or obesity [iii]. However, this is not just an England issue. Obesity rates are increasing globally, and most governments are facing significant challenges in attempting to reverse this trend.
Rising rates of overweight and obesity are caused primarily by the consumption of excess calories. Changes to the food environment over the last 50 years have played a critical role in many of us eating more calories than we need each day. Foods high in saturated fat, sugar, salt (HFSS) and calories have become more affordable and available. In addition, HFSS foods have been promoted and advertised more. Marketing and advertising drives demand and reinforces eating habits, creating stronger commercial incentives to produce less healthy options which are more profitable. As a result, food businesses tend to concentrate on developing strategies to bypass food environment regulations, which reduces the effectiveness of those policies. For example, foods that are HFSS account for 43% of all price reduction promotions and 30% of multibuy promotions [iv].
At the same time, on average, healthier foods are more than twice as expensive per calorie as less healthy foods, with healthier food increasing in price at twice the rate in the past two years compared to less healthy options [v]. Whilst we know that, for the population as a whole, reducing calorie intake is needed to reduce obesity levels, the affordability of a balanced, healthy diet affects the ability to eat a nutrient-rich diet.
These shifts have had corresponding impacts on purchasing behaviours and food and nutrient intakes. This is particularly true for children [vi]. The National Diet and Nutrition Survey 2019 – 2023, found that, on average, the UK population does not meet government recommendations for a well-balanced and healthy diet, consuming too much sugar and saturated fat and not enough fruit and vegetables and fibre [vii].
Policies in the past have largely focused on individual responsibility and providing information to empower individuals to make healthier choices, through campaigns which seek to educate and inform or voluntary changes from industry. They have also focused too much on physical activity. While physical activity has an important role to play in promoting good health and maintaining a healthy weight it has a less significant role in weight loss than reducing calories. While there is a place for these types of policies, it has been noted by various organisations that they do not account for the wider environment that constrains the choices that people make and drives them towards less healthy diets [viii]. This is particularly the case for individuals from the most deprived communities – who have more fast food takeaway outlets in their local areas [ix], are exposed to more advertising of less healthy foods [x], and may have fewer resources, including time [xi], access to transport to bring home food and refrigeration to store it [xii], and money, at their disposal to resist these influences and ‘make the healthy choice’.
However, some policies have been successful, even though obesity rates continue to rise. For example, the Soft Drinks Industry Levy (SDIL) has reduced the sugar content of drinks subject to the levy by 47.4% between 2015 and 2024, removing 57,000 tonnes of sugar in retailer and manufacturer branded products and may have prevented up to 5,000 cases of obesity in girls in the last year of primary school. The success of the SDIL stems from the fact it did not require individuals to change their behaviour. Instead, it incentivised manufacturers to reformulate soft drinks, which meant consumers were buying and consuming products with less sugar, without taking any action themselves. As the SDIL applies across the UK, it affected everyone including groups with higher rates of obesity and those living in more deprived areas and data shows it has impacted all socio-economic groups. In contrast, an awareness campaign about choosing lower sugar soft drinks would have relied on individuals to change their behaviour and would not be expected to have the same effect as SDIL. That does not mean that there is not a role for raising awareness, but it needs to be part of a package, and not the sole action.
The restrictions on the promotion of less healthy food and drink products in key store locations also aim to change the food environment. These restrictions are expected to accrue health benefits of over £57 billion and provide NHS savings of over £4 billion, over the next 25 years, and some initial early evidence indicates that this is having an impact on the purchasing of foods, with authors of a recent study concluding these restrictions are driving meaningful reductions of sales of in-scope products [xiii].
The Government recognises that there is no silver bullet to tackle obesity and improve diets. We recognise that food choices are an individual choice, but they are also influenced by the shifts in the affordability, availability and promotion of less healthy foods. This is supported and evidenced by organisations such as Nesta [xiv], The Tony Blair Institute [xv] and the independent National Food Strategy.
A suite of policies that reduce the commercial incentive for businesses to maximise the sales of calorie-dense, nutrient-poor foods that are more profitable than whole foods and are associated with poor health outcomes when consumed frequently, are required. We therefore need a package of measures that includes support for those already living with obesity and action to improve the food environment, making healthier choices more accessible and affordable for all, as well as supporting the most vulnerable to access healthier food.
The Government is committed to creating a food environment that is healthier and supports people to live longer, healthier lives balancing personal responsibility with state responsibility and not being afraid of ‘nanny state’ criticisms that have delayed or halted policies in the past. This will need a whole society approach, with Government partnering with industry to drive innovation and giving people the power to make healthy choices.
On 3 July 2025, we published the 10 Year Health Plan, which sets out decisive action on the obesity crisis [xvi]. In a world first, we will introduce mandatory healthy food sales reporting for large food businesses, by the end of this Parliament. This will set full transparency and accountability around the food and drink that businesses are selling and encourage healthier products. Using that reporting, we will set targets to increase the healthiness of sales for the largest food businesses.
We will fulfil our commitments to restrict junk food advertising targeted at children on TV and online and strengthen it by updating the Nutrient Profile Model (NPM). We will ban the sale of high-caffeine energy drinks to under-16-year-olds, continue to drive innovations in the soft drinks industry and update school food standards legislation, to ensure all schools provide healthy, nutritious food. We will also take action to support people already living with obesity such as establishing pioneering relationships with industry to test innovative models of delivering weight loss services and treatments to patients effectively and safely – this is addressed in response to later questions.
Delivering the commitments set out in the 10YHP, will be supported by the cross-government Food Strategy which is being developed and led by Department for Environment, Food & Rural Affairs (DEFRA). This will set the food system up for long-term success and provide wide ranging improvements. The Food Strategy will work to provide healthier, more easily accessible food to help people live longer, healthier lives.
The food system is impacted by policies directly related to food and many ancillary policy issues including trade, health, poverty reduction and economic growth. One of the main aims of the food strategy is to bring together different parts of government to tackle food issues in a more joined-up way, supporting national priorities and the Plan for Change. It also links closely with other strategies and policies across the UK and devolved governments, for example, the Child Poverty Strategy. The “Good Food Cycle” is a new government framework designed to improve Britain’s food environment. It aims to support public health, protect nature, and strengthen the food system for the long term.
Transforming the food system is a long-term project. This needs effective action across government, including devolved governments and local authorities, as well as across industry and all of society. The 10YHP and Food Strategy are major programmes of cross government work to drive food environment change and improve health outcomes. We will continue to engage with stakeholders and bring together the entire food system so that every child, every family, and every community can access healthy, affordable food and live healthier lives.
Finally, it is important to note that, it takes time for impacts of policies to emerge, such as reduction in obesity prevalence and a subsequent reduction in health harms. Many of our existing regulatory policies have only recently been implemented, or have yet to be implemented, for example, volume price promotion restrictions and advertising restrictions on less healthy food or drink online and on TV will come into force in October 2025 and January 2026 respectively. It will take time for reduced calorie consumption to affect people’s weight across the population and then change the number of people living with obesity. It is reported that it can take approximately three years from seeing calorie reduction in the population to changes in weight and therefore obesity prevalence [xvii]. We need the courage to hold our course as we wait for the benefits of these policies to come to fruition.

2. Which public health interventions have been the most effective, either domestically or internationally, at reducing obesity or consumption of less healthy foods? What should the Government learn from them?

The food environment has a significant influence on health and one intervention alone will not reverse the increasing trend in obesity levels [xviii]. We are implementing an ambitious programme of work to create a healthier food environment as set out in our 10 Year Health Plan and summarised in response to question one. It is difficult to directly compare public health interventions, particularly as they are in different stages of implementation. However, below we have described the potential effectiveness of a range of domestic and international policies that aim to reduce the consumption of less healthy foods and levels of obesity. This is in addition to action to support people already living with obesity which is addressed in response to later questions.

Effectiveness of domestic policies

We have listed policies that have been implemented in England, and provided an indication of their effectiveness, in chronological order below:

The voluntary sugar reduction programme resulted in reductions in sugar levels in all categories covered by the programme, including a 14.9% reduction in breakfast cereals and 13.5% reduction in yogurts and fromage frais, between 2015 and 2020. However, the other categories in the programme did not achieve the same level of sugar reduction. Overall, there was a 3.5% reduction in sugar between 2015 and 2020, as the larger reductions achieved in some categories were negated by increased sales of higher sugar products (for example, chocolate confectionery)[xix]. Although the programme indicated that reformulation is possible, it also demonstrated that progress was not fast or consistent enough under a voluntary mandate. As set out in question one, this programme is being superseded by the introduction of mandatory healthy food sales reporting and targets for large food businesses.
The Soft Drinks Industry Levy (SDIL) reduced the sugar content of drinks subject to the levy by 47.4% between 2015 and 2024, removing 57,000 tonnes of sugar in retailer and manufacturer branded products [xx]. The changes in products have had an impact across all socio-economic groups. A modelling study showed that SDIL may have prevented up to 5,000 cases of obesity in girls in the last year of primary school. Reductions were greatest (9%) in girls whose schools were in deprived areas [xxi]. Modelling studies also show that the sugar reductions delivered by the SDIL have resulted in reductions in the admissions to hospital for dental caries related tooth extractions of children aged 0-9 years [xxii], and hospital admissions for children aged 5-18 years for asthma related complications [xxiii]. As announced in the Autumn Budget 2024, we are taking steps to ensure the SDIL remains effective and fit for purpose. The uprating of the Levy to bring it in line with inflation came into effect on 1st April 2025. To maintain incentives for soft drinks manufacturers to reduce their sugar content and protect the real-term value of the levy, HM Treasury have consulted on: lowering the minimum sugar content at which the SDIL applies to qualifying drinks from 5g to 4g and removing the exemption for milk based and milk substitute drinks. The consultation closed on 21 July and HM Treasury are now considering the responses.
There are successful examples of local government using planning policy to control the food environment in their local area and reduce the density of fast-food outlets, particularly near schools. The most deprived decile of lower tier local authorities has double the number of fast-food outlets as the least deprived decile, meaning that children living in less affluent areas are more likely to see less healthy food in their high streets [xxiv]. In 2019, 50% of local authorities had a policy restricting the over proliferation of hot food takeaways [xxv]. Amongst these local authorities, the most common approach was to create exclusion zones around places for children and families [xxvi]. An evaluation of the use of planning policy in the North East of England found a reduction in the proportion of fast-food outlets by 14%, and the density of takeaway outlets available to 12.45 fewer outlets for every 100,000 residents [xxvii]. Building on these existing practices, the National Planning Policy Framework, published in December 2024, gave local authorities stronger powers to block new fast-food outlets near schools and where young people congregate.

There are a number of regulatory policies which have been more recently implemented or are soon to be implemented. We will evaluate each policy for impact through the Post Implementation Review process. At appraisal these policies have been estimated to deliver benefits, as described below.

The locations promotions restrictions which prohibit the placement of less healthy products in key selling locations such as checkouts, aisle ends, store entrances and their online equivalents came into force in October 2022. They are expected to accrue health benefits of over £57 billion and provide NHS savings of over £4 billion, over the next 25 years [xxviii]. OHID analysis of food purchasing data shows that for food taken into the home, the proportion of volume sales from HFSS products in food categories subject to locations promotions restrictions reduced from 48.5% in 2021 to 44.1% in 2023 [xxix]. The greatest reductions were seen in categories that contain pizzas (57.3% down to 43.1%), soft drinks (40.1% down to 30.5%), crisps and savoury snacks (93.5% down to 88.4%) and breakfast cereals (31.6% down to 25.0%).
The advertising restrictions for less healthy food and drink on TV and online are due to come into force in January 2026, however, the Government has secured a unique public commitment from industry to voluntarily comply with the restrictions from 1 October 2025. These restrictions are expected to deliver health benefits of around £2 billion, provide NHS savings of £50 million and deliver an additional £119 million of economic output, over the next 100 years [xxx]. Evidence suggests that similar advertising restrictions on the Transport for London estate were associated with an estimated 1,001 kcal (6.7%) decrease in average weekly household purchases of energy from HFSS products compared with what would have happened without the policy [xxxi]. Modelling data suggests the policy has resulted in 94,867 fewer individuals living with obesity after 3 years [xxxii].

As set out in question one, no one policy alone will be sufficient in reducing the consumption of less healthy foods and levels of obesity across the population. We are committed to taking a range of actions across government that will improve our food environment to enable access to healthier diets over time.

Effectiveness of international policies

The UK government keeps abreast of the success and challenges of international policies that have been implemented to improve the consumption of healthier diets. The UK is working with the World Health Organization (WHO) as part of their acceleration plan to stop obesity [xxxiii] and also hosts the WHO EU sugar and calorie reduction regional network [xxxiv]. The network aims to encourage and provide the tools for the 53 member states to implement coherent, evidence-based policy to reduce sugar and calorie consumption, given the global nature of the food supply and the importance of co-ordinated action. The UK was asked to take on this role due to its leadership and expertise in this area. The dialogue between countries that these collaborations generate provides opportunities to share current initiatives and learning on how to reduce obesity.
The following international examples are grouped by policy type:

Fiscal policies on sugar sweetened beverages (SSBs) - A number of countries have introduced policies as recommended by WHO as part of a collection of policy measures to prevent and manage non-communicable diseases and levels of childhood obesity [xxxv]. In addition to the UK, these include Barbados, Mexico, Chile, Peru, Columbia and South Africa [xxxvi]. Some countries in Europe (including France, Belgium, Norway and Latvia), South America (including Chile), and some parts of the US and Canada (including British Colombia, San Francisco, Philadelphia and Cook County) also include non-sugar or artificial sweeteners in their SSB tax [xxxvii], [xxxviii]. The effectiveness of sugar sweetened beverage taxes in reducing sugar content of drinks is dependent on the tax design. Where there is an incentive for producers to reformulate, like in the SDIL, this promotes sugar reduction.
Tax on energy dense snacks - Some countries including Mexico and Hungary have implemented taxes based on the energy density of foods or foods high in saturated fat, salt or free sugars (HFSS)[xxxix], [xl] and Colombia is the first country to introduce fiscal policies stated as being based on ultra-processed food and drink products; however, the foods in scope of the tax are HFSS [xli]. In the case of the 8% Mexican excise tax on energy dense snacks, data shows that taxed food items were substituted for cookies marketed as healthy, cereal bars and cereal boxes which were not taxed. Because of these substitutions, while the purchase and sales of taxed items decreased, overall calories and fat purchased did not. However, multiple studies from Mexico have consistently shown the largest decrease in purchases of taxed nonessential energy-dense foods was among consumers of lower socio-economic status or households who showed stronger preferences for taxed foods prior to the implementation [xlii], [xliii], [xliv].
Mandatory salt reduction targets - A voluntary salt reduction programme has been in place in the UK since 2006 which covers around 80 food categories [xlv]. This was initially combined with a public health campaign. Progress was achieved at the beginning of the programme with reductions of up to 20% being made in some foods and salt intakes fell by 1g between 2005/06 and 2018/19 [xlvi]. The last assessment of progress showed that 83% of retailer and manufacturer products were at or below maximum targets; 74% of products sold in the out of home sector were at or below the maximum targets set specifically for the sector [xlvii]. However, progress has stalled in recent years and intakes remain above dietary recommendations. Mandatory targets can be effective in driving down salt levels in food. Both South Africa [xlviii] and Argentina [xlix] have implemented mandatory salt reduction targets across a range of foods and have published evaluations of their respective policies. Data suggests that Argentina’s mandatory salt targets have led to reductions in salt levels in foods, with 85% of products being compliant in 2015, increasing to 90% four years later. As salt content in foods in Argentina remained quite high, some targets have now been reduced to drive greater reductions [l], [li]. Two studies conducted in South Africa provided initial evidence to show that salt intakes reduced in the first few years following the introduction of mandatory salt targets [lii],[liii]. Data from a study in rural South Africa that measured urinary sodium levels and blood pressure at time points before and after implementation of the mandatory targets found that estimated salt intakes significantly reduced [liv]. Their analyses showed that every gram of sodium reduction was associated with -1.30 mm HG reduction in systolic blood pressure.
Mandatory sugar and calorie reduction - No country has implemented mandatory targets for sugar and calorie reduction in food and drink.
Front of pack nutrition labelling (FOPNL) - Evidence suggests that, compared with when no FOPNL is present, FOPNL improves consumer understanding of the nutritional quality or content of foods, and improves healthier food choices and purchases (all with moderate certainty of evidence)[lv]. The UK’s FOPL has been in place since 2013. It uses a multiple traffic light approach (MTL) showing less healthy as ‘red’ and healthier as ‘green’. We estimate that around 60% of products sold in the UK carry the label and it has also proved to be popular with consumers [lvi]. The Health Star rating and Nutri-Score scheme [lvii],[lviii] are voluntary front of pack labelling measures developed and implemented in Australia and France, respectively. Nutri-Score was developed based on the UK2004/05 NPM and has now been officially adopted on a voluntary basis in 7 countries in Europe.
Over the last 10 years, an increasing number of countries have introduced FOPNL, and a number are introducing mandatory labels, such as Israel (from 2020) and Canada (expected from 2026). Warning labels are used across the South American region with Ecuador and Bolivia, Chile, Paraguay and Columbia have used the presence of a warning label as a standardised approach to defining a less healthy product. They have used this to then apply advertising restrictions and in Columbia’s case a HFSS tax. Further details on Chile’s approach is included below. There is a small amount of international evidence suggesting that mandatory FOPL policies, with labels displayed on all packaged foods, are more likely to be effective than voluntary policies. Voluntary FOPNL policies can lead to selective display of labels on foods with favourable ratings. For example, evaluation of Australia’s voluntary FOPNL scheme has shown that, 5 years after implementation, around a fifth of foods displayed the label and, of these, around two thirds were rated as ‘more healthful’xxxvi.
Chile’s Food Law - In 2016 Chile implemented a suite of measures to limit the marketing of HFSS food and drink to children, and sales of these products in schools, and the labelling of products with a highly visible logo (warning label) if they are high in salt, saturated fat and sugar [lix]. These policies were implemented in three phases. Research analysing changes in purchasing following phase two, noted a 36.8% decline in sugar, 23.0% decline in energy, 21.9% decline in sodium, and 15.7% decline in saturated fat purchased compared to a counterfactual scenario. This was partially offset by increased purchases from not high-in products. However, the overall changes resulted in net declines in the purchasing of nutrients of concern ranging from 8.3% to 20.2%[lx]. A study by Food and Agriculture Organisation of the United Nations (FAO) found that of 1915 products reviewed for nutrient content before and after implementation of the law, 276 products (15 %) were reformulated and changed from being classified as being “high in”, especially for ”high in sugar” and ”high in sodium” products [lxi]. Chile’s Food Law is an example of how a range of regulatory measures can improve the healthiness of foods and drinks and shift purchasing towards healthier products. Further studies demonstrating sustained long-term impact of these measures are welcome.
Amsterdam Healthy Weight Programme - In 2013, Amsterdam introduced the Amsterdam Healthy Weight Programme, consisting of a range of community and family-based services to prevent overweight and obesity in children. There has been no direct evaluations of the effect of the programme in Amsterdam on obesity, although the Public Health Service of Amsterdam estimates that the prevalence of overweight and obesity amongst children 0-18 years in Amsterdam fell from 21% to 18.5% between 2012 and 2015. Whilst it is not possible to directly attribute the falls in obesity prevalence to the programme, the UK have been keen to understand what elements might have contributed to its effectiveness, for example political leadership and adequate funding.[lxii]
School food - There is a lack of long-term evidence on the impact of school meal programmes due to the short-term nature of the evaluations and the different school meal policies countries have adopted. However, the overall picture is that countries have moved to impose stricter nutritional standards on school meals. A systematic review looking at the effectiveness of school food environment policies on children's dietary behaviours concluded that specific policies, such as school meal standards, can improve dietary behaviours, but that the effects on health outcomes such as adiposity were unclear and require further investigation [lxiii].
The existing school food standards in England have been in place since 2015. Government is currently in the process of updating these standards to reflect the latest dietary recommendations, particularly in relation to sugar and fibre.

While not all programmes and policy measures implemented internationally are monitored and evaluated, data shows that some of these have been effective. We continue to learn from other countries whilst taking into account the unique contexts in which they are delivered. Although no country has reversed the tide on obesity, evidence suggests that some mandatory measures, be that regulation or fiscal, and a package of other policies will have the most impact in improving diets across the population.

4. What action could be the most effective in reducing ethnic and social disparities relating to rates of obesity, and how could any barriers to implementation be addressed?

Evidence shows that obesity prevalence increases with deprivation and that this inequality has widened over time [lxxiii]. In the 2023/24 school year, the prevalence of obesity was more than twice as high among children living in the most deprived areas than among children living in the least deprived areas (both in reception and year 6)[lxxiv]. Additionally, children who live with obesity are 5 times more likely to live with obesity as adults, in comparison to children who are not living with obesity [lxxv]. There are also significantly differing rates by ethnicity and gender: for example, 34% of Chinese men were either overweight or obese with 74% of Black Caribbean women [lxxvi].
Reducing ethnic and social inequalities in obesity is mainly about improving the food environment. As such, the most significant impact will come from national-level, population-wide policy interventions that shape food systems, pricing, marketing, and access, and aim to address the barriers that the groups with the highest rates of obesity face. The Government’s Health Mission aims to shorten the time people spend in ill health and reduce health inequalities, including obesity related ethnic and social disparities, and create the healthiest generation of children ever. The 10YHP, Child Poverty Strategy and Food Strategy support the Governments Plan for Change and the Health and Opportunity Missions. That said, there is still an important role for local action, especially where local food access, cultural factors, or economic barriers have a direct impact. Local efforts can support national strategies and fill gaps where targeted approaches are needed.
To effectively tackle obesity and reduce ethnic and social disparities we need to ensure equitable access to healthy food and weight management services. It is important to address local food environments and the socioeconomic and ethnic barriers, that may affect how policies are designed and delivered. For example, body mass index (BMI) is widely used to estimate obesity prevalence, however, individuals from Black, Asian, and other minoritised ethnic groups have a higher risk of developing weight-related health conditions than individuals from white backgrounds. To account for this, the National Institute for Health and Care Excellence (NICE) updated the BMI guidelines, most recently in 2025 [lxxvii]. This resulted in an increase in obesity prevalence across all groups, especially those from minority ethnic groups.
Poverty is a wider determinant of health. Although not a direct cause of specific health conditions, poverty is a risk factor for malnutrition, obesity, ill mental health, and tooth decay. Evidence shows that children living in poverty are more dependent on getting their calories from cheaper, less nutritious foods, with almost 1 in 5 living in food insecurity, affecting their health and attainment at school [lxxviii]. We need to improve access to healthy food, especially for the most vulnerable in society. Fruit and vegetables have become more expensive relative to other foods having risen in price by 29% and 49% relative to average food prices since 1980. For households in the lowest income quintile, 45% of disposable income would need to be spent on food to meet the Eatwell Guide, compared to only 11% in the highest income quintile [lxxix]. A recent report on purchasing behaviours showed that food and drink price inflation had the largest impact on low-income households and those with young families and as a result, these groups switched to cheaper brands [lxxx].
The Food Strategy’s “Towards a Good Food Cycle: a UK government food strategy for England, considering the wider UK food system”[lxxxi] will improve access to healthy, affordable food for families and give them the skills and support to cook and eat healthily. This is a key part of the Government’s wider action to tackle child poverty and support families with the cost of essential goods. It builds on the expansion of Free School Meals to an additional 500,000 children and the rollout of free breakfast clubs for primary school pupils and will form part of the Government’s Child Poverty Strategy. The Child Poverty Taskforce are working to publish the strategy in the Autumn which aims to tackle child poverty and give every child the best start in life.
As announced in the 10YHP, the Government will restore the value of the Healthy Start scheme. The Healthy Start Scheme and Free School Meals are the most effective polices to address inequalities and to support the most vulnerable in society. The Healthy Start Scheme supports low-income families and contributes to the Government’s efforts to address child poverty. Pregnant women and children aged one or older but under four will each receive £4.65 per week, and children under one year old will receive £9.30 every week. The scheme encourages a healthy diet for pregnant women, babies and young children under four from very low-income households. One recent study found that the scheme allows ‘families to buy foods they would not otherwise be able to afford, allowing children to be introduced to healthy foods from an early age’[lxxxii]. The funding for Healthy Start can be used to buy, or be put towards the cost of, fresh, frozen or tinned fruit and vegetables, fresh, dried and tinned pulses, milk and infant formula. Healthy Start beneficiaries are also eligible for free Healthy Start Vitamins. A survey examining the eating habits of children aged 16-18 months old found that, for caregivers had registered for the Healthy Start scheme, most commonly used it to buy fruit (88%), vegetables (86%), or cow’s milk (77%)[lxxxiii].
Areas of deprivation are more likely to have greater access to unhealthy food. For example, the most deprived decile has double the amount of fast-food outlets as the least deprived decile, meaning that children living in less affluent areas are more likely to see less healthy food in their high streets [lxxxiv]. Additionally, it is estimated that 1.2 million British residents, who live in deprived areas, are estimated to be in food deserts, i.e., an area with limited access to affordable, nutritious food [lxxxv].
Research conducted by the University of Cambridge and charity Bite Back found that nearly 3,500 schools across the country now have a major food outlet within 400 metres - 1000 more schools than in 2014 [lxxxvi]. We will take decisive action to stop the relentless targeting of children and young people by the fast-food industry, which is a particular problem in some of the most deprived areas. Our revised National Planning Policy Framework gives local councils stronger powers to block new fast-food outlets near schools and where young people congregate.
As mentioned in our response to question two, the Soft Drinks Industry Levy (SDIL) reduced the sugar content of drinks subject to the levy by 47.4% between 2015 and 2024, removing 57,000 tonnes of sugar in retailer and manufacturer branded products. The changes in products have had an impact across all socio-economic groups. However, a modelling study showed that SDIL may have prevented up to 5,000 cases of obesity in girls in the last year of primary school with the greatest reductions (9%) seen in girls whose schools were in deprived areas.[lxxxvii]
As highlighted, population-wide preventative measures will address both childhood and adult obesity and poor diet and could be especially effective at reducing health inequalities. This is because disadvantaged communities are more exposed to cheap, less healthy food and have less access to affordable healthy food and therefore more likely to face higher rates of obesity and related health problems.
Additional population-wide preventative measures that might be expected to have a greater positive health benefit for those in greatest need include:

Limits on unhealthy food advertising. There is evidence that unhealthy food advertising is viewed more by people from lower socioeconomic backgrounds [lxxxviii]. An analysis of Transport for London’s advertising restrictions on high fat, salt and sugar products showed greater expected health benefits were expected to accrue to individuals from the most socioeconomically deprived groups compared to the least deprived [lxxxix].
Reformulation policies, such as the Soft Drinks Industry Levy, can have the greatest health impacts among children and young people in the most deprived areas [xc].
Breastfeeding promotion. There is a small inverse association in the data (with significant limitations with these analyses) between breastfeeding prevalence and the prevalence of children living with obesity and overweight at ages 4 to 5, which is independent of the role of other factors [xci]. Breastfeeding rates are also lower in areas of high deprivation [xcii].
Reducing maternal smoking, as maternal smoking is associated with a higher risk of overweight or obesity in childhood [xciii].

It is also important that access to weight management services is based on who would benefit the most, regardless of what population group a person belongs to, including their ethnicity or socioeconomic status. There is evidence that reports some population groups are less likely to engage with weight management services, such as males and people from deprived areas [xciv].
Data on access should be monitored by providers and commissioners to understand who is accessing their services, and the potential consequent impacts on health inequity, so that efforts can be made to target services at the people who would benefit most. We have set out, in our responses to other questions:

that increasing access to obesity medicines on the NHS could address disparities in overall access to these medicines in England, which are currently at risk of being based on the ability to pay.
how GPs often refer into weight management services, and evidence from the NHS Digital Weight Management Programme shows that GPs have good reach into deprived communities and with people from ethnic minority backgrounds [1], meaning uptake in these groups is higher than their proportion in the general population.
GP referrals may also help men access the NHS Digital Weight Management Programme. Evidence has also suggested that men are more likely to take part in weight management services when they are specifically invited to them [xcv], and the evaluation of the programme reported that 44.6% of participants were male [xcvi], which is more than observed in some other studies which focus on other programmes [xcvii] [xcviii]
local authorities, as commissioners of local behavioural weight management services, can target their provision at specific high-need groups in their populations

5. What more should the Government and/or the food industry do to address disparities and deliver on the Government's Food Strategy aim of improving access to affordable, healthy food?

The Government is committed to reducing health inequalities, creating a fairer, healthier food environment and driving economic growth. We will take action to improve poor diets and reduce obesity by making healthier choices more accessible and affordable for all, as well as supporting the most vulnerable so that they can live longer, healthier lives.
To improve the food environment, it will be important for government to work closely with the food industry, this includes retailers, manufacturers and the out of home sector (cafes, restaurants fast food outlets). The food industry plays an important role in feeding the UK population and driving economic growth. They need to be part of the solution, to shift sales to affordable, healthier food and drink and to reduce the overall calories purchased across all sectors of the food industry.
The Food Strategy will work to provide healthier, more easily accessible food to help people live longer, healthier lives. The Food Strategy’s “Good Food Cycle” sets out ten key outcomes, including better access to affordable and nutritious food, support for food sector growth, and stronger community food initiatives. The aim is to create a food system that benefits everyone, boosting public health, protecting the environment, and supporting economic resilience.
Improved food environments and access to healthier and more environmentally sustainable options, combined with the right knowledge and skills, support consumer behaviour change towards healthier and more sustainable diets. This creates new and growing markets for healthier and more affordable products, produced in the UK and accessible to all, generating further opportunities for growth.
Healthier diets result in a healthier and more productive population, with improved wellbeing, reduced burden on the NHS and a stronger foundation for growth across the economy [xcix]. Improved resilience to shocks reduces volatility in food availability and prices, strengthening the foundations for economic growth and increasing food security, particularly for the most vulnerable. Together, this process will maintain and enhance food security, as defined in the UK Food Security Report [c].
As set out in question one, in July 2025, we published our 10YHP which sets out decisive action on the obesity crisis [ci]. These policies are population-wide measures to reduce obesity and improve access to healthier foods, but as outlined in Question 4, they could be the most effective in reducing disparities because disadvantaged communities are more likely to have a higher prevalence of obesity and related health problems. Disadvantaged communities are more exposed to cheap, less healthy food and have less access to affordable healthy food. Evidence also shows that obesity prevalence increases with deprivation and that this inequality has widened over time.
Transforming the food system is a long-term project and will take time to deliver at scale. For example, improving the food environment requires businesses to make changes to the products they produce and how they promote and market them, alongside wider changes to our food culture. Businesses need time to prepare and plan for those changes. We are committed to working with industry and we ask them to do the same by supporting regulations that shape a healthier food environment and, make improved public health outcomes a core objective alongside profit making.
The Government is also committed to tackling poverty and ending mass dependence on emergency food parcels. To inform this work, Department for Work and Pensions officials are engaging with a range of organisations to better understand the complex food aid landscape. Working people should not have to turn to food banks. Our plan to Make Work Pay is part of the mission to grow the economy, raise living standards across the country and create opportunities for all.
Our Get Britain Working White Paper, backed by an initial £240 million investment in 2025/26, will target and tackle economic inactivity and unemployment and join up employment, health and skills support to meet the needs of local communities. In addition, we are providing £742 million in England to extend the Household Support Fund (HSF) by a further year, from 1 April 2025 until 31 March 2026. This will enable Local Authorities to continue to provide vulnerable households with immediate crisis support towards the cost of essentials, including food parcels/vouchers, and develop their schemes to help prevent poverty locally and build local resilience, such as food pantries.
Tackling child poverty is at the heart of this Government’s mission to break down barriers to opportunity and ambition to raise the healthiest generation of children ever. The Child Poverty Taskforce aims to publish the Child Poverty Strategy in the Autumn that will deliver fully funded measures that tackle the structural and root causes of child poverty.
Ahead of this, the Government has already announced the expansion of free school meals, to provide a nutritious lunchtime meal every school day to over half a million more children from the most disadvantaged backgrounds from the start of the 2026 school year. This is alongside the commitment offering a free breakfast club in every state funded school with primary aged pupils in England. This has been rolled out in 750 schools as Early Adopters, reaching more than 180,000 children and 70,000 pupils from schools in the most deprived parts of the country. Learnings from these Early Adopters will be used to confirm details of a national rollout.
The Taskforce will continue to explore all available levers to drive forward short and long-term action across government to reduce child poverty.

6. What challenges and opportunities do weight loss medications like Wegovy and Mounjaro present to the NHS and to individuals?

Opportunities for individuals

New obesity medicines can provide an effective tool, when prescribed alongside diet, physical activity and behavioural support, to support some people living with obesity to lose significant amounts of weight. For example, clinical trials have reported that patients receiving semaglutide (licensed as the brand Wegovy for weight management) alongside diet and physical activity had lost an average 15.3kg (14.9% of their starting body weight) after 68 weeks [cii], whilst patients receiving tirzepatide (licensed as brand Mounjaro) alongside diet and physical activity had lost an average of 24.4kg (20.9% of their starting body weight) after 72 weeks [ciii][2]. Emerging evidence, outside of controlled clinical trials, has reported that the weight loss seen in real-world settings may not be as great, with one study reporting that individuals taking 2.4mg of semaglutide lost 11% of their weight loss over 60 weeks [civ]. Bariatric surgery can also lead to substantial weight loss; one systematic review reported an average weight loss of 20.23kg for patients at 60 months [cv].
The average weight loss from obesity medicines and bariatric surgery is more than the average weight loss typically seen in behavioural weight management programmes. One systematic review and meta-analysis reported average weight loss after behavioural weight loss programmes of 4.9kg (% weight loss not published)[cvi]. Despite showing less weight loss than surgery or pharmaceutical treatments, these behavioural programmes can still result in clinically meaning weight loss and are less invasive, have a substantially lower risk of side effects, and are lower cost than treatment with obesity medicines or surgery. These programmes can therefore make meaningful differences at population-level.
Excess weight reduces life expectancy and is a risk factor for serious diseases and conditions including cancer, cardiovascular disease, chronic respiratory disease, osteoarthritis, back pain and depression [cvii]. Reducing excess weight, can improve health by preventing the development and progression of, and in some instances potentially contributing to an improvement or reversal of, obesity related health conditions [cviii].
Generally, there is a trajectory of weight gain in the population over the life course, therefore weight regain is common in many people following a weight management intervention. However, even modest amounts of weight loss can benefit health, and generally, greater weight loss is associated with more health benefits.
There is evidence that the weight loss seen in behavioural programmes affects cardiometabolic risk factors [cix], which may lead to a lower risk of developing weight-related comorbidities. There is evidence that the introduction of the Diabetes Prevention Programme – a nine month behaviour change programme for people at risk of type 2 diabetes – reduced the population incidence of type 2 diabetes [cx]. Similarly, research continues to be published that reports that treatment with obesity medicines can have impacts on health outcomes, as part of, or in addition to, the weight loss. Consequently, where appropriate, the National Institute for Health and Care Excellence (NICE) is reviewing and expanding indications for the use of these medicines through the standard Technology Appraisal process.
If, following a NICE technology appraisal, NICE recommends a medicine as a cost-effective use of NHS resources, for treating specified conditions in specified populations, then this triggers a legal mandate for the NHS to make funding available for these treatments on the NHS. The NHS is normally required to fund NICE recommended medicines within three months of final guidance publication, but the implementation period can be extended where there are significant barriers to implementation.
There is also growing evidence about the potential positive effects that these medicines have on the body outside of appetite and weight loss, such as glycaemic control, lowering blood pressure, and inflammation [cxi], and the potential use of these medicines for other purposes, such as treating addictions [cxii], or dementia [cxiii]. However, it is important to note that, for these medicines to be routinely used in the NHS to treat different conditions, they must be approved by the Medicines and Healthcare products Regulatory Agency as safe and effective treatments for that particular use; and be given a positive recommendation as a clinically and cost-effective use of NHS resources by the NICE. However, it should be noted that a positive recommendation does not mean that treatments are cost-saving to the NHS. New treatments often add costs to the healthcare system, although they are cost-effective in terms of the health benefits gained.

Challenges for individuals

There will be challenges for individuals receiving these treatments. Like all medicines, GLP1 treatments can have side effects. Some of the most common are gastrointestinal, like nausea, vomiting, and diarrhoea. They are usually mild to moderate in severity or short in duration following medication initiation and dose increase, although they can sometimes lead to complications, like dehydration. Other side effects can be more serious in nature. For example, some recent media reports have focused on the risk of acute pancreatitis (or inflammation of the pancreas). This is a known side effect of these medicines and, although infrequent, it can be serious [cxiv], and sometimes fatal. If more people are taking tirzepatide or semaglutide the total number of cases will rise, as NICE has sets out in its evidence to this Inquiry.
The side effects associated with GLP-1 medicines and media publicity surrounding them might put some people off trying these treatments. Side effects might also mean that some patients do not tolerate the treatment well and choose to stop; and, in rarer cases, they may require NHS treatment. Whilst semaglutide and some other GLP-1 treatments have been used in the treatment of diabetes for some-time, semaglutide when used for weight management as well as newer medicines like tirzepatide, are subject to more intense monitoring by the MHRA as part of their Black Triangle scheme [cxv]. Ongoing monitoring of these medications by the MHRA ensures that their benefits continue to outweigh any risks. Real-world evidence on long-term use of these medicines is needed to understand the understand the long term safety and effectiveness in real world settings.
Another challenge is weight regain. Regain is not limited to GLP-1 treatments, and is seen when stopping all obesity treatments, including after bariatric surgery or a behaviour change intervention. However, the regain can be quicker for obesity medicines compared with some other treatment options. One study found that one year after the withdrawal of semaglutide and a lifestyle intervention, participants regained two-thirds of their weight loss [cxvi]. The impact of structured nutrition and lifestyle therapy to prevent weight re-gain after stopping GLP-1 treatments has not been rigorously studied [cxvii], and further research is needed.
In contrast to GLP-1 treatments, a study into bariatric surgery reported that participants on average regained about 9.5% of the maximum weight lost one year after reaching their lowest weight [cxviii]. As such, some patients taking obesity medicines may need to take them long-term to ensure sustained weight loss. However, as noted above, research is needed to establish the safety profile of these medicines with continued long-term use.
These medicines should be used as an adjunct to a reduced-calorie diet and increased physical activity as per their licenced indication [cxix]. NHS patients taking semaglutide or tirzepatide should receive wraparound support which includes: dietetic advice to prevent malnutrition, given their drug’s appetite-suppressing effects; physical activity guidance to minimise lean muscle mass loss; and behavioural support to help patients adopt sustainable long-term lifestyle changes, including if patients come off these medicines. Published evidence reports that people using GLP-1 treatments have a greater risk of developing nutritional deficiencies [cxx]. Nutritional priorities and physical activity advice for patients is complex and should be tailored to individual needs [cxxi]. NICE Quality Statements have been recently updated to reflect this [cxxii].
However, we recognise that when people stop obesity medicines or other weight management interventions, they are returning to the same obesogenic food environment that might have contributed to them gaining excess weight in the first place. Consequently, these individuals might find it difficult to maintain the weight loss. We announced ambitious proposals to tackle the obesity epidemic – such as the Healthy Food Standard – in our 10 Year Plan for Health (see our response to earlier questions) this will support people to maintain a healthier weight.
There are further considerations that individuals taking GLP-1 treatments and healthcare professionals will need to consider. This includes the effects of the medicines on oral contraceptives, safety in pregnancy and breastfeeding, and use of these treatments around the time of a surgery or an operation [3][cxxiii]. and interactions with mental health medicines. Relevant important safety information is published in the British National Formulary [cxxiv]. The MHRA has published information for the public on these considerations, as well as the side effects [cxxv].
Another potential challenge arises from widespread publicity about these treatments which seems to be driving people to private use. It has been estimated that, in March 2025, approximately 1.5 million people in the UK now access GLP-1s privately every month [cxxvi], predominantly through online pharmacies. We have not been able to verify these figures and do not have access to data on who is accessing these medicines; there is no national data collection on privately prescribed medicines. In addition, as tirzepatide uses the same brand name – Mounjaro – for diabetes treatment and obesity management, it is not possible to precisely separate prescription data by indication. DHSC is currently running a call for evidence to gather more evidence and data about private prescribing, which will include private prescribing of GLP-1s.
However, given access in the private market is based on ability to pay, it is possible that some people accessing these treatments privately might not be eligible to receive these treatments on the NHS. It is also possible that patients receiving these treatments privately are not offered the level of wraparound support expected from the NHS.
There are also risks associated with the private market for this product which the appropriate regulators are considering and responding to where they judge this is needed. This includes:

Provision of incorrect information from potential patients about their weight or body mass index in online forms, meaning some people who are ineligible under the terms of the MHRA authorised indication can access the medicines inappropriately [cxxvii].To address this, the General Pharmaceutical Council (GPhC), who regulate pharmacy premises and pharmacy professionals, published updated guidance in February on providing services online [cxxviii]. It states that the prescriber should not base its prescribing decisions on information provided in a questionnaire alone, and they should independently verify the person’s weight, height, and/or body mass index. The GPhC can take enforcement action against pharmacies that do not meet their standards.
Illegal promotion of these drugs. These are prescription-only medicines (POMs) and should not be advertised to the public [cxxix].The Advertising Standards Authority has recently issued a warning to businesses and individuals targeting the public with ads for these medicines and publishing several rulings in July 2025 to require them to take ads down. [cxxx]
Fake and unlicensed products. There are also risks for individuals around medicines being sold, without prescription, by illegally trading sellers both online and on the high street. Individuals may receive fake products, with too much or too little of the correct active ingredient, and some may contain harmful toxins. These medicines do not meet UK medicine safety standards and can lead to hospitalisation. The MHRA is responding to these concerns, including through action by its Criminal Enforcement Unit (CEU)[4], and through running it’s #FakeMeds campaign that aims to protect the public when buying medicines or medical devices online.

Opportunities for the NHS and the economy

Obesity is estimated to have significant costs for the NHS, the economy, and wider society. The latest estimate of the annual cost of obesity to UK society has been estimated at £74.3 billion per year. This includes a cost to the NHS of obesity related ill-health at £11.4 billion, costs to businesses of £8.9bn, costs for social care of £0.4bn, and quantified costs of the reduced quality of life from obesity of £48.1bn [cxxxi]. As noted above, these medicines present significant opportunities to reduce the likelihood of patients developing weight related conditions or improving the management of existing ones
As obesity increases the risk of ill-health, it can also negatively impact the labour market. Individuals living with obesity are at a greater risk of becoming economically inactive due to long-term sickness/disability [cxxxii]. They are also estimated to miss four more days of work than those who are healthy weight [cxxxiii] and may experience 0.81% overall productivity loss due to working whilst ill. For bariatric surgery specifically, there is some evidence that individuals who had a bariatric surgical procedure had an increased probability of being in work in the time after the surgery [cxxxiv].
Whilst the new generation of weight loss treatments have the potential to deliver benefits to the NHS and the economy over the medium to long term, real-world evidence on effectiveness, tolerability and maintenance of weight loss, and on how patients use healthcare after weight loss or after experiencing side effects, is still emerging. There is a range of research ongoing or planned. This includes the real-world SURMOUNT-REAL study [cxxxv] which will aim to collect data on healthcare resource utilisation, health-related quality of life, and changes in participants’ employment status and sick days from work, and the national evaluation of weight medication access [cxxxvi]. Medication adherence will be particularly important; one clinical trial reported that 82.9% of patients had continued treatment throughout the trial (i.e. 17.1% discontinued treatment), whereas real-world studies have reported much higher discontinuation rates [cxxxvii] e.g., 50.3% at 12 months for patients living with obesity [cxxxviii]. Research will continue to inform the NHS’ approaches to making these medicines available.

Challenges for the NHS

Whilst these medicines bring benefits, they also pose challenges for the NHS due to the large eligible population, which NICE estimate to be 3.4 million people for tirzepatide for managing obesity [5], and slightly more for semaglutide. The main challenges include:

Affordability of the rollout, including the costs of the medicine; patient clinical management costs; and costs from providing the required behaviour change support.
NHS resourcing and healthcare professional capacity and training. For example, NHS England estimated that, if all patients eligible for tirzepatide for managing obesity on the NHS presented in the first year of access, it would take up 20.22% of all GP appointments available in England [cxxxix].
Ensuring NHS services are ready to provide the necessary ‘wraparound’ support services alongside the medicines. This requires setting up a new service that has not previously existed. The content of NHS wraparound support being set up is described above.
Ensuring there is sufficient supply of the medicines for all their recommended uses. Although there are no current supply issues with these medicines, there have previously been supply chain issues with semaglutide. The Department works intensively with the pharmaceutical industry, NHS England, the MHRA and others in the supply chain, to resolve supply issues when they emerge.

These challenges apply slightly differently to the different medicines that have been approved for NHS use. For semaglutide and liraglutide [6] (which has various brand names, such as Saxenda), NICE’s recommendations restrict usage to NHS specialist weight management services and for two years of treatment. These are mainly hospital based with an estimated capacity to see 20,000 to 40,000 patients a year. As such, the capacity of these services is a rate-limiting factor for access to these medicines. Tirzepatide, however, which has been recommended for use more recently, has no such restrictions on its settings, which means that it can be prescribed in primary care settings. This provides the opportunity for the NHS to significantly expand capacity for this treatment.
In addition, the scale of the private market for these drugs, and forthcoming tirzepatide list price changes, also poses an unprecedented challenge for the healthcare system in relation to ensuring equity of health outcomes and demand from patient cohorts which are not currently eligible for NHS funded treatment.

NHS plans to make these medicines available

For tirzepatide, NHS England, working with NHS Integrated Care Boards, the DHSC and stakeholders, has developed an implementation plan to address the challenges for the NHS, and ensure a sustainable, fair rollout. It submitted its plans to NICE, who published its final guidance on tirzepatide for managing overweight and obesity in December 2024. It was agreed that there would be a phased roll out taking a maximum of 12 years with around 220,000 people able to access tirzepatide in the first three years prioritised based on clinical need with new service models tested which might enable the roll out to accelerate.
The legal duty for ICBs to meet the costs of funding access to tirzepatide for the management of obesity in existing NHS specialist weight management services began in March 2025, whilst the duty for ICBs to fund access in primary care settings began in June 2025, in recognition of the extra time ICBs needed to develop new service models and arrange provision in primary care.
NHS England has provided support to ICBs with their responsibility to make tirzepatide available, including:

identifying the groups of people to be prioritised in each phase of the initial rollout;
helping develop local treatment models;
setting up an interim, centrally funded ‘wraparound care service’, known as the ‘Healthier You: Behavioural Support for Obesity Prescribing’ for patients to be referred into, with a procurement underway for a longer-term offer;
providing funding support, as well as regular communication channels with NHS ICBs.

NICE has also published some implementation support resources [cxl].

NICE will evaluate evidence generated during the initial 3-year implementation period and may set a revised timeline for full implementation after that. Speeding up NHS rollout may help increase equity of access in England on the basis of clinical need, rather than ability to pay for a private prescription.
For the two other GLP-1 treatments approved by NICE for managing obesity, liraglutide and semaglutide, NICE’s recommendations restricted their use in the NHS to specialist weight management services; and semaglutide is also restricted to a maximum length of two years. NHS ICBs are responsible for commissioning these specialist services locally, and for making these treatments available. However, the commissioning of these services varies across England. The financial resource provided by NHS England included prescribing costs for the entire cohort eligible for tirzepatide. This could cover the medicine cost of semaglutide (Wegovy®) or tirzepatide (Mounjaro®) in Specialist Weight Management Services. This is for ICBs to manage. Liraglutide is a less effective option for managing obesity than semaglutide or tirzepatide, and NHSE has advised us that it is being used less frequently by ICBs.

Opportunities for the NHS to go further than the current rollout

We recognised the transformative potential of these medicines for obesity and type 2 diabetes care in our recent 10 Year Health Plan for England [cxli]. As set out there, we recognise that there is a risk that these medications become the preserve of those who can afford them privately, despite those without the financial means to access these medicines potentially having a higher clinical need. We therefore believe it is important to expand access to weight loss services and treatments free at the point of need [7] as rapidly as possible and, to that end, we will be establishing pioneering relationships with industry to test innovative models of delivering weight loss services and treatments to patients safely and effectively [cxlii].
We have already announced our first steps towards delivering our ambition to establish pioneering relationships with industry to test new models of care. On 12 August we announced an £85 million competition intended to provide funding to local health systems in the design and delivery of new community and primary care weight management pathways that would enable access to interventions such as weight loss medications. The UK government will contribute up to £50 million of new UK-wide investment and the pharmaceutical company Eli Lilly, as part of their £279m strategic collaboration with the UK, will contribute up to £35 million of grant funding. This funding will support local projects with the expectation that tens of thousands of patients will directly benefit from increased access to available and clinically eligible interventions, such as GLP-1s. In addition to the £50 million investment, the NHS will also provide funding for the costs of the drug provided to any patients that are supported with GLP-1 treatments in this programme. The evidence generated through this programme will inform NICE’s future review of the rollout of tirzepatide and ultimately inform future commissioning [cxliii].
There are estimates of over 150 future ‘clinical-stage assets’ in the obesity medicine pipeline [cxliv], and further evidence is being generated on the best ways to provide clinical and behavioural support to patients on the NHS. We believe that these developments may make it possible to bring costs down through competition, expand access to patients with a higher clinical need more quickly, and potentially achieve better outcomes with greater weight loss or fewer side effects.

7. Are weight loss injections cost-effective to the NHS and how does this compare with other treatments?

Assessing weight loss injections

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for developing evidence-based guidance for the NHS on the use of licensed medicines based on an assessment of their clinical and cost-effectiveness. We understand that NICE will be submitting evidence to the Inquiry separately.
In its guidance on overweight and obesity management, and in the corresponding technology appraisals, NICE recommends tirzepatide, semaglutide, liraglutide and orlistat [8] as medicine options for weight management in adults [cxlv]. It specifies for whom, and under what circumstances, these medicines are considered cost-effective for routine use on the NHS, based on its published methods and processes for health technology evaluation [cxlvi]. An overview of these medicines is available on the NICE’s website, here: Medicines and surgery | Overweight and obesity management | Guidance | NICE.

How cost effectiveness of weight loss medication compared to other weight management interventions

In this section we provide examples to illustrate how the cost-effectiveness of weight management medication compares with other interventions using ‘quality-adjusted life years’ (QALY), which are a common way of comparing health benefits. NICE describes that ‘One quality-adjusted life year (QALY) is equal to 1 year of life in perfect health.’[cxlvii].
As noted in paragraph 60 for medicines to be routinely used in the NHS, they must be given a positive recommendation as a clinically and cost-effective use of NHS resource by NICE. Being cost-effective and having a positive recommendation does not mean that treatments are immediately cost-saving to the NHS, i.e., they do not reduce current healthcare spend. new treatments (including GLP1 medicines) often add costs to the healthcare system initially but could reduce subsequent healthcare utilisation and save some costs in the longer term, and they are cost-effective in terms of the health benefits gained.
In relation to obesity medicines:

Semaglutide, when used in specialist weight management services for a maximum of two years, has a cost of approximately £16,337 per QALY, when compared with diet and exercise [cxlviii]
Tirzepatide, used in the eligible population and settings, has a cost per QALY of between £17,171 and £21,372 in the eligible population and setting compared with diet and exercise [cxlix]

NICE advise that there are significant caveats to their estimates of the cost per QALY for both semaglutide and tirzepatide, based on numerous uncertainties including around the costs of actual provision on the NHS. There were also key differences between the tirzepatide and semaglutide appraisals which mean that the cost per QALY figures should not be directly compared [9] . NICE have advised that tirzepatide is considered cost effective when compared with semaglutide in a specialist weight management service setting.
In relation to other weight management interventions:

The NHS Digital Weight Management Programme has been found to be effective at achieving clinically meaningful weight loss [cl], and we expect that ongoing, independent modelling will demonstrate that the cost effectiveness of the Programme is several times greater than weight loss medicines. This is because, although patients lose less weight than with the new medicines the cost of providing the Programme to each individual is substantially less.
We are not aware of comprehensive estimates of the cost per QALY for local authority commissioned services. However, we know that they can be very heterogenous in how they are delivered, the programme components that are included, and whether they target specific populations. All of these elements will affect the cost per QALY that can be achieved. We know the NHS Digital Weight Management Programme commissions substantially more places than individual local authorities do, so it is likely to have greater buying power, and we expect this means it achieves a better unit price.
It is difficult to provide a cost-effectiveness estimate for specialist weight management services overall, because they provide a range of interventions to patients, including treatment with medicines and more intensive behavioural support. Some patients might receive a total diet replacement low or very low energy diets, plus behavioural support. NICE assess these diets (and support) to be cost-effective [cli], with an estimated cost per QALY of £16,456 for people living with obesity with or without diabetes; and £6,317 for people with diabetes who are either overweight or living with obesity
Bariatric surgery is estimated to have a cost per QALY from £6,176 for people with a BMI of 40 or higher and diabetes [clii] to £10,126 for adults with a BMI of 35+[cliii].
Evidence indicates that the nine month Healthier You NHS Diabetes Prevention Programme, aimed at people with pre-diabetes, is cost-effective, and likely cost-saving [10][cliv], although a cost per QALY is not available.

We expect the methodology between all the estimates presented above to vary slightly, due to differences in assumptions and inputs. For example, there are differences in the eligible population for which these estimates are calculated. We would therefore advise against direct comparisons of the specific figures, although the overall magnitude can help to provide a sense of scale across services.

Cost-effectiveness estimates of children’s weight management services

Children already living with obesity also need support, but the aims of weight management services for children can be slightly different to adults, and the evidence on cost-effectiveness is also different.
Depending on a child’s stage of development, the goals of weight management interventions for children and adults can be slightly different. For example, for children who are growing taller, NICE suggest that avoidance of further weight gain and maintenance of weight whilst continuing to grow to reduce BMI centile is a realistic and appropriate goal [clv].
Local Authorities are able to use the Public Health Grant to commission behavioural weight management services for children, young people and families. We provide more information about the public health grant and LA responsibilities in our response to question eight. There are, however, challenges with demonstrating the cost-effectiveness of children’s behavioural weight management interventions. NICE has previously said that in most cases the overall change in a child’s BMI z-score [11] was small and showed very little meaningful impact of weight management interventions on BMI z-score after 6 months or longer post-intervention [clvi]. In other words, the evidence indicates that there is a lack of a sustained benefit for these interventions. Similar to adults, overweight and obesity in children is a long-term health issue that requires ongoing support and maintenance advice to sustain any changes that are achieved, and NICE has concluded that more evidence is needed to understand the long-term support needs for children and young people. That said, it is recognised that supporting children is important, and that there are wider benefits that can be achieved in these services such as improvements to diet, physical activity levels, and self-esteem. On this basis they continue to be recommended.
NHS England has estimated that over 160,000 children are living with severe obesity and an identified comorbidity [clvii]. Many of these children suffer from very poor health outcomes in young adulthood and are likely to be economically inactive later in life [clviii]. In 2020-21, 77% of NHS trusts did not offer specialist weight management (SWM) services for children [clix]. There was also disparity access in areas of the UK, for example, only 4% of trusts in the Midlands provided access to NHS SWM services for children, despite the West Midlands having the highest prevalence of severe obesity among children. There was inconsistent funding, eligibility criteria, and service delivery models across different trusts. This lack of standardisation meant that children in some areas received comprehensive, multidisciplinary care, while others had limited or no access.
To address this, since 2021-22 the NHS has been piloting Complications From Excess Weight (CEW) clinics for children living with severe obesity and comorbidities. The clinics are specialist weight management service, providing holistic multidisciplinary treatment and person-centred care packages developed with the child’s family, including mental health treatment, coaching and advice around a healthy diet. There are currently 37 pilot sites across the country, with approximately 4,000 children able to access them every year.

Cost-effectiveness comparisons and the overall care pathway

Although the available weight management interventions can vary in terms of cost-effectiveness, they provide different levels of intensity, at different stages of the obesity care pathway. This is in line with NICE [clx] and NHS advice [clxi], that medicines may be recommended to help support weight loss and weight management in adults after dietary, exercise and behavioural approaches have been started and evaluated, and are not helping sufficiently on their own. This could include participation in a structured weight management programme. As such, it is important to ensure patients can access a range of cost-effective NHS weight management interventions locally, even if some interventions (like surgery or medicines) may offer a greater weight loss, or others might be more cost-effective.

8. How well are weight management services functioning in the NHS and are they providing equitable access to treatment?

Current provision of weight management services

There is a range of different weight management services available. Integrated Care Boards and Local Authorities are responsible for commissioning weight management services in line with local decision making and priorities. However, both NHS England and the Department of Health and Social Care have made additional investments in centralised provision that is accessible across England. For adults, the available public sector provision, aligned with NICE guidelines on overweight and obesity management [clxii], includes:

Universal population health based advice and information that everyone can access, such as the 12 week NHS Weight Loss Plan App (commissioned by DHSC).
Behavioural programmes that support individuals with dietary and physical activity changes, including the NHS Digital Weight Management Programme (commissioned nationally by NHS England) services commissioned by Local Authorities (LAs) from their Public Health Grant.
Specialist weight management services, commissioned by ICBs, that provide more intensive provision and, previously, were the only places that patients could receive GLP-1 medicines for weight management. NHS England has previously estimated that specialist weight management services have capacity for around 20,000 to 40,000 patients per year. 
Bariatric surgery, commissioned by ICBs. 5,479 patients having at least one type of bariatric surgical procedure in 23/24 [clxiii]. This is more than 22/23 when approximately 4,800 patients having at least one type of bariatric surgical procedure. But this is less than pre-pandemic levels 19/20 where approximately 6,400 patients had at least one type of bariatric surgical procedure.

There are also two programmes commissioned by NHS England that are aimed at patients with, or at risk of developing, type 2 diabetes that can support weight loss:

the NHS Type 2 Diabetes Pathway to Remission Programme provides a low calorie, total diet replacement treatment for people who are living with type 2 diabetes and obesity or overweight. The service has been rolled out in waves and became available across the whole of England in April 2024. To date over 45,000 referrals have been received and over 28,000 people have been supported on the programme (including over 13,000 in 2024/25).
The Healthier You NHS Diabetes Prevention Programme is a behaviour change programme that supports people identified as being at risk of developing type 2 diabetes, providing personalised support with practical tools and advice on healthy eating and lifestyle, increasing physical activity and weight management. Launched in 2016, over 1.94 million referrals have been made to date, and over 944k people have been supported on the programme.

In addition, as noted in response to question six, there are local weight management service models being developed by ICBs to support prescribing of new medicines. NHS England is providing a national wraparound support offer for patients accessing tirzepatide from primary care, including dietary advice, physical activity and behavioural change.
The provision of children’s weight management services has similar commissioning responsibilities and can form part of a comprehensive healthy weight approach, as illustrated in the Amsterdam Healthy Weight Programme described under our response to question 1. However, there are key differences in the evidence base between adults and children, which mean that the types of support provided are different. We have set out more detail about children’s weight management services in our response to question seven.

How well are WMS functioning in the NHS including equitable access to treatment

NHS England has sought to establish the National Obesity Audit (NOA) for the past three years. The ambition for the audit is bring together data on weight management service provision including places and outcomes to drive improvement in access and quality of care for those living with overweight and obesity in England. The NOA provides comprehensive data on the provision of bariatric surgery but further work is needed to improve the data collection from other NHS and local authority funded weight management services. NHS England is working with closely with Healthcare Quality Improvement Partnership to develop a quality improvement plan for the NOA to address certain data challenges it is facing. In particular, access to comprehensive data on obesity from primary care is a key challenge.
There are eligibility criteria for different weight management interventions so that they are targeted at those who will receive the most benefit from them. This is particularly true for access to tirzepatide, where a clear prioritisation protocol based on clinical need has been put into place, and NHSE is providing a significant programme of support to ICBs to meet their commissioning duties. For specialist weight management services, The Society for Endocrinology and Obesity Management Collaborative UK have created a joint position statement outlining the proposed referral criteria into Specialist Weight Management Services, which aims to identify those of highest clinical need and standardise referrals across the country
Most weight management services will require some form of clinical referral. For example, the NHS DWMP will accept referrals from a range of healthcare professionals, including GPs and community pharmacies. There is good evidence people from more deprived backgrounds as well as people from ethnic minority backgrounds [clxiv] are more likely to be referred to theNHS DWMP by GPs. Additionally, the appointment with a clinician allows for a ‘brief intervention’ to motivate behaviour change and provide information to patients about relevant services, as recommended by NICE guidance [clxv] . Some local authority weight management services may allow self-referrals. Some local authorities may target weight management services at specific groups such as individuals from ethnic minority backgrounds who are at a higher-risk of developing weight-related comorbidities.

Equitable access to weight management services across England

The NHS 12-week weight loss app is nationally available and free to download for anyone living with overweight or obesity and easily accessible offer for individuals considering how they can lose weight. The NHS Digital Weight Management Programme is nationally commissioned by NHSE meaning that individuals in every area of England have access to a behavioural weight management programme (where they meet the eligibility criteria). We have recently committed to expanding access to the NHS Digital Weight Management Programme to 125,000 more people per year, and NHSE is considering changes to the eligibility criteria accordingly.
However, there will always be some variation in access where there are locally commissioned weight management services as local authorities and ICBs will adopt differing strategies, and may need to commission services to meet the differing needs of their local populations.
In 2025/26, the Government provided £3.884 billion to local authorities through the Public Health (PH) Grant, and the 100% retained business rate arrangement for local authorities in Greater Manchester. This is an average 6.1% cash increase, or 3.4% real terms increase, in local authority Public Health Grant funding, compared to 2024/25. This represents a significant turning point for local public health services, marking the biggest real-terms increase after nearly a decade of reduced spending. This funds a range of treatment and preventative services which can include supporting weight management services in their area, although they are not mandated to do so. Local authorities are responsible for deciding how best to allocate their PH Grant to improve the health of their population and fulfil their public health responsibilities.
ICBs have responsibility for commissioning specialist weight management services and bariatric surgery. We are aware of inequities in access to these services where capacity is significantly outstripped by demand. This can lead to long waiting times for some patients. An NHSE survey in April 2024 noted an average waiting time of 16 months for specialist weight management services and 12 months for bariatric surgery [clxvi].
Whilst we recognise that there will be some commissioning differences across NHS ICBs, they do have a legal duty to make the funding available for treatments recommended in NICE technology appraisals in line with the timescales set out by NICE in its guidance. This includes semaglutide and tirzepatide.
Semaglutide can only be prescribed in a specialist weight management service and for a maximum of two years. Therefore, as mentioned in response to question six, use is constrained as, NHSE has estimated that these services have the capacity to treat about 20,000-40,000 patients a year compared to over 3.4million eligible patients.
However, tirzepatide can be used in primary care and therefore provides greater scope to scale access. As set out in our response to question six, NHSE has set out a phased roll out plan which will see 220,000 patients be able to access tirzepatide over the next 3 years with those with the highest clinical need prioritised first. New local service models are also being tested which might enable roll out to reach additional communities. NHS England is providing support and regular engagement with NHS ICBs to learn from where implementation has been successfully implemented into the weight management pathway, has set up forums to share these successes and support ICBs where access to tirzepatide (Mounjaro ®) is limited, to help develop locally adapted pathways.
As set out in our response to question six, we also announced plans for a new Obesity Pathway Innovation Programme (OPIP), as part of the strategic collaboration between the government and the pharmaceutical company Eli Lilly, which will help establish innovative solutions that could enable more patients to access clinically appropriate weight management services, including medications where appropriate. NHS ICBs that bid for the funding will be required to explain, as part of their application for the funding, how they will design weight management pathways that ‘maximise accessibility with a strategy for how you will identify and target specific patient cohorts to reduce health inequalities and a plan for evaluating uptake and impact across different cohorts’, and ‘enable referrals for patients requiring additional support’[clxvii]
We also recognise that the provision of bariatric surgery in England has capacity to see a small proportion of the patients that are eligible. Typically, patients are reviewed in Specialist Weight Management Services (sometimes known as Tier 3) for suitability for bariatric surgical interventions. As previously discussed, the waiting lists for these services are long and vary between regions. Bariatric surgery services (sometimes called Tier 4) are not commissioned in every ICB. Prior to bariatric surgery, patients have a thorough psychological and physical assessment to assess readiness for surgery. NHSE have advised that, anecdotally, it is reported that the main barrier to increasing the number of bariatric surgeries is operating theatre time.

[1] The evaluation of the NHS Digital Weight Management Programme reported that one third of those referred were people of Asian, Black, Mixed, or Other ethnicity.

[2] For consistency, from hereon in we will refer to the medicine generic name with the active ingredient (i.e., tirzepatide and semaglutide) throughout our submission, except where it is more appropriate to refer to a brand name. We will also refer to these medicines as GLP-1 treatments for simplicity. Whilst semaglutide is a GLP1 receptor agonist, tirzepatide is in reality a dual agonist for GLP-1 and GIP.

[3] As this medicine slows the emptying of the stomach, it increases the risk that stomach contents (e.g. food and drink) could enter into the airways and lungs during surgery or procedures whilst patients are under general anaesthesia or deep sedation. This means that a modification to the pre-procedure instruction and anaesthetic technique may be required.

[4] The CEU is the MHRA’s dedicated law enforcement capability, responsible for preventing, detecting and investigation illegal trafficking in all human medicines, including weight loss products. The CEU is equipped to take proportionate enforcement action using the full range of its powers and, where appropriate, this includes criminal prosecution and asset forfeiture.

[5] NICE recommended tirzepatide as an option for managing overweight and obesity, alongside a reduced-calorie diet and increased physical activity in adults, only if they have: an initial body mass index (BMI) of at least 35 kg/m2 and at least 1 weight-related comorbidity. A lower BMI threshold is recommended for individuals from certain ethnic backgrounds.

[6] Liraglutide is an older GLP-1 treatment that has to be injected daily (whereas semaglutide and tirzepatide are weekly injections). For weight management, patients using liraglutide see lower levels of weight loss than patients using semaglutide or tirzepatide.

[8] Orlistat is a medicine that has been available for managing obesity for a number of years. It is not a weight loss injection; it is a tablet taken orally. It is also a different class of medicine compared to GLP1-RAs like liraglutide, semaglutide, and tirzepatide. Clinical trial evidence has reported much lower amounts of weight loss than for the newer GLP1-RA medicines. We understand it has unpleasant side effects including oily bowel movements; oily spotting of underclothes; and an inability to hold bowel movements.

[9] This includes the setting of care, which was specialist weight management services only for semaglutide, compared with specialist weight management services or primary care for tirzepatide; and that there was no stopping rule including in the modelling for tirzepatide, whilst there was for semaglutide.

[10] Independently evaluated long-term estimates, published in April 2024, which model gains across a more relevant 35-year time horizon, show that in 98% of scenarios it costs below the NICE threshold of 20k per QALY for cost effectiveness/saving, is likely cost-saving within 3 years, and for every 1000 people referred into the programme, the return on investment is around £136,000 and on average generates 40.8 incremental QALYs. Cost-effectiveness analyses based on information up to March 2020 project that the program will save £71.4 million ($121.38 million) and generate an additional 21,472 quality-adjusted life-years (QALYs) over 35 years.

[11] BMI Z-Score is a measure of how a child’s BMI compares to a standard growth reference chart which indicate how many units a child's BMI is above or below the average BMI value for their age group and sex. It is a way of comparing weight for children that considers their sex and changing height as they age. It is also known as BMI standard deviations [SDs].

[i] National Child Measurement Programme (2023). https://digital.nhs.uk/data-and-information/publications/statistical/national-child-measurement-programme/2022-23-school-year

[iv] The Broken Plate 2025 (2025). https://foodfoundation.org.uk/publication/broken-plate-2025.

[v] The Broken Plate 2025 (2025). https://foodfoundation.org.uk/publication/broken-plate-2025.

[vii] National Diet and Nutrition Survey 2019 to 2023: report (2025). https://www.gov.uk/government/statistics/national-diet-and-nutrition-survey-2019-to-2023/national-diet-and-nutrition-survey-2019-to-2023-report.

[viii] Metcalfe, S., Sasse, T., and Institute for Government (2023) Tackling obesity: Improving policy making on food and health, Institute for Government. https://www.instituteforgovernment.org.uk/sites/default/files/2023-04/tackling-obesity.pdf.

[x] Yau, A. et al. (2021) 'Sociodemographic differences in self-reported exposure to high fat, salt and sugar food and drink advertising: a cross-sectional analysis of 2019 UK panel data,' BMJ Open, 11(4), p. e048139. https://doi.org/10.1136/bmjopen-2020-048139.

[xiv] Innovative approaches in food environment policy around the world (no date). https://www.nesta.org.uk/feature/innovative-food-environment-policy/.

[xv] Dace, H., Bradshaw, A. and Shaheryar, S. (2023) Fit for the Future: A Fair Deal on Food for a Healthier Britain. https://institute.global/insights/public-services/fit-for-the-future-making-fair-deal-on-food-for-healthier-britain.

[xvi] Secretary of State for Health and Social Care (2025) Fit for the Future: The 10 Year Health Plan for England, CP 1350. report. https://assets.publishing.service.gov.uk/media/6888a0b1a11f859994409147/fit-for-the-future-10-year-health-plan-for-england.pdf.

[xvii] Department of Health and Social Care (DHSC) and Global and Public Health Group, O.B. (2018) Department of Health and Social Care (DHSC) calorie model. https://assets.publishing.service.gov.uk/media/5b8557dced915d7e20e0bd70/dhsc-calorie-model-technical-document.pdf.

[xlii] Aguilar A, Gutierrez E, Seira E: The effectiveness of sin food taxes: evidence from Mexico. Latin American and The Caribbean Economic Association (LACEA) 2018, LACEA working paper series

[lxvi] Scarborough, P. et al. (2020). Impact of the announcement and implementation of the UK Soft Drinks Industry Levy on sugar content, price, product size and number of available soft drinks in the UK, 2015–19: A controlled interrupted time series analysis. PLOS Medicine, 17(2), p.e1003025. Available at: https://journals.plos.org/ plosmedicine/article?id=10.1371/journal.pmed.1003025

[lxix] Vogel C, Shaw S, Strömmer S, Crozier S, Jenner S, Cooper C, Baird J, Inskip H and Barkeret M. Inequalities in energy drink consumption among UK adolescents: a mixed-methods study. Public Health Nutrition 2022; volume 26, issue 3, pages 575 to 585

[lxx] C Ajibo C, Van Griethuysen A, Visram S, and Lake AA. Consumption of energy drinks by children and young people: a systematic review examining evidence of physical effects and consumer attitudes. Public Health 2024; volume 227, pages 274-281.

[lxxiv] National Child Measurement Programme (2023). https://digital.nhs.uk/data-and-information/publications/statistical/national-child-measurement-programme/2022-23-school-year

[lxxvii] NICE (2025) Overview | Overweight and obesity management | Guidance | NICE. https://www.nice.org.uk/guidance/ng246.

[lxxviii] Triple wins for children’s poverty food insecurity and health (no date). https://foodfoundation.org.uk/news/triple-wins-childrens-poverty-food-insecurity-and-health.

[lxxix] The Broken Plate 2025 (2025). https://foodfoundation.org.uk/publication/broken-plate-2025.

[lxxx] Office for Health Improvement and Disparities (2025) Changes in food and drink purchasing behaviour and the impact on diet and nutrition: 2021 to 2023. https://www.gov.uk/government/publications/changes-in-food-and-drink-purchasing-behaviour-and-the-impact-on-diet-and-nutrition-2021-to-2023.

[lxxxi] Department for Environment, Food & Rural Affairs (2025) 'Government launches ‘Good Food Cycle’ to transform Britain’s food system,' GOV.UK, 14 July. https://www.gov.uk/government/news/government-launches-good-food-cycle-to-transform-britains-food-system.

[lxxxii] Barrett, M., Spires, M. and Vogel, C. (2024) 'The Healthy Start scheme in England “is a lifeline for families but many are missing out”: a rapid qualitative analysis,' BMC Medicine, 22(1). https://doi.org/10.1186/s12916-024-03380-5.

[lxxxiv] Wider Determinants of Health: statistical commentary on the location of fast food outlets, February 2025 (2025). https://www.gov.uk/government/statistics/wider-determinants-of-health-february-2025-update/wider-determinants-of-health-statistical-commentary-february-2025#:~:text=fast%20food%20outlets%20per%20100%2C000%20population%20in%20the%20most%20deprived,chart%20in%20the%20Fingertips%20profile.

[lxxxv] What are the barriers to eating healthily in the UK? (2018). https://www.smf.co.uk/publications/barriers-eating-healthily-uk/.

[lxxxvi] Bite Back. Out of Home report. (2024). https://cdn.bitebackmedia.com/media/documents/Bite_Back___Out_of_Home_Report__Final___High_res_2.pdf

[lxxxvii] Rogers, N.T. et al. (2023) 'Associations between trajectories of obesity prevalence in English primary school children and the UK soft drinks industry levy: An interrupted time series analysis of surveillance data,' PLoS Medicine, 20(1), p. e1004160. https://doi.org/10.1371/journal.pmed.1004160.

[lxxxviii] Yau, A. et al. (2021) 'Sociodemographic differences in self-reported exposure to high fat, salt and sugar food and drink advertising: a cross-sectional analysis of 2019 UK panel data,' BMJ Open, 11(4), p. e048139. https://doi.org/10.1136/bmjopen-2020-048139.

[lxxxix] BMC (no date) The health, cost and equity impacts of restrictions on the advertisement of high fat, salt and sugar products across the transport for London network: a health economic modelling study. https://researchonline.lshtm.ac.uk/id/eprint/4667197/.

[xc] Cobiac, L.J., Rogers, N.T., Adams, J., Cummins, S., Smith, R., Mytton, O., White, M. and Scarborough, P. (2024). Impact of the UK soft drinks industry levy on health and health inequalities in children and adolescents in England: An interrupted time series analysis and population health modelling study. PLoS medicine, [online] 21(3), pp.e1004371–e1004371. doi:https://doi.org/10.1371/journal.pmed.1004371.

[xci] Small area associations between breastfeeding and obesity. (2022). https://assets.publishing.service.gov.uk/media/6290959e8fa8f50395c09ff8/Small-area-associations-between-breastfeeding-and-obesity.pdf.

[xcii] Breastfeeding at 6 to 8 weeks, 2023 to 2024 statistical commentary (2024). https://www.gov.uk/government/statistics/breastfeeding-at-6-to-8-weeks-after-birth-annual-data-april-2023-to-march-2024/breastfeeding-at-6-to-8-weeks-2023-to-2024-statistical-commentary

[xciii] Maessen, S.E. et al. (2023) 'High but decreasing prevalence of overweight in preschool children: encouragement for further action,' BMJ, p. e075736. https://doi.org/10.1136/bmj-2023-075736.

[xcix] A UK government food strategy for England, considering the wider UK food system. (2025). https://www.gov.uk/government/publications/a-uk-government-food-strategy-for-england/a-uk-government-food-strategy-for-england-considering-the-wider-uk-food-system.

[c] United Kingdom Food Security Report 2024: Introduction. (2024). https://www.gov.uk/government/statistics/united-kingdom-food-security-report-2024/united-kingdom-food-security-report-2024-introduction#defining-food-security.

[ci] Secretary of State for Health and Social Care (2025b) Fit for the Future: The 10 Year Health Plan for England, CP 1350. report. https://assets.publishing.service.gov.uk/media/6888a0b1a11f859994409147/fit-for-the-future-10-year-health-plan-for-england.pdf.

[cii] Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021; 384:989-1002. 

[ciii] Jastreboff AM, Aronne LJ, Ahmad N, Wharton S, Connery L, Alves BES, et al. Tirzepatide once weekly for the treatment of obesity. The New England Journal of Medicine [Internet]. 2022 Jul 21;387(3):205–16. Available from: https://doi.org/10.1056/nejmoa2206038

[civ] Little D, Deckert J, Bartelt K, Ganesh M, Stamp T. Weight Change With Semaglutide. Epic Research. https://epicresearch.org/articles/diabetes-drug-helps-with-weight-loss-in-both-diabetics-and-non-diabetics. Accessed on August 14, 2025.

[cv] Avenell A, Robertson C, Skea Z, et al. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation [published correction appears in Health Technol Assess. 2020 May;22(68):247-250]. Health Technol Assess. 2018;22(68):1-246. doi:10.3310/hta22680

[cvi] Hartmann-Boyce J, Theodoulou A, Oke JL, Butler AR, Scarborough P, Bastounis A et al. (2021) Association between characteristics of behavioural weight loss programmes and weight change after programme end: systematic review and meta-analysis British Medical Journal 2021; 374 :n1840 DOI: 10.1136/bmj.n1840

[cxxxii] Each 1 kg/m2 increase in BMI is associated with an increased odds of unemployment due to sickness/disability of 1.076. Campbell, D.D., Green, M., Davies, N. et al. Effects of increased body mass index on employment status: a Mendelian randomisation study. Int J Obes 45, 1790–1801 (2021). https://doi.org/10.1038/s41366-021-00846-x

[cxxxix] NHS England’s analysis was published as part of the suite of documents that NICE published alongside its technology appraisal of tirzepatide for managing obesity. Available here: https://www.nice.org.uk/guidance/ta1026/history

[clii] Gulliford MC, Charlton J, Booth HP, et al. Costs and outcomes of increasing access to bariatric surgery for obesity: cohort study and cost-effectiveness analysis using electronic health records. Health Serv Deliv Res. 2016;4(17).

[cliii] Boyers B, Retat L, Jacobsen E et al. Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model. International Journal of Obesity (2021) 45:2179–2190.

[clvii] NHS England, 2022. Internal NHSE modelling based on Health Survey for England data, shared with DHSC in August 2025.

[clxvi] Available as part of the suite of documents that NICE published during its appraisal of tirzepatide for managing overweight and obesity. Here: supporting-documentation-12

Summary