Caroline Ruda/ShutterstockFor many people living with obesity, Wegovy and Mounjaro offer the possibility of substantial weight loss without surgery. Yet data from one private provider points to a troubling divide: prescription rates of these drugs in England are lowest in communities where obesity is most common.Wegovy contains semaglutide, which acts on the GLP-1 hormone pathway involved in appetite. Mounjaro contains tirzepatide, which targets both GLP-1 and another hormone pathway called GIP. In trials involving adults without diabetes, participants taking semaglutide lost an average of 14.9% of their starting weight after 68 weeks. Those receiving the highest dose of tirzepatide lost an average of 20.9% after 72 weeks. Both trials also provided support with diet and physical activity.The 2026 analysis of 113,630 patients found that private prescribing rates were 32% lower in England’s most deprived areas than in the least deprived. Once the higher prevalence of obesity in deprived areas was taken into account, the estimated prescribing rate per person living with obesity was 120% higher in the least deprived areas.The analysis cannot show that cost caused this difference. It covered one provider and estimated deprivation from patients’ postcodes rather than their individual incomes. It also examined access rather than treatment outcomes.Even so, the findings bring a difficult question into focus: while NHS access to these treatments is still being rolled out, does the ability to pay influence who can access treatment sooner?Obesity and deprivationObesity is sometimes presented as the result of personal choices, although evidence is clear that body weight is influenced by genetic and biological processes alongside income, education, food prices and the environments in which people live. A review of the socioeconomic evidence found that, in high-income countries, lower socioeconomic status is generally associated with a greater likelihood of obesity, particularly among women.Cost can affect what people are able to eat. A meta-analysis covering ten countries found that healthier dietary patterns generally cost more than less healthy ones, although the difference varied according to the foods and methods being compared.Despite this, England’s obesity policy has often concentrated on encouraging individuals to change their behaviour, rather than addressing systemic causes.An analysis of 14 government strategies published between 1992 and 2020 found that many proposed policies placed high demands on individual agency, and were unlikely to be effective or reduce inequalities. Medication can improve treatment for individuals, but it does not remove the conditions that make obesity more likely.NHS access is being phased inEngland’s National Institute for Health and Care Excellence (Nice) recommends tirzepatide for adults with a body mass index of at least 35 and at least one weight-related health condition. Lower BMI thresholds apply to people from some ethnic backgrounds because their risk of weight-related illness can increase at a lower BMI.NHS England estimates that around 3.4 million adults meet the Nice criteria. Tirzepatide is available to eligible patients through specialist weight-management services, subject to a clinician’s decision. Access through primary care is narrower and is being introduced according to BMI and the number of related health conditions.The phased primary-care rollout is expected to cover around 220,000 people during its first three years. The approved funding variation allows up to 12 years to make treatment available to the full eligible population. Many people who meet the wider Nice criteria may therefore wait years for primary-care access.Private prescriptions provide another route for people who meet the relevant clinical requirements and can afford treatment. Although this analysis cannot establish exactly why uptake differs between areas, its results are consistent with affordability influencing access. While NHS prescribing is still being phased in, people who can pay for private treatment may be able to access these medicines sooner than those who cannot, making cost a potential additional barrier for those living in more deprived areas.Treatment may involve continuing costsThe financial divide could become greater if people need prolonged treatment. A 2026 systematic review found that participants regained around 60% of the weight they had lost within a year of stopping GLP-1 receptor agonists.Longer-term evidence remains limited, and people will not all have the same experience. But these findings suggest that some patients may need continued treatment or another maintenance plan to preserve much of their weight loss. For people paying privately, maintaining treatment over months or years could involve substantial ongoing costs. And the benefits of treatment may also depend on the support available alongside the prescription.These medicines reduce appetite and food intake, which can make it harder to obtain adequate nutrition from a smaller amount of food. Clinical guidance recommends assessing diet quality and the risk of nutrient deficiencies and muscle loss, while providing individual advice during treatment. A recent article in Nature Medicine warned that unequal access to nutritious food and professional support could lead to unequal treatment outcomes.NHS England requires nutritional and behavioural support to accompany tirzepatide prescriptions. Ensuring that this support is available in practice will be particularly important for patients already experiencing food insecurity, or who have difficulty accessing healthcare.GLP-1-based medicines could improve health for many people living with obesity. Their wider effect on health inequalities will depend on how quickly NHS access expands, and whether treatment reaches communities with the greatest clinical need.Appropriate continuing support will also influence how safely and effectively people can use them. Without an equitable system, population health could improve while the gap between socioeconomic groups grows wider.Rachel Woods does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.